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2nd Night with Aircurve 10 ASV
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marose1 Offline

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Posts: 11
Joined: Jan 2016

Machine: Resmed Aircurve 10 ASV
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: Integral
CPAP Pressure: EPAP 10 to 10 PS 0 to 15
CPAP Software: ResScan SleepyHead

Other Comments: Former PR BiPaP @ EPAP 15 IPAP 20

Sex: Male
Location: Las Vegas

Post: #1
2nd Night with Aircurve 10 ASV
As a result of a recent sleep study, my Pulmonologist prescribed ASV treatment. I considered the Resmed Aircurve 10 ASV and the PR System One BiPAP AutoSV Advanced, and chose the Aircurve 10 ASV (AC ASV). In addition to the new AC ASV Machine, I started my first night with several changes: 1) Stopped taking Zolpidem 5 or 10 mg per night; 2) Prescribed Machine Settings: AutoASV, Min EPAP 10, Max EPAP 10, Min PS 0 and Max PS 15; 3) Change from Mirage Quattro FF to Fisher Paykel Simplus FF Mask. I have no complaints about the Aircurve 10 ASV or the Fisher Paykel Simplus Mask. Notwithstanding that, my first 2 nights with the new machine have not improved on my poor recent past experience with my PR System One BiPaP Machine. I am attaching an image of my Sleepyhead Report for Last Night, March 23, 2016. I did not sleep well and awake feeling short of Breath (Oxygen) and with a headache. After I got up, the shortness of breath and headache slowly subsided.


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03-24-2016 09:58 PM
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DeepBreathing Offline
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Posts: 2,294
Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Perth, Western Australia

Post: #2
RE: 2nd Night with Aircurve 10 ASV
G'day marose1, welcome to Apnea Board.

You've made some significant changes all at the same time, so it might take more than a couple of nights for everything to settle down. Apart from a cluster around 04:15 you had very few apneas or hypopneas, but the pressure indicates the machine was working hard all night. This in itself will be tiring, but again is something you'll get used to. You can help the machine by sleeping on your side - this is proven to reduce the occurrence of obstructive events and I have seen at least one paper which suggests it's also helpful for central apnea.

Are there any other health issues involved which might be contributing to your fatigue and headaches? Do you use (or should you consider) supplementary oxygen? Finally, you slept for 9.5 hours - is this normal for you? I know if I ever sleep that long it's because I'm sick and I always wake up feeling like #@$%.

DeepBreathing
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
03-24-2016 10:17 PM
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Asjb Offline

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Posts: 173
Joined: Oct 2014

Machine: Aircurve 10 CS Pacewave ASV. Before 11/2015 Airsense 10 Auto
Mask Type: Full face mask
Mask Make & Model: FP Simplus & Remzzzs liner
Humidifier: Integral
CPAP Pressure: Current info in this post
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Undisclosed
Location: France

Post: #3
RE: 2nd Night with Aircurve 10 ASV
Hello Marose1, welcome to the forum!

I too use the Aircurve ASV and found it took several weeks to get used to the way it 'tries to help you breathe' (*very* different feeling to my previous APAP). It's tremendous that you have adapted so well to be able to keep the machine going with your mask on for so many hours on only your second night.

I agree with Deep Breathing that your morning symptoms may be connected to oxygen drops, or that you slept for 'too long'. Has your pulmonologist been concerned about your oxygen levels? Perhaps you wear an oximeter? - which will tell you if things weren't right last night.

I suspect also you may have had poor quality sleep because of stopping the Zolpidem. Many people have quite a lot of symptoms, including rebound insomnia, when they stop the tablet (try Googling 'Zolpidem withdrawal') and that can take weeks to settle.

Your Sleepyhead numbers and graphs look really good, let alone for just your second night. Your doctor has prescribed PS settings that are rather 'wide open' and you may need over the next week or so to increase your minimum PS and maybe also reduce the maximum PS (depends on the type of apnoeas you are having). The PS will deal with centrals and hypopnoeas. A PS max of 10 is high enough for many people for the machine to effectively 'blow through' centrals and the minimum PS is usually more usefully set at around 3-4 rather than zero.

The graphs show you did have some apnoeas (very few) at your maximum IPAP pressure of 25 (max EPAP + PS), so you already have useful information as to what sort of max pressure levels you are likely to need. You are being treated for mixed obstructive and central sleep apnoea?

Any persistent obstructive apnoeas will need to be controlled by increasing particularly the minimum EPAP, but maybe also the maximum. Your doc seems to have 'cancelled out' the auto function by setting both the min EPAP and max EPAP at the same number, and most people with ASV report that it is better used in auto-mode with a range between min EPAP and max EPAP.

Just to mention - with the Resmed Aircurve ASV the AHI numbers for 'centrals/clears' and 'obstructives' will always be zero as the machine responds so quickly on a breath-by-breath basis that it doesn't have the time to put out a test puff to see if the airway is clear or closed. So all the centrals + all the obstructives are numerically lumped together in 'Unknown Apnoea' and you have to look at the detail of the flow wave in Sleepyhead to see what type the apnoeas were.

If you you would like to share (you don't have to) any more details on the forum about your type of sleep apnoea, why you were changed to ASV, oxygen levels etc, then there are lots of people here who can offer advice about your settings if you want.

In the meanwhile I suggest the only things you change this week are to increase your minimum PS to 3, find out more about how Zolpidem withdrawal can effect sleep quality, and review the detail of Sleepyhead graphs to see what type of residual apnoeas you are having. And next week you'll likely be better off by changing the EPAP to true 'auto' i.e. with a range between min and max EPAPs. The settings to chose then will be guided by your Sleepyhead data and your previous settings with BiPAP (that you mention in your profile were 14-20).

I think it likely, given your previous BiPAP settings, your ASV prescription of min & max EPAP at 10 may not hold your obstructives. It seems likely that long-term you will need higher EPAPs and maybe lower max PS, but I'd suggest you take it slowly and take at least a few days to get used to each change. Your AHI results from last night are so good that you have got plenty of room, so to speak, to not rush into changes and you may just want to focus on getting used to a different sort of sleep pattern without Zolpidem.

Fantastic start with ASV, congratulations! I hope you achieve the results I now have with it - excellent undisturbed sleep night after night, and average AHI of less than 1.

And a PS - you might find the Simplus mask suits you well with ASV. It has a lot of fans here on the Forum, particularly with people needing high pressures.

best wishes, asjb
................................................................................​...............
My current pressures: Auto-ASV. EPAP 11-14. PS 3-10
(This post was last modified: 03-25-2016 03:54 AM by Asjb.)
03-25-2016 03:53 AM
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marose1 Offline

Members

Posts: 11
Joined: Jan 2016

Machine: Resmed Aircurve 10 ASV
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: Integral
CPAP Pressure: EPAP 10 to 10 PS 0 to 15
CPAP Software: ResScan SleepyHead

Other Comments: Former PR BiPaP @ EPAP 15 IPAP 20

Sex: Male
Location: Las Vegas

Post: #4
RE: 2nd Night with Aircurve 10 ASV
Fantastic advice from DeepBreathing and Asjb -- Thank you so much. I will post more after a full week on the machine.
03-25-2016 09:23 AM
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Asjb Offline

Advisory Members

Posts: 173
Joined: Oct 2014

Machine: Aircurve 10 CS Pacewave ASV. Before 11/2015 Airsense 10 Auto
Mask Type: Full face mask
Mask Make & Model: FP Simplus & Remzzzs liner
Humidifier: Integral
CPAP Pressure: Current info in this post
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Undisclosed
Location: France

Post: #5
RE: 2nd Night with Aircurve 10 ASV
(03-25-2016 09:23 AM)marose1 Wrote:  Fantastic advice from DeepBreathing and Asjb -- Thank you so much. I will post more after a full week on the machine.

Great! Look forward to hearing how you've been doing - but you can always come back earlier than a week if you've got any new problems/questions.

................................................................................​..............
My current pressures: Auto-ASV. EPAP 11-14. PS 3-10
03-25-2016 09:38 AM
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trish6hundred Offline

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Posts: 6,430
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #6
RE: 2nd Night with Aircurve 10 ASV
Hi marose1,
Good luck to you with your new ASV machine.
I look forward to hearing of your progress.

trish6hundred
03-25-2016 03:27 PM
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marose1 Offline

Members

Posts: 11
Joined: Jan 2016

Machine: Resmed Aircurve 10 ASV
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: Integral
CPAP Pressure: EPAP 10 to 10 PS 0 to 15
CPAP Software: ResScan SleepyHead

Other Comments: Former PR BiPaP @ EPAP 15 IPAP 20

Sex: Male
Location: Las Vegas

Post: #7
RE: 2nd Night with Aircurve 10 ASV
So much good info provided by members on this forum. As Asjb mentioned in his last reply, I was using a PR BiPaP with EPAP 15 and IPAP. With these settings, I was getting lots of centrals and my AHI was in the range of 14.5 to 20, so my pulmonologist scheduled another sleep study, which diagnosed that I had Complex Sleep Apnea and recommended that "..patient should be initiated on bi-level positive airway pressure ASV with the following settings..."

COMMENTS
1) I am an ex-smoker and recently had a pacemaker installed, but I am not aware of any serious health issues, other than sleep apnea, which might be contributing to shortness of breath and headaches -- both of which seem to be lessening since I stopped taking Zolpidem 3 days ago and begin adapting to my new equipment.

2) So far I like the FP Simplus FF better than my previous Mirage Quattro FF Mask. I often sleep in the prone position and the Simplus seems to be more comfortable over the bridge of my nose and where it contacts my forehead. Also, as previously noted, the Simplus is often recommended for higher pressures.

3) On average, I sleep 6-7 hours at night. While my posted Sleepyhead report indicates that I slept for 9.5 hours, I wasn't sleeping during a significant amount of that time due to the new equipment, absence of Zolpidem, etc.

4) I have a 24 hour recording pulse oximeter and on the occasion that I wear it I will include the oximitry data in SH graphs that I post in the future. I have shown the oximetry readings that I have recorded so far to my pulmonologist and neither he, nor the sleep study indicated a serious level of oxygen deprivation.

5) With my current settings of ASVAuto, Min EPAP=10, Max EPAP=10, Min PS=0 and Max PS=15, I can appreciate the sound advice from Asjb that I consider raising the Min PS to 3 or 4, and maybe later raising EPAPS to a range (auto mode) and Lowering the Max PS. My next appointment with my pulmonologist is on April 25 and I would like to hold off making any changes until then unless it becomes obvious that changes are necessary before that time.

QUESTIONS
1) Previously, when I used Encore Basic with my PR BiPaP Machine, the graph areas where periodic breathing occurred were highlighted in yellow. If periodic breathing
occurs when using the AC10 ASV, is it identifiable in Sleepyhead Reports?

2) When posting a Sleepyhead Screenshot on apneaboard, what are the most useful criteria (graphs) to post?

3) If I upload my screenshots to Imgur and follow instructions to copy the screenshot URL, how do I enter that copied URL into messages that I post on apneaboard?
03-25-2016 11:04 PM
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DeepBreathing Offline
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Moderators

Posts: 2,294
Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Perth, Western Australia

Post: #8
RE: 2nd Night with Aircurve 10 ASV
Quote:1) Previously, when I used Encore Basic with my PR BiPaP Machine, the graph areas where periodic breathing occurred were highlighted in yellow. If periodic breathing
occurs when using the AC10 ASV, is it identifiable in Sleepyhead Reports?

I don't think your machine reports periodic breathing. I believe that Resmed's position is that the Pacewave algorithm completely eliminates central aneas and PB, hence there is no need to report it.

Quote:2) When posting a Sleepyhead Screenshot on apneaboard, what are the most useful criteria (graphs) to post?

Event flags, flow rate, mask pressure, leak rate, flow limitation. Also the pie chart and data above and below that.

Quote:3) If I upload my screenshots to Imgur and follow instructions to copy the screenshot URL, how do I enter that copied URL into messages that I post on apneaboard?

We have a handy "How do I" thread here: http://www.apneaboard.com/forums/Thread-How-to-HOW-DO-I

DeepBreathing
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www.ApneaBoard.com


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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
03-26-2016 02:36 AM
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Asjb Offline

Advisory Members

Posts: 173
Joined: Oct 2014

Machine: Aircurve 10 CS Pacewave ASV. Before 11/2015 Airsense 10 Auto
Mask Type: Full face mask
Mask Make & Model: FP Simplus & Remzzzs liner
Humidifier: Integral
CPAP Pressure: Current info in this post
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Undisclosed
Location: France

Post: #9
RE: 2nd Night with Aircurve 10 ASV
Quote Don C: Previously, when I used Encore Basic with my PR BiPaP Machine, the graph areas where periodic breathing occurred were highlighted in yellow. If periodic breathing
occurs when using the AC10 ASV, is it identifiable in Sleepyhead Reports? [/quote]

Quote DeepBreathing: I don't think your machine reports periodic breathing. I believe that Resmed's position is that the Pacewave algorithm completely eliminates central aneas and PB, hence there is no need to report it.

Yes, that's interesting. And maybe a little over-confident of Resmed. I have occasional nights (I think due to either of 2 intermittent health issues I have that effect my breathing) with runs of apnoeas and hypos that are clearly a form of 'periodic breathing'. These episodes have never been flagged as 'periodic breathing / Cheyne Stokes' by the Aircurve 10, but identical episodes when I was using the Airsense 10 *were* flagged as such.

But at least The Superb Sleepyhead gives us clear details of flow waves during bouts of events, so one can self-diagnose periodic breathing if one needs to.

................................................................................​...............
My current pressures: Auto ASV. EPAP 11-14. PS 3-10
(This post was last modified: 03-26-2016 05:20 AM by Asjb.)
03-26-2016 05:19 AM
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vsheline Offline

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Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #10
RE: 2nd Night with Aircurve 10 ASV
(03-26-2016 05:19 AM)Asjb Wrote:  DeepBreathing: I don't think your machine reports periodic breathing. I believe that Resmed's position is that the Pacewave algorithm completely eliminates central aneas and PB, hence there is no need to report it.

Yes, that's interesting. And maybe a little over-confident of Resmed. I have occasional nights (I think due to either of 2 intermittent health issues I have that effect my breathing) with runs of apnoeas and hypos that are clearly a form of 'periodic breathing'.

Hi Asjb,

Actually, the occasional clusters of apneas and hypopneas in the data you've posted on Apnea Board from your ASV machine have, I think, all been obstructive in type.

I think by definition Periodic Breathing and CSR are breathing patterns which are caused by our central nervous system. Meaning, to be properly identified as being PB or CSR I think these must be central events rather than obstructive events.

It is possible for a central apnea to transition into an obstructive apnea, starting as a central apnea but ending as an obstructive apnea. However, if memory serves, the apneas in the data you've posted appeared to me to be purely obstructive.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 03-26-2016 06:44 PM by vsheline.)
03-26-2016 06:25 PM
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