Doctor switched my wife over to an ASV machine, it has doubled her AHI

[SarcasticDave94]

OK, if they're willing to try it, instead of what looks like EPAP 6-15, EPAP Max could be lowered to something like 12. Try it several hours at most, determine if it's acceptable or not.

I found ASV edits to not take long to notice and determine if they're good or not.

[robbob2112]

You are right about that... when my dr sent in edits in after I had already made the change it doubled what we had agreed. I could tell in the first 20 minutes something was not right.
Also shows that the changes from a provider just add on to whatever is there verse setting an absolute number.

[Sleeprider]

MaybeTowlie. Can we revisit the CPAP results and why ASV was suggested? ASV is used to treat central and complex apnea. I assume most of your wife's events with CPAP were obstructive. It would really help if you could post a typical chart from her CPAP days. I want you to read two brief wiki articles. Your wife's events remain obstructive and they occur in clusters. ASV will not resolve this without addressing her "chin-tucking" or whatever other mechanism results in the obstruction of her airway. Excess pillows, sleeping inclined and even sleeping in a fetal position with the chin-tucked can result in these obstructive clusters. Many members here have found a soft cervical collar to be a very effective solution.
Positional Apnea: https://www.apneaboard.com/wiki/index.ph...onal_Apnea
Soft Cervical Collar: https://www.apneaboard.com/wiki/index.ph...cal_Collar

[robbob2112]

There you go asking for data and information - the smart thing - I am just an egg

[MaybeTowelie]

The reason they had her switch to ASV is because the pressure was maxed out on her old machine.  Her original sleep study sent her in a script for a pressure of (if I remember correctly) 27.  This delayed getting her first machine until the doctor could send in a new script for the max of the machine, as the original script was over what a normal machine could do (is what she was told).  So with the max pressure, and still getting AHI over 10, they recommended the ASV.

We did not change the settings last night.  She wanted to give it another night since she had the best night of sleep she has had since getting the ASV.  Results from last night not as great, but thanks to all of you, I believe we have found the culprit, positional apnea.  The spikes of AHI seems to be when she switches from her sided to on her back.  Ordered a cervical collar, and will try that out.

Here are last night results, also a night from her old machine.  

Thanks again!

[Gideon]

By any chance do you still have the VAuto? or an APAP?

That chart shows a ton of positional apnea. This is something very, very few doctors see or know about and it is impossible to see when looking at summary data.
What is happening is she is tucking her chin into her chest kinking that hose we call an airway.
the fix is either a pillow modification, using 1 vs 2 pillows, or a flatter, less firm pillow with the concept being to keep the neck straight while sleeping. This is causing clusters of obstructive events, including flow limitations which are not logged in this BiLevel modem all of which cause pressure to increase, but as is typical, no amount of pressure can relieve this condition. Should the pillow modification not work a soft cervical collar will be needed, read the wiki article linked in my signature. I see Sleeprider already referred you to this wiki plus one on positional apnea.

Based on this IMHO the ASV is the wrong machine for her.

[Sleeprider]

Without central apnea, the maximum pressure of the Vauto,VPAP-S are equal to the ASV without the backup rate and ASV algorithm. The Vauto is absolutely the best for obstructive apnea in individuals needing up to 25 cm pressure. Your wife will resolve her apnea at much lower pressure if we can persuade you to try the soft cervical collar. Your doctor's prescription of ASV reflects a lack of knowledge of the most appropriate device, assuming complex or central apnea is not identified.

[SarcasticDave94]

The thing about this is the current generation of doctors give hit or miss recommendations regarding sleep medicine. If this were not the case, Apnea Board would likely be less busy.

The good thing about getting VAuto, the time controls are available if they're ever needed. VAuto will help clean up the flow limits and likely be more comfortable.

So here's a case of CPAP to ASV pretty much just like that. Crazy, says the guy that can't get his device yet.

Here's the dart board, and the recommended treatment is ?

[Sleeprider]

The Vauto can also mitigate therapy onset centrals from pressure support and manage flow limits. It's a great machine. The ASV is relatively uncontrollable as everything is on auto-pilot.