OSCAR Data: Random spike in flow rate

[ThisIsNotHowIAm]

Hello, I have been trying on and off for a while to get use to my ASV but I can't keep it on for longer than about 1 hr, after about 20 min I see this signature spike in the flow rate and it throws my breathing off and wakes me, maybe you guys have a better idea of what may be causing it. I don't get much leaking from my mask (f30i), I also tried increasing min epap pressure but I get aerophagia. Not sure exactly what it is so I can't begin to try troubleshooting. Thanks in advance for any ideas/help!

[Rich66]

I see your PAP Mode is "ASV". Have you tried "ASVAuto". You can go into the clinic menu to change it.
My experience is doctors are no help, and the DME is no help. My doctors recommended EPAP Min was 8.0. I finally set it to 4.0 and am doing better with it that way.

I can't seem to figure out how to provide a link to Resmeds site and their documentation -- others on here have it.
But Resmeds ASVAuto recommended settings are
EPAP Min -- 4.0
EPAP Max -- 15.0
PS Min ---- 3.0
PS Max --- 15.0.

I found the pressures too high and got too many mouth farts and eye washes -- both of which would wake me up. I turned the pressures down and then made mask adjustments to fight leaks. I'm doing better but it seems to be a slow process of 'what works for me'.

[SarcasticDave94]

My flow rate interpretation skills lack in the finer aspects most of the time.

I can share what I can to help otherwise. I think you may be more comfortable with the ASV set a bit different.

Try this:
Mode ASV Auto
EPAP 4-10
Leave PS as is.

When I used the same ASV, my EPAP would range a bit then PS would come in, because I was using ASV Auto mode with an EPAP range. It was much more comfortable than the static EPAP with all the range coming from PS.

[Geer1]

That is simply a deep breath occurring during an arousal. It is not waking you up, it is occurring because you are waking up. I don't see anything obvious to explain the cause of these arousals so I would assume spontaneous in nature and the best advice I can give is to learn to live with them and learn how to relax and fall back to sleep while continuing to use the machine.

The main issue right now is probably your inconsistent use and not being used to using the machine. You need to try and get into the habit of only trying to sleep with the machine even if that means getting some worse sleep the first few days.

One trick you can try is using the machine for a while before you go to sleep while watching some tv or reading a book etc. Do that for an hour or two until breathing with the machine is second nature. You might also need to learn what some people call the blow back technique if you feel ASV is trying to force too much pressure on you and affecting your ability to fall back asleep. 

Some other ideas are to research good sleep hygiene principals and CBT for insomnia to help learn to how to get comfortable and return back to sleep efficiently.

[ThisIsNotHowIAm]

I see your PAP Mode is "ASV".  Have you tried "ASVAuto".  You can go into the clinic menu to change it.
 My experience is doctors are no help, and the DME is no help.  My doctors recommended EPAP Min was 8.0.  I finally set it to 4.0 and am doing better with it that way.

I found the pressures too high and got too many mouth farts and eye washes -- both of which would wake me up.  I turned the pressures down and then made mask adjustments to fight leaks.  I'm doing better but it seems to be a slow process of 'what works for me'.

I had mine set to ASVAuto until someone else suggested ASV was more consistent because the algorithm can take too long to adjust but i can certainly try that again. I'll give those settings a try thanks! 

I'm also not working with a dr unfortunately because they haven't been any help :/ so learning as much as I can on my own and scratching my head a lot.

Thanks again for the reply and glad to hear you're making progress on what works for you

---

My flow rate interpretation skills lack in the finer aspects most of the time.
I can share what I can to help otherwise. I think you may be more comfortable with the ASV set a bit different.

I appreciate any help I can get, thanks for taking a look at my charts! I'll adjust my ASV to that and give it a go

[ThisIsNotHowIAm]

The main issue right now is probably your inconsistent use and not being used to using the machine. You need to try and get into the habit of only trying to sleep with the machine even if that means getting some worse sleep the first few days.

You're right, I do need to be more consistent about using it and those are great suggestions. I feel like sometimes I go a couple weeks forcing myself to use it and then feel defeated when I don't see much or any improvement and try it again after a month or so. 

I was hoping something on the charts would show what is causing these arousals :/ since nothing is showing it makes it much more difficult to determine what is waking me. Thanks so much for the reply lots of tips for me to try out!

[SarcasticDave94]

If need be, put some time in during the day if you're able to. Sit or recline with mask on, ASV running regular therapy. Kill time watching your TV, listening to the radio, or reading. Try breathing slow, steady rhythm, and relaxed.

And Geer1 was correct about blow-back. In 2 years of use on the ASV, I had to do blow-back 3 or so times. Basically the ASV reads your wake sleep transition wrongly and gives you a hard PS blow, thinking you're in a Central. To tell it you're not, blow-back. At least this description was my experience.

Every PAP, even the ASV, the settings have basic, fairly standard theory behind adjusting this or that to modify symptoms and events. From there it's adjusting to make it your individual therapy. For myself, I ran ASV Auto mode. ASV mode was felt as more harsh, my theory was ASV mode with static EPAP forced any increase for events to come off the PS, which seemed abrupt. The ASV is quick to respond. So to minimize PS harshness, I added EPAP range via ASV Auto mode. Now in this setup, any Obstructive events are mostly within EPAP range control and Centrals under PS range control.

[Geer1]

I get similar spikes from spontaneous arousal and it can get frustrating not knowing what to do but at least in your case you are still early in treatment. It is possible that these arousals are just occurring (or being worsened by) because of the new ASV use and what would normally be a tiny micro arousal you aren't aware of turns into a full awakening because of the new machine noise, air, mask etc. You need to use the machine each night for probably a couple of months before your body will fully adapt to it, if at that time the arousals are still an issue you can try to figure out more about them.

If your doctor is like mine the next step after ruling out breathing will be to try different medications to see if anything helps...

[Rich66]

I don't get much leaking from my mask (f30i), I also tried increasing min epap pressure but I get aerophagia.

You don't show "Large Leaks", but your chart shows a lot of leaks on a continual basis.  That means the machine is pushing more air to make up for it.  And the chart shows you frequently hit the maximum air pressure you have the machine set at.  I think you should concentrate on those leaks - maybe the next size smaller cushion is what you need.  Or maybe mouth tape or a chin strap or different mask.  My DME gave me the wrong mask to use at the very beginning.  It took a long time to figure it out (the leaks kept waking me up).  If you wake up with a sore throat, you're losing pressure out the mouth. 
Also, "min epap pressure" is your exhale pressure.  Aerophagia is from Inhale Pressure.  EPAP vs IPAP.  And your inhale pressure is amplified because of the leaks.

[SarcasticDave94]

On the OSCAR chart I saw, leaks hit a Max of 4.8. Yes, there's a small consistent leak trace, but it should be OK unless it's a disturbance. My own ASV use, I frequently had Max leaks at 10 or so with my Fisher and Paykel Vitera.