Newbie with setup questions for AirCurve 10 ASV

[WildSteelhead]

Hi Folks,

Great input from everyone, thank you!  I know this is a long thread, so to recap my background and goal as a COMPLETE beginner with this:

* My sleep study didn't really show any OSAs, just Hypopneas and then Emergent CSAs, which got me on the ASV machine.  The sleep study had me in the Mild range for Oxygen readings, and just barely in the Moderate range with AHI of 16.
* Initial use of AirCurve 10 ASV was causing a) air down the stomach (hated it), and b) the "blasts" were arousing me awake (impacting actual sleep)
* I definitely have the claustrophobic feelings with this.  I am using a Dreamwear FFM
 
So, to summarize, I believe the recommendations were to make adjustments to settings to get the pressures down to try to a) get below the "air in the stomach" pressure level (my current priority), and b) reduce the strength of the "blasts" I'm getting in the actual therapy (so I can actually sleep).  My prescribed settings were:

EPAP Min 8
EPAP Max 15
PS Min 2
PS Min 10

For suggested new settings to address the issues described above, I believe the new settings we landed on are:

EPAP Min 5
EPAP Max 10
PS Min 2
PS Max 7
Ramp Time reduce to zero, but I may just use 5 minutes until I'm used to it.

At this stage I'm more concerned with eliminating the problems above than I am looking for the best therapy.  If we eliminate the problems consistently it seems I can slowly increase things as needed to reduce AHIs.  Does that sound right?

Lastly, can someone explain how EPAP and PS work together?  I'm guessing that the settings you use establish, for example, what the max IPAP pressure would be, and the same for EPAP.  I'm just not sure how they interact.  

Thanks.

[Gideon]

EPAP is what resolves OSA. I'm assuming your mode is ASV Auto and not ASV. That means that the EPAP will be adjusted to resolve Obstructive Apnea. PS, Pressure Support, is added to the EPAP to determine the IPAP or Inhale Pressure. With ResMed ASV PS is adjusted on every breath to maintain a 90 second moving average of the minute vent.

Is this what you were looking for?

[SarcasticDave94]

Hi Folks,

Great input from everyone, thank you!  I know this is a long thread, so to recap my background and goal as a COMPLETE beginner with this:

* My sleep study didn't really show any OSAs, just Hypopneas and then Emergent CSAs, which got me on the ASV machine.  The sleep study had me in the Mild range for Oxygen readings, and just barely in the Moderate range with AHI of 16.
* Initial use of AirCurve 10 ASV was causing a) air down the stomach (hated it), and b) the "blasts" were arousing me awake (impacting actual sleep)
* I definitely have the claustrophobic feelings with this.  I am using a Dreamwear FFM
 
So, to summarize, I believe the recommendations were to make adjustments to settings to get the pressures down to try to a) get below the "air in the stomach" pressure level (my current priority), and b) reduce the strength of the "blasts" I'm getting in the actual therapy (so I can actually sleep).  My prescribed settings were:

EPAP Min 8
EPAP Max 15
PS Min 2
PS Min 10

For suggested new settings to address the issues described above, I believe the new settings we landed on are:

EPAP Min 5
EPAP Max 10
PS Min 2
PS Max 7
Ramp Time reduce to zero, but I may just use 5 minutes until I'm used to it.

At this stage I'm more concerned with eliminating the problems above than I am looking for the best therapy.  If we eliminate the problems consistently it seems I can slowly increase things as needed to reduce AHIs.  Does that sound right?

Lastly, can someone explain how EPAP and PS work together?  I'm guessing that the settings you use establish, for example, what the max IPAP pressure would be, and the same for EPAP.  I'm just not sure how they interact.  

Thanks.

Answering the segment I bolded:

Absolutely OK. It's better to go the way you're thinking and gain some benefit rather than be miserable and/or skip usage altogether. You will get used to ASV therapy and in time can bump pressures to better control apnea without sacrifice of your comfort.

[WildSteelhead]

Hi,

Fred, yes that's the description I was seeking, thanks.

Dave, thanks, glad the approach I'm taking is ok.

So I used the new settings last night.  I have attached the OSCAR charts here.  A few observations:

1.   I used the machine from 10:15 - 2:00 with a single 5 min Ramp, and then had to take it off because my nose congested badly and couldn't really breathe fully through nose. Even though I am using the DreamWare FFM and could breathe through my mouth it was uncomfortable from a claustrophobic standpoint

2.   Seemed to feel like overall the pressure was lower, which was good

3.   As far as air in the stomach goes, it was certainly much less than before.  However, I don't feel like I slept much during the whole period to really know if it was going in my stomach.  It's hard to tell.

4.  It seemed like when I was awake and trying to doze off and breathing normally, the machine was mostly breathing in rhythm with me, which was comfortable.  However, then it would kick up in some pressure AND have a longer respiration rhythm than I was actually breathing.  Not sure why it would do that.  Could it have been that I actually DID doze off and maybe was starting an event and it kicked in?  I really don't think I dozed, but who knows.  Would that be clearly depicted anywhere on the graphs?  I even tried the "Blow Back" when it would do that, which may have helped a little, not sure.

5.  As far as air going into the stomach, do we know how that happens mechanically?  I noticed something last night.  In those instances when the machine was providing longer inhalations at higher pressure, I was still doing my normal rhythm of breathing.  So I felt like I would breathe in, and at the peak of my breath when I would normally exhale the machine was still blowing in at me for a little longer of a breath before the machine would exhale.  Could it be that period of the "extra breath length" that it gets pushed down into the stomach?

As far as my OSCAR data goes, there is a LOT of information that is collected and portrayed in the many graphs, which is great.  Can it be used to help verify whether any of my observations make sense?  For example, where I feel like my normal respiration rate is slower than what it is pushing at me? Can it show where the two are out of synch?  And can it help show if I am actually sleeping?  

Assuming my nose is not fully congested I plan to try again tonight with the same settings, unless anyone suggests adjusting settings, in which case I am happy to try them.  Oh, and someone had recommended switching to just a Nasal mask.  I had tried both the DreamWare FFM, and then the Nasal when I did my last sleep study before they prescribed the ASV machine.  I definitely would like to use the Nasal, since it felt much nicer, less obtrusive to wear it.  I just have to get past some of this congestion.

Thanks everyone!

[SarcasticDave94]

Hi,

Fred, yes that's the description I was seeking, thanks.

Dave, thanks, glad the approach I'm taking is ok.

So I used the new settings last night.  I have attached the OSCAR charts here.  A few observations:

1.   I used the machine from 10:15 - 2:00 with a single 5 min Ramp, and then had to take it off because my nose congested badly and couldn't really breathe fully through nose. Even though I am using the DreamWare FFM and could breathe through my mouth it was uncomfortable from a claustrophobic standpoint

2.   Seemed to feel like overall the pressure was lower, which was good

3.   As far as air in the stomach goes, it was certainly much less than before.  However, I don't feel like I slept much during the whole period to really know if it was going in my stomach.  It's hard to tell.

4.  It seemed like when I was awake and trying to doze off and breathing normally, the machine was mostly breathing in rhythm with me, which was comfortable.  However, then it would kick up in some pressure AND have a longer respiration rhythm than I was actually breathing.  Not sure why it would do that.  Could it have been that I actually DID doze off and maybe was starting an event and it kicked in?  I really don't think I dozed, but who knows.  Would that be clearly depicted anywhere on the graphs?  I even tried the "Blow Back" when it would do that, which may have helped a little, not sure.

5.  As far as air going into the stomach, do we know how that happens mechanically?  I noticed something last night.  In those instances when the machine was providing longer inhalations at higher pressure, I was still doing my normal rhythm of breathing.  So I felt like I would breathe in, and at the peak of my breath when I would normally exhale the machine was still blowing in at me for a little longer of a breath before the machine would exhale.  Could it be that period of the "extra breath length" that it gets pushed down into the stomach?

As far as my OSCAR data goes, there is a LOT of information that is collected and portrayed in the many graphs, which is great.  Can it be used to help verify whether any of my observations make sense?  For example, where I feel like my normal respiration rate is slower than what it is pushing at me? Can it show where the two are out of synch?  And can it help show if I am actually sleeping?  

Assuming my nose is not fully congested I plan to try again tonight with the same settings, unless anyone suggests adjusting settings, in which case I am happy to try them.  Oh, and someone had recommended switching to just a Nasal mask.  I had tried both the DreamWare FFM, and then the Nasal when I did my last sleep study before they prescribed the ASV machine.  I definitely would like to use the Nasal, since it felt much nicer, less obtrusive to wear it.  I just have to get past some of this congestion.

Thanks everyone!

First off, the numbers look pretty good in reflection of what you're dealing with on comfort vs therapy best setting. I do not see any need for changes right now. Just use and get used to this.

I've forgotten if the ASV was involving health insurance payments and a DME. If it is, you'll be subject to compliance to get insurance to keep paying. Compliance requirements would typically be a 21 day, 4 hours use per day within a month's time, and having 3 months to meet the requirement. If insurance is NOT involved just disregard this.

I'll try to answer each numbered section.
1. I face similar with mine at times, my FFM is ResMed F20, transitioning to N30i and/or P30i (when I get the ordered cushions next week) This wearing an alien octopus on your face isn't what we're used to.

2. Very good results despite a purposeful therapy restriction for comfort. I see no issue here.

3. I've not researched into an explanation of the how or why aerophagia happens, I suffer from it at times but I can say it's less frequent and less severe with more time on xPAP treatment, some think acid reflux may make one more susceptible to it with more swallowing actions happening

4. When alternating between sleep and wake, we're generating potential mixed signals to that ASV, I think it falls into the sleep wake junk (SWJ) folder, on the numbers we toss out SWJ data, it can affect breath cycles I suppose and machine confusion causes odd ASV response it seems, if it gets off kilter either do a Blow Back or power cycle ASV, I've had to do both in the past. Can we know exactly? No not definite because we're not wired up like in sleep studies. I think the OSCAR data can help indicate what's going on by patterns if they're visible though.

5. Nothing to add after # 3

Yes, at times inspiration or exhalation can seem to be out of sync. I've not come across a resolution. It seems to be a variance in what the body wants in breathing pattern and timing vs what the ASV wants. I don't have an answer on this, but they do seem to sync up eventually. It would seem if you're aware of it, you're awake and the ASV is a sleep therapy machine. So I'm inclined to include it in the SWJ folder. If it gets objectionable, power cycle the ASV is my reply. I'm open to input though.

Hope this addressed it all. Keep at it and best wishes on continued success.

[RayBee]

Congratulation WildSteelhead. Your AHI numbers look fantastic. I wish my raw numbers were as good, but I do have a bit of SWJ that I discount which yields 1.5 +/- AHI numbers on a regular basis.

Once in a while I will wake up with my machine's pressure running rampant accompanied by massive mask leakage. I quickly rip off my mask and find my nose is completely blocked. Then I realize I had spent a lot of time outdoors and probably OD'd on pollen. Once I realize my allergies were to blame, I take a 12 hour Sudafed and within 20 minutes I can breathe through my nose again. Then I quickly fall asleep with a content ASV machine. Sudafed is the only thing that works for me when allergies take over. I'm Glad I can still purchase it here in Kalifornia.
  

[WillSleep]

4.  It seemed like when I was awake and trying to doze off and breathing normally, the machine was mostly breathing in rhythm with me, which was comfortable.  However, then it would kick up in some pressure AND have a longer respiration rhythm than I was actually breathing.  Not sure why it would do that.  Could it have been that I actually DID doze off and maybe was starting an event and it kicked in?  I really don't think I dozed, but who knows.  Would that be clearly depicted anywhere on the graphs?  I even tried the "Blow Back" when it would do that, which may have helped a little, not sure.

5.  As far as air going into the stomach, do we know how that happens mechanically?  I noticed something last night.  In those instances when the machine was providing longer inhalations at higher pressure, I was still doing my normal rhythm of breathing.  So I felt like I would breathe in, and at the peak of my breath when I would normally exhale the machine was still blowing in at me for a little longer of a breath before the machine would exhale.  Could it be that period of the "extra breath length" that it gets pushed down into the stomach?

Morning.  If you want to have a look to better understand what is going on search for examples to use when your Flow Rate chart has sudden changes in density (In the example you posted above your Flow Rate chart goes from solid black to gray) and times when your Resp. Rate chart shows a sustained drop (not just a spike down for one breath). 

If you want we can have a look.  Post 2 minute and 30 second long charts starting 23:40, 23:56 and 0:39 

WillSleep

[WildSteelhead]

Thanks everyone for the feedback.

WillSleep, I will pull that data later today when I get back to the house. I’ll play around with how to do snippets like that.

Thanks

[WildSteelhead]

WillSleep,

I have attached the first charts you requested.  I hope I got what you were looking for.

Thanks.

---

Second batch of graphs.

[WildSteelhead]

Final batch of graphs.