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[carl47715]

Not sure if this helps.

[carl47715]

Now that I look at this I have tried ASV. sorry for any confusion.

[vsheline]

Now that I look at this I have tried ASV. sorry for any confusion.

Hi carl47715, welcome to Apnea Board.

Do you still have your ASV machine?

The pressure settings were very high, and I'd suggest starting with less intense pressure settings, and (perhaps more importantly) I also recommend taking precautions to avoid sleeping in the supine (flat on back) position.

The Obstructive Sleep Apnea portion of the problem is usually strongly positional and usually can be mostly avoided by not allowing ourself to roll into the supine position while asleep.

By using the free SleepyHead data plotting computer program to look at the data stored in the machine's SD memory card, we can see how much pressure our machine is providing every minute of the night, and can learn to spot times when we have probably rolled onto our back, resulting in the pressure getting raised. (The other thing which commonly causes us to need high pressures is REM sleep stage, and REM stage sleep while we are supine is usually worst of the worst.)

Some of us place a couple tennis balls in pockets or in a sock sewn on a snug teeshirt sewn along the spine right between the shoulder blades or higher. Others wear a light knapsack with something light but bulky in it. Others place long body pillows under the bottom sheet to help us stay on our side. Others sleep in a comfortable reclining chair, so that the head can be elevated. Whatever it takes ...

ASV machines quickly adjust (breath by breath) the Pressure Support (PS). PS is the amount by which the pressure is being boosted while we are inhaling, to help us inhale. When we are exhaling the pressure drops to a lower pressure called EPAP. The pressure during inhalation rises to what is called IPAP. PS is the difference between EPAP and IPAP, and the higher the PS the easier it is to breathe in and breathe out.

By the time PS has been raised to around 10, the machine is doing for us just about all the work of breathing, for a person with normal lungs. I think although 15 may have been your ASV machine's default value for Max PS, I think few patients need that high of a value for Max PS and it is often unnecessarily bothersome if the Max PS setting is higher than around 10.

To start with, I suggest trying a lowered Max PS of 10 or 8, and you could gradually work back to a higher Max PS after you find solutions to the Leak problems. When the Max PS is as low as 8 it might not be able to fully eliminate as many central apneas, but it would still be helping a lot.

If keeping off your back allows the machine to keep EPAP at its Min EPAP value pretty much all the time, then the Min EPAP setting can be gradually lowered until it is usually around 1 cm H2O below our nightly average EPAP.

The lower the pressures, the easier to control leaks.

I need to use high pressures and a Full Face Mask and have found that I must use a cloth Mask Liner. Using a liner takes a while to get used to, but it completely stops the mask from bothersome mask flutters/burping/trumpeting. What leaks remain are softer and not as bothersome. I use RemZzzs brand, which recommends using a fresh liner each night. I ignore the directions by being careful to not let the liner get stretched out at all and usually can use one for about a week.

Take care,
--- Vaughn

[Sleeprider]

Your attachment does sum it up pretty good. Under the titration study, they had you at EPAPmin 10, EPAPmax 15, PS 2-15 and you still had 23 events per hour, but based on only 13 minutes of sleep. That's a tough case. Did you get an ASV machine for home?

[trish6hundred]

Hi carl47715,
WELCOME! to the forum! and, much success to you.

[ST1300]

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