Dreamless (ASV Therapy) Waking frequently

[Dreamless]

I’ve been using an ASV pap machine to treat primary (idiopathic) central apnea for the past 10 years. Currently I’m using a Resmed AirCurve 10 ASV.

For the last 3 or so weeks, when I go to sleep and start dreaming, I wake up suddenly with a feeling of anxiety and can NOT go back to sleep. I usually sleep on my back and when I do go back to bed when sleepy, I tried to sleep on my side. Like before, the same thing happened when I was dreaming. And again, I am unable to go back to sleep. 

Any thoughts? 

- Dreamless

[OpalRose]

Dreamless,
You've been at this for a few years now and have had this same problem prior.

Sometimes it's not possible to say why someone is waking up as you describe. Can you think of anything that has changed lately? Are you taking any different medications?

Practicing good Sleep Hygiene is important. Maybe there's some tips in this article that can help.

https://www.sleepfoundation.org/articles/sleep-hygiene

There also may be something in your settings that need adjusted.

Please post a chart or two of the daily page in OSCAR.

Use this link to guide you on Organizing the chart.
http://www.apneaboard.com/wiki/index.php...ganization

Be sure to use the Attachment Feature to post your chart here.

[Dreamless]

OpalRose,

Thank you for your reply!    Yes I have had this problem before, apparently it does goes away for a while.  

I think the only thing that is different this time is a chemo cream I am using for skin cancer.  I started using that in February.  I've read up on the side effects but I'm only using it on a dime sized spot on my ear so I'm not sure if it could be causing the problem this time.  ??

Here are a couple of nights from this week. 

   
   

Thank you again.
 -Dreamless

[OpalRose]

Thank you for posting your charts.  
I'm going to alter your thread title slightly to attract some help with your ASV settings.  

I know it can be frustrating to try and get a decent nights sleep.  Waking up frequently can take a real toll.  

I hope you find some relief from this so you can get some rest.

[Dreamless]

OpalRose,

Thank you for your help!  I really appreciate it. 

Dreamless

[SarcasticDave94]

What I would suggest to consider as pressure edits would be drop both EPAP Min and PS Min by 2.

The settings appear to be currently
ASV Auto mode
EPAP 9-11
PS 6-11

It's possible you're starting too high on EPAP 9 and getting hit with too high initial PS at 6. Editing both will maybe add in some comfort without sacrificing therapy effectiveness.

New settings
ASV Auto
EPAP 7-11
PS 4-11

[Sleeprider]

That is a very unusual ASV chart with persistently high PS and extremely high tidal volume and minute vent. You basically have zero spontaneous breathing. Can we zoom in on a 3-4 minute segment to see the respiratory wave and mask pressure? As Dave suggested above, that is a very high EPAP and minimum PS, but your machine is cranking out the maximum PS of 11 all the time. That does not seem right. My biggest concern is the median tidal volume of 1400 mL and 10 L/min minute vent with a respiration rate of 7 BPM. Call your doctor. This isn't right.

[Dreamless]

Last night we changed the Epap Min and PS Min down 2 per Sarcastic Dave's suggestion.  So now the Epap is 7/11 and PS is 4/11.  Last night I had a pretty good night of sleep - first time in about 4 weeks or so.  

Sleeprider - you mentioned seeing a 3 to 4 minute segment... please see attached chart and let me know what time you'd like to see and I'll do that.  You also are concerned about the tidal volume, when I was on Respironics bipap (prior to the middle of Sept 2021), those numbers were quite a bit lower.  The DME set this new Resmed machine to those settings that were on the Respironics machine and the first 2 nights were completely intolerable.  I called the DME provider and never got a response about it and we made changes ourselves to lower that IPAP Max down from 30.  When the doctors see the data and say, oh you're doing good, keep up the good work.     Lot of help there.


      
   

- Dreamless

[SarcasticDave94]

Yep that's a common doctor response about Apnea. If it's under AHI 5 you're doing great. And you must believe it or doc thinks you're mental. According to them that is.

Besides the high tidal volume and a likely you high leak rate, things look better in the OSCAR stats. You say you sleep better, OK we're on the right track.

One issue that occurs with anyone that goes from Respironics to ResMed is that the numbers don't always work well as a simple copy/paste because ResMed works differently.

[Sleeprider]

This result looks very good. As a radical suggestion, it would be really nice to see what happens if you set the machine to something near the default settings so we can observe in data if events become present with the lower starting pressures. Those settings, modified based on your results to date are ASVauto mode, EPAP min 5.0, EPAP max 10.0, PS min 3.0, PS max 12.0. One important change is when you mask up, you should be completely relaxed and your respiration has settled closer to your sleeping respiration rate.

The Resmed ASV targets the user's minute vent, and when you mask up with an abnormally large respiration volume or rate, the machine tries to maintain that, even though you are now relaxed and sleeping. Your charts show a very high flow rate when you first start therapy, then the machine kicks in pressure support to keep that high volume. Compare to the second session after 05:00 when you start with a lower respiratory volume, the machine has much more variation in pressure support, and your respiration looks much more normal here. I hope that is clear. You really need to give the machine an appropriate resting respiratory target when starting. Future graphs, might be better to see the Advanced View which has respiration statistics. Just us the menu in Oscar View/Reset Graphs/Advanced, then take the screenshot. Your leaks are relatively high, but may be a function of high pressure.