Switched to ASV - AHI is great, but still feel like I'm not sleeping well

[Sassbeek]

Well this is much better from the perspective we have 8-hour of therapy vs 1.75 in the previous chart. There is no significant difference in AHI or respiratory statistics.  I don't see any evidence of central apnea and if sleep is being disrupted, it is due to the varying PS through the night.  I still think you are on the wrong machine and the Vauto would have been a lot more comfortable to deal with whatever you are trying to resolve. I assume your diagnosis is obstructive sleep apnea and I am unclear why you thought ASV would be better.  Unfortunately, with the Resmed ASV, you either get CPAP or ASV. There is no option to make this machine mimic the therapy on a Vauto or VPAP-S. The good news in you have a machine worth more than a simple bilevel, and if you choose to do a swap with someone like Supplier #2, you should come out with some surplus funds.

Appreciate the feedback!

So ASV is based on talking to my Dr after failing on APAP. My original diagnosis was a combination of hypopnea and central apnea (Attached it here if you're curious) and on apap I'd be split 50/50 between the two in terms of my AHI there. So between that and showing signs of cheynes-stokes my Dr recommended an ASV since it can do fixed biPAP if needed also and I can try both approaches, but yeah doesn't have the vauto

So you think the problem here is just down to arousals because of the pressure changes, everything else looks good? If so, is there anything else I can do here? I'm happy to try another machine for sure, but obviously any chance I can to make this one work is ideal so I'm happy to experiment with any settings that may work here. However, if vauto will just give me significantly better results though thent hat's what I'll go for

If vauto, what settings should I aim for?

Thanks again for all the help, really appreciate you helping me make sense of all of this

[Sleeprider]

Based on your diagnostic test results, my assumptions were incorrect, and based on this information I too would have suggested ASV. In fact your diagnostic study is very similar to "Zeoce's" http://www.apneaboard.com/forums/Thread-...apy-Thread where he was started on CPAP and we have just recently gone to ASV with very promising results. This new information is very important and I have to re-boot my thinking on what we're doing here. Based on a diagnosis of central sleep apnea, putting you on bilevel therapy would not be a good idea. With ASV, you have a very low threshold need for triggering a breath, but I have seen this before. My mistake was interpreting that as an indication ASV was not needed at all. In my defense, I see a lot of people that show up with ASV that have self-diagnosed and concluded it will help their upper airway restriction, and it's often a disaster. Without knowing your diagnostic results I was inclined to see your results in that context. I'll own that and try to revise my thoughts with consideration of the diagnostic information.

Your results on ASV is excellent from the standpoint of AHI, so the goal now is to find comfortable settings. We made some pretty dramatic changes from your first set of data where EPAP was 6-15 and PS 2-19 and used revised settings of EPAP 6-8, PS 3-8. The results of both scenarios were nearly identical in terms of both AHI and respiratory statistics, and actual pressure statistics were slightly lower with the revised settings, but surprisingly close. Your subjective feedback is that these settings did not make much difference. The start of therapy did not feature the high breathing rate and this reduced some of the PS, so good job of settling in before masking.

It's clear that the range of EPAP and PS in the revised settings was sufficient to accomplish the same results as the original much higher settings. I think it will be helpful to keep the revised settings, but change PS min to 2.0. This may help in reducing CO2 loss and minimize the tendency for breathing fluctuation. Let's not do any other changes for now. Eventually I'd like to try fixed EPAP pressure (ASV mode) and see if that improves comfort.

[Sassbeek]

Based on your diagnostic test results, my assumptions were incorrect, and based on this information I too would have suggested ASV.  In fact your diagnostic study is very similar to "Zeoce's" http://www.apneaboard.com/forums/Thread-...apy-Thread where he was started on CPAP and we have just recently gone to ASV with very promising results.  This new information is very important and I have to re-boot my thinking on what we're doing here.  Based on a diagnosis of central sleep apnea, putting you on bilevel therapy would not be a good idea. With ASV, you have a very low threshold need for triggering a breath, but I have seen this before.  My mistake was interpreting that as an indication ASV was not needed at all.  In my defense, I see a lot of people that show up with ASV that have self-diagnosed and concluded it will help their upper airway restriction, and it's often a disaster. Without knowing your diagnostic results I was inclined to see your results in that context.  I'll own that and try to revise my thoughts with consideration of the diagnostic information.

Your results on ASV is excellent from the standpoint of AHI, so the goal now is to find comfortable settings.  We made some pretty dramatic changes from your first set of data where EPAP was 6-15 and PS 2-19 and used revised settings of EPAP 6-8, PS 3-8.  The results of both scenarios were nearly identical in terms of both AHI and respiratory statistics, and actual pressure statistics were slightly lower with the revised settings, but surprisingly close.  Your subjective feedback is that these settings did not make much difference.  The start of therapy did not feature the high breathing rate and this reduced some of the PS, so good job of settling in before masking.

It's clear that the range of EPAP and PS in the revised settings was sufficient to accomplish the same results as the original much higher settings.  I think it will be helpful to keep the revised settings, but change PS min to 2.0.  This may help in reducing CO2 loss and minimize the tendency for breathing fluctuation.  Let's not do any other changes for now. Eventually I'd like to try fixed EPAP pressure (ASV mode) and see if that improves comfort.

No worries whatsoever on the ASV confusion. You're volunteering your time to answer tonnes of these and genuinely help people achieve a higher quality of life, for free, and have limited information with which to do it. That's completely fair.

Glad to hear though I won't have to go and change the machine out, that's great. So I've switched PS support to 2 min and kept the other changes, I'll give it a few days and report back here with the findings and see if there's other steps worth taking

Thank you so much for this, I really do appreciate it

[Sassbeek]

So I've had the new settings for a few days, and attached is every night with them in case you're curious. So far

- Sleep is definitely better! So thanks for that, it's noticeably better sleep than before for sure
- Still seem to wake up a bit towards the end of the night, usually hour 6 of sleep I'll wake up at least once maybe twice
- Aerophagia has been a minor issue, only causing a problem last night where it woke me up and I had to get out of bed. Otherwise it's been manageable, though could be causing some minor sleep disturbances I don't notice

Do you see anything worth experimenting with here, or should I keep going as is? As I said, the progress has been noticeable and I'm definitely sleeping better than I was before (So thank you very much for that), just curious if there's any obvious tweaks or experiments to try. If not, I'll keep going

Happy to provide closer looks anywhere needed

[Sleeprider]

With improved sleep and few violations of the aerophagia threshold, this may be where you need to be. I’m sure your medical team will agree this is effective therapy. When is your follow-up?

[Sassbeek]

With improved sleep and few violations of the aerophagia threshold, this may be where you need to be.  I’m sure your medical team will agree this is effective therapy.  When is your follow-up?

Not for a couple of months, but definitely looking good so far.

One other point, which could be nothing, I recorded my sleep last night to see my movement and still noticed alot of movement and tossing and turning constsntly throughout the night. Is that a cause for concern?

If not, I'll just keep on keeping on with the current setup and really appreciate all the help

[Sleeprider]

Most people will move more at the beginning and end of sleep, or shift position to find more comfort or in response to pain. There are movement disorders that usually show up in a sleep test like periodic limb movements and restless leg syndrome. Neither is likely related to your ASV therapy. It's problematic when it results in numerous arousals or awakenings. I don't know how to advise on this as it is hard to know when it is a problem unless you have a spouse that is disrupted or are aware of a problem other than by recordings or surveillance. . There are ways to reduce movement in sleep using body pillows or weighted bed covers. This article may help: https://www.rcpe.ac.uk/Journal/things-go...laboratory

[Sassbeek]

random question maybe should be its own thread.

Why do my flow limitation and snore charts change so drastically when using a nasal mask vs full face?

On Dec 17th I tried my dreamwear nasal mask, and flow limitations and snoring is significantly lower than my average with a full face mask
On Dec 18th, see a pretty typical night for flow limitations and snoring

Unfortunately I really struggle with the nasal due to air filling my cheeks and constantly getting pushed out of my mouth but is this a reason to try and push through, or is it just a reporting quirk? I've tried the nasal mask with this machine on two other nights and seen the same results, so it's not just a one off

[Sleeprider]

The mask setting on both charts shows full-face setting. Nasal masks have lower volume and produce a more direct path for pressure which makes the ASV more responsive. It's also possible the full face impinges on your sinuses and actually creates some flow limitation. Mask farts are a notorious source of snores as the vibration feeds back to the sensor in a very similar way to a vibratory snore.

[Sassbeek]

The mask setting on both charts shows full-face setting. Nasal masks have lower volume and produce a more direct path for pressure which makes the ASV more responsive. It's also possible the full face impinges on your sinuses and actually creates some flow limitation. Mask farts are a notorious source of snores as the vibration feeds back to the sensor in a very similar way to a vibratory snore.

I forgot to change the setting on the machine, but yeah the earlier night was nasal (Dreamwear nasal in one, resmed airfit f30i in the other)

So if the nasal mask makes the ASV more responsive, should I really push to adapt to the nasal mask? I assume that means it would give superior treatment. It's certainly alot more comfortable, I really wish I could wear it without issue