(11-15-2019, 04:16 PM)WildSteelhead Wrote: Hi Folks,

Great input from everyone, thank you!  I know this is a long thread, so to recap my background and goal as a COMPLETE beginner with this:

* My sleep study didn't really show any OSAs, just Hypopneas and then Emergent CSAs, which got me on the ASV machine.  The sleep study had me in the Mild range for Oxygen readings, and just barely in the Moderate range with AHI of 16.
* Initial use of AirCurve 10 ASV was causing a) air down the stomach (hated it), and b) the "blasts" were arousing me awake (impacting actual sleep)
* I definitely have the claustrophobic feelings with this.  I am using a Dreamwear FFM
 
So, to summarize, I believe the recommendations were to make adjustments to settings to get the pressures down to try to a) get below the "air in the stomach" pressure level (my current priority), and b) reduce the strength of the "blasts" I'm getting in the actual therapy (so I can actually sleep).  My prescribed settings were:

EPAP Min 8
EPAP Max 15
PS Min 2
PS Min 10

For suggested new settings to address the issues described above, I believe the new settings we landed on are:

EPAP Min 5
EPAP Max 10
PS Min 2
PS Max 7
Ramp Time reduce to zero, but I may just use 5 minutes until I'm used to it.

At this stage I'm more concerned with eliminating the problems above than I am looking for the best therapy.  If we eliminate the problems consistently it seems I can slowly increase things as needed to reduce AHIs.  Does that sound right?

Lastly, can someone explain how EPAP and PS work together?  I'm guessing that the settings you use establish, for example, what the max IPAP pressure would be, and the same for EPAP.  I'm just not sure how they interact.  

Thanks.

(11-16-2019, 10:37 AM)WildSteelhead Wrote: Hi,

Fred, yes that's the description I was seeking, thanks.

Dave, thanks, glad the approach I'm taking is ok.

So I used the new settings last night.  I have attached the OSCAR charts here.  A few observations:

1.   I used the machine from 10:15 - 2:00 with a single 5 min Ramp, and then had to take it off because my nose congested badly and couldn't really breathe fully through nose. Even though I am using the DreamWare FFM and could breathe through my mouth it was uncomfortable from a claustrophobic standpoint

2.   Seemed to feel like overall the pressure was lower, which was good

3.   As far as air in the stomach goes, it was certainly much less than before.  However, I don't feel like I slept much during the whole period to really know if it was going in my stomach.  It's hard to tell.

4.  It seemed like when I was awake and trying to doze off and breathing normally, the machine was mostly breathing in rhythm with me, which was comfortable.  However, then it would kick up in some pressure AND have a longer respiration rhythm than I was actually breathing.  Not sure why it would do that.  Could it have been that I actually DID doze off and maybe was starting an event and it kicked in?  I really don't think I dozed, but who knows.  Would that be clearly depicted anywhere on the graphs?  I even tried the "Blow Back" when it would do that, which may have helped a little, not sure.

5.  As far as air going into the stomach, do we know how that happens mechanically?  I noticed something last night.  In those instances when the machine was providing longer inhalations at higher pressure, I was still doing my normal rhythm of breathing.  So I felt like I would breathe in, and at the peak of my breath when I would normally exhale the machine was still blowing in at me for a little longer of a breath before the machine would exhale.  Could it be that period of the "extra breath length" that it gets pushed down into the stomach?

As far as my OSCAR data goes, there is a LOT of information that is collected and portrayed in the many graphs, which is great.  Can it be used to help verify whether any of my observations make sense?  For example, where I feel like my normal respiration rate is slower than what it is pushing at me? Can it show where the two are out of synch?  And can it help show if I am actually sleeping?  

Assuming my nose is not fully congested I plan to try again tonight with the same settings, unless anyone suggests adjusting settings, in which case I am happy to try them.  Oh, and someone had recommended switching to just a Nasal mask.  I had tried both the DreamWare FFM, and then the Nasal when I did my last sleep study before they prescribed the ASV machine.  I definitely would like to use the Nasal, since it felt much nicer, less obtrusive to wear it.  I just have to get past some of this congestion.

Thanks everyone!

(11-16-2019, 10:37 AM)WildSteelhead Wrote: 4.  It seemed like when I was awake and trying to doze off and breathing normally, the machine was mostly breathing in rhythm with me, which was comfortable.  However, then it would kick up in some pressure AND have a longer respiration rhythm than I was actually breathing.  Not sure why it would do that.  Could it have been that I actually DID doze off and maybe was starting an event and it kicked in?  I really don't think I dozed, but who knows.  Would that be clearly depicted anywhere on the graphs?  I even tried the "Blow Back" when it would do that, which may have helped a little, not sure.

5.  As far as air going into the stomach, do we know how that happens mechanically?  I noticed something last night.  In those instances when the machine was providing longer inhalations at higher pressure, I was still doing my normal rhythm of breathing.  So I felt like I would breathe in, and at the peak of my breath when I would normally exhale the machine was still blowing in at me for a little longer of a breath before the machine would exhale.  Could it be that period of the "extra breath length" that it gets pushed down into the stomach?