Resmed Aircurve 10 ASV: Central Apnea Not Relieved

[RVSleeper]

I've been struggling since winter of 2023 to obtain relief from Cheyne-Stokes central apnea using a Resmed Aircurve 10 ASV. The sleep clinic recommended the ASVAuto setting with Min Epap 4, Max EPAP 15, Min PS 4, Max PS 14. On the very rare occasion that I get a tight mask fit, I seem to get some relief. However, most of the time I struggle. I'm attaching an OSCAR analysis screenshot for a nap I took yesterday afternoon. The mask in use was an Airfit F-30, medium size. You can see my breathing starts out uniform, but eventually mask leaks start to undermine everything, and my breathing becomes a ragged mess.

Does anybody have suggestions to improve my breathing during sleep? I almost always wake up feeling tired and drained. I've tried different masks, starting with the Simplus full face, the Evora full face, and Airfit F-30, F-20, and F-40 masks. I also tried the Resmed P30-i nasal pillows, but they require my mouth to be taped shut, and the tape eventually blows loose on the pressure peaks, ruining the seal.

[staceyburke]

According to your OSCAR you posted, you have no Central Apnea.... You are having large amounts of positional apnea.  

You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes or ANY cpap machine.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

[RVSleeper]

Wow! OK, I do sleep on my back and use elevated pillows at home because of a gastric reflux issue, and that might have the effect you mention. But the sleep clinic in late 2022 showed me the Cheyne-Stokes pattern in my breathing on their graphs, and the doctor diagnosed Cheyne-Stokes central apnea and the Aircurve 10 ASV for therapy.

I do have a cervical collar. Haven't used it in years, but it still fits. I just tried it on.

[SarcasticDave94]

On top of the probable Positional Apnea Stacey mentions, your ASV settings are 2 clicks away from default. C'mon, my dog can hand you an ASV in a box that's on default. They only edited your PS from 3-15 to 4-14. Wow thanks for making the settings unique.

Maybe go back to that default PS range of 3-15, but edit the EPAP to 6-12. Keep ASV Auto mode.

You mention the mask needs to be tight to work, then that's the wrong mask. It shouldn't need to be clamped tight to work. Since you do, either the mask model is wrong, wrong sized, or wrong adjust method. This mask thing is the hardest thing with CPAP.

Oh and you need your sleep study in your possession. Don't have it yet? Get it ASAP. HIPAA law gives you the right to request and receive it, period. It would be helpful to see what they have on it.

[RVSleeper]

The masks are indeed the hardest part to make work. The medium size F-30 has been the model that comes closest to working on a regular basis, and I always return to it after trying something else.

Thanks for the other tips too! I'll have to get a copy of the study.

[SarcasticDave94]

Ever try a Fisher and Paykel? I had Vitera and Simplus, both full face, and they were strapped somewhat loose. But they could handle the ASV I was on that had to deliver IPAP 25 at times. My leak rate was 10 @ 95%.

I'm about to get a new machine after ASV therapy didn't mix well with my increasing COPD/Asthma. Getting a VAuto end of month and looking hard at Fisher and Paykel Evora Full. Take a look.

[RVSleeper]

I've used the Evora full face mask with decent results compared to others, although Airfit F-30 is similar to Evora in performance, but with headgear that doesn't irritate my skin.

[SarcasticDave94]

OK copy that. Then maybe would a cover over the Evora headgear help any? The assumption is there's something available.

By the way, example, Etsy has satin covers for that mask, $45 was what I saw.

[RVSleeper]

Yes. In my case, I put a strip of moleskin padding under the top strap over the head for the Evora, to cushion the contact with my scalp, and it was pretty effective.

[SarcasticDave94]

Good to know thanks.