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having trouble with aircurve 10 asv
#11
RE: having trouble with aircurve 10 asv
Here are my observations/opinions. First, your EPAP minimum of 5.0 is okay, and your median is over 9.0. The pressure is rising in response to hypopnea and apnea as it is intended. I think we should focus on your pressure support settings to get the most benefit. Your tidal volume is on the low side, but very short females may have tidal volume under 300, so it is really dependent on your build. There are many articles on normal tidal volume on the internet, and your "normal" is clearly different from mine. That said, I think you should increase the minimum PS to 3.0 to get more "assist" on inhale and perhaps improve that volume.

You are experiencing hypopnea and some UA events which may be either central or obstructive. The machine is responding with everything it has, with the PS max set to 8.0. This is an uncharacteristically low setting for ASV and is insufficient to keep your respiratory volume at a normal level when you are not making sufficient respiratory effort. Resmed suggests default setting for auto ASV of EPAP 4-15 and PS 3-15. I think you should consider higher PS max to treat the events that are not responding at your current settings. You will only experience the higher pressure support when it is needed to maintain your respiratory volume and rate, so my recommendation is 12.0, but if you find that to be overwhelming, then moving to 10.0 would be a bare minimum for efficacy. In my opinion, using higher pressure support will actually keep your EPAP at a lower level, as it is currently rising due to unresponsive apnea events. The higher PS max should relieve those currently unresponsive events.
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#12
RE: having trouble with aircurve 10 asv
I'll definitely make those changes!  I suppose 5' is a very short female, but I feel bigger then that for some reason. 

I do have one concern with higher pressure, I don't know if it's valid or not.  I have had multiple surgeries in my right middle ear.  I had a repeated stapedectomy due to an incredibly unusually high rate of failure in that ear.  I had the same replacement in my left ear, but it has not failed.  So I don't know.  The left ear was done years prior to the right, and before I used a sleep machine so I wonder if it had time to cement in place better than the right.  Also, I have some bad luck, so my right ear may just be contrary and rejecting the implant without help.

Regardless, I need the sleep, but that's a fear that I have with putting the pressure too high.  Do you have any knowledge or information about that?

Also, I don't recall the last time I replaced my headgear, so I will order some now and hope that will help with the leaks, but that will take a couple of days.

Thanks again, I really really appreciate your help!
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#13
RE: having trouble with aircurve 10 asv
Now I remember, besides my ear, I was having problems with swallowing a lot of air.  That's what made me try to change the settings.  Here is from last night.
I was able to use it longer, but it looks like my AHI went up, as did the leak rate. 

I was thinking of switching from the nose pillows to the nano.  Do you have any opinion about that?  The videos I watched make it sound like they should have less leaks, but they also sound like ads, so I was wondering if you have any ideas on that?  
Thanks!


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#14
RE: having trouble with aircurve 10 asv
I myself am not familiar with the nano mask, but if I were you, the mask and leak control would be a priority. Get whatever mask brand and style you feel is best for your success. This mask/leak issue would tie with maintaining overall comfort. I have the ResMed F20 full face mask and ResMed N30i nasal mask myself.

Sooner or later you might want to address Ramp usage. For myself I cannot use it as it makes AHI increase. The ramp time means you’re bypassing therapy pressure for ramp pressure settings. I turned Ramp off on day 2 of ASV usage; thought it was needed but I found out by trying it off. AHI was much better for me with Ramp off.

Coffee

PS the ear aspects I’m not sure what to make of it. I’ve got an old eardrum rupture injury to the right side...
Dave

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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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#15
RE: having trouble with aircurve 10 asv
I'm seeing some clustering of events, and if your apnea and hypopnea are related to positional apnea with occlusion of the upper airway, then increased pressure is not going to open your obstructed airway. If you are aware of chin-tucking being a potential issue we need to try to find a way to keep your chin up. You an simulate the effect by sitting comfortably in a chair and as you relax, let your head drop so your chin falls to your chest. If this makes breathing difficult or even impossible, this positional obstruction may be what is happening at night. Supporting the jaw without causing pressure on the throat is a way to prevent positional apnea and it has the side-benefit of improving mask fit and preventing mouth leaks. You may want to consider a soft cervical collar, wedge or even a low-profile pillow to avoid anything pushing your chin towards your chest. This wiki article may help. http://www.apneaboard.com/wiki/index.php...onal_Apnea
Sleeprider
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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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#16
RE: having trouble with aircurve 10 asv
That sounds like it could be right.  I have been having issues with sore and swollen throat anyway, for at least 6 months.  The doctors seem to think that I'm not really suffering from it, although they do see that it is sore, and they haven't done anything besides antibiotics to address it.  I will try the collar and I will also be more aggressive with getting them to do something else about treating it, since it may be causing/affecting some of these issues with my sleep.  I read the wiki article, and I barely need to touch my throat there and it closes up, and I also noticed a returned snoring ability since the time my throat started feeling swollen, which was formerly prevented by surgery, so having it back is a sign of something. 

In the meantime, I'd like to put it on the lowest working pressure settings, can you let me know what you thing those would be?

Hopefully that, plus the collar, will hold me over until there's some progress with my throat!
Thanks!
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#17
RE: having trouble with aircurve 10 asv
If you use a collar, and it effectively prevents positional obstruction, then you will be able to tolerate lower EPAP pressures. I would still like to see PS min 2 and PS max 10. Based on current results I would us PS min 5.0 and PS max 8.0. This is 3-cm lower than your 95% EPAP, and will drop your 95% and maximum IPAP. It is important to combine this with positional therapy, but I think it should give you aerophagia relief and maintain effectiveness.
Sleeprider
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____________________________________________
Download OSCAR Software
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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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#18
RE: having trouble with aircurve 10 asv
The ASV algorithm does not work well in the presence of large leaks. I would recommend setting back all the settings to default but then since you have known OSA events, start with min EPAP 5 and max EPAP 15. Then just raise EPAP each night by 1 if needed, until the events mostly go away. You don't want to limit PS min and max.

The goal of the ASV is to monitor your breathing and target your own recent minute ventilation. For ResMed they recommend starting at PS min 3 and PS max 15. PS min would only be adjusted from there for comfort reasons. The PS will go up and down all night and it's important to let the ASV do it's job so it can prevent over and under ventilation.
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#19
RE: having trouble with aircurve 10 asv
I'm glad you said that, for some reason I thought I had already set it to 2 and 10.  I made the change but forgot to put the card back.  I also wore the collar but had a very restless night so I put the card in first thing this morning and will try get a reading tonight. 
I did have some cheek puffing the first time I woke up, and I put it back on, but took it off a second time but I don't remember why that time. 
My throat does feel less sore today, so that's good.
Thanks again!
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#20
RE: having trouble with aircurve 10 asv
Thanks for the reply! 
I don't know why I'm having the large leaks, but I have ordered new nasal pillows to see if that helps. 
I'm a back-sleeper which I guess is the worst for people with apnea.  Maybe I will try some different head pillows as well.  I wonder if I stretch the tube out or something and that pulls the mask off my face a little? 
I never really had a problem with large leaks until this year, so I'm not sure why.  I had great results for quite a while, then I stopped using it for a couple months after ear surgery and when I went back to using it, I had all sorts of issues at once!  I did lose close to 20 lbs this past year, so I wonder if that has anything to do with it...
Hopefully we can get it sorted out soon!  I'm anxious to get it resolved.
Thanks again!!!
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