new to ASV, Aircurve10 question

[trish6hundred]

Hi oldfart59,
WELCOME! to the forum.!
Good luck to you with your new machine and just hang in there, it will take some time to get used to, but, as you use your machine, and find a mask that will work for you, it does get better over time.

[DeepBreathing]

EPAP: Expiratory positive airway pressure - this is the pressure the machine maintains as you're breathing out. This is the key to treating obstructive events.

IPAP: Inspiratory positive airway pressure - this is the pressure the machine maintains as you're breathing in.

PS: Pressure support - this is the additional pressure added to EPAP to achieve IPAP.

EPAP + PS = IPAP

When the machine senses you're starting to inhale, it provides pressure support to assist. If you stop breathing or have a significant reduction in airflow, it will increase the PS to give you a higher IPAP. If you turn on the airflow and mask pressure charts (you can turn off the resp rate and tidal volume) you will see how the machine responds to each hypopnea and apnea.

Your machine is set in "normal" ASV mode with a very low EPAP. Ask your doctor why he thought it should be so low - it's unusual to see such a low fixed EPAP. Most of us who have been using ASV machines for a while find that changing to AutoASV mode gives a big improvement - it allows the machine to set the EPAP in response to events and precursors, as well as varying the PS. In my experience (getting on for four years) AutoASV is both more effective and more comfortable.

[ajack]

It seems there was a mixup in the script, the 7 was a fixed epap and the 4 seems to be half an auto setting, missing out setting a max epap. Switching to auto can be intimidating to a new user and the DME won't change it without a script. We know the 4 isn't working. So I would go back to 7 epap till the doctor can sort it out.

[DeepBreathing]

It seems there was a mixup in the script, the 7 was a fixed epap and the 4 seems to be half an auto setting, missing out setting a max epap.

Well that's a reasonable assumption but it is just an assumption. The doctor presumably changed things for a reason and a new user would be best advised to seek out that reason from the doctor, even if it is just to identify that a mistake has in fact been made.

[ThrownOutTheAsylum]

Welcome. I, too, have recently started on an AirCurve 10, the CS PaceWave version.

The machine does indeed not classify CAs in the way that other machines do, effectively because it thinks it sorts them all in the ASV modes, and so lists anything breaching its limits as other apneas. The clinician manual states "AHI and Total AI: Central sleep apnoea detection (CSAD) is not active in ASVAuto and ASV modes. The ASV algorithm eliminates central apnoeas. Therefore, any apnoeas reported by the device will be obstructive or indicative of a closed
airway." I started a thread on this a few days ago and it has some useful info.

I, too, am dealing with mask fit issues. Another thread I started on this a few days ago and it has some info you might find useful.

[Sleeprider]

I agree that a conversation with the doctor would be helpful. A fixed exhale pressure (EPAP) of 4.0 cm is quite low. It would be perfectly reasonable to be in AutoASV mode with a minimum EPAP of 4 and maximum EPAP of 7, and Pressure support range of 0-12. Your machine was setup with a minimum pressure support (difference between inhale and exhale pressure) of 4 cm. Pressure support can be a cause of increased central apena, so for most complex apnea patients on ASV, they seeem to do better with a low or zero minimum pressure support. That also makes the contrast when a breath is needed more effective.

Clearly your doctor will decide, unless you want to try this yourself, but my recommendation for effectiveness and to avoid injecting air into your stomach would be
Mode ASVauto
Min EPAP 4.0
Max EPAP 7.0
min PS 0.0
Max PS 12.0

These are fantastic machines, but unfortunately very few doctors really know how to best set them up.

[oldfart59]

Morning, 
I tired my old mask, and I THOUGHT it was better. It was more comfortable and I saw there was a mask test feature, so I selected it and adjusted the mask for no leaks. I did wake up around 1 AM with leaks, but I just move the mask and it was fine.

Thank you all for your responses, I am going to make a list of questions and call the doctor again. I will also do more reading on the posts you people provided.

I Guess I had a bad night last night, and woke up with a headache, the machine said I had a AHI of 10.0. I noticed the last time I woke with a headache, I had an AHI of 6.8. Attached is a screen shot If it works.

Can this ASV give you a headache? I never had headaches before when using the cpap and bipap. I would only get them if I nap during the day.

Does this say the ASV is not working?

When I talk to the doctor, what other information should I ask him to look into ( I see there are many other things recorded by the machine.) I am also going to tell him the days I had a headache, he should be able to pull the data from those days, and hopefully get to the bottom of this. 

I will suggest the settings stated here.

Thanks again.

[attachment=3730]

[ajack]

The machine is working..The headache is too much of a variable to say, but you are better to continue using the machine over the weekend, it's obviously is treating a lot of your apnea. You do need the machine adjusted and I'd ring the doctor monday.

Just check that your head isn't propped up on pillows, or bringing your chin to your chest. You want your chin up and head back to keep the airway open. There are some clusters where either you are a wake or there may be some positional apnea happening. The most common of theres are bringing your chin to your chest, propping your head up on pillows or back sleeping. For $10, a foam cervical collar may come in handy, to see if you keep your airway open.

[oldfart59]

I agree that a conversation with the doctor would be helpful.  A fixed exhale pressure (EPAP) of 4.0 cm is quite low.  It would be perfectly reasonable to be in AutoASV mode with a minimum EPAP of 4 and maximum EPAP of 7, and Pressure support range of 0-12.  Your machine was setup with a minimum pressure support (difference between inhale and exhale pressure) of 4 cm.  Pressure support can be a cause of increased central apena, so for most complex apnea patients on ASV, they seeem to do better with a low or zero minimum pressure support.  That also makes the contrast when a breath is needed more effective.  

Clearly your doctor will decide, unless you want to try this yourself, but my recommendation for effectiveness and to avoid injecting air into your stomach would be
Mode ASVauto
Min EPAP 4.0
Max EPAP 7.0
min PS 0.0
Max PS 12.0

These are fantastic machines, but unfortunately very few doctors really know how to best set them up.

Sleeprider:
Thanks for the setting suggestions, but I see there are only:
PS Max
PS Min
EPAP

Currently set to:
PS MAX 19
PS Min 4
EPAP 4 ( was 7 originally, and when I said the pressure was too high, that is what they changed)

Are you saying change 
to autoASV
and set EPAP back to 7
PS MAX 15
PS MIN 0
?

I would like to try this, but not sure if I will have issues with the insurance company if I start changing settings.

[DeepBreathing]

I think at least part of the issue is that your EPAP is pegged at 4.0, which is way too low for most people. You should definitely talk to your doctor - if you can't talk to your doctor, then you should follow the advice above and change your settings to SleepRider's recommendation and see how that goes.

Mode ASVauto
Min EPAP 4.0
Max EPAP 7.0
min PS 0.0
Max PS 12.0

ASV are fantastic machines and work extremely well, but they do need to be set up correctly. It may be (as ajack said) that you've only got part of the prescription. Talk to your doctor, find out why he set it like he did or see if that was a mistake. Explain that you're frequently getting a high AHI with lots of hypopneas, and also talk about the headaches. (ASV shouldn't give you a headache, but if you're getting a lot of events combined with maximum pressure, that could be the cause of the problem.