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New ASV User - Not sleeping through night
#1
New ASV User - Not sleeping through night
Hello,

I was hoping someone more experienced than I, could take a look at my charts and settings, and let me know if anything appears out of the ordinary.

I started this journey with a high AHI over 30, and insurance only let me do a home sleep study, so CPAP was prescribed (ResMed AirSense 11). This did not work for me, and an in-person sleep study was approved, where I was told I had Central and Obstructive Sleep Apnea, and would require VPAP ASV. I purchased a refurbished AirCurve 10 ASV, instead of letting the DME take their time to get me a machine (as this has already been nearly 2 years since I started this journey).

Anyway- my AHI looks like it has dropped dramatically, but I still am waking up during the night, and not able to use the machine for very long (ranging from 2 - 4 hours a night).

Last night I noted I was woken up by the machine emitting a louder whirl and huge pressure increase, it happened around 1:45 am - I'm not sure what exactly happened, I suspect maybe a leak - but the leak alarm did not go off. I also often feel like the pressure is way too high, and it makes me take the mask off. Should I try lowering the pressure (which setting? - - PS Max?) or do I just need to keep trying to get used to ASV?

Can someone take a look at the attached charts and provide some guidance or interpretation? If there are any additional charts I should post, please let me know.

Thanks so much.

V/r,
Wex

ResMed AirCurve 10 ASV
EPAP 14.00
Max IPAP 23.20
PS Min 2.00
PS Max 10.0

Additional charts...


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#2
RE: New ASV User - Not sleeping through night
I would suggest a few things. Get your sleep study detailed reports and post it redacted here. Call the ordering physician's office and request this report. If they tell you that you have no need for it, remind them that HIPAA law permits you to request and receive it.

On the ASV, I would redo the setup. I would use ResMed default Titration for ASV Auto as it gives an EPAP Min and Max, where you have a single EPAP now. That high EPAP, narrow PS range, and using Ramp are probably not the best setup for ASV usage.

Try this:
Mode ASV Auto
EPAP 4-15
PS 3-15
No Ramp

I would also get the free report tool OSCAR from the link at the top of this page or within the name OSCAR in this sentence. It needs to be installed on a computer. You will need to get a standard form factor SD card, that is any brand, between 2-32 GB capacity. Beyond that specific SD card info, get the cheapest you find. It does not need to be a ResMed card. Place that in the SD slot under the rubber door flap on the left side of your ASV. The SD needs to be in place before detailed data is saved for OSCAR usage. After a night's use, post the daily detail screenshot, showing Events, Flow Rate, Pressure, Leaks. Skip Flow Limits as treating these are counterproductive to Central Apnea therapy.

After seeing OSCAR data and you telling us how you felt, we can suggest further edits from there.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: New ASV User - Not sleeping through night
Thanks for the response Dave- 

Are you unable to see the attachments I posted from OSCAR in my initial two posts?

Best,
wex
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#4
RE: New ASV User - Not sleeping through night
I did see them. That's where I've gotten the current setup info. I do think once that rearrangement of settings is done you'll feel more comfortable for it.

PS a further peek at the charts shows you've got some leaks to look after as well.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: New ASV User - Not sleeping through night
Dave et. al,

Thank you for your suggestions. I tweaked my settings to what you had suggested - and it seemed to be more comfortable - it didn't seem like their was overwhelming pressure like previously - in fact, it almost seemed like there wasn't enough pressure where I was wondering if it was working. The numbers still appear to be pretty low - I'm still not sleeping great, but I think last night was an improvement. I am still pretty amazed, I went from an AHI over 30, and was still seeing that number with a regular CPAP machine (which I could not tolerate well at all) - and now with this ASV, it seems to be in the normal range - which is pretty amazing to me - as I have been suffering for quite some time.

Here are my charts, ordered as you suggested, if there are any additional charts I should post, please do let me know.

Thank you so much for your help - it is greatly appreciated.

Best,
Wex


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#6
RE: New ASV User - Not sleeping through night
It looks a lot better. If you want to add a touch more air, and this may address the small amount of Hypopnea if you choose, add 1 to your EPAP Min. This should then make EPAP Min 5.0. Similar process as before, edit this one setting, then go a night with it if at all possible, decide how you felt overnight, look at OSCAR and take the screenshot to post. Tell us how it went.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: New ASV User - Not sleeping through night
Dave et. al,

Thank you again for all of your insight. Attached are my charts from last night - I added 1 to EPAP Min as suggested. Although I fell asleep before putting on my mask, I did get some time with the machine (two sessions- totaling about 2hr30min). I'm trying my best to increase the amount I use the machine, but it is still difficult. I believe it is still beneficial getting some sleep without as many events.

Attached below are my charts for last night. Appreciate the help.

Best,
Wex


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#8
RE: New ASV User - Not sleeping through night
OK, besides shorter than optimal duration, how did the therapy feel after the edit? Numbers look good so I believe you're after best feel for therapy use now.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: New ASV User - Not sleeping through night
Dave -

I think it felt much better. I will be able to get a better sense after a few nights with the changes..

Thanks!
Wex
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#10
RE: New ASV User - Not sleeping through night
OK copy. Check back in another few days and tell us if it's getting better. Myself on ASV, I had between 0-3 AHI for 2 years and was the better for it in that area. Just don't fall down the rabbit hole of zero events or bust.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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