Resmed ASV: Lowered AHI, but High Aerophagia

[Sleeprider]

Obstructive events are generally controlled by EPAP. You have demonstrated that your central apnea responds to a queue to breathe. This is the aame principle that we use for the Vauto when we move trigger sensitivity to high or very high. The person using the PAP is not so much reliant on pressure support to actually complete a breath, as a pressure change, or queue, to initiate a spontaneous breath. You have already show PS max 10 is sufficient to cause you to take a breath, we are just challenging you to see if less stimulus works the same way. What this tells us, is that you are primarily a spontaneous breather, but you need an occasional reminder to take that breath. That is actually pretty good news, especially as we try to avoid aerophagia by minimizing machine pressure.

[DevinJones]

Thanks for explaining this for the OP and the other ASV users who also may not need high pressure support to prompt them to breathe but who can breathe on their own with a more gentle pressure cue.

[DevinJones]

.....

[ar10]

As suggested, I tried for a month reducing PS to 3/8 (from 3/10), but left EPAP at 5/7, yielding an IPAP of 8/15.  [I use an AirCurve 10 set on ASV Auto, and that auto adjustment setting seems to work great for me.]

Initially after making the change, the AHI went up to the mid-2s, but now seems to have stabilized in the low- to mid-1s.

Unfortunately, the aerophagia continues.

I noticed that the Oscar data seem to show that I don't have much in the way of obstructive events.

I also noticed that the aerophagia may be beginning (gurgling stomach) as I'm about to drop off to sleep.

Could the minimum EPAP be higher than needed, and contributing to the aerophagia? Would it be worth trying to drop the EPAP minimum to 3?

If not, is reducing the PS further the only viable option?

Thanks in advance for your invaluable help

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Sorry, but I can't seem to post the latest Oscar charts.

[DevinJones]

I'm doing well now with EPAP 4.0/5.0 and PS 2.8/7.8 in ASVAuto mode. I've very gradually increased max PS and decreased max EPAP from about 10.0 to 5.0. I need more PS than I do EPAP. High-pressure surges are much better now.

[ar10]

Thanks, I've gradually reduced my settings  to about where yours are, and it seems to be helping a bit.

[DevinJones]

That's great that the setting adjustments have helped you. 

What would help ResMed AirCurve 10 ASV users even more is if ResMed improved the pressure adjustment options for users who experience sleep-onset events, such as sleep-onset periodic breathing pattern and sleep-onset central sleep apnea.

With the current flawed design of the AirCurve 10 ASV, users with sleep-onset events often suffer disturbing, intolerable pressure surges as they try to fall asleep if the device is set to the ASVAuto default pressure settings. But if users rein in the pressure settings to prevent runaway pressure surges during sleep onset and allow users to fall asleep, the reduced pressure settings may not be adequate to prevent all the apnea events that happen later when users are sound asleep.

ResMed needs to improve the design of the AirCurve 10 ASV to allow users to set lower pressures for the beginning minutes of a session and higher pressures for later in a session when users are asleep and can tolerate the higher pressures. For example, an improved ResMed ASV device would allow a user with sleep-onset CSA to set a ramp time with pressure settings at, say, EPAP 5.0/6.0 and PS 2.0/7.0 and to set post-ramp pressures at, say, EPAP 5.0/10.0 and PS 2.0/12.0. But with the current AirCurve 10 ASV device, users can set a ramp time with only low, ineffective pressures (i.e., the minimum EPAP and PS settings).