New to ASV, could use some advice.

[sms832]

Hello,

Long time lurker, first time posting.  I've been struggling with early awakenings for 20 years and I'm a very light sleeper.   Finally on 3mg Lunesta for the study only, sleep studies confirmed central apneas.   I had been prescribed a CPAP earlier, but it really never helped me sleep longer or feel better.   I've now got an ASV machine.

My first night on ASV was incredible, the best I'd had in many years.  I was exceptionally sleep deprived which helped me crash, hard.   The remainder of nights I've woken in the middle of the night and once that happens, I'm up for a while - and once morning comes Im lucky if I really got 5 hours of sleep in.

I've attached a printout from my sleep lab along with screen captures from OSCAR.  You'll see the first night was great.

Current settings:

• ASV (Not ASV Auto)
  
• EPAP:  8
  
• PSmin:  0
  
• PSmax:  17
  
• Max IPAP:  25
  
• NOT taking any Lunesta.
  

Here are my questions!

1.  What do you think about these pressure settings based on the lab result and OSCAR?
2.  My machine is on ASV, but not ASV Auto.   I see a lot of members like ASV Auto.  Should I ask about making this change?
3.  Is my main problem now that I am waking up from the high ASV pressures, and it's just a matter of becoming acclimated to it?   (Or medicating to sleep through it?)


The way I look at it, the first (amazing) night the machine was able to respond all night without ever going over 16, and I slept great.  I was coming off of two nights of nearly zero sleep however.   On the next nights, it looks like episodes of high pressure woke me up - which I don't remember well - but the pressures often rose higher than 16.   I'm guessing that the higher the pressures are the more likely they are to disturb, and I'm wondering if I really need it to go higher than 16.

[stevew77]

I would suggest increasing your PSmin to 1 or a bit more, and see if it increases your tidal volume somewhat. Not sure about your height or BMI however. With a higher PSmin you might be able to tolerate higher IPAPs. Your AHI is great, regardless!

[sms832]

Do you guys see anything that might explain why I haven't been sleeping through the night?   Or any differences between my first great night and the rest of the nights??

Thanks everyone for any help you can offer.

[Sleeprider]

I like to see a PS min of PS 2 used to reduce respiratory effort. This can help with the sense of fatigue you experience. The PS max is there to mitigate events like CA and hypopnea, but a steady minimum pressure support can be more comfortable than no pressure change from EPAP to IPAP.

[sms832]

I like to see a PS min of PS 2 used to reduce respiratory effort. This can help with the sense of fatigue you experience.  The PS max is there to mitigate events like CA and hypopnea, but a steady minimum pressure support can be more comfortable than no pressure change from EPAP to IPAP.

Hi Sleeprider,

I've been staring at the data from my good first night, and the following nights.   What I noticed is that I slept all night long that first night really without pressure excursions above 16.   (There was one around 1 AM.)  

In following nights I'm seeing higher pressures in OSCAR around the times of my awakenings.

Would it make sense to adjust my settings to:
     EPAP  8.0  (no change)
     MinPS  1.0 or 2.0  (up from 0)
     MaxPS  8.0  (up from 17... giving me a max at 16, matching that first great night)
   
    ASV mode... Change to ASVAuto?

I wonder if very high pressures are waking me up.  I'd also like to have a looser mask fit - it's hard to pass the mask fit check without pretty tight straps at these pressures, especially for side sleeping.   I'm feeling that in my neck.

[Sleeprider]

If you want to try titrating to lower pressure, I have a perfect solution for you. EPAP min 5.0, EPAP max 7.0, PS min 2-3 and PS max 10.0. You'll get the good results you are used to and much lower pressure. These settings will allow us to narrow your EPAP and PS to an even narrower range.