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ASV Auto Settings
#1
[attachment=5898] Just recently started treatment for Complex Mixed Apneas (40-60 events/hr) and went through a few CPAP and APAP machines without good results. Just received a new ResMed 10 ASV device without any manuals/documentation. I tried using the settings from prior devices and had very good results with the event reduction but the inhalation pressure seems too high for me causing the mask to leak pretty bad. I will work on the mask but I would like for someone to take a look at my charts to see if I'm going in the right direction with the settings. I just switched to the ASVAuto mode last night and haven't changed the default settings. I have little to no support from my doctor or equipment provider.
I will attach my ResScan data if I can.
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#2
Welcome to AB Kensheehan.

Congrats on getting the ASV. I believe running the ASV in Auto is the right direction. It gives the most pressure settings available to you. It gives you EPAP Min and Max and PS Min and Max. IPAP Min and Max get filled in automatically in response to your needs at that time, based upon in part by these other settings and whether you have apnea events or not.

More likely your EPAP Min is going to be a minimum of 6. Anything less results in too little air and will feel like air starvation.

Unfortunately, all the other settings are somewhat based on what we will see via Sleepyhead and maybe your sleep study data too.

Best to your success, myself and others will follow-up after posting data.

Coffee
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

Wiki Info for Beginners
Sleepyhead Chart Organization
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#3
Your machine is compatible with SleepyHead, and that is going to give us much better information.  Meanwhile, the image below is the recommended protocol flow-chart for ASV.  It's pretty easy to follow, and resolve the issues as they arise.  Obstructive apnea and unclassified events, generally require higher EPAP pressures, while hypopnea and centrals are usually treated with the minimum and maximum pressure support respectively.  Once you post some images, I'm sure we can help.  Just follow the links in my signature to learn how to organize a Sleepyhead chart and post it as an attachment in the forum.


[Image: attachment.php?aid=4210]
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#4
Thanks Dave. Was my data attached?
Ken
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#5
(05-15-2018, 04:00 PM)Kensheehan Wrote: Thanks Dave. Was my data attached?
Ken

Sorry no it's not where I can see it.

Try here for directions: http://www.apneaboard.com/forums/misc.ph...elp&hid=22
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

Wiki Info for Beginners
Sleepyhead Chart Organization
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#6
Thanks. I'll get to work on the charts. 
Ken
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#7
Was finally able to get the Sleepyhead files prepped and attached. Any suggestions. I also made a few changes that I believe helped.
Thanks,
Ken S


Attached Files Thumbnail(s)
   
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#8
Well, IMO you're off to a real good start. AHI 1.19 for the night, large leaks under 2%, over 7 hours time for the session, and it seems to almost already be good to go. It does depend on how many nights in a row you can get similar results, and one subjective thing to consider. How did you feel after sleeping with it? Anything irritating, or didn't seem comfortable? This can bring in pressure settings and comfort/humidity settings as well, to a degree. The main thing is though to get you to use it consistently and getting similar results too.

Anything else, just ask. Happy Memorial Day weekend.

Coffee
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

Wiki Info for Beginners
Sleepyhead Chart Organization
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#9
I like your changes. Try PS min at 2.0. Looks a lot better and lower overall pressure.
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#10
Hi Ken,

I think you don’t “need” to change any settings, because the data already looks fine. Nonetheless, in view of your occasional hypopneas and Flow Limitation, I think you may sleep better if the Min EPAP (the minimum pressure the machine will ever target while you are exhaling, to help keep your airway open and free from obstructive apneas and obstructive hypopneas) is raised at least a little and if the Min PS (the minimum Pressure Support, the amount by which the pressure is boosted while you are inhaling, to help make inhaling easier and free from Flow Limitation) is raised at least a little.

Presently, the Min EPAP is 4 cmH2O and the Min PS is 3.0 cmH2O, which I think are both the default settings on your machine and, if increased, would likely reduce your tendency to suffer Flow Limitation.  Flow Limitation is the result of a type of partial restriction in your airway during inhalation which gets worse the harder you try to inhale.  When it senses FL, your machine will automatically raise PS to better open the airway, thereby reducing the amount of effort you will need to exert in order to inhale an adequate amount of air. 

I suggest you consider raising the Min EPAP to 5.75 or higher (5.75 is close to your 95 percentile EPAP as reported in the SleeyHead "Statistics" table).  The 95 percentile EPAP is the pressure EPAP was at or below at least 95% of the time, and it is also the pressure EPAP was at or above at least 5% of the time.  I think raising Min EPAP to 5.75 would actually be fairly conservative, and I suggest keeping in mind that raising the Min EPAP to 7.0 or a little higher may be even better for eliminating the hypopneas, especially since, perhaps to reduce the occasionally bothersome effects of PS jumping unnecessarily high, you have lowered the Max PS to 10. 

I also suggest raising the Min PS to 4.5 (near your median PS, which can be estimated as the difference between what SleepyHead reports as the average exhalation pressure (Median EPAP) and the average inhalation pressure (Median IPAP). 

Take care,
— Vaughn
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.
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