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Trouble with new ASV machine
#1
Trouble with new ASV machine
Last December I finally got my CPAP machine (Airsense 10 Autoset) and wasn't getting the relief I needed. You all helped a lot (see this thread).
I finally jumped through all the many hoops and got an ASV machine as was recommended. I've used it 5 nights now. Three of those nights have been wonderful. Two (2nd and 5th nights) not so much because I experienced the sensation of the machine pushing against my expirations with the mask leaking and squealing terribly after wearing for a few hours. I had to shut the machine off to get some rest. I've included two screenshots of the 5th night OSCAR results here.

   
   

Can someone please help me? My doctor doesn't know how to read these things. Thanks!
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#2
RE: Trouble with new ASV machine
There is a blowback technique that you need to use to tell the ASV to reset. Forcibly blowback and the algorithm will spend the next several minutes re-calibrating. Use it when you feel that the ASV is pushing against your expirations
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#3
RE: Trouble with new ASV machine
I'm going to suggest a few setting edits. Others that are better at general pressure settings may suggest other things, but I think this will get you started on finding better therapy. Below are suggested edits 1-3, and I see these in order of importance. I also see needing 1 and 2 together. If advised not to do all at once, then I see step 3 as one to consider holding for later.

1. Go into the clinical menu and find the setting for Mode. Switch from ASV to ASV Auto. This will enable a range for EPAP, and you will have to set EPAP Min and Max next. Why needed? You will likely find having a range here feels a bit more comfortable than all the range work via the PS. Also EPAP is your air splint that keeps your throat open. I have found you sometimes need this stronger than other times, and the range enables this.

2. Set an EPAP range via EPAP Min, use 6 that you have now, EPAP Max of somewhere around 11 should be OK for now. We need to establish what your body wants and would see this in another OSCAR in the future. I would consider EPAP of 6/11 knowing we may adjust as necessary later.

3. Edit the PS Min down to 3 from 5. A PS starting at 5 can sometimes be more abrupt, and I think dropping it down 2 may be helpful. I would also drop the PS Max down a bit as PS Max has been shifted over to the EPAP Max side.

Recap of new pressures:
EPAP Min 6 Max 11
PS Min 3 Max 12
These will equal IPAP Min 9 Max 21

NOTE IPAP is not directly adjustable and will not be seen in settings. EPAP Min plus PS Min equals IPAP Min, and EPAP Max plus PS Max equals IPAP Max. In ASV Auto mode, EPAP, PS, and IPAP ranges will vary via the control algorithm as needed.

PS as bonjour mentions, Blowback can be used when the ASV hits with strong pressure.
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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#4
RE: Trouble with new ASV machine
From what I see in these charts, the blow-back may be helpful, but the very few events we see are obstructive. I suggest changing to ASVauto mode and using EPAP min 6.0 and EPAP max 9.0. You're doing great, but the residual events are obstructive, and you need the EPAP to change to prevent them. You actually have very little pressure support changes considering the ASV has a set range of 5 to 15 cm. The biggest problem I see is short therapy time. You need to enable ASVauto to eliminate the remaining obstructive events.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Trouble with new ASV machine
Thank you all for providing such highly knowledgeable advice which my highly paid sleep doctor is unable to. I made some changes in the settings as suggested as shown here:

   

However I had a terrible night, perhaps because I could barely feel the pressure compared to the night before? I didn't realize, BTW that the machine learns as it goes. Anyway I had to take the mask off for a while during the night. The screenshot is here:

   

Please make any further suggestions that you feel worthwhile and I guess my plan would be to keep at it and the let the machine and me get used to each other?

BTW I noticed that this new machine actually gives OSCAR the correct local time with which to plot the data. My previous machine just scaled the cumulative time. Much more helpful this way.

Thanks!
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#6
RE: Trouble with new ASV machine
With those changes making this more optimized, now is time to consider if it impacts how you feel.
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: Trouble with new ASV machine
The reason you did not feel the pressure as much is the reduction of PS min from 5.0 with ASV to the current PS 3.0. I did not suggest resetting PS min to 3.0, however do what feels best to you. With PS min at 5.0, your ventilation minute vent and tidal volume were a bit higher. I think using ASVauto mode was able to help with the hypopnea, and resulted in AHI being less than on ASV mode.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Trouble with new ASV machine
Thank you all again for helping me with my machine settings.

Here is what I used last night:
   

and (tada) here were the results from last night's sleep:
   

Best of all I slept through the night without waking up, and I felt clear and energized in the morning. I think I've finally achieved what I have been looking for since I started this CPAP journey over a year ago. Too bad it took so long. Some changes need to be made in the medical system, but what else is new?

Thanks and have a great day!
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#9
RE: Trouble with new ASV machine
Very good there. Leave settings as is and see how it trends for a few days. Congrats.
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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#10
RE: Trouble with new ASV machine
Congrats on arriving at the goal-line! It was a long struggle, and you did your part to self-advocate and get the care you needed. Be sure to share with the doctors what good therapy looks like.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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