[Treatment] Am I getting the best from AirCurve 10 ASV?

[AHI Tuna]

Newbie here.  To the forum, not to PAP therapy.
AirCurve 10 ASV(Auto mode)
F30i mask

I don't think that my 4 year history is important here, so I'll just get into the current status.

I am 77 y/o in good health, 6'2 - 220. I do not have any diagnosed heart or lung problems, quit smoking 54 years ago, only occasional minimal alcohol and carbonated beverage use.  I have been diagnosed with a Hiatal Hernia, symptoms controlled with omeprazol, 40mg 2x weekly.

Five sleep studies over four years and not one of the analyst/theorist doctors bothered to tell me that I actually had a physical obstruction causing the majority of my apnea problem.  They have given me AirCurve 10 ST and then the ASV..  First Sleep Disorder Center was useless.  Second one much better, Prescribed AirCurve 10 ASV and follows up with quarterly Telehealth visits, monitoring my stats.


Good

After limited success with ResMed Aircurve 10 ASV(Auto mode),Since March 2021, in October 2021 I went to ENT doc on my own,and was diagnosed with swollen turbinates.  ENT said bad enough when upright, likely swelled like balloon when lying down, thus blocking nasal passages 80% or more.  I underwent turbinate reduction procedure(piece o'cake) and once the swelling from the procedure went down, it is like having a new nose. Really.  So now, as you will see by my OSCAR shot, things are pretty stable. Sleep disorder Nurse Practioner says keep doing what you are doing.

Aside from occasional wild shots of leak or low usage nights, I think i am doing ok and feel good and awake during the day, I still feel that something is not right. 

I think I am getting too much air. I feel abdominal discomfort in the morning which dissipates after a few "exhaust cycles".  Pressure seems to run between 16 and 18.  I have played with the settings some, based on stuff I found on YouTube, but never any better, but sometimes worse.  I have tried a ResMed N30i, nasal cradle mask for four or five nights where AHI went down but I have trouble with the head gear pulling over and off an leak was way up.

Soooooo, what I am looking for here is some guidance as to maybe getting the IP and EP to an optimal level.   I have created a profile and have an OSCAR screen shot available.  Which OSCAR pages would be the most help?

Ok, there is some info to start with.  Thanks so much in advance for whatever help you can be.

[SarcasticDave94]

First up is a standard OSCAR Daily Detail screenshot with the following: Events, Flow Rate, Pressure (or mask pressure), Leaks.

Flow Limits chart will not be useful so it can be skipped. ASV doesn't target FL. Other detailed charts may be asked for, but the basics will help to see what's going on.

Mention your settings as well.
Mode ?
EPAP ?
PS ?

[AHI Tuna]

       
Thanks for your response, Dave.

ASV Auto
Min EPAP  5.0
Max EPAP 9.0
MIN PS 5.0
Max PS 10.0

[SarcasticDave94]

I would consider changing EPAP Min to 6, whether in a single edit or gradual is your choice. I would also lower PS Min to 3.

As to my reasoning, EPAP Min going up might address the Hypopnea events that I'm seeing. Lowering PS Min maybe will give more comfort. As is, every inhale you get is an IPAP of 5 over the EPAP. Dropping to PS 3 Min might make the transitions a bit easier/more comfortable to deal with. If you need higher PS, it's still there within that PS range, just not for every breath like now.

[AHI Tuna]

Hey, Dave.

Thanks for your recommendations yesterday.  I changed the settings on my machine to those as you recommended.  I don't think it worked so well.

6.3 hours use
Pressure 16.0
Exp pressure 8.9
Leak 2L/min
AHI 15.3
Total AI 8.7

I think I had a decent night's sleep, but still....I will try same settings tonight and tomorrow night.  And see what happens.  Meantime...

Attached is Oscar for last night.

[Gideon]

See the clusters of UA and hypopnea events? These indicate that you are tucking your chin to the point that you need to get this fixed, you need a soft cervical collar. You may get some relief by modifying your pillow, 1 vs 2 pillows, think less firm, flatter to straighten your neck out. If you were trained in rescue breathing think that position. I do think you will need a collar though.

http://www.apneaboard.com/wiki/index.php...out_Collar

[SarcasticDave94]

It also appears you have a Ramp enabled. This is counterproductive to any therapy during its time duration, besides being a bad idea with your CA. I'd turn that Ramp off and research the soft cervical collar.

[Sleeprider]

Your clusters of apnea and hypopnea look very familiar. Read the soft cervical collar wiki to see examples of other members using ASV with the same issue. http://www.apneaboard.com/wiki/index.php...cal_Collar

[AHI Tuna]

Thanks for your input guys. 

I have reviewed SSC and would do that as last resort because I cannot see my self sleeping through the night that way.  I would try it, though, if nothing else works.

Meanwhile, attached is card upload from last night, Sunday, 1/30/22,   The only thing changed from Saturday night was the pillow thing.  From two pillows to one, thin, soft-ish.  That's all.
Note the difference in the graphs.

Also of note, please check out stats from 1/14/22 through 1/22/22.  One night I did not use the machine at all.  All other nights in that period I used my wife's discarded ResMed N30I mask.
Yeah, I had trouble with leak because the headgear slipped forward over the top of my head.  All machine settings were at those that had been in use for months.  Can you explain why I had such event results as I did, changing nothing but the mask?

Thanks again for youz's input. 

I feel like we are gaining on this thing.

Have a good day.

ATB,

Rich

[AHI Tuna]

So sorry.  First data screen shot failed.   Here is good one.