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Air Curve ASV after two years use - TSVanwinkle - 07-28-2021
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I am looking for a little feedback and review whether a little tune-up may be needed, now nearly two years into my ASV therapy. I have a diagnosis of moderate to severe complex sleep apnea. When I first started the ASV journey, the Apnea forum was a great discovery and a lot of good feedback and advice helped me to get acclimated. I'm happy to say, for the most part, it has been a successful run, but there are some new bumps that are becoming a bother. I am discovering that an AHI that is 0 and .5 (on a bad night) doesn't necessarily mean a good nights sleep. I am not waking up refreshed and experience drowsiness during the day. My settings have pretty well remained the same, as well as the mask (Respironics Dreamware full nasal mask) I use a cervical collar and Cpap pillow. Recently, however, the machine either keeps me from dropping off to sleep or wakes me up multiple times during the night when it decides I'm not breathing right. In most cases, there is no mask leakage or flow limits. One of the areas I still don't understand is the relationship between higher mask pressures and respiration. From all that I have read, my Resmed ASV looks at the most recent three minutes and strives to keep respiration minute vent at a consistent rate when it has to step in and breathe for me. My normal respiration when sleeping peacefully is appx 14 - 16 bpm. When the ASV kicks in, my respiration drops to 9 and sometimes down to 4 bpm. When I start breathing again, I and the machine are at first sometimes out of sync and that will wake me up. There are periods when the ASV will kick in even though I'm fully awake and breathing at a normal rate. Is this slower rate considered the programed "backup"? There are nights when it gets bad enough, with minute vent tidal, flow and respiration are all over the place and I have to stop and restart the session. I have included a recent chart where I lowered PS min from four to three and it seems to have helped smooth things out, however, according to a Fitbit sleep data chart, I had very little deep, nor rem sleep--which probably explains why I am not always feeling like I had a good night's rest. Thanks in advance to the forum experts for your comments and suggestions.
RE: Air Curve ASV after two years use - Sleeprider - 07-28-2021
I see some areas where your respiration rate drops, tidal volume increases and the machine appears to be more active in mitigating some variations in flow rate. All of this maintains your minute vent target, but it would take a closer look at events like at 1:10 to see why the machine is behaving like this. Overall, the therapy looks great with EPAP 6.0-15 and PS 3-19. Your EPAP is actually changing less than 1-cm and your PS is consistently between 3 and 11 cm, so your ranges can easily be tightened up, but I don't know if that will result in any improvements.
RE: Air Curve ASV after two years use - TSVanwinkle - 07-28-2021
Hi. Thanks very much for the quick reply. I've included a expanded view of the chart around 1:08, where the ASV gets triggered. I have also posted two screen shots from last night (Tues). The second two graphs show an overall view of when things went off the rails at appx 3:36A and an expanded view in the same area. I finally had to stop the session, because I was then fully awake and could not handle it any longer. The last one is an expanded view of what was going on when the ASV took over. As I looked closer at the flow rate during the time when ASV has just triggered and there is a transistion from my breath rate to the ASV's, I can see where my breath rate seems to be fighting with the ASV backup rate. Eventually, the ASV takes over and my BPM drops by nearly 50%. It seems UN-natural to be "forced" to a lower breath rate and I can't help but wonder if that isn't part of the struggle I seem to be having when my bodies natural breath rate collides with the ASV. So, my question would be, why doesn't the ASV sync up with my natural breath rate rather than impose a slower rate at high pressure? Prior to these episodes, there were no mask leaks, nor flow limits. Flow limits and mask leaks do begin to appear when the mask pressure hits 19CM and higher. Thanks again for your valuable input!
RE: Air Curve ASV after two years use - SarcasticDave94 - 07-28-2021
I would consider shrinking the PS range, PS Max 19 specifically. Maybe it changes nothing in practice, but I'd drop it to the ResMed default of Max PS 15. PS 19 sounds too high IMO. EPAP Max 15 isn't needed really it appears also. Either or both can be lowered if you want.
My guess says you're borderline overtreating, and robbing yourself of some comfort.
RE: Air Curve ASV after two years use - S. Manz - 07-28-2021
I don't rely on wristband gadgets reporting on my sleep and I too have a variety of expensive and inexpensive gadgets all the way from fitbit to high end Samsung and even an apple watch.
These gadgets algorithm relies mostly on your heart rate in order to determine what type and /or quality of sleep you are getting and given their poor input that they rely on, their reporting should be taken with a pinch of salt, rather than seriously.
In general you are the best judge of your own sleep so if you are getting a restful sleep with minimal disruptions and at least 20%b of your sleep dreaming (REM sleep) , then you are doing fine and if not, I would check into any new factors (barring technical issues with your machine),that may be contributing to a poor sleep, given that you have already had a great two year run with it.
RE: Air Curve ASV after two years use - TSVanwinkle - 07-29-2021
Follow up to Dave's recommendation:
Two ASV setting changes: I lowered PS Max from 19 to 15; Lowered Epap Max from 15 to 14.
In addition:, I decided to try a medium size mask (Respironics Dreamware) formerly Large. Reason: I've lost some weight and the medium seems to fit better with more comfort and less strap pressure.
Observations: Posted three graphs, one overall overall and one expanded for the first ten minutes from last night; and- for comparison, one from June 2020 when my therapy was going really well and rough nights were the exception. Now, with no settings changes prior to last night, the situation seems to have reversed and a good peaceful night is the exception. Some of the bad nights can be explained due to positional stupidities like knocking the mask loose; not changing it out often enough or forgetting to put on the cervical collar. But, one thing that seems to be consistent is the rougher periods when going to sleep.
Looking at last night, since making the changes, the "startup" period went a little faster and smoother than with the previous settings; overall, a slightly better night. However, the keen eyes of you experts may see things that I have missed.
Tidal Volume and minute vent levels dropped a little, which brings up a couple of more questions:
According to my height and weight, my ideal minute Vent should be 7-8 and Tidal Vol should be 468 or thereabouts and that's pretty much where I was a year ago. Last night's MV and TV, when things were calm and I was sleeping peacefully, was 5.66 and 398 respectively. o2 levels were steady through the night between 95-98%. How critical or non critical are these factors?
The startup duration, though less in length before sleep is still bothersome and it would be very helpful to understand why my respiration rate tanks and I feel like I'm struggling when the ASV PS kicks in. I've also noticed that other members using the Aircurve ASV have expressed similar experiences. It feels like the ASV is trying to take over before it needs to. Is the respiration rate drop due to the built in backup rate of the ASV or could it be that it is my response to higher pressure and higher TV and MinV causes me to slow down my breathing? If the ASV is supposed to have paced itself to my breathing rate the prior three minutes, than it would seem it should have matched my normal 14-16 BPM.
Thanks again for you analysis and educational guidance. Ajack helped me a great deal when I first started ASV therapy two years ago and Ajack, if you are still weighing in on the forum I would love to hear from you too.
With regards,
Van Wink
RE: Air Curve ASV after two years use - Sleeprider - 07-29-2021
It appears that the ASV is maintaining your respiration rate at a minimum of around 7.5 bpm and increasing tidal volume. In the close-up chart in post #3, it seems your spontaneous breathing rate slows a lot, so the machine delivers more pressure support to maintain minute vent. Your spontaneous breathing resumes a rate of 15-16 at 01:18:30 and the pressure support backs off to the minimum. I can only speculate that from 01:06:45 the machine is triggering most of your breaths or at least keeping the volume higher, and that you resume normal breathing at 01:18:30. Your SpO2 and pulse never change, so whatever this is you seem to sleep through it.
I agree with the changes to settings, and regardless of settings, PS never really goes over 10.
RE: Air Curve ASV after two years use - SarcasticDave94 - 07-30-2021
The only suggestion now from me is only edits to maintain comfort and sleeping well. No changes just to change it as it were.
IF you feel uncomfortable with the PS, you have a bit of therapy cushion to lower PS Max if you need it, but only if you need that for gaining more comfort.
That's my opinion on this for now, upon seeing OSCAR.
Do you feel any comfort gain from this edit? It seems so, but I'm asking directly.
RE: Air Curve ASV after two years use - TSVanwinkle - 07-30-2021
Dave, re comfort, I would say yes. Last night was pretty good. Many thanks!
RE: Air Curve ASV after two years use - SarcasticDave94 - 07-30-2021
OK good to hear it. Just keep running as is then. Go build a nice trend of good therapy.