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[Diagnosis] ASV for UARS - some good days but generally tired
#1
Ohmy 
ASV for UARS - some good days but generally tired
Hi Apnea Board community! Hoping you guys can give some pointers to improve my treatment journey.

Background: I am a relatively healthy 28F with chronic fatigue. I've been diagnosed with UARS (see sleep study attached). I've tried the CPAP for 1 month but ended up with a large amount of central sleep apneas and was determined that it wasn't the suitable treatment. Currently I am using a rental ASV machine.

I've had some success with the ASV - there were a few days when I woke up feeling very refreshed. It was like I was a completely different person! But on a majority of the days, I am still super tired. I've attached my latest sleep study and current machine settings/data. Data was from last night March 1st - I woke up feeling like a zombie and suspect that it's because of the leak rate.

Hoping to get some suggestions for improving the settings. Thanks y'all!


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#2
RE: ASV for UARS - some good days but generally tired
Leaks are definitely an issue. Do you know if they are mouth or mask leaks (I am guessing mouth)?
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#3
RE: ASV for UARS - some good days but generally tired
I am not sure but I do have a soft cervical collar. If I don't wear it, I wake up from the air leaking out of my mouth. I use a nasal pillow mask (ResMed AirFit P10). Is there a way to tell if I am leaking from the mask vs mouth from the charts?
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#4
RE: ASV for UARS - some good days but generally tired
Have you tried the next larger size of nasal pillow? This often provides better flow and a seal. You have a mixture of mouth leaks and seal issues, but the majority appear to be mouth leaks as they are limited in flow and tend to plateau between 18-36 L/min. Have you tried PS range of 4.6 to 9.6?
Sleeprider
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#5
RE: ASV for UARS - some good days but generally tired
Something that may help is to consider using ASV Auto mode, introducing an EPAP range, after the leaks are addressed.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: ASV for UARS - some good days but generally tired
(03-03-2022, 08:38 AM)Sleeprider Wrote: Have you tried the next larger size of nasal pillow?  This often provides better flow and a seal.  You have a mixture of mouth leaks and seal issues, but the majority appear to be mouth leaks as they are limited in flow and tend to plateau between 18-36 L/min.  Have you tried PS range of 4.6 to 9.6?

Thanks! I will try the next larger size nasal pillow. I see the current PS range is 4.6 - 10.0 currently - should I change from 10.0 to 9.6?
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#7
RE: ASV for UARS - some good days but generally tired
In theory the ASV uses the pressure support you need, when you need it to maintain minute vent. If the machine applies a higher PS, then it is because minute vent has fallen below the rolling target, either because of airway resistance or lack of spontaneous effort. Your minimum PS is relatively high and I assume you arrived at that to overcome airway resistance, however I'd like to know your experience at lower minimum PS. The pressure support above that is there mostly to overcome the therapy induced CA events, and a couple tenths is not going to make much difference in either your experience or AHI. Your 95% PS is below the maximum, so it looks like you have just enough PS to do the job. Your onset of fatigue and less satisfying sleep may be leaks or the disruption of PS to your sleep. There is no way to know until we eliminate the leaks. Let's review how you arrived at your EPAP and PS min numbers so we have more background.
Sleeprider
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____________________________________________
Download OSCAR Software
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Organize your OSCAR Charts
Attaching Files
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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.
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#8
RE: ASV for UARS - some good days but generally tired
I missed that. The nice thing about these Resmed ASV's is that they are very responsive to both lowering minute volume and flow limitations. You using 4.6 PS as a min results in a significantly higher average PS (6.7 in the example given, which is quite high). This could also be part of the reason for having mouth leaks.

Unless you have already used it extensively I would recommend dropping min PS down to 3, max can stay the same.
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