Trying to Reduce CA Events

[jcp519]

Your situation sounds very similar to mine and ASV made a huge difference for me.

ASV does have a learning curve and can be a little tough to get used to the varying pressure support. Make sure to relax and breath at a nice steady rate when you first put on the mask. I try to calm myself in bed without the mask for a while before trying to sleep with it. If the ASV goes a little crazy with the pressure and its uncomfortable, exhale sharply and it should back off for a while.

[chrotteg]

Awesome sounds good! Thanks for the tips. I am glad someone else has something similar to my issue and found ASV helped. Getting this ASV was a risk for me as I couldn't find anyone else with my same issues since I feel I have a combination of issues. However, it seemed like the most logical machine just based on my research and knowledge I've gained these last few months.

[jcp519]

I had much more OA on my sleep test, but was in the same position with using only CPAP. Had persistent CAs that never went away and felt like garbage everyday, not matter the settings I changed. ASV made such a difference and I'm feeling great now!

I hope it helps you just as much as it did me!

[chrotteg]

Hi all. The ASV seemed to help a lot with my events. I had only 1 event throughout the night. The only issue I had was waking up constantly. I feel like this is the consistent issue with UARS as I see minor RERAs throught my whole night. I also seem like I am consistent with my previous statement on how my breathing looks great when the ASV is at a high IPAP for a long period of time. Would it be crazy to try a PS min of much higher, say 8 instead of 3, to try and fix this?

Also the ASV I got is a Aircurve 10 ASV, however, it is much louder than the aircurve 11 apap I used before. Is this normal?

[jcp519]

You wouldn't want to increase the PS min that high because it could over ventilate you and actually cause central apneas. High PS suppresses respiratory drive because it makes lots of CO2 flush from your body. The reason the breathing looks nice when IPAP is high is because its the machine initiating your breaths.

My ASV was louder than my AS11 and I think that is just because it changes the pressure way more often. I just got used to it over time.

Are you sure that what was waking you up was RERAs? I don't really see any RERAs in those charts. I know when I first started ASV the changing PS would keep waking me up. I reduced my PS max to 10 and it help with keeping me asleep.

[chrotteg]

This is the video I watched that talked about what I was referring to https://www.youtube.com/watch?v=WzCGa9_a9KI&t=1073s and is mentioned around 14 minutes. 

Regarding the RERAs, I could be wrong and they could just be arousals but it is another thing I saw in a Lankylefty video where the large sharp inhales are arousals that wake you up. I am not saying he is 100% correct with that but I decided to mention it to get the opinions of others. 

If others can get away with such a high IPAP on a standard bipap to combat UARS why is increasing the PS on an ASV any different? I did find out the min PS can only go to 6 as well.

Also, the noise is a wheezing noise exactly the same as a bad pneumatic block I found Sleeprider discuss in another post. I think thats what I get for getting a cheap used ASV from someone online haha. However, even getting the repair Ill still be saving a lot of money than getting a new one or even used refurbished one.

[jcp519]

I bought mine used as well, its much cheaper than buying it anywhere else. Just so you know, the parts for an AirSense 10 CPAP are exactly the same as the part for the ASV. That means if you can find a AS10 CPAP for parts, you can just repair yourself. As long as you're comfortable taking it apart yourself.

Having arousals is also completely normal. Even completely healthy people have them. Your sleep study doesn't show an RERAs at all and you only had 5 spontaneous arousals, which is pretty normal. Once you start pushing PS really high for long periods of time, you are basically just using the machine as a ventilator. There are instances of people using bilevel on this forum putting their PS on 8+ and making their AHI shoot up into the 50s because they give themselves central apneas.

All of this to say, ASV will take time to get used to. You're only on your first night and only slept for 5 hours with it on. Don't rush too much into conclusions with whether or not you have UARS. I started to do the same when I was first starting ASV, but I stuck with it and my tiredness slowly faded away.

[SarcasticDave94]

The PS on any BPAP is not the same as high IPAP. Specifically on the ASV, the Min PS can be zero, so it can be lower than 6 if necessary. I don't think you'll want a PS min of 8 though. That pressure differential will be a steep jump, it will be instant EPAP to adding PS 8 or more, and likely will be uncomfortable, and probably will include a negative affect on therapy.

On ASV the only limiting setting aspect I know of is that min and max PS spread needs to be at least 5.

[chrotteg]

Sounds good thank you for the help. Is there any minor adjustments you believe I can make to improve the therapy at all the first night? I know when I was working with the APAP, it was common to set the min near the medium pressure on Oscar, is that the same for ASV? My min IPAP is 9 but my med was 11.68. Just asking out of curiousity so I know for future reference and fine tuning and such. I feel like I am using a broad range right now which is what I am assuming the point was since it was first night haha.

[SarcasticDave94]

You could change EPAP Min to be a little closer to median if you want. I don't think it's proven to be required as of yet for you. I for one would not want my median to be my lowest on the ASV. I'd like to be delivered lower than median on occasion. My own last settings were

ASV Auto mode
EPAP 7-12
PS 3-15

My sleep study that got me to ASV had me at 124 CA 24 OA, AHI 74 or so.