New Aircurve 10 ASV machine - help please

[Spy Car]

I asked my sleep doctor--not a slouch, he came out of the Stanford Sleep Clinic--after my second sleep demonstrated the efficacy of ASV if now I'd need an ECG? I was expecting yet another hurdle.

He said, you have no history of heart disease and said if I had a low ejection fraction of <45 that I'd have clear symptoms (like not being able to walk short distances without feeling winded.

I was very happy to get an ASV the same day.

Bill

[Sleeprider]

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.

On-going issue...don't worry about it.

[Spy Car]

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.

Based on a single deeply flawed study where participants were non-compliant in their usage (average 3.4 hours) and did not use optimized settings, and using an algorithm that has since been changed.

That flawed study ran entirely against the results of previous small studies, metadata analyses, and clinical practices where ASV had positive results in this low ejection fraction subgroup according to the experts.

Which you know.

Here are the results of SERVE-HF as reported by ResMed (in bold, emphasis added):

Results showed no significant difference between patients randomized to ASV and those in the control group for the primary endpoint of time to all-cause mortality or unplanned hospitalization for worsening heart failure (based on a hazard ratio=1.13 , 95 percent confidence interval [95% CI] =(0.97, 1.31)), p-value= 0.10). However, there is a statistically significant 2.6% absolute increased annual risk of cardiovascular mortality for those randomized to ASV therapy compared to the control group. In the study, 10.2% of the ASV group experienced a cardiovascular death each year compared to 7.6% of the control group, representing a 34% relative increased risk of cardiovascular mortality (HR=1.34, 95%CI=(1.09, 1.65), p-value=0.006).

So a 10.2% risk cardiovascular mortality in the group of very sick and on average non-compliant users of ASV vs 7.6% of the control group.

That's a 34% increase, not a 500% increase.

Bill

[SarcasticDave94]

Sleeprider has chosen the same PS numbers as I'm using. And agreed that is typical from what I see. There tends to be more differences when it comes to EPAP settings. Trust me on this, his suggestion for settings will be pretty close to what's needed. I'm also on-board with the heart issue in that if yours was bad enough to fail allowance onto an ASV, you'd be getting checked for it by a cardiologist already IMO. Best wishes on getting this worked out. This ASV, when set properly for you, will do an amazing job for you.

[ajack]

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.

A doctor will be able to check out some of the medically treatable causes of this recent aerophagia, like GERD, or a hiatal hernia. You may already be aware of using a wedge pillow. I actually lifted the head of the bed so that I sleep on a slope.

@spy, There was an overall 34% compared to the control group. I have shown you the data from the people who did the trial, about the subgroup with low EF that had the larger risk. It would be best to take this to a new thread

[trish6hundred]

Hi Kolaphos,
WELCOME! to the forum.!
Good luck as you continue CPAP therapy and also with getting your new machine fine-tuned.
You have come to the right place for guidance, I look forward to hearing how things go as you get adjusted to this new machine.

[Kolaphos]

Hi Kolaphos,
WELCOME! to the forum.!
Good luck as you continue CPAP therapy and also with getting your new machine fine-tuned.
You have come to the right place for guidance, I look forward to hearing how things go as you get adjusted to this new machine.

Thank you, trish6hundred.  I used the settings that were helpfully suggested and got a decent night's sleep last night (the machine reported AHI of 4.75 or so).  More importantly, no more aerophagia episodes!!  I was going to wait a few nights to get some better data before posting.  I've begun to realize that I waited way too long before posting here.  The collective knowledge on this board is amazing.  There's no doubt that if you guys are kind enough to continue giving advice, I could get my AHI down to under 3 on a regular basis.

[Kolaphos]

Well I've been using the new Aircurve 10 ASV for a few days now, and holy cow, what a difference from my old PR System One! My AHI is regularly less than 2, I'm sleeping longer than I have in years (8+ hours), and I feel fantastic. That's with the settings that you so helpfully recommended. Is it worth posting Sleepyhead data to try to fine tune more, or should I just leave well-enough alone?

[Sleeprider]

That's fantastic. Dive in and watch your life come back is what I've seen from member after member here.

[SarcasticDave94]

Well I've been using the new Aircurve 10 ASV for a few days now, and holy cow, what a difference from my old PR System One!  My AHI is regularly less than 2, I'm sleeping longer than I have in years (8+ hours), and I feel fantastic.  That's with the settings that you so helpfully recommended.  Is it worth posting Sleepyhead data to try to fine tune more, or should I just leave well-enough alone?

Congrats on the success. IMO the answer to your question would be based on you stating how you feel is fantastic. I'd not change things to possibly leave fantastic.