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

[Sleeprider]

On future graphs, let's use mask pressure instead of pressure so we can see the breath by breath pressure support. Your UA and H appear to be obstructive in origin, and likely positional. Your EPAP max is not sufficient to resolve obstructive events, and I recommend you increase the setting for EPAP max to 10.0. Mostly, you need to consider the possibility of chin-tucking aka positional apnea. The machine is responding appropriately but is too limited to resolve obstructive events. The goal has to be to manage sleep position to avoid postures or positions that encourage obstruction, and enable enough EPAP to deal with it when that fails.

[DevinJones]

Thank you for your helpful comments and suggestions.

Attached are two screenshots for last night's data with mask pressure data above.

Yes, EPAP was set lower last night, but notice that the EPAP settings were much higher on the previous night (April 15) I used the ASV:

Mode ASVAuto
Min EPAP 5.00 cmH2O
Max EPAP 15.00 cmH2O
PS Min 3.00 cmH2O
PS Max 15.00 cmH2O

See also attached OSCAR screenshot for April 15, 2023.

[Sleeprider]

For any individual with central apnea, the higher pressure support or IPAP will cause a significant amount of air to enter the lungs, but a person with obstructive apnea will experience apnea. This is obstructive apnea, and the solution is going to be higher EPAP min or resolution of the cause of obstruction if it is positional. We can see that between periods of positional obstructive apnea, the low EPAP around 7.0 seems to hold the airway patent, but where high IPAP pressure does not result in a breath, that is obstruction.

[DevinJones]

Thanks so much, Sleeprider! Tonight, I'll increase the EPAP max to 10.0, change my sleeping position to try prevent chin drop and positional OSA, and use a soft cervical collar. Let's see how all that works out.

[DevinJones]

Night 3 on April 19, 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 5.00 cmH2O
Max EPAP 10.00 cmH2O (which was increased from Max EPAP 7.00 cmH2O)
PS Min 3.00 cmH2O
PS Max 12.00 cmH2O

Attached are three OSCAR screenshots for April 19, 2023.

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

[Sleeprider]

Results are excellent although that was a fairly long hypopnea, and the machine was giving you 12 cm PS breaths throughout. Is this feeling like something you want to keep for a while? I could see increasing EPAP min to 6.0, but I think you can hold here for a while and see if these good results continue.

[DevinJones]

Thanks very much, Sleeprider.

I'd like to know the significance and interpretation of the long hypopnea, including what likely caused it at that time and whether it is dangerous in any way.

I don't know if it's best to continue with the current settings or make adjustments to prevent any lengthy hypopneas. What would you do if you had similar hypopneas?

[DevinJones]

Attached are two screenshots of my pulse oximetry data for April 19, 2023, at around 5:38 a.m. It shows that during my hypopnea at that time, my oxygen saturation level dropped from 97% to 85% (5:38:13 a.m.)

[Sleeprider]

It is no desirable to see SpO2 below 88% but it’s brief and infrequent. Overall I thik your therapy looks good and seems comfortable. I don’t see any harm in raising EPAP min by 1-cm and it may knock down the few hypopnea that we see.

[DevinJones]

I'm so glad therapy looks much better now. I'll increase the EPAP minimum to 6.0 tonight, and we'll see how that works out. Really appreciate your helpful comments and suggestions. Thanks again.