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Need ASV Tips/Advice
#1
Need ASV Tips/Advice
So, I finally got my ASV machine, a Resmed aircurve ASV. My backstory is here in this thread http://www.apneaboard.com/forums/Thread-...stand-data  So the machine itself works as it is supposed to I believe. my AHI is down and the centrals are gone but I feel worse than ever because I can't seem to sleep at all and when I do for a few minutes I wake up bloated from swallowing air.  I've lowered my max pressures a little bit and it seems to help the aerophagia and arousals but it made my AHI go up just a bit and I still wake up multiple times an hour leaving me exhausted. As soon as my centrals are detected the pressure ramps up and wakes me up. If I do manage to stay asleep for more than a few minutes it pumps up my guts. I realize that these are fairly common problems and they may subside in time but right now I need to sleep more than I do, so my question is this.... can I lower my pressures even more at the cost of my treatment effectiveness in order to allow myself to sleep more and adapt to the machine and then raise pressures as needed to lower my AHI as my body gets used to it?  My max pressures seem to be close to the limit in a couple of spots throughout the night so I was hesitant to lower it more without getting some advice. the thing is, going through the daily graphs it only gets close once or twice over the night and most of the time its at a lower pressure. im thinking that even if my treatment is less effective at these rare instances that my overall comfort will be better for now untill I can recover some sleep. I'm attaching some sleepyhead data, (went out and got a newer computer just so I could get sleepyhead lol) so I hope I can do it right. the first graph shows what was happening immediately before I woke up with pretty bad bloat. The IPAP at this time was near max this was a night with low ahi.  The second shows a night with slightly higher (still well within the "treated" range) AHI but I had lowered the pressure max and feel like I slept better and swallowed a little less air. I zoomed in on a spot where the pressure was quite a bit higher than most of the night and my respirations at this point look a bit "ugly" and strange but this was a rare spot and I may have even been awake at this time so I'm not sure if the EPAP being high at this point means anything.  I look forward to any tips and advice that anyone might have, thanks!


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#2
RE: Need ASV Tips/Advice
@TheMacGyver,

One tip we ASV users use has been dubbed the "blowback" method by Sarcastic Dave. The idea is that when the machine starts blowing too hard, one exhales strongly (as in almost over-blowing) into the mask. After a few such breaths, this technique settles the machine down.

It was my experience (and common with reports of other ResMed ASV users that this struggle with the machine overpressurizing tends to fade. I've said it before, but I'm not sure if the machine "learns" to read us, or if we get "trained" by the machine, or a bit of both. But users and ASVs do seem to fall into sync.

The blowback technique helps. If it isn't enough, I'd lower pressure so you can get some sleep.

I tend to defer to gurus here on pressure settings. But getting sleep is critical.

I hope you have a better night. When you get in sync with the ASV (as I'm sure will happen) it is a very positive technology. Hang in there!

Bill
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#3
RE: Need ASV Tips/Advice
Congrats on the new machine.

Spy Car Wrote:One tip we ASV users use has been dubbed the "blowback" method by Sarcastic Dave.

Actually it was called that by me. I just let Dave use it on a royalty-free basis. Smile The blowback method can be very helpful if the machine gives excessive pressure while you're transitioning to sleep, but obviously it doesn't work when you are already asleep.

Looking at your overall results it's obvious the machine is doing its job in controlling your apnea, but if you're not getting restful sleep then your overall health target is not being achieved. I think it's a trade-off between comfort and efficacy, and in your position I'd be prepared to experience a few more apneas if it meant I got a better night's sleep overall. Probably the easiest step to take at this stage is to drop the pressure support a bit further. Keep lowering it by maybe 0.5cm at a time, monitor it for a few nights and see what happens. I suspect the hypopneas will rise, but at some point you'll strike the balance you need.
DeepBreathing
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#4
RE: Need ASV Tips/Advice
I'm really new to all this, but yeah, try dropping the pressure way down. Maybe even set the range at just 6-8. Yeah, this might sound crazy, but it sounds like you're not getting much sleep anyway and if you're max pressure is only needed a few times a night, well maybe you can just let those events happen like the good ole days before your machine. My recommended pressure was 8 but it was making me swallow air, especially when laying on my side. I dropped it down to 6 in straight cpap mode with EPR of 3. I still swallow air on my side but on my back I'm fine. And my AHIs are still under 3.

Note, I didn't look at your charts, and I'm definitely new to all this so take everything I say with a grain of salt.
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#5
RE: Need ASV Tips/Advice
MacGyver, it would help if you could describe the process by which you got to your current pressure settings of EPAP 6.0 to 9.0 PS 3 to 11 and max pressure 20. Given that you have only a few hypopnea, it might be possible to lower your pressures without a significant adverse impact on your event rate. The minimum EPAP your machine can produce is 4.0, and the minimum PS is zero. Your current results are very good, but have you considered lower EPAP and PS minimums?
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#6
RE: Need ASV Tips/Advice
Good to hear from you Macguyver and glad you got your machine.

You are getting some great advice from the great folks above and I cant offer any better other than to follow their advice.

I can say that the ASV acts completely different compared to traditional therapy and in my opinion will take a little longer to adjust to. But once the machine is dialed in and you have become acclimated, the therapeutic value is phenomenal.
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#7
RE: Need ASV Tips/Advice
(05-24-2018, 11:55 PM)DeepBreathing Wrote: Congrats on the new machine.

Spy Car Wrote:One tip we ASV users use has been dubbed the "blowback" method by Sarcastic Dave.

Actually it was called that by me. I just let Dave use it on a royalty-free basis. Smile  The blowback method can be very helpful if the machine gives excessive pressure while you're transitioning to sleep, but obviously it doesn't work when you are already asleep.

Looking at your overall results it's obvious the machine is doing its job in controlling your apnea, but if you're not getting restful sleep then your overall health target is not being achieved.  I think it's a trade-off between comfort and efficacy, and in your position I'd be prepared to experience a few more apneas if it meant I got a better night's sleep overall. Probably the easiest step to take at this stage is to drop the pressure support a bit further. Keep lowering it by maybe 0.5cm at a time, monitor it for a few nights and see what happens. I suspect the hypopneas will rise, but at some point you'll strike the balance you need.

Duly noted. 

For me anyway, the tricky part of the ResMed ASV was its tendency to blast just as I was entering the sleep transition. The one huge annoyance with an otherwise brilliant device.

Blowback (and time) have tamed that problem. Seems like many of us pass through this phase.

Bill
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#8
RE: Need ASV Tips/Advice
Thank you all for the great responses!! I plan on lowering the pressure incrementally. I have been employing the blow back technique but as some others have experienced, the pressure only bothers me as I'm actually dozing off into a peaceful sleep and then BAM! lol. This is when my centrals begin, during that important transition. Blowing back at this point helps for a while but the damage has been done as I am now awake again. I know I will adjust but until then I'm trying to get my pressure set to lowest effective values for now. I was thinking about this at work today and how to be more specific with my concerns and this is my main curiosity.... From what I've been able to find out so far about the Aircurve ASV it seems this machine makes no attempt at all to record or track central events. Their stance is "it just won't happen so why bother". Obviously though, if one set the pressures too low then the machine would not be able to provide proper ventilation during a central event. With cpap/apap and obstructive events, too low of a pressure will result in a higher number of recorded events and a higher AHI, but with ASV how would one tell where this threshold of too low might be??  If the machine was set too low to adequately ventilate during centrals, might this show up as hypopnea? or would the only clues be hidden somewhere in a divergence of target ventilation and actual minute ventilation?  or perhaps a lowering of average tidal volume?? I think this is a valuable piece of information to anyone trying to adjust an ASV machine but I haven't been able to find out much about this specific scenario. With the high pressures that are already involved with ASV getting to settings in the lower range of "effective" seems ideal especially with those who don't also have issues with obstructive events. So, knowing what data to watch out for as far as how to know when settings might be too low for centrals would make me more comfortable with getting this thing dialed in, as I don't want to get too close to "the edge".
           Sleeprider, the first couple of nights I dialed back the max pressures just a bit and set the min pressures low. after that I used what the machine "thought" I needed and dialed the max pressures back further based on the max that the machine had set for the previous nights.  However after seeing the data on sleepyhead I realized that the max pressure set by the machine occurred infrequently. I now feel confident that I am safe to lower it a bit more, I just didn't want to go too far. I found that for some reason, even when I set the min ps to zero that the machine immediately raises it over the first few minutes of turning the machine on so I  went ahead and set it to 3 and found that this allows me to get used to it from the start. I think I will lower min EPAP. Should I try to also lower max EPAP and PS?
        I want to thank everyone again for their help. I went from being scared and clueless, to feeling somewhat informed and knowing that any problem that I run into can quickly be addressed by experienced people who are willing to help and that removes a lot of stress out of the situation!
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#9
RE: Need ASV Tips/Advice
Macgyver,

I'm glad that you are taking interest in this machine and getting very familiar with it. Your interest seems enthusiastic and spells out a good attitude. Kudos!

Correct me if I'm wrong, but it seems to me like your expecting the machine to breathe for you, which it will not. The machine will detect a central apnea and give you a bump in pressure to induce a breath from you. You can experience this while awake by exhaling and holding your breath. The longer you hold out, the higher the pressure will go. Again, correct me if I misidentified your train of thinking.

Sleep well sir!
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#10
RE: Need ASV Tips/Advice
Follow the protocol from Auto ASV. You can't go wrong.  You know you don't need 15 PS, so just go from there. The main area I disagree with the protocol is the start of minimum PS at 3 cm. Some people do better at a minimum PS of zero. This is logical since pressure support can increase CA, but you have to experiment a bit to see if you need the PS to avoid hypopnea, or if its better without it.

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