Getting used to ASV pulses

[JesseLee]

Also, how or why was ASV the first machine you obtained? Would you mind posting a copy of your sleep study?

[b.e.wilson]

I need to scan it. Summary is:
No mask: 28.4 AHI (all OSA)
CPAP@5 cmH2O: 36.7 AHI (All central)(C-flex = 3)
CPAP@7 cmH2O: 96.6 AHI (All central)(C-flex = 3)
ASV (5-9, PS 0-15): 3.2 AHI (All central)

As I look at the breath patterns, after some of the large pulses there is a minute or two or periodic breathing. Seems odd, the cure for not breathing (a pulse) induces more episodes of not breathing (by using elevated pressures).

[JesseLee]

I need to scan it. Summary is:
No mask: 28.4 AHI (all OSA)
CPAP@5 cmH2O: 36.7 AHI (All central)(C-flex = 3)
CPAP@7 cmH2O: 96.6 AHI (All central)(C-flex = 3)
ASV (5-9, PS 0-15): 3.2 AHI (All central)

As I look at the breath patterns, after some of the large pulses there is a minute or two or periodic breathing. Seems odd, the cure for not breathing (a pulse) induces more episodes of not breathing (by using elevated pressures).

Your numbers definitely have you in for ASV therapy. AHI of 3.2 is not too bad. Let me recommend instead to simply aim at your pressure pulses. So your settings will look like this: min EPAP 5 , max EPAP 9. Min PS 1, max PS 8. This more gradual approach will help with aggressive feeling pressure pulses, while keeping the risk of increased centrals to a minimum.

[Sleeprider]

I think your results look pretty darn good. Your EPAP never seems to rise, and remains near 5.0 through the entire session. I am not tempted to raise your EPAP min based on this. I think it may be useful to set PS min to 2.0 to help clear some flow limitation and possibly hypopnea. The posted report did not include a summary of events, but it doesn't look like things are out of control and you have more spontaneous breathing than many ASV users I have seen. The occasional periodic breathing does not look like much of a problem, and the machine is using pressure support to encourage more volume on the low-points of those events.

[b.e.wilson]

I'm not too disappointed with the results so far. But there is a thing that happened when I'm awake that's keeping me awake. I'll stop breathing, get a big pulse, then as the pulses subside (as per the programming) I start to drift off, and just as I begin a dream, I get another big pulse. Four-breath cycles. I think it may be either the pressure,e or the volume stimulating this four-breath cycle thing. Eventually I sleep through a pulse, and stay asleep for a while. I'm thinking of lowering my PS max again, from 8 to 4. I want that pulse to keep me going, but not so much that I wake. On PSmax=8 it felt just like PSmax=15.

[JesseLee]

I experienced exactly the same circumstances. While awake, if I took a little to long exhaling, the machine would begin to issue pressure pulses. By my experimentation, I found that you can train your machine and yourself. While on the machine I would practice breathing long and slow exhales. The machine calmed down. It wouldn't hit me so quickly with a pressure pulse if I didn't start my inhalation before the machine thought that I should. I'm not exactly sure how long your machine (Dreamstation) takes to write and modify the data it collects about how you breath, but it certainly does. It may take some time to get the machine trained to your breathing characteristics, but the breathing exercises helped my machine (Aircurve ASV) to let me have a little more time before it started to issue pressure pulses.

[Spy Car]

Here's to hoping you get your ASV machine tweaked properly. FWIW my ResMed ASV may do a pressure spike occasionally. As far as I know I don't get, or at least notice, anything like your pressure pulses. Unless these are the same thing, or I may get them while sleeping. And the more mine gets used, the better my therapy results become. Makes the fight to get this thing all the more worth it.

Reading the thread, this fellow ResMed ASV user has been wondering what is a "pressure pulse?"

Like you, I have not noticed anything like this, unless it refers to the sort of pressure spikes I typically got in the beginning period of starting ASV (and typically just as I was in sleep transition).

Like you Dave, I would use the "blow back" method (forcefully exhaling into the mask) to settle the machine down. These (to me very annoying) spikes have mostly faded away. I don't know if the machine trained me, or if it learned my patterns or a combination of both, but those spikes of high pressure (the only negative part of otherwise delicious ASV therapy AFAIK) are basically gone.

I'm just not sure if that's what the OP means by a "pressure pulse?"

Bill (having coffee )

[b.e.wilson]

By "pressure pulse" I mean the increase in pressure according to the pressure support programming, when the device has figured out that I'm not breathing anymore. I'm cruising along at 5 cm and it jumps to 10 cm about three seconds after the last breath, or two seconds after the next breath was expected. Ish. The big pulse is followed by a series of decreasing pulses to get my breathing back to normal.

[SarcasticDave94]

OK I think I have an idea what you're meaning, and I am making an uneducated and uninformed guess here. Is it possible the pulsing thing is specific to a Respironics machine? Or I suppose the PR and ResMed both do this, but in ways that "feel" different to the user. Anyone feel free to share enlightenment to me.

What's described here is not something that sounds anything like what I have dealt with on my ResMed AirCurve10 ASV. Like Spy Car, I have had my ASV give me high pressure while transitioning to sleep at times. I did the "blow back" to get it back in line. After a few times of that happening at various nights use, it obeys lots better for me.

FWIW I have not used the PR DreamStation ASV, but I did have a BiPAP (model 700 something or other) in the DS prior the current ASV.



PS thanks for clarifying for me, b.e.wilson. Sincere hopes this ASV gets better each time you use it.

[Spy Car]

By "pressure pulse" I mean the increase in pressure according to the pressure support programming, when the device has figured out that I'm not breathing anymore. I'm cruising along at 5 cm and it jumps to 10 cm about three seconds after the last breath, or two seconds after the next breath was expected. Ish. The big pulse is followed by a series of decreasing pulses to get my breathing back to normal.

Thanks for clarifying. I initially had issues with my ResMed ASV (as mention in a PP) as it seemed my breathing pattern just as I was entering sleep would set off the device. I believe I typically took a deeper than usual breath and held it a little longer, and I'd bet blasted (thereby ending the transition to sleep).

That cycle has largely passed for me. Again, not sure if the machine "learned" or if I was "trained" or both. I was never aware of pressure increases otherwise.

Ones that disrupt sleep are quite annoying and counterproductive to good sleep.

I hope you get it sorted soon!

Bill