[Pressure] Advice Needed: AirCurve 10 ASV Pressure Settings - First-Time User

[bruno.mosconi]

Hi Folks,


I'm reaching out to this knowledgeable community for some advice and insights. Last night, I had my first experience using an ASV machine – a big leap from my usual Resmed AirSense 10 AutoSet. I've got some interesting results and a few questions.
Here's a quick rundown: My AHI with the AirSense 10 AutoSet was always fluctuating between 4 and 1. But last night, with the ASV machine, it plummeted to an AHI of 0.45! I'm pretty stoked about these results. It seems like my previous AHI scores might have been underestimated, as the graphs indicated several CA occurrences that the machine software didn't pick up.
However, I've noticed that the ASV machine reaches much higher pressures compared to what I was used to with the AirSense 10 AutoSet. Is this normal or something I should be concerned about?

I'm currently using a "loose" setup to allow the ASV algorithm to work its magic. Here are my current settings:

• Mode: ASVAuto
  
  
• Max EPAP: 15.0
  
  
• Max IPAP: 35.0 (not sure how to adjust this)
  
  
• Min EPAP: 5.0
  
  
• Min IPAP: 9.0
  
  
• PS Max: 20.0
  
  
• PS Min: 4.0
  
  
• Ramp: Off
  

I've also attached my Oscar reports for a better understanding.
I would really appreciate any advice, tips, or thoughts on these settings. Are there any adjustments you'd recommend? Any insights into the higher pressure levels with ASV compared to AutoSet?
Many thanks in advance for your help. Looking forward to learning from your experiences!

Best,
Bruno Mosconi

[Sleeprider]

Your results were very good for a first night on ASV. Your settings of 5-15 EPAP and PS 4-20 are working, but we can reduce the max EPAP and PS quite a bit. EPAP min appears effective in a very low range from 4.0 to 7.0 cm. The low end of that range should be set based on comfort and your needs for ventilation. If you can tolerate EPAP min at 4.0 you can start there, but considering this chart, EPAP min 5.0 and EPAP max 7.0 should meed your needs. Similarly, you can set PS min at 3.0 or 4.0 based on comfort. We have no data with the lower minimum PS , but that is something you should be able to experiment with and not harm your therapy. PS max is far greater than your actual needs. Based on what I see in these results, you can tolerate PS max at 9.0 or 10.0 without any loss in efficacy.

The maximum IPAP shown is Oscar is simply the sum of EPAP max plus PS max. So with these lower pressure suggestions, your max IPAP will show up as EPAP 7 + PS 9-10m or 16-17 cm. Regardless of settings, the maximum pressure of the ASV is 25 cm, so you would never see a 35 cm pressure.

[SarcasticDave94]

Agreed with Sleeprider.

IPAP isn't self adjustable, directly. However if EPAP plus PS are edited, IPAP follows the sum of those other two.

Example, EPAP 4 plus PS 4 equals IPAP 8

For some, the ASV needs higher pressures to blow and persuade a breath when in a CA episode. So it can be acceptable for ASV to be higher than AutoSet, etc. However it's not always required for proper treatment. That's why we'd always suggest edits to make your settings personal.

Again for some with certain settings, IPAP Max may read higher than that physical limit of 25. This gives flexibility in settings, some will need higher EPAP Max, others need higher PS Max, others yet seem to need high both Max that's higher than 25 IPAP Max. The ASV will slide EPAP and PS around the settings to slide IPAP according to need, when in ASV Auto mode.

Give the edit Sleeprider mentions a try. The first night you do, you'll notice if it's "better", "worse", "same as" this current one. It will not take long to dial it in.

Post OSCAR chart after next use, include how you felt about the therapy.

[bruno.mosconi]

Thank you so much for your advice! It’s really helpful to get insights from someone who knows their way around these settings. I’m going to adjust the EPAP and PS as you suggested – lowering the max EPAP to 7.0 and the PS max to around 9.0 or 10.0. It’s great to know that these changes won’t compromise the therapy’s efficacy.

I’ll try these new settings tonight and will definitely post my results tomorrow. Looking forward to seeing how these adjustments work out. Thanks again for your guidance – it’s greatly appreciated!

Best,
Bruno Mosconi

[bruno.mosconi]

Hi Everyone,

I wanted to give a quick update and also seek a bit more advice regarding my new ASV experience. First off, I’m feeling great overall – the therapy has me waking up feeling fully rested, which is a huge improvement. However, there’s a small issue: I’ve been waking up with a light headache. I’m not sure if this is related to the pressure settings or something else.

Also, my wife has noticed that the machine is making more noise than usual. We’re thinking this might be due to the higher pressure settings. Has anyone else experienced increased noise with higher pressures? And could this be linked to the headaches I’m experiencing in the morning?

I’m planning to adjust the pressure settings as previously discussed, but I wanted to see if anyone here has had a similar experience or any insights on the headache and noise issues. Any advice or suggestions would be greatly appreciated!

Thanks in advance for your help!

Best,
Bruno Mosconi

[SarcasticDave94]

Unfortunate for us both, there can be many things that affect us, giving headaches. It's possible to be coming from the higher pressure. But there's lots of other headache causes as well, at least for myself. I have migraines, sinus, stress, oxygen deprivation styles. Thankful not all at once.

Do whatever you must to get you through headache.

Noise is also tricky. The ASV is more powerful than CPAP, and it cycles different too.

I would ask you wait to see if things get better with the edits. Having used ASV myself, one night with edits, the results will manifest very quickly, within 1 night there will be things to note.

[bruno.mosconi]

Thank you for sharing your insights and experiences. It’s helpful to know that headaches can have various causes, and it’s a good reminder to consider all possibilities. I appreciate your advice on dealing with the headache and understanding the nature of the ASV machine’s noise.

I’m looking forward to trying out the new settings tonight and seeing how they affect both the headache and the noise issues. Your point about the ASV being more powerful and cycling differently than a CPAP is well-taken, and it’s something I’ll keep in mind as I adjust to this new machine.

I’m hopeful that these changes will bring better results, and I’ll be sure to share my experiences tomorrow. Your support and advice mean a lot, and it’s great to have this community to turn to for guidance.

Thanks again for your help!

Best regards,
Bruno Mosconi

[Jay51]

Bruno, I experienced headaches when using a nasal pillow mask at high pressures, but did not experience headaches with a full face mask and high pressures.  I am not suggesting that you have to get a full face mask; but something to consider if the headaches persist and become intolerable.  Lowering the pressure could relieve the headaches, too, but the pressure has to be high enough to be effective though.

[bruno.mosconi]

Thank you for sharing your experience with different mask types and how they relate to headaches. It’s interesting to hear that you had a better experience with a full face mask at high pressures.

I’m currently using a nasal pillow, specifically the Philips DreamWear, as I find it more comfortable for side sleeping. The design, with the tube connection at the top of my head, gives me more freedom to move and rotate during sleep, which has been a significant factor in my choice.

Based on the suggestions I’ve received here, I’m going to lower the pressure settings and see how that works out. I appreciate your input and will keep in mind the option of switching mask types if the headaches persist or become intolerable after these adjustments.

Thanks again for your advice!

Best regards,
Bruno Mosconi

[Sleeprider]

Re-read my previous post.  

EPAP min 5.0 and EPAP max 7.0 should meed your needs. Similarly, you can set PS min at 3.0 or 4.0 based on comfort. We have no data with the lower minimum PS , but that is something you should be able to experiment with and not harm your therapy. PS max is far greater than your actual needs. Based on what I see in these results, you can tolerate PS max at 9.0 or 10.0 without any loss in efficacy.

I am suggesting EPAP min 5.0, EPAP max 7.0, PS min 3.0 and PS max 10.0.  This is consistent with titration recommendations by Resmed for individuals starting in ASV and the results of your previously posted chart.  The Resmed ASV Titration Protocol is reproduced below.  Your machine will be quieter and you should be more comfortable if you follow the setting guidance I have suggested, and we can do any additional fine-tuning based on your results and qualitative feedback.