(03-24-2016 09:34 AM)DonC Wrote: The second night was good again. I slept for 6 hours 40 minutes.
Total AHI 1.19 / UA 0.41 / HYPO 0.78
I changed to ASV Auto / EPAP 6.6 to 14 / PS 4 to 14.The results were great after I made the changes. Asjb - thanks for the guidance.
The only problem I had was that the pressure felt really high and woke me up three times pushing the mask away from my face. But, as it caused a big drop in the UAs do I just need to suck it up and get used to it or are there any more adjustments I can make? I didn't go as low as Asjb on the PS. Could that be the problem?
I have the mask pretty tight, to the point that it leaves marks on my face for an hour after I take it off.
Hello again Don - those are great AHI results and sleep hours but a nuisance you were woken up.
Do you have last night in Sleepyhead? If so, can you relate the times of being woken to bursts of particularly high pressure? as your current settings will of course give you a max IPAP of 24 (max EPAP 14, max PS of 10) which is quite a 'shock to the system' if you are not used to pressures that high but need them. It took me several weeks with ASV to get used to the high pressures I need (up to IPAP 25) having previously experienced pressures that I found tolerable at only up to 14 with APAP.
You could look at the Sleepyhead daily graph that gives y-axis 'time spent' and x-axis 'pressure' - if you see that you have not spent much time during the night at IPAPs of, say, more than 20, then I'd suggest you reduce your maximum EPAP to 10, or even perhaps 9, and try that for a few nights. Your obstructive apnoeas on the flow waves in SH (expressed numerically within 'unknowns' with the Resmed ASV) and hypopnoeas may increase slightly but I think that is a small price to pay for slow acclimatisation to the pressure settings that are right for you.
But even if you did spend quite a lot of the night at IPAPs in the twenties (and they 'blew your mask') and so you are probably going to need those sorts of pressures in the future, then 'slowly does it' would still be my advice. I don't think you need to adjust your pressure support now - but other people may think differently and I hope they, mostly much more expert than me, will join in on this thread. PS Edit: Sorry - just noticed you wrote today that you had increased your PS last night to a max of 14. I'd suggest you reduce that back down to the 10 you had the night before.
What were your median and 95% pressures? as those figures will help you to arrive at the right settings and to smooth out some of 'pressure bursts' that could wake you. And you used APAP or BiPAP before the ASV? - at what pressures?
You're only on Night #2 with ASV and many people have described that they needed some time to adjust to the different way the pressure feels compared to APAP and BiPAP. You'll get there!
There are many previous threads on the Board about mask adjustment, best masks for high pressures and leaks, and similar, that you might want to look at. I found that over-tightening was counter-productive but at high ASV pressures I was frequently being woken by the noise of brief 'mask farts'. This I finally solved by using a mask liner. The very short bursts of high leaks (my overall 95% leak stats are good) are still there on the SH leak graph but they don't (I assume) make such a noise now with a liner as I routinely now sleep undisturbed right through the night.
A number of people on the Board have mentioned that they find the mask I use (FP Simplus) to be particularly comfortable and effective with high pressures - you might want to try one some time if it turns out you will actually need such pressures.
What's the right phrase? - oh yes, 'onwards and upwards'!
best wishes, asjb
My pressures currently: Auto-ASV. EPAP 11-14. PS 3-10