[Pressure] New to ASV and Wanting to Understand Pressure Settings Better

[kbeards]

Hi there!

I'm about 2.5 weeks into my journey with an ASV machine and so far it's going OK. I did all of my testing and diagnoses through Sleep Doctor and while the process worked well, I'm finding some of their customer service and follow through lacking. I had a call today to review issues I was having. They did answer a few of my questions on Humidity well, but when I mentioned that I was struggling with falling asleep due to it feeling like it was pretty violently ramping up even while awake she checked my settings and proclaimed that they were never adjusted based on my test results.

I tried the ramp mode but it seemed like it was way too low and my breath was getting hot in the mask itself. I figured out how to adjust the minimum pressure on ramp cycle so hopefully that is addressed.

I finally looked up how to see the clinical settings and this is where it was set:

Mode: ASV Auto
EPAP Range 4 - 15.0
PS Range 0.0 - 19.0

I guess my main question is whether the PS Range is supposed to be that wide. I've seen a few other posts where that appears to be a much narrower, but I don't really want to take wild guesses as that seems irresponsible.

The technician on my video call today said she was going to e-mail me with the settings it should be at as well as push those settings directly to my device. I never received the e-mail and the settings appear to be unchanged. Definitely a mixed review on my end from using Sleep Doctor.

Appreciate any thoughts and opinions on this, also let me know if other settings would be useful to know. Overall it's not urgent as I'm getting much fewer events per hour compared to before I had the machine, even with the challenges, but I would love to fine tune things.

Cheers,
Kevin

[SarcasticDave94]

You should be able to get some info about your sleep sessions via OSCAR charts.

I had a 10 series ResMed ASV for 2 years. I didn't like using Ramp as it suppressed therapy and when it switched off the pressure change was abrupt. It seemed to introduce a few CA which was counterproductive to treating them.

My most used settings were:
ASV Auto mode
EPAP 7-12
PS 3-15
Giving IPAP 10-27

I think you might do better with a somewhat more narrow PS with about 3 minimum to require a differential between inhale and exhale, while also lowering PS Max some. Also EPAP Min probably needs to increase a bit. 4 is typically too low for adults.

Guidelines for how I handled edits, EPAP gives a baseline therapy for anything not CA mostly. PS is the power that kills off the CA events. Given this, again some PS Min is probably best. The differential it provides helps exhale to be easier and promoted CA treatment.

Those are guidelines only, set it how your therapy is made most effective. Back to the beginning. You'll need to see an instrument panel to gauge therapy. Get OSCAR, using an SD card to save data and to transfer to your computer and onto OSCAR. You'll then post your thoughts with a new attachment OSCAR chart. Start with no zoom to get an overview, no calendar. Discuss how therapy felt, what settings you used.

[kbeards]

Really appreciate the response and sharing your most used settings. I did end up giving those a shot since I didn't hear back from them and it was a drastically different experience. It gives me confidence I can continue to dial it in. 

I also really appreciate the suggestion on OSCAR charts! I saw people uploading pictures of theirs on other posts and tried to download Resmed's program only to realize it was blocked unless you're a physician. I don't get their obsession with hiding the details from patients...

[kbeards]

You'll need to see an instrument panel to gauge therapy. Get OSCAR, using an SD card to save data and to transfer to your computer and onto OSCAR. You'll then post your thoughts with a new attachment OSCAR chart. Start with no zoom to get an overview, no calendar. Discuss how therapy felt, what settings you used.

Didn't realize I could get OSCAR up and running so quickly. I've attached both nights. I'm already working on the leakage issue by ordering a new mask that I hope is better sized for my face. 

The pressure chart with the updated pressure settings seems a lot more in control... although it's interesting it seems to be slightly trending up as the night goes on until I took a couple hour break.

Lastly, I found out you can't change the time zone once there's data on the card, that's fun...

Any thoughts on my initial data?

[Jay51]

Too many leaks.  That can happen though with ASV's higher pressure swings.  

Here are some tips:   

Mask Primer

• Mask leak solutions                                                                                                                                                                                                                                                                                                                                                                                                        
  Dave may have some more suggestions for you also.  Actually, you could probably try lowering your PS max from 15 to say 10.  Then see how it affects your therapy.  You can then keep decreasing it by 1 and keep seeing how it affects your therapy in your OSCAR charts.  
  

[SarcasticDave94]

OK, yes, if you need it, set both EPAP and PS Max at 10 or so just for the near short term. It's an artificial Max cap, trying to band-aid the therapy just until you get leaks under control better.

Unfortunately, therapy is mostly blowing out due to the leaking. Your median leaks were 24, already the ResMed redline.

If you want to save OSCAR chart posting real estate, move the flow limits chart down and move up mask pressure. Flow limits will mostly be like this current activity due to artifacts in ASV CA combat duty.

Make certain no mask you try gets tightened too far as it'll crush the cushion promoting even more leaking.

[Macka]

Hi kbeards,
I think you should fix your settings to those that give you the flat sections in your breathing. A lot of people with TECSA get put on ASV & wrongly titrated imo.

The pressures that may help a person with a neurological central apnea problem are likely going to blow your head off. I don't know if even they should have these kinds of settings.

   

I would set your min and max epap at a stable pressure, like your median of 9cm. Then min ps to 2 max to 7. Fix your ramp, set it to 5 mins starting at 8cm. This will give you the same therapy as all those flat sections, and limit the crazy pressure swings you see between those times that is actually giving you events.

This should help you gain control over the leaks and settle into good therapy.