CPAP to ASV Transition

[PilotoLoco]

I have been on APAP with a Resmed Airsense 10 Autoset since 2017.  At first, the pressure range was 6-20cmH20.  I felt like I was suffocating a lot until I turned the ramp off and upped the base pressure to 8, then to 9.  It always ended up higher during the night, but at least I didn't feel like I was working so hard to breathe.

Fast forward to this month.  My AHI's had gotten pretty high on a nightly basis...10-15, occasionally 25-30.  Lots of waxing and waning breathing, and a ton of central apneas.  I contacted my doctors who moved me to an ASV machine, and I contacted AXG Diagnostics.  Jason recommended some changes on my Airsense 10 to help with the AHI's, as well as focused efforts to control the high leak rate.  

Bam!  The first night after meeting with AXG, my AHI went to less than 5.  The best numbers were on the CPAP with a static pressure of 11, mouth taped, with a nasal mask.  Still had some CA's, but great sleep, crazy dreams, and success.  The doctors, who arguably don't have the experience and will to troubleshoot the details like AXG Diagnostics, wrote an Rx for an ASV machine to address the CA's.  

Enter the ASV machine.  The first night, I put the ASV machine in CPAP mode with the F30i full face mask, didn't tape my mouth, and set my pressure to 12.  I still had a good-for-me AHI of 4.4, but had several runs of CAs with pretty large leaks...looked like positional issues to me (from what I've learned here.) And, maybe 12cmH20 was too much. 

When I tried the machine on ASV Auto mode, I went back to the nasal mask and mouth taping to see how low of an AHI I could get.  The next two nights on ASV Auto, I had a .45 and a 1.3 AHI.  Clearly record low AHI numbers for me.  However, I woke up several times feeling like I was suffocating.  I felt like I just couldn't get enough air.  I've been wearing a pulse-oximeter ring and it also showed a desaturation from 98 to 93%.  I set the machine back to CPAP mode until I can get an answer from my Dr.  

Can I set the Aircurve 10ASV to ASV (not Auto), set the pressure of 10 or 11, and let the back-up rate help as needed?  Or, can I at least up my EPAP min a bit?

Current Rx is Min EPAP: 6cmH2O, Max EPAP: 15cmH2O. PS:0, Max PS: 10.  Can I increase the Min EPAP to 8 or 10? I want to love the ASV machine, but I just feel like I need more air.  I have a call in to my sleep doctor.  I feel like I sleep better with the machine in CPAP mode set at a constant pressure of 11 than I do with the current AutoASV settings.  The AHIs are lower on the ASV, but dang, I feel like I wake up with an octopus on my face, suffocating me.  Maybe a bit dramatic....can I have more pressure without causing more problems?  

Thanks for the help!

[Sleeprider]

With a new ASV, we need to start over and use the ASVauto mode with EPAP min 5.0,EPAP max 15  PS min 3, PS max 15. After using these settings the first night, we can look at the charts to see if any residual events occurred. If there was obstruction present, the machine would have increased EPAP to address it. There will not be any centrals or hypopnea, so we need to get feedback on your comfort.  I will post the Resmed Clinical Titration Guide for your machine. Although the recommended starting point for Vauto is 4.0 EPAP min, I generally take that to 5.0 with someone with previous PAP experience.  If you feel the machine is taking control and you want it to calm down, just remember to do the blow-back technique.  It is a short series of assertive breaths that show you are in control.

The Resmed ASV learns your normal respiration rate and volume over the past 90 seconds and uses that as its target rate.  Try to be calm and relaxed before you mask up so the machine does not learn a high rate and volume of breathing as its target. Normal sleep respiration is slightly shallower and more rapid than daytime awake breathing, so it can be counter-productive to mask up and do deep slow breaths.  

[PilotoLoco]

Thank you, Sleeprider. I went through an ASV titration sleep study in the sleep lab. The current settings are what they recommended. But I raised the min EPAP to 8cmH2O...otherwise I wouldn't have wanted to use it in ASV mode.

Last night, I felt so much better with the min EPAP of 8cmH2O. The AHI was .14 for 7 bours with no OA or CA events tagged, and only one hypopnea for the whole night. The machine raised the min EPAP to over 10 cmH2O on its own a few bours into my sleep. Maybe the doc will be okay with raising the min to 10 at some point in the future. I'm dealing with the Dallas VA and to ask about pressure adjustments, I first have to endure the lecture about they should be the only ones to change anything on my machine.

When I received the Airsense 10 Autoset in 2017, there was no proactive follow-up to optimize the therapy. I don't want to repeat that here. If only I had known the variety of amazing resources available here, I am confident that I would have avoided the whole high AHI issue to start with.



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At least I feel like I can tolerate these settings until I can get some more data to take to the sleep doc.