Newbie with setup questions for AirCurve 10 ASV

[WildSteelhead]

Hi folks,

New to CPAPs and new to the forum, but was hoping you could help with a question or two.  As background, I had two sleep studies in the last two months.  The first was a hybrid sleep study where I slept half the night and then into testing treatments, first with CPAP and then BIPAP, which were both unsuccessful because I have Central Apneas.  Second sleep study was using just ASV and it appeared to work.  I used a Dreamware FFM mask in the sleep study with the ASV, since I am a side sleeper and seem to end up eventually breathing out of my mouth.  So the doctor prescribed an ASV machine and I just got my ResMed AirCurve 10 ASV.

The machine has been set up with the following from my doctor:
Max Pressure 25
Max EPAP 15
Min EPAP 8
Max PS 10
Min PS 2

I am really tentative about this whole thing, and definitely have the feelings of "smothering" that I need to get over.  The one thing that seemed good from the sleep study using ASV was that the machine really felt good from an air pressure standpoint when I first put it on and was trying to fall asleep.  When I inhaled the pressure felt good an inline with what I was breathing, and the same when I exhaled.  It felt relatively comfortable.

So, here is my issue:  While at my DME to get the machine, instructions on use, mask fitting, etc., I tried on the same mask and hooked up to the AirCurve with my prescribed settings.  Immediately I could tell that I had what seemed like a lot of pressure, particularly when trying to exhale.  The exhaling really was bothering me right out of the gate!  So I went back and looked at my ASV sleep study data and throughout the night the EPAP was between 4 and 8, and mostly around 6-7.  I thought the idea behind the "brains" of the ASV machine is that you set a range of pressures that it operates in and, essentially, it would probably be at the lower range, and start to increase only if symptoms required it.  Is that not the case?  

I guess what I am really asking is if my EPAP Min pressure was set lower than 8, would it be more comfortable for me to start off with to get to sleep, yet the machine would have the ability to rise if needed?  Should I try it with a lower setting?  I recognize I have not even had my first night with the machine, but I REALLY want to position myself for success (and getting over the stress of it) by not fighting a setting that doesn't need to be set so high in the first place.

Anyway, sorry for the long post.  I really want the benefits this treatment can bring, and recognize it isn't necessarily going to feel wonderful and happen over night (ha ha, no pun intended), but I also don't want to be fighting it from the get go either, if it isn't necessary.  Would really appreciate insight/suggestions from the experts here.  BTW, if it is a good idea to adjust the EPAP Min, I have no idea how to do that, but I assume their may be some other menus to get into in order to accomplish that.

Thanks for your help!

[Gideon]

in the black bar at the top of this page click on CPAP Setup Manuals and following the instructions request the manual for your machine.  It is a manual process so it may take a while.  That will tell how to change the options.

Post your OSCAR charts.  That will provide data on which to base changes.
I would try your doctor's settings first, then adjust.  A combination of modifying the min EPAP and adjusting the min PS may be called for.

One hint that our many ASV users suggest is that if/when the ASV seems to get ahead of you just forcibly blowback.  That resets it to reanalyze your recent breathing pattern which it tries to match.

[SarcasticDave94]

Hi WildSteelhead,

Welcome to the Apnea Board and the ASV club. I've got the same ASV so as it applies, I'll pass on my experiences. First up, yes you can choose to set this yourself. These ASV machines have a grand total of 4 pressure settings you directly can edit. If you're running in ASV Auto mode, my preference BTW, this gives EPAP Min & Max then PS Min & Max. IPAP equals whatever your EPAP and PS are right then. Your settings dictate the upper and lower boundaries. FWIW the ASV mode eliminates EPAP as a range and is signified as a single pressure, IMO just not as good therapy-wise for most.

How to access settings? In our top banner is our CPAP device manuals. Look yours up specifically, and grab it. You'll be looking for access to Clinician Mode, accessed by pressing and holding Home button and the control knob for about 5 seconds.

What to adjust? IMO consider finding Mode; there should be available modes CPAP ASV and ASV Auto. My personal preference is again ASV Auto. Next or I should say nearby is EPAP Min and Max. Most adults will need 6 or more EPAP Min. Edit if you choose. Similar on PS. I believe EPAP Min should be around your median EPAP pressure requirement. ResMed allows more flexibility than Respironics on this aspect. You will not find IPAP as an adjustment. ASV will control that as you sleep. However, EPAP and PS could modify the IPAP limits; this probably isn't a beginner issue and we can revisit.

As for the actual pressures, I'd ask you to get OSCAR and post up a chart or 2. This could be when you use pressures mentioned or your edited version. We can see how good therapy was by various numbers including AHI and event type, etc. Also important is how you felt. Note that with a chart post. Then we'll see if or what can be done for best and consistent results.

As bonjour said, blow back could be something to consider

[WildSteelhead]

Hi,

So had my first night using the AirCurve 10 ASV using the prescribed settings set on ASVAuto.  Here is what I experienced:

1.  I got the Dreamware FFM situated pretty well and generally felt OK with it and the Ramp period made it feel OK breathing and I didn't really feel excessive pressure trying to exhale, which was good news.

2.  I had to get up three times, mostly for bathroom, which you will see in the OSCAR data below.

3.  During the three "sleeping/use" periods I never felt like I was fully asleep, but on the edge of sleep, if that makes sense.


4.  During the first sleep period it seemed I was able to get on my side comfortably, which is very important since I am a side sleeper.

5.  During the second sleep period not really sure I was sleeping, which leads me to a question on the "Pressure" section of the OSCAR data below.  If you have a period where the pressures are consistently high, and then they drop consistently, does that possibly mean you were sleeping during the high pressure and maybe more awake and doing your normal breathing during the low pressure section?  If so, I wonder if that means during my second sleep section I wasn't really sleeping since the pressures weren't up.

6.  During the third sleep period from 2:50 - 4:40 where I feel I really experienced problems.  It seemed the machine was REALLY hitting me with high pressure, and it would kind of wake me up because, even though I was breathing through my nose, it was pushing air into my stomach and I would have to stop a breath to push out a burp.  It seemed like I was in a cycle of high IPAP pressure sending air into my stomach, me holding a breath to push out a burp, and then the machine giving me another.  This was horrible and certainly was "sleeping."  I finally got up and went to the bathroom

7.  I started the fourth sleep cycle late and I really couldn't seem to fall asleep.  Looks like I was coming out of the Ramp time by the time I decided to give up, since at this point my nose was VERY congested and I was having to breath through my mouth.  I also felt like I hadn't gotten any sleep.

8.  I took the mask off and "slept normal" until 10:00 to be sure I got 'some' sleep.

I feel that if I didn't have those big pressures pushing down my stomach I could have been alright.  I don't know.  Would love to hear any feedback on this.  I understand it is just the first night. 

Thanks.

[WildSteelhead]

Adding the rest of the charts from OSCAR.
Thanks.

[SarcasticDave94]

I'll probably have more about this later, but let's get you to minimize or eliminate Ramp. The entire Ramp time is a No Therapy segment. The ASV can't be itself fending off events during ramp. It also looks like you might have positional clusters of events.

[WillSleep]

Hi folks,

New to CPAPs and new to the forum, but was hoping you could help with a question or two.  As background, I had two sleep studies in the last two months.  The first was a hybrid sleep study where I slept half the night and then into testing treatments, first with CPAP and then BIPAP, which were both unsuccessful because I have Central Apneas.  Second sleep study was using just ASV and it appeared to work.  I used a Dreamware FFM mask in the sleep study with the ASV, since I am a side sleeper and seem to end up eventually breathing out of my mouth.  So the doctor prescribed an ASV machine and I just got my ResMed AirCurve 10 ASV.

The machine has been set up with the following from my doctor:
Max Pressure 25
Max EPAP 15
Min EPAP 8
Max PS 10
Min PS 2

I am really tentative about this whole thing, and definitely have the feelings of "smothering" that I need to get over.  The one thing that seemed good from the sleep study using ASV was that the machine really felt good from an air pressure standpoint when I first put it on and was trying to fall asleep.  When I inhaled the pressure felt good an inline with what I was breathing, and the same when I exhaled.  It felt relatively comfortable.

So, here is my issue:  While at my DME to get the machine, instructions on use, mask fitting, etc., I tried on the same mask and hooked up to the AirCurve with my prescribed settings.  Immediately I could tell that I had what seemed like a lot of pressure, particularly when trying to exhale.  The exhaling really was bothering me right out of the gate!  So I went back and looked at my ASV sleep study data and throughout the night the EPAP was between 4 and 8, and mostly around 6-7.  I thought the idea behind the "brains" of the ASV machine is that you set a range of pressures that it operates in and, essentially, it would probably be at the lower range, and start to increase only if symptoms required it.  (Q #1) Is that not the case?  

I guess what I am really asking is if my EPAP Min pressure was set lower than 8, would it be more comfortable for me to start off with to get to sleep, yet the machine would have the ability to rise if needed? (Q #2)   Should I try it with a lower setting?  (Q #3) 

BTW, if it is a good idea to adjust the EPAP Min, I have no idea how to do that, but I assume their may be some other menus to get into in order to accomplish that. 

Thanks for your help!

Welcome!  

Answers, a trifecta!: 
Q #1   Yes
Q #2  Yes
Q #3  Yes

Your understanding and theories are good.  

I fully agree with David and YOU.   

1) Positional clusters ..  read this link from Bonjour's signature  Soft Cervical Collar 

2) Lose the ramp and start with EPAP Min set to 6.0 cm H20   

"I have no idea how to do that, but I assume their may be some other menus to get into in order to accomplish that."   

1. Tap the ASV so the lights come on
   
2. At the same time, sure use two hands, press the Home button below the screen and press in the dial and hold them both down for 3 seconds.  The clinical Settings Menu will appear.
   Tap the dial to drill down into the new Menu 
3. Use the dial to turn down EPAP Min from 8 to 6 and when at 6.0 push in the dial to confirm the configuration.   
   
4. While you are in the clinical menu make sure your Time and Date are set correctly.  
   
5. Leave your bedroom and go watch some football. 
   

 WillSleep

[WildSteelhead]

I can back down on the Ramp Time.  If you have no ramp and you just start from 0 will it be lower pressures initially until I have an event, or will it just start right from the get go with high pressure?  If it is the latter, I don't think I am ready for that.  Biggest thing I want to solve figuring out why it was going down my stomach and how to stop it.

Thanks.

[WillSleep]

I can back down on the Ramp Time.  If you have no ramp and you just start from 0 will it be lower pressures initially until I have an event, or will it just start right from the get go with high pressure?  (Q #1)   If it is the latter, I don't think I am ready for that.  Biggest thing I want to solve figuring out why it was going down my stomach and how to stop it.

Thanks.

For sure go with zero ramp, the use of ramp is making your experience post ramp worse.

Q #1  The machine will start at 6cm H2O on inhale and 4cm H2O on exhale which is really pretty gentle, REALLY gentle.  Some people complain they don't like how the ASV starts because they are not even sure the machine is on.  

I updated / expanded the next steps to account for this question and repasted below 

Steelhead, very tasty but so darn hard to catch.  

WillSleep

Your understanding and theories are good.  

I fully agree with David and YOU.   

1) Positional clusters ..  read this link from Bonjour's signature  Soft Cervical Collar 

2) Lose the ramp and start with EPAP Min set to 6.0 cm H20   

"I have no idea how to do that, but I assume their may be some other menus to get into in order to accomplish that."   

1. Tap the ASV so the lights come on
   
2. At the same time, sure use two hands, press the Home button below the screen and press in the dial and hold them both down for 3 seconds.  The clinical Settings Menu will appear.
   Tap the dial to drill down into the new Menu 
   
3. Use the dial to turn down EPAP Min from 8 to 6 and when at 6.0 push in the dial to confirm the configuration.   
   
4. While you are in the clinical menu make sure your Time and Date are set correctly.  
   
5. Take the machine with you and use for a bit while you are watching football so that you help answer more questions and are more comfortable with it when you are ready for shuteye.
   
6. A min PS of 2.0 is a mite lower than most use.  If the pressure is too high at the beginning go back into the clinical settings menu and bump it up to 2.6cm H2O, and then if needed 2.8cm H20.    
   

 WillSleep

[WildSteelhead]

Hi,
On Sunday night I reduced the Min EPAP from 8 to 6, and for the first two segments you will see on the data I dropped Ramp time from 45 to 20, and after I awoke before the third segment I dropped the Ramp to 10 minutes.

I don't think I was really sleeping during the first two segments, but maybe was drifting in and out and the machine was giving me a "blast" to get breathing again.  That's frustrating because it seems those blasts arouse me awake somewhat.

For the third segment I was probably sleeping some, in and out, but I was getting the "blasts" again and getting air going down my stomach.  So I would get a blast, have to stop a breath to force a burp, and the get another, and on again.  I think the high pressures and air in my stomach really woke me up around 2:55, or so it seems from the pressure chart.  I'm guessing that lower pressure is me awake and breathing normal, not sure.

I know I have only done this for two days, but this air down the stomach thing has got to get fixed.  And I really don't think I can do a cervical collar.  It's frustrating, and on top of the complete change to the way you sleep, it is very disheartening.   Would really appreciate any guidance.

Thanks.