New Aircurve 10 ASV machine - help please

[Kolaphos]

Hi - 
So here's my story, followed by questions.

I was diagnosed with mixed apnea back in 2012. I've been using a PR System One since then, with pretty good results (average AHI of between 4-6 for all these years). Until two weeks ago, when it decided to give me "system inoperative" errors repeatedly. Anyway, I had been looking at getting a new machine already, so I bit the bullet and ordered an Aircurve 10 ASV. It was supposed to be configured by the provider, since I provided my prescription (EPAP 9; Max PS: 20; Min PS 8).

I tried using it for the first time last night, and after about 1.75 hrs I literally vomited into my mask, almost aspirated it, and then burped out the most massive quantity of air. Sorry to be gross - not a great introduction for a newbie. Needless to say I stopped using it last night, with the intention of researching what was wrong today. I've done a LOT of reading today, but still have many questions. A few additional data points to note: On the new machine, it was configured with the following settings - 

Mode: AutoASV
Min EPAP: 8.0
Max EPAP: 9.0
Min PS: 6.0 (this is the highest the machine will allow)
Max PS: 17.0 (this is the highest the machine will allow)
I cannot find a setting for EPR at all, but Sleepyhead indicates that it is not turned on.

My old PR System One settings:
Max Pressure: 20
EPAP Min: 9
EPAP Max: 9
BPM: Auto
PS Min: 8
PS Max: 11
BiFlex (which is guess is the same as EPR): 3

I've been reading about aerophagia today, and given that I do have GERD (and take medication for it), I think that what happened last night was a massive influx of air into my esophagus and stomach.

Questions:
1. Why does my prescription indicate Max PS 20 and Min PS 8, if the Resmed machine won't allow those settings? Why would PR System One allow those settings, but the Resmed Aircurve doesn't?
2. Why would my prescription say PS MAX 20, but my PR System One be set up to PS MAX 11? I do not believe I ever changed that setting. 
3. Does the Resmed Aircurve 10 ASV allow me to set the EPR? Could that have been disabled by the provider who configured the machine (and why might they have done so)? In the clinician manual, it doesn't give any details at all about EPR (there's one reference to it, but is just says "if EPR is available". How to get it since it doesn't currently show up in any of the menus?

My current plan (and please let me know if this is the right approach):
1. Lower my PS Max setting to 11 from 17.
2. Call the provider to try to get access to EPR settings (assuming they exist), so that I can set that to '3'.

Does anyone have any other ideas? I'm dying of exhaustion, since I have been without a machine going on 2.5 weeks now.
I really appreciate any advice anyone might have.

Oh, and I can attached the 1.75 hours worth of Sleepyhead data from last night, if that helps.
Thank you!

[ajack]

You were prescribed an ASV or you self decided and used the bpap script to get one? You need an echocardiogram to check out your ejection factor because of sudden cardiac death with some people.
Go back to the doctor to change the script or arrange another sleep study to titrate the ASV and asses your suitability to use an ASV. You wouldn't normally just use your bpap numbers.

[Kolaphos]

No, I was prescribed ASV based on two sleep studies done in 2011 and 2012, and then done again two years ago.  I didn't decide to do so on my own - especially given that I could get a CPAP for $3500 less!

From my 2012 sleep study: "RECOMMENDATIONS: The patient should use ASV nightly at settings of EEP 7 cm. of water, IPAP minimum of 11cm of water, and IPAP maximum of 22 cm of water with a heated humidifier.  Mask size and style should be determined at the time the equipment is dispensed to the patient. "

But what you say worries me a bit.  The original lab (first two studies) was very professional and seemed very legit.  But the study I had two years ago was at a lab I wouldn't go back to, and I didn't trust the doctor.  The numbers I gave you are from that second lab.  Did they use a prescription using bpap figures?!

Oh - now I see: I should have said that my original PR System One is an "autoSV advanced". Maybe not saying so caused confusion.

[SarcasticDave94]

I can tackle what I know here. I have the same machine. Unfortunately or otherwise, EPR is not to be found in this ASV. Running in ASV Auto, you will have EPAP Min and Max, and PS Min and Max. IPAP is automatically determined by the per breath algorithm which equals EPAP plus PS.

[ajack]

Did the doctor do an echogram? because all the rules changed in 2015. You really should go back to the doctor first.

" ASV nightly at settings of EEP 7 cm. of water, IPAP minimum of 11cm of water, and IPAP maximum of 22 cm "
what the setting is is manual epap 7 min ps 4 max ps 15
I would change this to auto, min epap 6 max epap 15, min ps 0 or the default 3, max ps 15 and then get some sleepyhead charts up.
This titration guide with help you understand how it is titrated on page 41, initially you move the min epap up until the UA and H settle down, then look whether there is enough PS, as you go.
https://www.scribd.com/document/35340282...-Titration

[Sleeprider]

Good grief ajack! Give the ASV danger a rest!

Kolophos, your new Aircurve 10 ASV is a bit faster to supply pressure support and pressure increases. Your old machine was set at a fixed EPAP pressure of 9 with pressure support of 8 to 11. The new machine is similarly set to an auto EPAP pressure of 8 to 9, but was allowed PS 6 to 17, which would have created a maximum IPAP pressure of 26 cm. That is a lot higher than the 20 you had on the PRS1 ASV.

This can be easily fixed. Let's try a little wider EPAP pressure range and make sure you need the high EPAP pressure. An EPAP min of 5.0 and EPAP max of 10.0 will encompass your old prescription. If we're lucky, you will stay nearer the lower range based on your needs, but if you need the higher pressure it will be there. Use PS in 3.0 and PS max 12.0. These settings are pretty good for most users I have seen, but we can fine tune.

This will avoid the high pressures that caused the severe aerophagia, and should let us see what your real needs are. Be sure to download #Sleepyhead and we will be able to see precisely how these pressures work out.

[ajack]

For the population this affects, it is a very serious thing and shouldn't be discounted. A 5 times death rate with low ejection rate is serious. I know the doctors don't take it lightly. I'm sure you wouldn't suggest using an ASV without a medical clearance.

[Sleeprider]

[ajack]

me too mate, I think it's irresponsible for members of a forum to discount the medical experts on such a serious matter. A review with the doctor could also shed some light on the current aerophagia, it is treatable in some cases.

[Kolaphos]

First, thank you all for taking the time to reply.  I very much appreciate it.

AJack - noted, though each of the studies seems to have included an echocardiogram.  Regardless, I was planning on going to a doctor as soon as I can find a decent one, but given my schedule over the next few weeks (lots of travel for work) I doubt it will be before another month from now.  Still, I appreciate the recommendation to play this carefully, since I didn't realize the degree to which this could be related to cardiac events.

SarcasticDave - thank you so much. I was looking and looking for the EPR, and thought that either I was missing it or is was some kind of problem with the set up.  You saved me lots of time, since I would have ended up calling the DME.

SleepRider - Thank you for your help.  I think that your interpretation of my post was correct (even though I wasn't able to state the question correctly) that I want this machine to function within the range of what my old machine was using.  I'll try those settings and then report back with Sleepyhead data.

I'm sorry that my post inadvertently caused a dispute.  All I want is to get within the realm of a decent night's sleep, and avoid the unpleasantness of another serious aerophagia episode.

I'll report back soon.