New to me, ASV, Initial Questions

[SarcasticDave94]

The old chart gives you an idea what you're dealing with. OK put it up.

That focus on Median is my plan of attack, it's OK to follow same but if another better idea for you presents itself go with that.

[Whitenoise]

Old 2018 Sleepyhead data S10 AutoSet 13 to 17 for comparison,

   

[Whitenoise]

I've completed trials of a week or more of ASVAuto Titration at   MIN EPAP 6   MAX EPAP 15   MIN PS 3   MAX PS 15 and will post a representative example for comment or suggestions as to what to try next regarding narrowing in on setting improvements.  I  felt more rested after the nights with the lowest Apnea duration times, more so than the AHI value it seemed.

Jim

   

[SarcasticDave94]

I'm not sure if positional Apnea had been discussed, but at least a few examples of Hypopnoea clusters may be just that, positional. A few unclassified events are present as well.

How is comfort in using the ASV? And are you beginning to feel any better for the usage?

I'd consider taking a critical assessment of the possibility of positional Apnea. Also consider a bump on EPAP Min. up to 7 from 6 (or a factional step between 6-7 maybe 6.6) and see if that addresses the unclassified. If this bump is done, note how it changes comfort, feel and events on OSCAR.

[Whitenoise]

Dave, No one has suggested positional apnea before, and I pretty much sleep on my sides. Comfort wise I do ok handling the ASV breathing, though I do wish the breath in was a bit longer as I only do 10 to 11 RR in a shallow thready manner. What does "backup rate to 15" mean and what would trigger more than my "natural rate?

I did just receive the F&P Vitera mask, but haven't done anything but a few quick mask fit tests where I have yet to find any consistent sealing despite varying strap tightness both loose and even holding the mask on my face trying to find a sweet spot. You'd mentioned you might have some tips from your own experience. I did also get that Resmed F30i I had ordered earlier, but with the same problem which is one I have yet solve. I may hold off and stick with what is working for the Titration results, for now, but that Dreamwear FF is really mashing my teeth, top of head, and back of neck to the point of headaches still.  10 years but still nothing even close to comfortable, so my oral facial structure is quite the non fit for everything I've tried.  

I'll up the EPAP MIN from 6 to 7.

[SarcasticDave94]

OK, positional Apnea would be when your neck is bent, as in your chin pointing towards your chest, then the angle restricts the airway. Side sleeping doesn't mean it's not applicable. Maybe look at the positional wiki just in case.

Backup rate is a respiratory breath rate, the backup is a setting where the PAP steps in to initiate a breath, if the rate drops. Your ASV has a backup rate, but it's auto controlled by the algorithm. So if something is pushing that up, it may be higher than normal rates kicked by anxiety or similar. IF you backup rate were adjustable, you'd want it about 2 clicks below your normal.

Vitera mask:

1. Lie back on the bed, hold mask onto your face rather lower down than others you may have tried, run PAP on therapy pressure & loosen all straps
   
2. Holding mask in place, try to determine the tension necessary to minimize leaks
   
3. Add the straps, add tension to bottom set, keeping it light
   
4. Add top set, again light tension
   
5. Having loosened the top of head strap pull mask off your face just enough to settle it lower then attach that top adjuster
   
6. You may have to redo them to prevent leaks across nasal bridge, but do not cinch any down tightly, this Vitera has a bellows that will only work decent with light strap tension
   
7. Move the mask around for best results, L-R and UP-DOWN. It will do back or side sleeping fine but due to looser strap tension, it may move a bit if the pillow pushes on it.
   

[Gideon]

I am pretty convinced that you both were and are tucking your chin. The clustered obstructive events are present in both your AutoSet charts and your ASV charts. The fix for this is a soft cervical collar to prevent you from tucking your chin and thus collapsing your airway. See the soft cervical collar wiki article (my signature) and let's eliminate this. NO amount of pressure will eliminate this.

[Whitenoise]

Dave,  I had just been reading about positional apneas via the wiki (an extraordinary and thorough database that I almost lose time perusing) and this led me to reconsider the collars. I came back here to report to you and here you have already written the followup post directly targeting this further!

I agree, lets eliminate this,,, I'll read further on collars, but will ask as well your approach to getting the right one off Amazon, if you would guide me in selecting.

Thanks for your detailed mask fitting procedure on the Vitera. I think I'll keep things the same for now and get a collar so we can correlate with all things equal at least right now.

I find I can maintain Hope best when I have a logical causative possibility to work on and you just provided it.

This board and folks like you are making a huge difference for those of us who just can't give up. I know there are answers somewhere, but it is only through a collective with personal and similar motivations that true support is achieved.

[SarcasticDave94]

Not trying to dodge, but I can help point positional out but there's several that's better at these collars. I will take a swing though.

You're not looking to have one so tight as in neck injury situations. Do take a measurement around the neck and leave about 2-3 fingers worth of space so it's slightly loose. You'll want one tall enough to prevent your chin from dropping or falling behind the collar.

[OpalRose]

Whitenoise,
Just to add what Dave has said, measure the bottom of your chin to your sternum.  This should give you some idea on the height of collar needed.  A person with a longer neck will need a taller collar, compared to someone with a short neck may do well with a 2.5-3" collar.

Measure circumference plus 2-3 inches so that you can slip a couple fingers under it.  You don't want to choke yourself.  

Finally, this isn't a collar meant to stabilize an injury.  This is a "soft" cervical collar.

Search Amazon for "soft cervical collar".