Wjg's Therapy Thread

[wjg1]

Here are last nights results. At least I didn't have the weird results as the night before. And if someone could help with the settings of an ASV machine that would be great. I go to my primary Doctor tomorrow morning. Thanks

[Sleeprider]

When we use ASV for upper airway resistance and mild CA events, the EPAP range may be higher and PS range is generally lower than when used for pure CA events, so we can talk about defaults vs some specialized settings.  First let's talk about that pattern at about 23:38 in your last charts.  Your respiration rate here is a normal 13 bpm, but has a lot of jagged lines that may be cardiogenic oscillation (however they are very abrupt for that) that occur at a frequency of 30 to 40 per minute, so probably slower than your heart rate, or not all visible. Anyway regardless of the cause there are multiple peaks in inspiration that do not look like flow limitation. A good strong peak of inspiratory flow, followed by a small echo just as flow reaches zero and before full expiration.  I've seen this before, but have never been able to explain it. Some members have actually had more chaotic forms of this that caused the PAP machine to count multiple breaths resulting in some very high respiration rates being charted up to 50 bpm. This was generally able to be calmed with bilevel or ASV.

The recommended titration decision-tree for titrating a Resmed Aircurve 10/11 ASV is in the figure below.  Typical default starting values are, ASVauto mode, EPAP min 4.0, EPAP max 15.0, PS min 3.0 PS max 15.0.  I expect you will end up with EPAP min 7.0 EPAP max 9.0 PS min 3.0 PS max 10.0, but let's start with defaults and observe results first. You will ask for a Rx for Resmed Aircurve 10 ASV HCPCS E0471 (respiratory assist device bilevel with backup rate), set to default EPAP min 4.0, EPAP max 15.0, PS min 3.0, PS max 15.0, patient to self-titrate for optimum AHI and comfort.  Your supplies should not change.

[wjg1]

Thank you so much Sleeprider. I will do just as you suggest. I am hoping my doctor agrees.

I can’t say how much I appreciate you and this board. So helpful.

Wish me luck.

[wjg1]

Just got home from my primary doctor's visit. Good news, she is sending the prescription for the ASV machine to the DME. She was very impressed at how prepared I was. She says she never sees that and had never heard of OSCAR. She was curious how Oscar works. I told her what little bit I knew about it.


Anyway I couldn't have done it without you all and especially you sleeprider. Thank you all very much.

I will update when I get the new machine.

[Sleeprider]

The forum is interactive, so if you don't learn as we go through the process, we failed. At this point you can probably intelligently discuss therapy with any professional, and be on a fairly equal footing in terms of understanding therapy options, and what changes can help with different problems. As you become more comfortable with this, you will likely reach out and help others to get started or to improve their therapy and comfort, at least we can hope.

[wjg1]

Thank you so much Sleeprider. I will do just as you suggest. I am hoping my doctor agrees.

I can’t say how much I appreciate you and this board. So helpful.

Wish me luck.

[wjg1]

Hello again. Well I think I am finally getting my new ASV machine today. Had to fire original DME because they thought they could demand I get a new sleep study to prove I needed an ASV machine. After several attempts to reason with them I told the doctor we needed to change DME's. She agreed and sent me to another. I had my doctor put on the prescription Dispense As Written. I don't know if she did or not but the second DME agreed to give me the ASV machine. Without this board I wouldn't have known how to do all this. So again I thank you all very much.

Anyway, I have a quick question. Should I use the same SD card in this new machine or use a new one? 

Thanks
WJG1

[Sleeprider]

Glad you dumped the DME trying to force a sleep study. Amazing that a business doesn't have a clue about their business and just assumes they can order sleep studies, titrations and increase the expenses of their clients by not dispensing what is ordered by the doctor. I suggested settings above in this thread. Let me know if you have questions. Format the old SD or use a new one.

[wjg1]

Thanks Sleeprider. I will set it as you suggested and report the results.

If I hadn't found this board I wouldn't have had any idea what the DME could do or not do. Can't wait until I walk in the old DME returning the Airsense 10 I currently have.

[wjg1]

I know this is only one night but I thought I would share my graphs. I had a little trouble falling asleep. About when I would drift off to sleep it would apply more pressure. I had some leaks. not sure if this is due to me getting use to the ASV and letting it do it's thing or due to the new mask they gave me. Probably shouldn't have tried a new mask right away.

But almost all of the apneas are gone. Just a few hypopnea show up. So that is good.