[Treatment] ASV settings for treatment of complex sleep apnea

[SarcasticDave94]

Me thinks they are same/similar.

According to NCBI article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2765300/

"Respiratory effort- related arousal (RERA)
It is a breathing disorder characterized by obstructive upper airway airflow reduction (which does not meet the criteria of apnea or hypopnea), associated with increased respiratory effort that resolves with the appearance of arousals (RERAs).
'

[Geer1]

The backup rate is automatically calculated to match the patient’s needs so that mandatory breaths are delivered at the patient’s recent spontaneous breath rate

It is only supplying breaths at around 8 bpm and your spontaneous is around 14. 

I wish I could find an explanation of the algorithm because it doesn't seem right to me. 

Are there any settings you can adjust regarding backup rate?

[mper6794]

hi,  Joey,
...contrary I iniatially thought, it looks to me (based on my own daily counted discriminated sometimes audio recorded events) your dominant remain few minutes duration arousals could eventually not be respiratory-driven. I would investigated-audio recorded further them. They might be RLS/PLMS-driven or other stimula. How is your behavior in bed during your awakenings? quiet? unquiet? is there any associated groaning, even minor ones?
---just to compare, my remain non-respiratory driven arousals, coming out of nothing, sometimes with groaning, would be essentially PLS/PLMS-driven (audio-recording, no effort antecedent, response to medications, etc, suggest this account);
.... if not yet, take look at this paper..... I am here with minor groaning/unquiet events.: https://academic.oup.com/sleep/article/4...63/2731733

all the best

[JoeyWallaby]

Tried acetazolamide and acetazolamide + EERS. Was good last night, no events, didn't wake up at all, vivid dreams so REM sleep must of been good. Feel pretty good today, not sure why it's still pressure cycling so much. Maybe I need to lower the range by upping min pressure and decreasing max pressure? ASV is weird... for example, I'm breathing good with a high PS, then it drops PS by five points and my breathing is obviously perturbed by this massive drop, so it instantly puts it back up. Like, why?

I'm going to try BiLevel again tonight to see if acetazolamide + EERS is enough to control centrals.

hi,  Joey,
...contrary I iniatially thought, it looks to me (based on my own daily counted discriminated sometimes audio recorded events) your dominant remain few minutes duration arousals could eventually not be respiratory-driven. I would investigated-audio recorded further them. They might be RLS/PLMS-driven or other stimula. How is your behavior in bed during your awakenings? quiet? unquiet? is there any associated groaning, even minor ones?
---just to compare, my remain non-respiratory driven arousals, coming out of nothing, sometimes with groaning, would be essentially PLS/PLMS-driven (audio-recording, no effort antecedent, response to medications, etc, suggest this account);
.... if not yet, take look at this paper..... I am here with minor groaning/unquiet events.: https://academic.oup.com/sleep/article/4...63/2731733

all the best

Haven't been waking up the last couple nights, but when I was, it was usually just waking up feeling "jolted"/"shocked" then either falling back asleep quickly or rolling in a bed for a few minutes before falling back asleep. I did use an audio recorder before but it wasn't sensitive enough to pick up breathing.


Acetazolamide 125mg instant release


Acetazolamide 250mg instant release (Not relevant, slept for under 2 hours with mask on. Not sure why I took it off)

Acetazolamide 250mg instant release + EERS

[Croweater]

I'm finding the ASV settings to be very confusing and I need someone to help me please.

I have the following settings that seem to work very well with my nasal mask (as long as I tape my mouth shut):
EPAP Min = 6
EPAP Max = 15
PS Min = 4
PS Max = 15
Humidifier = 4

My goal is to transition off of the nasal mask and onto a full face mask so I don't have to use tape any longer.
Wouldn't it make sense to use the exact same settings as above?

I'm finding that using these same settings with a full face mask is not effective. It not only increases my AHI, it also causes serious aerophagia. So which settings do I change to reduce the aerophagia?

I'm fearful that I will have to go back to a nasal mask and tape, since that seems to be so much more effective.

[SarcasticDave94]

Croweater, to get the best help possible, create your own thread asking for assistance. It will be seen easier, progress will be tracked easier as well.

However, regarding aerophagia, some respond better reducing Max EPAP while others find that reducing Max PS. It should be noted that this is to be approached as a temporary measure to address air swallowing. Reducing pressures can also reduce effective therapy against apnea events. I would keep track of how therapy results change via OSCAR data.

Also of note is that not everyone needs overall max pressure levels on IPAP. You might benefit from optimization of pressure settings. And when switching mask types, make sure to change mask settings on the ASV.

[sheepless]

I'll toss a couple things out there. with other modalities I've seen suggestions that it might be necessary to increase pressure with ffm compared to nasal mask. probably some physics related to size of area under the mask. regarding aerophagia, my guess is that it's worse with a ffm because both nose and mouth are subject to air flow and pressure; no way to breathe around one or the other. in contrast, a nasal mask leaves your mouth (mostly) outside the pressure circuit so you can vent air and avoid it being forced back down your gullet under the ffm. not sure that's very clear but fwiw.

[JoeyWallaby]

I've been using the same Min PS and Min EPAP for consistency but I'm going to change them to tighter values soon, which hopefully will reduce pressure cycling. Maybe EPAP 5-8 and PS 6-9. It's annoying and weird that you can't the set Min PS higher than 6... 

[mper6794]

hi Joey,

...sgnificant results with the acetazolomide. However, don't you think, as per Robert J. Thomas experience (video above), it could work better under more stable pressure, no signficant oscilations?

...Other than just observations on this Forum, I don't have any experience with ASV, even though I (as a highly sensitive UARS person) don't like at all the idea of sleeping under such flying pressures and PS. For me, after 1 year experiencing with VAUTO, I have concluded pressure fluctuations definitively have not pay off. Maybe I would not get back ever, yet I know it work for heavy deep sleepers.

....I think it would be a good idea a new trial with VAUTO, maybe starting all over a new 10-15 day titration as per Resmed protocol.

goo luck

[SarcasticDave94]

I think there's a reason Min PS can't be higher than 6 above EPAP. In part, that would act more like a ventilator I'd think.

Here's a link, see if there's useful info for you to glean.
https://www.ncbi.nlm.nih.gov/books/NBK546706/