Newbie with setup questions for AirCurve 10 ASV

[SarcasticDave94]

WildSteelhead,

Can you post the 4 pressure settings you're using currently? I'm going to suggest something to help your air swallowing, but I need your settings to refer to since they're not listed in your left panel profile info.

Here's what I want:
EPAP Min and Max
PS Min and Max

[Sleeprider]

Resmed recommends no ramp on ASV. You are having events during ramp, and it's probably better to just turn ramp off or keep it to a very minimal time. If you feel the machine is applying excessive pressure, blow back forcefully, and the machine will reset. The pressure support activity on your ASV suggests you probably had a lot of central apnea activity prior to therapy. Your median EPAP is still going to 9.0 cm, so the lower starting point is not affecting your therapeutic efficacy, but take advantage of that lower starting pressure to turn off ramp.

You might want to include the mask pressure chart which shows how the machine is responding to your flow rate (respiration) on a breath by breath basis. If you need more room, I would just demote the snore chart since snores don't appear to be an issue. Your results are looking better, and the next step is going to be to focus on more comfort as you adapt to the therapy.

[RayBee]

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.

Unfortunately you received no therapy for 33% of the time due to the machine being in "Ramp" mode. And even more time lost, as you were not solidly into quality sleep. On the up-side, you are gathering good data and knowledge.

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.

I too had major problems with aerophagia. For me, I eventually discovered that whenever the pressure got above 17 cmH2O, I would get air pushed into my stomach. With lots of repetitive experimentation on maximum settings, I found 17 was my threshold. So it was a balancing act for me to play with the numbers.

Now my settings are: EPAP 6 min, 7.6 max and PS 4.4 min, 9.4 max. Why the weird numbers? For me, the Max EPAP + Max PS can't go over 17 to control aerophagia. The Min EPAP of 6 keeps my OSA under control. And the Min PS of 4.4 provides me with the best comfort I can attain given the other settings. My therapy pressure can vary from 10.4 to 17.0 to treat Centrals, and that seems to work well for me. So overall, perfect balance found, for me, for now.

I've always said, one or two nights does not make for a trend. So I would make an adjustment and stick with it for two to four weeks if it was reasonably tolerable. Then I would note my results - good and bad. And ask questions here on AB.

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.

I tried a soft cervical collar too, to try to control chin tucking. In all honesty, it hurt my neck and was painful. And I just didn't want to fight that battle. With lots of experimentation and note taking, I found, as a side-sleeper, that I could just bunch up the top of my blankets and smash that under my chin. I could bunch them up to where it was really comfortable and effective. And according to my OSCAR charts, even when I tuck my chin, I don't seem to have obstructions as a chronic issue. I get a few event clusters on occasion, but I know why they are there, and they are few and far between. Since it isn't a chronic problem, I'm fine with it.

So, those are a few thoughts of worked for me. I hope this helps.

All the best.

[SarcasticDave94]

I too would try to get you to eliminate the Ramp entirely ASAP. For myself, any time in Ramp was also No Therapy on the ASV. I'd suppose yours would be roughly equal to mine in that aspect.

I think we can try the IPAP limits balancing act of aerophagia vs apnea events to enhance comfort.

[WillSleep]

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.

On beating the blasts.

The first thing I would do is switch from a full face mask to a nasal or pillows.   The ASV's high pressure aggression issues seem to significantly dissipate.  Only once across a number of weeks of time do I notice a blast.  Possibly my lips just part and release the pressure as it happens.  'Lip flutters'

A tech at a Sleep Lab told me the ResMed Airfit N20 Nasal mask is the easiest for people to learn and is the mask they have the most success with when people are struggling to get any mask to work.    Others like the DreamWare, the P10 and the Bleep! mask.   I see you have a DreamWare FFM now. If you don't already have the Nasal version fittings for your nose and the Nasal version I of the headgear/straps I think you can order both of those via Amazon prime. If your using a Medium FFM they say to just order the Medium nasal fitting.



Your AHI was so low last night. Congrats!! 

On settings. 

I agree with all the others, lose the ramp. 

We need to get the pressure at a place you find acceptable so you can actually get sleep and with a super low AHI we have some room to work with on pressure settings.  

To see how much pressure you can drop without causing a big jump up in AHI I would:

• Drop EPAP Min from 6.0 to 5.0 
  
• Drop PS Max from 10.0 to 8.0    
  

  
Every time I see your user name it puts a smile on my face.  I should schedule a fly fishing trip. 

WillSleep

[WildSteelhead]

Hi folks.  

Just gotta say thanks so much for everyone providing great guidance. I really appreciate it. 

Dave, the settings you asked about are:
EPAP Min 6
EPAP Max 15
PS Min 2
PS Max 10

WillSleep, I chose the Dreamwear FFM because I thought I might open my mouth while sleeping.  I could try a nasal mask, but not right away. 

Thanks

[WillSleep]

Two more quick thoughts:

We need to get the pressure at a place you find acceptable so you can actually get sleep and with a super low AHI we have some room to work with on pressure settings.  

To see how much pressure you can drop without causing a big jump up in AHI I would:

• Drop EPAP Min from 6.0 to 5.0 
  
• Drop PS Max from 10.0 to 8.0    
  

  
1) If the Pressure at PS Max 8.0 at pressure is still too much drop PS Max down to 7.0 which is as low as it can possibly go without lowering PS Min.    If you had to then still had to go lower you would drop PS Min 2.0 to PS Min 1.6 and PS Max to 6.6.

These lower pressures make it easier to skip the ramp and really lower the bullying from the ASV.  Even if you AHI goes up a bit will most likely be much better than not using the ASV at all or having a long lousy night fighting the ASV rather than sleeping.    



2) The "Blow Back" Method.  Don't just take the beating, let the ASV 'feel' your presence too.

  Lol.

Dave is often seen championing among FFM ASV users this concept he calls "Blow Back."  

This is a quote of text Dave posted in another thread.  
  
"I'm supposing you're familiar with the "blow back" term to "reset" the ASV's well-intended but unwanted desire to push your (Respiration Rate) RR (I'm assuming I'm assigning the correct term to what I intend) faster. It works for me to get the ASV to back off temporarily if it tries to get ahead of my RR (Respiration Rate) and force a breath unnecessarily (while awake or in wake/sleep transition only). My ASV no longer invades and wakes me; it took over a month to get here BTW."   SarcasticDave94  
 
Creating an unconscious habit of this method might help you get the upper hand over the ASV. 
 
WillSleep 

[SarcasticDave94]

I'd be inclined to shorten your EPAP range, dropping max from 15 down to between 10-11; this makes EPAP a span of about 5 on the EPAP pressure range. This drops 4 off the IPAP indirectly to maybe address the aerophagia issue.

I'm not certain if your therapy needs will closely mimic mine or not, but I tend to do better with a more narrow EPAP range than on the PS side.

Whatever pressure edit you do, post a chart, and let's see what it says. If it feels worse doing it one way, don't hesitate to revert back. There's also the possibility that nothing different occurs over 1 night, that's when I'd leave it as is and see what happens after night 2.

[Feedsack]

first let me state Im not an expert and I dont have the machine that you do. I am familiar with the problems that you feel your having as I had the same feelings. I thought I was a mouth breather at times. I could swear that I was but after training my tongue to sit right behind by front top teeth i am no longer a mouth breather
 I am getting AHI below three consistently with nose pillows or those little things that actually go in your nose a bit. At times I like one then the next day i like the other so i switch back and forth.  i to tried soft cervical collars and they didnt seem to effect the numbers just me  In my opinion the more you try different masks the more you will educate yourself on your best ones i put a picture i know its not much but where im at i can only do my dreamware program good luck

[WillSleep]

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.

I tried a soft cervical collar too, to try to control chin tucking. In all honesty, it hurt my neck and was painful. And I just didn't want to fight that battle. With lots of experimentation and note taking, I found, as a side-sleeper, that I could just bunch up the top of my blankets and smash that under my chin. I could bunch them up to where it was really comfortable and effective. And according to my OSCAR charts, even when I tuck my chin, I don't seem to have obstructions as a chronic issue. I get a few event clusters on occasion, but I know why they are there, and they are few and far between. Since it isn't a chronic problem, I'm fine with it.

So, those are a few thoughts of worked for me. I hope this helps.   All the best.

Hello WildSteelhead, 

I just wanted to tag on to RayBee's response with another alternative to traditional neck collars.   Check out the Caldera Neck Rest.

I have used this for sleep during air travel.

Soft, thin, nice fabric.  Needs to be worn a little loose in order to extend far enough out under your chin to prevent a tuck, which is great because it does get hot like some collars and I found it very comfortable to wear. 

For sure nothing smaller than a large.   Amazon Prime at a decent enough price.
[commercial link removed, instead, search Amazon for "Caldera Neck Rest"]

WillSleep

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