ResMed AirCurve 10 ASV settings for first night of treatment: Do you agree?

[DevinJones]

Night 4 on April 20, 2023, while sleeping mostly on my sides, instead of supine, and while using a DreamWear full-face mask, soft cervical collar, and Sleeprider's recommended device settings:

Mode ASVAuto
Min EPAP 6.00 cmH2O (which was increased from Min EPAP 5.00 cmH2O)
Max EPAP 10.00 cmH2O
PS Min 3.00 cmH2O
PS Max 12.00 cmH2O

Attached are three OSCAR screenshots for April 20, 2023.

Almost all of the flagged hypopneas occurred right after starting a new session during the night, i.e., right after pushing the "On" button at the very beginning of the night and right after resuming therapy after each bathroom break.

Thank you very much, Sleeprider, for your analysis and suggestions for adjustments to device settings.

[DevinJones]

Attached is one screenshot of my pulse oximetry data and one OSCAR screenshot for April 20, 2023, at around 2:51 a.m. to 2:56 a.m. It shows that during my hypopneas at that time, my oxygen saturation level dropped from 97% to 83% (2:55:34 a.m.).

[DevinJones]

When I start a new session, including after each bathroom break, it may feel as if my mask pressure is not real high. So I'm wondering if I hold my breath a little at the beginning of a new session to force the device to increase the mask pressure. I'm wondering if that is the cause of the hypopneas occurring right after each new session. I'm not sure about this, but that may be a possible cause.

[Sleeprider]

You can see your first few minutes of therapy after every break has a lot taller flow rate. this higher tidal volume and whatever respiration rate is associated with that is enough to be your initial targets for ASV, and that might be the cause of some hypopnea early in the session. Your analysis sounds good, but it could be a higher heart rate and respiration rate after activity. It might help to let things settle a bit before masking up.

[DevinJones]

Thanks a lot, Sleeprider. I believe I see what you're saying. I'll let things settle a bit at the beginning of sessions, continue using the same settings for now, and see if that helps.

[DevinJones]

Night 6 on April 28, 2023

Mode: ASVAuto

Min EPAP: 5.00 cmH2O (which I decreased last night from min EPAP 6.00 cmH2O after AHI (2.63 and 3.13) and hypopnea events increased somewhat on two nights when min EPAP was set to 6.00)

Max EPAP: 10.00 cmH2O

PS Min: 3.00 cmH2O

PS Max: 12.00 cmH2O

Attached are three OSCAR screenshots for April 28, 2023.

At times, as I start to fall asleep, I feel the ASV forcing me to inhale a higher pressure for a longer period of time than I need. That is, the ASV sometimes forces me to take long, deep breaths that I don't need and that cause stress.

This forced ventilation can happen even after I relax in bed before starting the session and even after I blow back in the mask to try to take control of the ASV and reset the recent minute ventilation and target.

How can we resolve this forced ventilation problem that occurs sometimes? Would turning on the ramp setting help or not?


Thank you very much, Sleeprider, for your analysis and suggestions for adjustments to device settings.

[Sleeprider]

When you feel the machine is taking over your breathing, blow-back. You don't have to lie there and let the machine deliver longer deeper breaths. Once you do that the machine will recognize spontaneous breathing. That is the suggestion of other ASV using members, I have never personally used ASV.

[DevinJones]

Thank you, Sleeprider.

After reading many posts in this forum and other forums on Reddit and elsewhere, I now know that:

* The forced high pressure while falling asleep with the ResMed AirCurve 10 ASV is a very common problem that many sleep apnea patients complain about and think may be a key defect in the AirCurve 10 ASV.

* Some people, but not ResMed, have talked about blowing back into the mask to take control of the ASV device.

* Other people, including Dave in this forum, have said that blowing back into the mask, especially for those not using a full face mask, does not work for some people.

* Many sleep apnea patients find that the AirCurve 10 ASV causes them such great distress and the inability to sleep that they discontinue using the device.

* Other users say that after struggling with the AirCurve 10 ASV for weeks or months, they eventually adapt to the device, or the device adapts to them (they are not sure which one is adapting).

I believe that this prevalent problem with the AirCurve 10 ASV and apparent difficulty in making setting adjustments to quickly resolve the problem are real shortcomings of the ResMed AirCurve 10 ASV.

I just ordered a ResMed AirTouch F20 full mask to replace a DreamWear hybrid full mask. I hope that this actual full mask will make the blow-back strategy effective for me or that I will eventually adapt to the device after continued use and device setting changes.

Even with the DreamWear hybrid full mask, I was able to fall asleep last night and sleep well with an AHI score under 1.0. But after waking up within a couple of hours, I, too, struggled to fall asleep again because the device wanted to force high pressure on me and could not care less about my blow-back attempts.

[JCW888]

I am new to ASV also about 3 weeks, using Resmed P10 mask.

Still could not adapt to the pressure rise and down. It seemed like I need to focus on my breathing or machine would start to try to take control and can't fall asleep, blow back from P10 did not work, I had tried so many times.

I would unconsciously hold my breath using ASV while I did not remember doing so back the time I used S10 Autoset or VAuto before. And this movement made ASV push up pressure harder and made my sleep even worse. I am still struggling with ASV and hope to adapt it sooner.

[DevinJones]

JCW888, do you have an AirCurve 10 ASV too? What are your settings?

This serious flaw regarding the ResMed AirCurve 10 ASV's taking control over users' breathing is a common problem that forum advisory member Dave has talked about. He said, "Me wonders if the OP will become another ResMed ASV lack of timing control victim."

Evidently, the Philips Respironics DreamStation BiPAP AutoSV (ASV) device has more setting options that control the timing and can prevent the device from causing the problem that the AirCurve 10 ASV is known for.

Some former AirCurve 10 ASV "victims" who have eventually and successfully adapted to their devices have disregarded ResMed's official titration recommendation to set wide pressure-setting ranges (EPAP and PS) and have instead set narrow pressure-setting ranges that have been appropriate for their particular cases.

It seems as if, in many sleep apnea patients, the AirCurve 10 ASV fails to auto-titrate properly if the device is set with wide pressure-setting ranges.