Worried about periodic breathing / CA patterns

[SarcasticDave94]

The ASV will feel different unfortunately. It's a different animal than the house cat AutoSet, more like a lion.

Preparation before strapping the mask on may help. As I recall, the ASV has a 3 minute window it's monitoring to target regarding ventilation. Don't strap up if you're breathing fast. It's gonna be pacing you with that faster rate. Maybe you haven't had this issue, yet. Just note it.

Also if the ASV jolts you while you're falling asleep, give a blow back into the mask to signal the ASV can back off for a bit. It's a signal you're still breathing.

[stevew168]

Your high IPAP pressure before going to sleep is probably due to to breathing too fast in the first two or three minutes when the ASV sets the backup respiration rate. I always start by breathing deeply and relatively slowly starting out, and no longer get a push to breathe when I'm still awake. The pressures stay at the minimum settings when it is determining backup rate, BTW. This also allows the ASV to stabilize your target minute ventilation, since it is a moving average of the minute ventilation, and therefore starts out at a lower value.

I believe you will get much better treatment if you set the PS to the default values of 3-15. A minimum value of 3 vs. 2 will give you better tidal volume. It will only go up to PS max if you need it. Concentrate on setting the EPAP range for comfort.

[Sleeprider]

You need more EPAP min. and I think you should increase PS max to 8 or 9. Give yourself time before masking up when you hit the bed. The ASV records your respiratory volume and rate, and if it is elevated, the machine will try to maintain that with pressure support and triggered breaths. That is why your session starts with max PS and it looks pretty uncomfortable. I still like PS 3-8 for you.

[Jorgo]

Thanks all for your responses.

It's weird, I tried breathing slowly and calmly for the first few minutes but it really felt like it was trying to overinflate me like a balloon.

Any tips? Maybe breathing shallower? I also had the sensation of it trying to push an additional breath on me after I had just inhaled so had to do a double inhale.

All in all it felt more like it was trying to (clumsily) breathe for me rather than passively assist.

[SarcasticDave94]

I'm wondering if the low PS is the reason for the complaint, as in pointing back to Sleeprider's suggested edit. If the PS is set too low, basically the ASV is "too weak" to answer whatever it's seeing needs addressed. Then it's a cycle of not enough PS but possibly giving Max PS too long or too frequent.

For myself, I didn't mind higher PS ranges. It didn't seem to last as long within the breath cycle, even if it was higher up the scale. EPAP always is there, but PS adds during inhale. I would base this on longer exhale and shorter inhale within this breath cycle.

Looking back at the April 2 chart, highest EPAP was 7.58 but you have set Max EPAP at 12. The roughly 7.5 EPAP Max used plus PS Max 7 brought you to IPAP Max 14.09.

So yes a long roundabout way to say your PS needs to go up. Obstructive Apnea that chart was zero, which I'm thinking is accomplished via EPAP. If you were to add to PS Hypopnea are better addressed. With them handled better, it might return a better feel.

[Jorgo]

Thank you all again for your ongoing support. For tonight I will try the following settings and post my results tomorrow:

EPAP min: 6 (up from 5)
EPAP max: 12 (unchanged)
PS min: 3 (up from 2)
PS max: 9 (up from 7)

[stevew168]

Well, we have an opinion from Sleeprrider, who we all respect, who uses an V Auto, to SarcasticDave94, who has used an ASV in the past, to me, who has been using an ASV for about 6 months very successfully with the best results of all machines I have used, CPAP, APAP and ASV. I could be wrong, but I believe there is a good reason for the ASV titration defaults of EPAP 5-15, PS 3-15. You might need to work up to the EPAP max settings, if necessary, but I respectively stand by my suggestions, and those of SarcasticDave94.

[stevew168]

You need more EPAP min. and I think you should increase PS max to 8 or 9.  Give yourself time before masking up when you hit the bed. The ASV records your respiratory volume and rate, and if it is elevated, the machine will try to maintain that with pressure support and triggered breaths. That is why your session starts with max PS and it looks pretty uncomfortable. I still like PS 3-8 for you.

The ASV will never Start with PS max. Maybe you are referring to after the first few minutes, if the minute ventilation drops below the minute ventilation target, which is based on a moving average of the actual minute ventilation.

BTW, have you noticed your flow rate graphs seem to have more rounded tops. I looks like you're on the right path.

[stevew168]

I would like see your results EPAP 6-12,
PS 3-15. Take care, we all love you.

[Sleeprider]

I have no problem with stevew168's suggested edits. The ASV will only use pressure support required to cause a normal breath volume. You said:
It's weird, I tried breathing slowly and calmly for the first few minutes but it really felt like it was trying to overinflate me like a balloon."

My suggestion was to relax and let your breathing settle into a normal or natural rested pattern. When people try to deliberately slow their breathing, they will typically breathe more deeply. This sets the wrong target for the ASV. You are actually better off with shallower, slightly more frequent breaths. I'm sure if you look at the flow rate pattern when you put the mask on, you will see a difference from when you fall to sleep. It's that sleep pattern you want to approximate if possible.