[Pressure] Understanding Pressure Settings on ASV

[Suzee]

Sleeprider:

OK.  Tonight I will try ASV auto EPAP 5.0 - 6.0, PS 2.0 - 7.0

Thank you so much!!

[Suzee]

Sleeprider:

I'm sorry that I am the problem child.   I appreciate all of your time, energy, kindness and expertise.

I know it sounds like I am being picky, stubborn and whiney.

Last night ASV auto was set at EPAP 5.0 - 6.0 ad PS was 2.0 - 7.0

Now on the surface, everything looks fine.  Numbers are good.  Events are minimal.
But that's only half of the picture.

I know EPAP of 5.0 is not so high for some people but my body has a strong physiological response against it.

After I turn on the machine I begin to cough and choke (I don't have a cold).  The pressure irritates my throat and lungs, creating increased mucous.  The pressure drives this fluid into my eustachian tubes and sinuses which causes ear ringing and some imbalance.

From the beginning of the night, the aerophagia causes me to belch all night as my stomach fills with air.

I wake up frequently at night from discomfort.  I don't get much sleep.  (Unfortunately resmed does not show sleep data.)  When I do sleep it is a restless sleep so I have not been able to overcome the severe sleep deprivation and exhaustion.

When I wake in the morning I am short of breath (SOB) for a couple of hours, then the SOB issue seems to resolve.

I start the day coughing and belching with stomach pain and nausea which lasts most of the day.

I looked at OSCAR for dates when I began with the ramp, which brought the EPAP down to 4.0 for 45 min.  And that low of pressure
was not able to rise to the occasion to prevent events.  I understand.

But with my body reacting in so many ways against the EPAP auto of 5.0 I don't know how I am ever going to recover.  It's been a long road, since symptoms started after surgery in 2015 and diagnosis and treatment began in 2018.   

I have struggled finding pressure settings that were high enough to manage events without causing all these physiologic side-effects.  I don't believe my body will ever become more tolerable to the pressure it is now reacting so wildly against.

I feel like I am between a rock and a hard place.  

I have attached 3 graphs.   One from last night, February 23 and February 24.  On those nights in February I was using ASV auto EPAP set at 4.6 and I had minimal events.  Feb 24 was 0.0!

But I was having trouble falling asleep and that is when it was suggested I use the ramp.  I have been so sick for the past 2 1/2 weeks and had no idea it was related to the long period of ramp causing events.  I am so grateful to you for figuring that out.  And grateful to you for all of your patience and kind assistance.

I want to keep trying different things to see if I can find a way to eliminate some of the side-effects while staying safely within a minimal event level.

Any other ideas for me?

Thank you.

[Sleeprider]

EPAP min 4.0, EPAP max 4.0, PS 2.0, PS max 7.0. Our next stop is PS min 1.0, PS max 6.0. We are scraping the bottom of the pressure possibilities.

[Suzee]

Sleeprider:

I set pressures at EPAP min 4.0, EPAP max 4.0, PS 2.0, PS max 7.0
Thank you!


Attached are 3 screenshots from last night - 3/17/24.

Four hypopneas, probably set off by an air leak.

No UAs that I can see.

Sorry.  There are gaps.  I went to the BR around 3 AM, got back in bed and forgot to put my mask back on.
But woke up around 6:30 AM and put mask on.

Your thoughts?

Much thanks!

[Sleeprider]

It looks like the few events were mostly due to leaks. Please include the leak chart. This is exceptional therapy by the numbers, and the lower pressure did not change respiratory parameters, but the real question is how did you feel? Have we solved the problem?

[Suzee]

Sleeprider:

Thank you for your response.

Attached are 3 views of the leak rate chart.

For sure, I had an easier night.  The pressures did not hurt my chest or cause coughing or choking.  I was able to go into a deeper sleep, so sleep was more restful.
But I haven't recovered from all the ill effects set off 2 weeks ago with the long low ramp settings.   


If you think this looks good then I would not to continue as is, to watch and wait, at least for a couple of weeks.

Your thoughts?

Thank you very much.

[Suzee]

Sleeprider:

ASV auto pressures at EPAP min 4.0, EPAP max 4.0, PS 2.0, PS max 7.0


Sorry.  That was a garbled message I rushed through to you this afternoon.  This is a correction to that message.

If you think it is safe to continue on those same pressure settings, then I would like to continue for a couple of weeks at those settings, to see how things progress, as I monitor the stats day to day and ask questions of you if something seems off.

Your thoughts.

Thank you.

[Sleeprider]

Good to go! I hope this good sleep and results continue.

[Suzee]

Sleeprider:

Thank you!  Thank you!  Thank you!!

[JCW888]

Hi Suzee

How is your treatment so far fixed EPAP ?
I used to hate my ASV and turn to VAuto.
Since I got a good deal and bought one again, then accidentally bump into your therapy thread。Then I think I may give it a try again.

I used ASV for about 4 months few months ago and can not bear with it, since it always blast me with huge amount of air out of nowhere when I just exhale slowly to all air out (inhale and exhale slowly). And I am just like you very sensitive to pressure.

So I would like to say hi and check if you experience the same or is better now and if EPAP ASV mode is so far good for you ? TIA. 

Hope all the best for you.