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[CPAP] Air Curve ASV - Newbie
#21
(04-11-2015, 06:55 PM)DeepBreathing Wrote:
Quote:Can you clarify the following: "You need to keep minimum EPAP within 4.0 cm of the minimum EPAP in order to utilize the range of PS that is set." Should that be minimum EPAP within 4.0 cm of the Maximum EPAP?

I think Sleeprider meant to say keep minimum IPAP within 4 cm of minimum EPAP. This just follows from the equation IPAP = EPAP + PS If your minimum PS is 4 and minimum EPAP is 10, then minimum IPAP should be 4 + 10 = 14.

Okay, I saw that equation before. When I go into the clinical menu it only has these additional settings.

Mode: ASVauto
Min EPAP: 10 (I have not change this)
Max EPAP: 12 (changed from 15)
Min PS: 4 (I have not change this)
Max PS: 10 (changed from 15)
Start EPAP: 4 (I have not change this)

Thank you for clearing that up. This is all new to me and I want to learn it.

Thank you,

Randy
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#22
Thanks DB. That's exactly what I intended.
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#23
(04-11-2015, 02:21 PM)randeh Wrote: Since I do not want another night like last night I am going to go ahead and lower my Max PS to 10 and Max EPAP to 13. My only concern is if there are ratios that should be maintained for Min and Max Epap. I was thinking of dropping the Min Epap to 8. Would that be okay or should I leave it at 10?

Hi Randy,

If last night was representative, your EPAP settings probably can be lower, as pointed out by Sleeprider.

Our pressure needs vary hour to hour. Obstructive apneas are usually strongly positional, and the worst cases are usually if we are on our back, or during REM sleep, or both.

Assuming you were asleep most of the time you were using the machine last night, I think 8 or 9 would be a reasonable setting for the Min EPAP, especially in view that you are experiencing a painful amount of air swallowing, and temporarily lowering Min EPAP may tend to help a little.

My general rule of thumb is that Min EPAP should not be lower than about 3 or 4 cm H2O lower than the 90% pressure or 95% pressure. But some patients do better in fixed-EPAP mode, where the fixed EPAP may be chosen near the 90% pressure or 95% pressure as measured in APAP mode.

(The 95 percentile pressure is the pressure we were at or below at least 95% of the time; the 95 percentile pressure is also the pressure we were at or above for at least 5% of the time.)

Actually, I suggest leaving Min EPAP at 10 (so you are not adjusting so many things at once), but I think it would be reasonable to lower the Min EPAP to 9 or 8. (A Min EPAP of 8 would be 3 lower than the 95% Pressure from last night.)

Lowering the Max EPAP would tend to limit aerophagia more effectively than lowering Min EPAP. I would suggest lowering Max EPAP either to what was measured last night (around 12.6) or perhaps a little lower, like 12.

This is in addition to lowering Max PS to 10.

Take care,
--- Vaughn

Added:
I also suggest raising the ramp Start Pressure to 6 or higher, for increased comfort when starting.

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#24
(04-11-2015, 07:15 PM)randeh Wrote:
(04-11-2015, 06:55 PM)DeepBreathing Wrote:
Quote:Can you clarify the following: "You need to keep minimum EPAP within 4.0 cm of the minimum EPAP in order to utilize the range of PS that is set." Should that be minimum EPAP within 4.0 cm of the Maximum EPAP?

I think Sleeprider meant to say keep minimum IPAP within 4 cm of minimum EPAP. This just follows from the equation IPAP = EPAP + PS If your minimum PS is 4 and minimum EPAP is 10, then minimum IPAP should be 4 + 10 = 14.

Okay, I saw that equation before. When I go into the clinical menu it only has these additional settings.

Mode: ASVauto
Min EPAP: 10 (I have not change this)
Max EPAP: 12 (changed from 15)
Min PS: 4 (I have not change this)
Max PS: 10 (changed from 15)
Start EPAP: 4 (I have not change this)

Thank you for clearing that up. This is all new to me and I want to learn it.

Thank you,

Randy

Randy you have started at EPAP 4.0. so with a PS range of 4-10 you may see 4/8 to start. Once ramp is complete, (not sure of time for Ramp mode), you should have EPAP/IPAP of 10/14 to 12/22.

That seems to be as good as any settings. It will be interesting to see how that works out and if you feel more rested and comfortable. It seems you had a sleep study and were titrated with ASV due to centrals. Do you know what the sleep study results were? What happened when you were put on CPAP pressure? ASV bilevel is an amazing technology, but since the machine takes over breathing functions when you don't initiate a breath in the expected time, the machine can take over in a way that you don't score any apneas, but you feel like crap. I still encourage you to get Sleepyhead so you can have a better idea of what is going on, and especially how many breaths are self-initiated vs initiated by the machine.
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#25
My sleep was somewhat improved last night with the new settings. I am still having the air swallowing issue although not to the point of being in pain. If I did have a central apnea event I was not awaken by the sudden force of air which is great. I still think the pressure is to high and I would be more comfortable at a lower setting. I have attached screenshots from sleephead for Saturday and Friday nights. If anyone can give me some feedback and what exactly you see in the charts I would appreciate it very much. I want to learn how to evaluate the charts since this is now a part of my life. Thank you all for your insight and sharing! Here are my current settings.

Mode: ASVauto
Min EPAP: 10 (I have not change this)
Max EPAP: 12 (changed from 15)
Min PS: 4 (I have not change this)
Max PS: 10 (changed from 15)
Start EPAP: 4 (I have not change this)

Thank you,

Randy

Saturday Night:

[Image: 4-11-2015-1.jpg]


[Image: 4-11-2015-2.jpg]


[Image: 4-11-2015-3.jpg]



Friday Night:

[Image: 4-10-2015-1.jpg]


[Image: 4-10-2015-2.jpg]


[Image: 4-10-2015-3.jpg]

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#26
So it has been just over a week since I started CPAP ASV therapy and what a rough start it was. I ended up changing my settings back since things were getting worst although my full face mask could not handle the pressure when I had central apnea events. I could not get a good seal and the air swallowing was terrible. I was considering going to a hybrid mask although I kept seeing good reviews for the P10 AirFit nasal pillow mask and decided to give it a try. I was hesitant because of my sinus congestion issues and I did wake at 3:00-ish in the morning with a need for more air. I tried ending my session and starting a new one hoping that it would have a higher pressure and provide more air. After 20 minutes with a ramp up time of 10 minutes I gave up because I could not get in sync with my machine which I think is because of my sinus congestion. I had my humidity setting at 7 and the hose heat at 80 degrees. Overall this was the best night I have had since starting therapy and the P10 is an awesome mask. Also the air swallowing was greatly reduced. I am thinking of trying a lower humidity although I am concerned about drying and soreness. Attached is images for Monday and Tuesday. Any feedback would be greatly appreciated. Thank you all in advance.

Kind Regards,

Randy

[Image: screenshot-20150415-072425.png]
[Image: screenshot-20150415-072057.png]
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#27
Great to see you're having some success Randy. A couple of things:

1. If you are not already using the Large pillow size, try it. With the P10 very often going one size larger than what you think you need will allow for more comfortable air flow.

2. When in "ramp," you are not being treated. So consider turning it off, or start it at a higher pressure and run for a shorter time.

3. Your "max" is really high. I think I'd rather have a little lower max as long as the CA's don't spike a lot. You're currently at zero, so that shouldn't be an issue.
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#28
(04-15-2015, 12:00 PM)retired_guy Wrote: Great to see you're having some success Randy. A couple of things:

1. If you are not already using the Large pillow size, try it. With the P10 very often going one size larger than what you think you need will allow for more comfortable air flow.

2. When in "ramp," you are not being treated. So consider turning it off, or start it at a higher pressure and run for a shorter time.

3. Your "max" is really high. I think I'd rather have a little lower max as long as the CA's don't spike a lot. You're currently at zero, so that shouldn't be an issue.

ASV relief won't kick in when in ramp? I'm on the same machine he is.

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#29
(04-15-2015, 12:00 PM)retired_guy Wrote: Great to see you're having some success Randy. A couple of things:

1. If you are not already using the Large pillow size, try it. With the P10 very often going one size larger than what you think you need will allow for more comfortable air flow.

2. When in "ramp," you are not being treated. So consider turning it off, or start it at a higher pressure and run for a shorter time.

3. Your "max" is really high. I think I'd rather have a little lower max as long as the CA's don't spike a lot. You're currently at zero, so that shouldn't be an issue.

Thanks for the feedback Retired Guy! I just tested the large pillow and I think that will workout it seems that the machine picked up on my breathing rhythm better.

I am going to try lowering my settings again based on Vaughn's suggestions as follows.
min epap 8
max epap 10
max ps 10
ramp 6

I like having the ramp on time set for at least 5 minutes to give myself time to adjust. Unfortunately I am having CA's as I am falling asleep and then I get the blast of air to get me breathing and it wakes me. I will report back tomorrow.

Kind Regards,

Randy

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#30
(04-15-2015, 12:00 PM)retired_guy Wrote: Great to see you're having some success Randy. A couple of things:

1. If you are not already using the Large pillow size, try it. With the P10 very often going one size larger than what you think you need will allow for more comfortable air flow.

2. When in "ramp," you are not being treated. So consider turning it off, or start it at a higher pressure and run for a shorter time.

3. Your "max" is really high. I think I'd rather have a little lower max as long as the CA's don't spike a lot. You're currently at zero, so that shouldn't be an issue.

Well I had a great night sleep and I felt good when I got up. The larger nasal pillow and lower settings sure helped. The report shows a large leak but I do not remember anything about that. Bed

1. I am still getting some air swallowing so maybe a lower EPAP max would help but I will wait a few nights.

2. My nose feels like it has Kleenex burn so I might have to use my nasal mask tonight. Hope not.

3. Out of the 6 hours and 10 minutes I was awake for the last hour. The amount of sleep I am getting is still around 5 hours but the quality was awesome. My goal is to get to bed by 10:30 and not wake until 5.

Here is the latest and greatest.

Thank you for the help it is truly appreciated!

Kind Regards,

Randy

[Image: screenshot-20150417-101759.png]
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