[Treatment] Help with New Resmed S10 ASV

[Hogback787]

To start, I really appreciate the community of support here!  

I was diagnosed with sleep apnea about a year and a half ago based on a sleep study and they put me on a Resmed S10 Autoset despite the fact that most of the events were centrals; mixed apnea.  At the time I had no clue about any of this.  Through trial and error I was able to get my AHI from about 35 to under 5 on most days.  However, the clear airway events were always the majority.

I was sent to a sleep Dr to evaluate the Central Apnea and had a new in-lab sleep study done.  After a two month wait for results - they goofed it up, and the results were thrown out.  It took forever to get the last machine and insurance.  Having lost patience with this extremely long process, I got lucky and found an almost new Resmed ASV for $400 to take matters into my own hands.

First night, I used the default settings and my AHI dropped to an amazing .36 with no centrals!  However, the pressure was so high and swinging it was very hard to use.  So based on some threads here I changed the settings and saw some improvement but still large leaks waking me up.  The third night I made another adjustment and the AHI dropped to .13 and still no centrals.  But the pressure is too high at times and causing large leaks and waking me up.

I need help!  The settings are confusing to me and I don't want to make further tweaks without advice.  

What do you guys recommend?  With my old S10 Autoset the pressure was min 5, max 9.4 and pretty comfortable.

Here's my latest ASV settings and screen shot attached.  Thanks much in advance!!

Device Settings
Mode
ASVAuto
Min EPAP
5.00 cmH2O
Max EPAP
10.00 cmH2O
Min IPAP
8.00 cmH2O
Max IPAP
19.00 cmH2O
PS Min
3.00 cmH2O
PS Max
9.00 cmH2O
Antibacterial Filter
No
Climate Control
Auto
Essentials
On
Humidifier Status
Off
Mask
Full Face
Ramp
On
Ramp Pressure
4 cmH2O
Ramp Time
15.00 Minutes
Smart Start
On
Temperature
27 ºC
Temperature Enable
Auto

   

[OpalRose]

Welcome to ApneaBoard!

When you repost your graph, leave the calendar off. This frees up all the statistics.

Someone should be along shortly to help with your settings.

[Hogback787]

Here are the results from last night, low AHI and no Centrals.  

However - I had to push pause at 1am due to air squirting out at every breath and waking me up, and again at 5am where I stopped.  I tightened down the mask straps several times during the night but ended up bruising the bridge of my nose.   By the way, I have no heart conditions, thin build, active, healthy and fit the criteria for the ASV according to my sleep physician - just don't have a new SS to back it up.

I need the max pressure down but don't know how to safely achieve that.  Thanks much for any assistance!!! 

Settings were:   
Min EPAP 5
Max EPAP 10
Min PS 3
Max PS 9

       

[Sleeprider]

I'm not familiar with your Eson mask, however your therapy stats are pretty good and we don't see a lot of leaks in the statistics or leak graph. We really don't need the Event Breakdown image, and that is preventing setting from showing. You seem to want maximum pressure to be lower. EPAP is generally under 6.0, so you could set EPAP min 4, EPAP max 6.0. PS 3.0 to 8.0 is the minimum spread (5 cm) between minimum and maximum PS, so your only option is to reduce those. I think the better bet is to change masks if this is not sealing at the relatively modest pressures. Your AHI is good and therapy seems effective at these settings, so I'm a lot more inclined to work on the mask fit, than to adjust settings. Are you certain you don't tolerate a simple nasal pillows mask?

[Hogback787]

I've been using a resmed air touch F20 full with the ASV. The pressure was usually fine but then all of a sudden ramps up and air starts spurting out. 

I'll adjust the settings a bit and switch back to my old nasal mask and keep tweaking. 

Thank you!!

[Hogback787]

I had a much better night last night with a nasal mask. It didn't leak. Thanks much!

[Sleeprider]

Due to normal pressure support changes with ASV a smaller mask is usually much more comfortable, as full face masks tend to inflate and deflate with changes in pressure. This is very disruptive and potentially leads to leaks. As long as you don't lose air through your mouth, a nasal pillows or mask will be much better.