Suddenly my Centrals got a lot more disruptive

[tcinoz]

So, after another typical cluster of apneas towards the end of my sleep earlier this week and with continuing high Flow Limitations (see screenshot), I got an email from my sleep centre with a prescription to rent an ASV Auto machine to try out. 

Hurray—at last! I thought. But my elation was short-lived. Less than two hours into the first night with the ASV I gave up and went back to my CPAP machine. The constant forceful puffs of air being blown at irregular intervals just made it impossible to fall asleep. 

The settings are currently as follows:

Min. EPAP 6   Max. EPAP 16
Min. PS     3   Max. PS      8

On my CPAP machine, I can tolerate a maximum pressure of 8 to 9 with pillows or 10 to 11 with a nasal mask. Does the maximum pressure need to be higher with an ASV machine? What is it that's making it feel like it's all too forceful? Is it the EPAP or the PS? Or should I reduce the maximum for both the EPAP and the PS to make it more comfortable?

Thanks for any advice - always appreciated. :-)

   

[RLRoth]

I’ve been using the AirCurve 10 for 3 years now with nasal pillows, and have never had an issue with too much pressure. My unit is set to the Auto settings so that the AirCurve determines optimal pressure.

Try checking to make sure you are in the Auto pressure settings. Also, set your Ramp Time to at least 20 min ti allow you to fall asleep before the unit potentially increases pressure.

Hope this helps!

[SarcasticDave94]

Keep the min EPAP 6 and PS 3, but I would shuffle some EPAP Max over to PS Max. Let's move 4 cmH2O around, taking away from EPAP Max 16 down to 12, add this 4 into PS Max making PS Max 8 into 12.

To help you follow me, set your ASV to:

ASV Auto as is now
EPAP 6-12
PS 3-12

Your IPAP range stays the same at 9-24

You likely do not need EPAP 16, my reasoning for moving it around to PS.

And the OSCAR chart for the ASV? Almost 2 hours is data...

[tcinoz]

Thanks Dave. I'll give those settings a try for tonight.

Here is the Oscar chart for that short period with the Aircurve ASV machine. It looks a lot better than it felt - but perhaps that's because I was awake for the duration so nothing much showed up.

   

[SarcasticDave94]

Best to you on this. The edit may help out.

[tcinoz]

I’ve been using the AirCurve 10 for 3 years now with nasal pillows, and have never had an issue with too much pressure.  My unit is set to the Auto settings so that the AirCurve determines optimal pressure.  

Try checking to make sure you are in the Auto pressure settings.  Also, set your Ramp Time to at least 20 min ti allow you to fall asleep before the unit potentially increases pressure.  

Hope this helps!

Thanks RL - I'll bear all that in mind.

[Phaleronic]

Thanks RL - I'll bear all that in mind.

We typically don't recommend the use of ramp unless it's absolutely necessary, and if you're properly titrated on an aircurve model there should be no use for using ramp, as you're not receiving the needed therapy during ramp (nor proper data recording)-I would suggest disabling ramp completely.

[tcinoz]

Thanks, yes I'm aware that the ramp is not favoured by most on here. I can however see its usefullness if it helps you get to sleep before the machine works its wonders. Getting to sleep is not normally a problem for me, and with CPAP I'm fine with its steady flow for the first few hours (apart from a handful of apneas and the flow limitation being too high), so it's not as if I need those distracting forceful puffs that the ASV hits me with as soon as I start to drift off. I'll see what happens tonight but at the moment all options are open if it means better sleep overall.

[SarcasticDave94]

One thing to practice with ASV is to relax to as for to normal breath patterns before masking. This says up the ASV to have normal rates to follow. Might be a difference maker.

[tcinoz]

Not sure what you're saying there Dave.

Also, could you please explain the reason you suggested upping the PS to compensate for lowering the EPAP? Is that how ASV works - a kind of zero sum equation between the two? Also, what is IPAP as oppsed to EPAP? Thanks again.