Resmed ASV settings for mild sleep apnea and UARS?

[Gettingbetter33]

Hi guys, I'll start by giving a little background info on myself and how I got to this point. I have had sleeping trouble for over 2 years now, it started with sleep maintenance insomnia along with nocturia, I was given many different sleeping pills by doctors, non of which helped at all.

The sleep maintenance insomnia sort of evolved into severely broken sleep, feeling like I was waking up every five minutes. Eventually I got past the gas lighting of my doctors and managed to get a sleep study, indicating I had an AHI of 6 and an RDI of 24. Lucky I'd done my research before hand so when the sleep doctor tried to dismiss how awful I was feeling just because my sleep apnea was 'mild', I informed him of the possibility of UARS due to the high RDI, and I was given a more comprehensive sleep test which confirmed UARS with almost identical AHI and RDI in that second test aswell.

Fast forward to now, I have got a hold of an resumed airsense 10 ASV which was no easy feat living in the UK. I am no longer under the guidance of a sleep doctor as I simply cannot afford to pay them here, they are far too expensive and to be honest even the top guys don't really seem to know what their talking about in terms of UARS and don't take it seriously, so I doubt they could treat me properly anyway. For example on my CPAP trail machine the results given back to the doctor showed an AHI of 0.0 and he was saying it was a success even though I felt just as bad as before, so he suggested more sleeping pills... LOL.

I've been using the ASV for the past couple of days but I have zero idea what I'm doing, I'm trying to follow people's anecdotal reports on here and info from Dr Barry Krakow, but I really just stabbing in the dark. I've not had any improvement at all so far in my objective sleep quality. Apologies in advance if I sound very stupid and am asking basic questions I am just so desperate for some guidance, I'm confused and extremely sleep deprived. Quite frankly I just want this nightmare to be over, this condition has turned my life into a living hell as I'm sure you can all relate. 

Any help would be greatly appreciated, and please let me know the best way I can contribute back to this community! 


Oscar screenshots from the past two nights have been attached.

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For some reason the other attachment wasn't included in the main post. Here is the first night. Bit more context aswell - Main difference between the two was I was I went from a nasal to full face mask. If you wondering why the complainace is low in terms of hours, it's because it's been a very uncomfortable eperenice for my and I'm almost subconsciously ripping it off in my sleep, so once its off I just fall back asleep and don't try to put It on again as I get stuck in sleep/wake loops.

[Sleeprider]

I really prefer to see individuals with UARS Using the Vauto rather than ASV, but that said, you are using an EPAP of 6.0 and the minimum possible PS of 0.0 - 5.0. I think you will find a minimum PS of 2 or 3 will end up being less disruptive as you should be using some PS all the time with UARS. The machine requires a PS max of PSmin + 5, so whatever increase you apply to PS min will also have to be made to PS max. Give a higher PS min/max a try. I would suggest trying 2.0-7.0 and see if that is better. In theory the machine only applies as much PS as needed to achieve a consistent minute vent and respiration rate. We can see that in your charts because most of the night is well below the maximum PS except for a few episodes. I think, but cannot know, that a PSmin above zero will be more comfortable and better relieve UARS, and the objective is not to hit PS max quite so often.

[Gettingbetter33]

Thanks, I really appricate the help. I will try these settings tonight for sure. 

The reason I set the PSmin to 0 - 5 was that anything above just seemed to be pumping me with wayyy too much air. Like I'd have a PSmax of say 10 and it would feel like I was getting pumped with 20. I confirmed the difference I was feeling by setting it to just standard cpap mode and feeling the difference between 10 and 20.

Also if you look at my Oscar data the pressure chart shows it going upto 11! How is this possible when the machine was set to a PSmax of 5?

[Sleeprider]

The maximum pressure is the sum of EPAP plus PS max. So 6.0+5.0 will result in peak pressure of 11.0. Like I said, the ASV is not the right machine for someone unaccustomed to pressure and pressure changes, and either the Airsense 10 Autoset (available at $399 from Supplier #1) or the Aircurve 10 Vauto (much more expensive but less than ASV) would have been good choices for you. The over-treatment of UARS with ASV is something we see a lot of here since Dr Krako came out with that suggestion. The real trick with the Airsense 10 CPAP is to use the EPR function which functions identically to bilevel with PS up to 3 cm. It is the pressure support during inspiration that gives significant relief to UARS. The CPAP that does this most effectively is the Resmed, and most others just provide pressure relief during the inspiration/expiration transition.

[chacha897d]

Hello,
WHY Vauto is better for airway resistance syndrome than ASV?

[chacha897d]

I feel overwhelmed; some experts suggest a BiPAP, others an ASV. Now, with the AirSense 10, I thought I had figured out a solution, but now there's different information. ?

[Sleeprider]

Assuming upper airway resistance is a constant, then adaptive servo ventilation should not be needed. We use bilevel therapy to provide a consistent mechanical assist on every breath or inspiration. Assuming the user has spontaneous respiration, the ASV algorithm with backup rate and adaptive/variable pressure support should not be needed. We want pressure support to overcome the airway resistance on inspiration, but ASV targets both respiration rate and minute volume and is designed to keep those constant. That works fine for people with central or complex apnea, or even periodic breathing that is unrelated to to obstructive causes (Cheyne-Stokes), but can be very disruptive to individuals that breathe spontaneously and can achieve good results with constant pressure support. All we are doing in UARS is compensating for airway resistance, not for lack of spontaneous effort or changing inspiratory pressure needs.

[Sleeptechmaster]

I would be careful with using ASV on your own due to it requiring cardiology to be done before using at least in the U.S.
EPR is similar to bilevel pressure support but not the same.
Bilevel has the increased complexity with its added features (rise time, fall time, ti control, trigger-cycle functions). With Bilevel apneas are controlled by EPAP and hypopneas by IPAP where with CPAP both apneas and hypopneas are controlled by the inspiratory pressure with epr providing the benefit of comfort and reduced mask pressure.
I wouldn't use ASV with only obstructive events. AHI of 6 is very close to the normal range.

[chacha897d]

Thank you for answering. I am planning to buy a bilevel machine as my first CPAP machine. Is there a way I can see from Oscar data if I need ASV if the bilevel machine doesn’t work well?

[SarcasticDave94]

I've not seen or heard info that indicates you're in need of the ASV. Stick with the ResMed AirCurve 10 VAuto, you'll be fine there. It has timing controls that the ASV doesn't allow manual setting.