[Pressure] Adjusting ASV Pressure

[SarcasticDave94]

Nothing from me right now. If you feel that edit makes a good difference on data and how it feels, I'd run with it a few days and see what trends pop out.

Charts look like a smoother and better therapy to me. Reminder, the goal is not zero events, but you can get them occasionally. The goal is good therapy that is comfortable and is reasonably repeatable.

[RayBee]

...... Any further thoughts or recommendations?

MLodge, it looks like your results on your ASV machine are pretty good. I have been on mine for about 3-1/2 years. And I learned a ton of information here on AB. I have also done a lot of experimentation with settings and masks. I set a personal rule for myself that if I make a change to the settings, I stick with it for two weeks to really get a good sense of what changes have occurred both in OSCAR data and how I feel. The only exception is if that change had noticeable negative results. I started, like almost everybody, with the default settings, a pat on the butt and out the door I went. I am so happy that I took the lead on my therapy with the wealth of knowledge and expert suggestions from the good folks here on AB.
 

First, the ASV is a simple machine from the user's perspective because there are only 4 primary settings related to your therapy. But it is far from a simple machine. The rest of the settings, I think of them purely as comfort settings.

The biggest challenge aside from the ASV machine was to find the mask that best suits my needs as far as comfort, minimum leakage, and efficacy of therapy. My first phase was learning everything I could about the ASV machine, then feeling out what my body wants and needs, lastly was the rocky road of finding the best mask for me. I tried numerous masks and found the ResMed AirFit F30 was by far best for me. Then I really delved into those four settings of the ASV.

The way I set up my ASV was as follows:

EPAP Min - I started around 4 and felt starved for air. So I adjusted this up so that I never had that starved-for-air feeling. That was around 7 to 8.

EPAP Max - I don't really think this is necessary for me, but I set this one point above EPAP Min so I could see when the machine thought it needed to make an EPAP adjustment. I don't really feel anything as this changes, but I like to see it in OSCAR.

PS Min - This in conjunction with EPAP Min was adjusted so I didn't get that starved-for-air feeling. So my IPAP Min settled in at 10.6. I find this to be a very comfortable setting for me.

PS Max - I adjusted this based on two criteria. First, I want the best efficacy of therapy I can get, and Second, I want to stay below experiencing aerophagia. The threshold of aerophagia for me is around 17 to 18. So I make sure that IPAP does not exceed this pressure. Aerophagia = wake up, can't sleep, what's the point of the higher settings. 

Ramp - I did find it beneficial to set up a 5 minute Ramp while playing around with higher pressure settings early on. But if you strike a good balance of these many moving parts, you should not need this special transition time. Keep it short if you think you absolutely need it.

SWJ - I have learned to identify SWJ (Sleep-Wake-Junk) flag clusters and occasional arousal flags, from real Apnea events. So when my AHI reports high, I find that these are the culprits and I'm not concerned. That's why they say don't fixate on getting a Zero AHI report.

Lastly, I had to monitor and adjust a delicate balance between IPAP Max, incessant mask leakage, and chronic headaches (with too-tight of headgear). Headgear gets tightened to prevent mask leakage, and if too tight, I get terrible, chronic headaches in the back of my head where the straps converge. These three things are very interactive with one another. Also, headgear ages and stretches over time. I've been able to determine that if I get a little mask leakage, I can usually tighten the side straps a few millimeters and all is good again.

So there are the highlights of my Complex Sleep Apnea journey. I hope you can find something useful in my ramblings.

BTW... My AHI averages around 3/h. I get 6 to 8 hours on the machine per night and I feel great.

 

[MLodge]

If pressure edits are needed, I would consider backing down the EPAP Max and transfer that over to PS Max. Pressure Support seemed to be shorter, burst like in duration, and having higher PS range was better for me.

The clusters are Positional as mentioned.

And you'll need to get to a place where you can turn off the Ramp. It was a variable that always made therapy less than OK. You're limiting yourself to straight 4 cmH2O for 15 minutes every session start. Here it looks like 3 starts meaning you lost 45 minutes therapy.

Thanks for the advice Dave! I think I have a good handle on my pressure settings now by having lowered EPAP and raised PS by the same amount. Much more comfortable night sleep.

Now I'm working on getting either my current mask to not fit more comfortably or find a new one I like better.

Lastly, I'm 30 days in to my therapy and I'm still experiencing very loud ringing in my ears all day. I can't seem to find many other people complaining about that or offering advice.

[SarcasticDave94]

I've noticed pressure in my ears when I first got a CPAP. Since I had tinnitus moderately severe already, I cannot attribute it to PAP.

[RayBee]

Ditto Dave, with me.

I can mitigate pressure in my ears if I resist the urge to yawn while masked-up.

I permanently lost my hearing & balance in my left ear when I was 16 from Ramsay Hunt Syndrome. I've had very loud tinnitus in my left ear as a result. I cannot perceive any additional ringing in my ears due to PAP therapy.

I might suggest experimenting with lowering your IPAP Max. Keep monitoring your OSCAR data for efficacy as well as how well (or not) you feel as a result.

Small adjustment, maintain for a week, evaluate. Rinse and repeat.

[MLodge]

Thanks for the advice and the encouragement. I'll tweak the pressures down a bit after I've had at least 4 more good nights with the newer levels I set last week. 

Wow, I don't know how people can make it through their first 30/60 days on CPAP without help from a community like this one!!!!