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Help with ASV Experience/Settings, coming from BiPAP ST
#1
Felt I wasn't getting as rested as I should be on BiPAP ST (set at 15/4 with backup rate 7), and since my diagnosis was Complex SA, the doctor set me up with an ASV.

I am curious if it's normal that I feel inhalation requires a fair bit of effort, as if there were some resistance. Almost feels like trying to suck air in through a thick air filter. I turned off ramp to see if that would help, and I think it did a little, but not much.

It's pretty much opposite of the BiPAP ST where when I even started a little inhalation, there would be a big release of air, which I actually found very easy to deal with and pretty comfortable.

I guess the two things that are weird to me is that heavy resistance while inhaling and the push/pull ease of the BiPap.

The Sleepquest tech set the Resmed Aircurve ASV at Min EPAP 5, Max EPAP 15, Min PS 0, Max PS 10, autoASV.
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#2
your minepap is pretty low, and you're likely not used to having a minimum of 0 ps.

though, if your reporting of your old prescription is correct, you had a HUGE ps on the old machine... and even lower min epap.
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#3
You breath in by using your diaphragm to create a partial vacuum that draws air in your lungs. You breath out by using your diaphragm to compress the air in your lung cavity outside the lungs, so that air is forced out.

Your diaphragm is a muscle, and like all muscles it adapts to stress by getting stronger. It is having to work harder than before to push air out so it might get a bit sore, just like your arm muscles would if you started lifting weights. Like your arm muscles on a weight lifting program the added exercise causes the muscle to partially break down and then rebuild itself stronger to handle the increased effort.

In a week or two your diaphragm will get "trained" and will be stronger and fitter and you will have little or no trouble breathing out. In the meantime you might find exhalation pressure relief ("EPR" helpful and you might even prefer to use it. That's fine unless your apneas and hypopneas are too high, and then you should probably work on training that diaphragm so you don't need it.
Ed Seedhouse
VA7SDH

Your brain is not the boss.

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#4
eseedhouse, I have no trouble breathing out, never have on my CPAP --> BiPap --> ASV journey.

I'm asking about breathing IN. It is almost suffocating in a way.
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#5
(03-18-2016, 03:18 PM)palerider Wrote: your minepap is pretty low, and you're likely not used to having a minimum of 0 ps.

though, if your reporting of your old prescription is correct, you had a HUGE ps on the old machine... and even lower min epap.

Just looked at my old BiPAP prescription to double check. Yep, 15/4 is what it says.
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#6
(03-18-2016, 03:48 PM)eseedhouse Wrote: You breath in by using your diaphragm to create a partial vacuum that draws air in your lungs. You breath out by using your diaphragm to compress the air in your lung cavity outside the lungs, so that air is forced out.

the diaphram contracts and pulls your respiratory cavity floor down, creating a vacuum, you're correct.

the diaphram *can't* force air out, any more than any other muscle can forcefully extend.
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#7
(03-18-2016, 04:11 PM)SimbaLion Wrote: eseedhouse, I have no trouble breathing out, never have on my CPAP --> BiPap --> ASV journey.

I'm asking about breathing IN. It is almost suffocating in a way.

Sounds like your pressure level as you breath in is too low. For instance APAP machines are often set "wide open" and it is common for new users to feel suffocated until they set the bottom pressure up a few cm.
Ed Seedhouse
VA7SDH

Your brain is not the boss.

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#8
(03-18-2016, 12:38 PM)SimbaLion Wrote: Felt I wasn't getting as rested as I should be on BiPAP ST (set at 15/4 with backup rate 7), and since my diagnosis was Complex SA, the doctor set me up with an ASV.

I am curious if it's normal that I feel inhalation requires a fair bit of effort, as if there were some resistance. Almost feels like trying to suck air in through a thick air filter. I turned off ramp to see if that would help, and I think it did a little, but not much.

It's pretty much opposite of the BiPAP ST where when I even started a little inhalation, there would be a big release of air, which I actually found very easy to deal with and pretty comfortable.

I guess the two things that are weird to me is that heavy resistance while inhaling and the push/pull ease of the BiPap.

The Sleepquest tech set the Resmed Aircurve ASV at Min EPAP 5, Max EPAP 15, Min PS 0, Max PS 10, autoASV.

Hello Simbalion,

I've been using the Aircurve 10 ASV for a few months and my experience is so different to yours that I wonder if either your loan machine is not working properly or your minimum pressure is too low for you. (IPAP minus EPAP = PS). I've read on the forum here that many people find an IPAP at around 4, 5, 6 (whatever the type of machine) to be too 'suffocating'. You perhaps could discuss this with your sleep tech or doctor. My suggestion would be to start by increasing your min EPAP to 6. If that makes inspiration more comfortable then you would be on the right path and you could then slowly further adjust your ASV settings, including increasing pressure support as required (a minimum PS of zero is low, I understand most ASVs are ideally set with a PS minimum of at least 3), by looking at your data with Sleepyhead and asking for advice on the forum if you need to.

I find inspiration with the ASV very comfortable and very 'aerating' - if that's the right word to use. My change to ASV allowed for much higher pressures (that I needed) than I could tolerate with CPAP/APAP and my diaphragm and chest muscles did take a week or so to get used to the different sense you get with an ASV and that my average tidal volume has increased from 420 (CPAP/APAP) to 500 (ASV) i.e. deeper breathing. My settings inflate my lungs very nicely! so I am sure you will find the correct settings to achieve that feeling for you too.

I hope it settles soon for you and that you achieve the same AHI results and sleep quality that I have with the Aircurve ASV.

best wishes, asjb

'Complex' apnoea due to OSA + CPAP-induced central apnoeas.
Currently EPAP Auto 12-14. Pressure support 6-11.
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#9
Hi SimbaLion,
WELCOME! to the forum.!
Hang in there for more suggestions and I wish you much success with your CPAP therapy and getting your machine fine tuned to meet your needs.
trish6hundred
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#10
G'day SimbaLion, welcome to Apnea Board.

I suspect your problem is with the PS min = 0. Effectively the machine is running like a CPAP at a very low pressure. The inhale and exhale pressures are the same until you have an apnea or hypopnea then it will start increasing pressure.

My suggestion is to set the PS Min = 3 or 4, which will give you a min IPAP of 7 or 8. Remember, it's the IPAP which controls inhalation. Changing your EPAP setting won't make any difference to your inhalation experience, but you may (or may not) need to set it a bit higher to counter obstructive events such as hypopneas and apneas.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


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