New to ASV, new to SleepyHead

[tmoody]

As I described in another thread, I was diagnosed with OSA ten years ago, and used a non-data CPAP. I had no problems that I was aware of, and never went back to the sleep doc for a tune-up, until last autumn. I saw the sleep doc again and he prescribed a DreamStation APAP, without an additional sleep study. Since the DreamStation is a modern machine that records data, I started watching the AHI and found that my average, on the APAP, was about 13, with a lot of hypos, a fair number of centrals.

Another sleep study was done, confirming the centrals, and I was prescribed a PRS1 Bilevel ASV, which I've now been using for a week. My average AHI for the week is about 4, sometimes as low as 1. So that's quite an improvement. With the ASV, most of my events are hypos.

I don't really understand the leak and leak rate information. I'll use last night's data as an example. AHI=4.2. Using the Min, Med, 95%, and Max headings, the Leak Rate values are:

0, 3, 27, 38.

The Total Leaks are:

27, 36, 66, 88.

The graph shows a fairly long spiky interval of leaks, from 11:30 pm to about 2:30 am, and another shorter interval from 6:15 am until waking up at 6:45. A bunch of the hypos occurred during that latter interval. Many of the remaining hypos were scattered through the earlier, longer interval. Plus, there was another bunch of hypos that took place during a time without leaks, but that was after I'd gotten up to go to the bathroom and was lying there trying to fall asleep again, so those non-leak-related hypos were waking hypos, for the most part.

I can't post a screenshot yet. Does any of this make any sense? I'm not sure why I'm getting the leaks and/or hypos, but I'd like to reduce them.

Interesting note: I had my lowest AHIs when--you won't believe this--I accidentally wore my Swift FX nasal pillow rig upside down.

[Sleeprider]

Leaks come and go, and your leak numbers are not too bad, but leave room for improvement. The leaks may settle down on their own, or you may just need to watch your fitting and keep the pillows clean (I use Dawn) so they keep a better seal. If the pillows are on the older side, it may help to get replacements. One of these days, you'll have to treat yourself to the Resmed Airfit P10 nasal pillows. I moved from the Swift FX over a year ago and never looked back.

[tmoody]

Leaks come and go, and your leak numbers are not too bad, but leave room for improvement. The leaks may settle down on their own, or you may just need to watch your fitting and keep the pillows clean (I use Dawn) so they keep a better seal. If the pillows are on the older side, it may help to get replacements. One of these days, you'll have to treat yourself to the Resmed Airfit P10 nasal pillows. I moved from the Swift FX over a year ago and never looked back.

The pillows are brand new. I'd been using a nasal mask for the past 10 years, but they had me try pillows in the lab for the recent sleep studies. I found that I liked the pillows. I'll try washing them with Dawn and see how that works.

Looking over the data for the past week, there does appear to be some correlation--not a perfect correlation though--between leaks and hypos, and I suppose this makes sense. The nights with the lowest leak numbers are also the nights with the lowest AHIs.

[robertbuckley]

You might want to try a full face mask using the ASV, especially because of the higher pressures. (I know, I fought it for a long time, but actually like my Resmed F-10). Are you experiencing any mouth leaks, that you can tell?

[tmoody]

You might want to try a full face mask using the ASV, especially because of the higher pressures. (I know, I fought it for a long time, but actually like my Resmed F-10). Are you experiencing any mouth leaks, that you can tell?

Once in a while I get a mouth leak, when I'm half awake, drifting off. I'm pretty sure if it happened during sleep it would wake me up, since the effect is pretty explosive. I think I had several in my first night with ASV, which was a tough night. Since then, only very occasionally.

I really do like the less encumbered feeling of the nose pillows. I think it's interesting that I had my best nights (in terms of low leak and low AHI) with the nasal pillow hear on upside-down. I may try that again, just to see what happens. Or, more than likely, the fit was just a big more snug that way, and I can reproduce it by adjusting the elastic band on the Swift FX.

I suspect that contact with the pillow sometimes shifts the nose pillows a bit, causing a leak. Maybe I should look for a much harder pillow that my head won't sink down into as much.

---

You might want to try a full face mask using the ASV, especially because of the higher pressures. (I know, I fought it for a long time, but actually like my Resmed F-10). Are you experiencing any mouth leaks, that you can tell?

Once in a while I get a mouth leak, when I'm half awake, drifting off. I'm pretty sure if it happened during sleep it would wake me up, since the effect is pretty explosive. I think I had several in my first night with ASV, which was a tough night. Since then, only very occasionally.

I really do like the less encumbered feeling of the nose pillows. I think it's interesting that I had my best nights (in terms of low leak and low AHI) with the nasal pillow hear on upside-down. I may try that again, just to see what happens. Or, more than likely, the fit was just a big more snug that way, and I can reproduce it by adjusting the elastic band on the Swift FX.

I suspect that contact with the pillow sometimes shifts the nose pillows a bit, causing a leak. Maybe I should look for a much harder pillow that my head won't sink down into as much.

I guess I can now post this screenshot:

[robertbuckley]

Shouldn't effect leaks really that much, but out of curiosity - is your backup rate set to auto? if it isn't and you are "fighting" the machine - that could cause you to be having some trouble. Also, what is your flex setting? I know when I transitioned to the ASV auto, having always had it set at 3 (highest) on the prior machines with C+ or A+ flex, it was set that way on the ASV initially. Given the incredible sensitivity of the ASV to adjust breath by breath it was much more comfortable to actually set the flex at 1.
Just trying to think of things that might be causing you to be uncomfortable and move more which will encourage leaking.

[tmoody]

My flex setting is 2. Maybe I'll experiment with that first. I don't see a backup rate menu. It's that in the secret hidden locked settings?

In any case, I'll try to fiddle with one variable at a time. I know that at least half of my hypos last night occurred when I was awake, trying to drop off again. If softening the transitions between inhalation and exhalation might reduce leaks...It's worth a try.

[trish6hundred]

Hi tmoody,
WELCOME! to the forum.!
Good luck to you with your new machine and much success as you continue your CPAP therapy.

[tmoody]

Hi tmoody,
WELCOME! to the forum.!
Good luck to you with your new machine and much success as you continue your CPAP therapy.

Thank you.

I'm going to keep a kind of ASV diary here, as I try to fine-tune things. All help is appreciated. It's kind of funny, after using CPAP for almost ten years, oblivious to AHI and all the rest, suddenly to be tracking things.

Last night's AHI was 2.6, which I'm pleased with. The SH graph shows zero centrals and zero OAs, so that number was entirely hypos. Although some hypos were scattered through the night, there was a cluster at around 5:30 am, about an hour before I woke up.

I got up to pee at around 4:10 (again), and, just like the previous night, had a bit of trouble getting back to sleep. I know that by 4:55 I was still awake, because I checked the clock then. I think I drifted off not long after that, but I'm not sure. Assuming I did, I got about another hour and 20 minutes of sleep, during which I had a dream, and during which I had six hypos, between 5:26 and 5:34.

My periodic breathing was up a bit from the previous night, from .88% to 2.3%. In the week+ I've been on ASV, that number has varied from 0 to 2.7. On APAP it was much higher.


A few hours before going to bed, I scrubbed the Swift FX nose pillows with cool water and Trader Joe's soap. And I set the Bi-flex from 2 to 3. I'm going to leave it there for at least a week to see if there's any trend. My leak numbers were also lower last night; I still need to learn how to interpret those.

When I woke up at 4:10, I felt like I had been sleeping very peacefully. There was no sense of discomfort. At no point do I recall mouth popping, air swallowing, or any of that. If I could have slept through till morning, it would have been, subjectively, a perfect night's sleep. As it is, I probably got seven hours of decent sleep, not bad.

[tmoody]

A question after a few more days on ASV, and reading a lot on here:

My AHIs since posting that screenshot have been lower, between 1.6 and 3.5. The number of centrals is going down, some nights to zero. Periodic breathing is also low (maybe 1%) or zero. So by far the events I still get are hypos. Indeed, even on APAP, with centrals untreated, most events were hypos.

My minimum EPAP and IPAP settings are 8. If I want to get my AHI lower by reducing hypos, should I bump one or both of these up? Would doing so have other, undesired, consequences? It's it better to settle in for a few more weeks and see if AHI, and with it the hypos, trends downward or stays where it is?

Any advice is appreciated.