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New to ASV-Need help getting more symptom relief - Printable Version

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New to ASV-Need help getting more symptom relief - jteetie - 03-20-2019

Looking for some advice to hopefully start feeling less tired.  It's been a nearly year long process from first sleep study to CPAP to BiPAP to FINALLY, an ASV.  I've been on the ASV for about 8 weeks.  For the first 6 weeks, the settings were 12 to 25 and i couldn't do more then 1 to 2 hours a night.  The doctor lowered it to 8 to 20 and now i'm having success keeping it on.  Many nights i am able to wear it for 6 to 8 hours and my AHI is typically between 3 and 7 down from 55 without the ASV.  Since the change i have 14 days with AHI below 7, most of those days being 3 or 4.  However, i'm not having much of a change in symptoms.  I do feel marginally better on some days, but often, I am still falling asleep at red lights or at my desk by the afternoon.  I pasted my last 2 nights below to see if anyone has any advice for things i can do to improve my results.  Thanks for the help.  

I can't seem to get these images any larger.  The instructions in wiki either didn't work or the option wasn't there, i.e. Left click on "Attach Image Icon" but that isn't one of the options i see when i right click on the image.  And when i copied the image address and pasted it into the Insert Image menu, the same size image appears in the preview.  

[Image: attachment.php?thumbnail=10883]

[Image: attachment.php?thumbnail=10884]


RE: New to ASV-Need help getting more symptom relief - Gideon - 03-20-2019

You are using an initial PS Min of 0 but you have a bunch of snores and hypopnea events occurring. With bilevel, and ASV is a bilevel, those events are managed with Pressure Support (PS). Your remaining Central Events are near breaks so are likely SWJ or Sleep Wake Junk.

I would raise the PS Min to 3 and see if that helps.


RE: New to ASV-Need help getting more symptom relief - jteetie - 03-20-2019

On my machine, my pressure min is 8.  I do see on the chart, that the EPAP min is 4.9 and the IPAP Min is 5.2 and the PS is 0.1.  How do i change that?  I know the pressure min and max on the machine, but i'm not sure about this setting.


RE: New to ASV-Need help getting more symptom relief - Gideon - 03-20-2019

On the top banner click on CPAP Setup Manuals and follow the instructions. You will find instructions on how to get the manual that you need. Many of these are manually filled so don't expect an immediate response.


RE: New to ASV-Need help getting more symptom relief - jteetie - 03-20-2019

Thanks. I've got the guide. This is very sweet. I wish i had this before. During the first 6 weeks, i knew the minimum was too high, preventing me from getting much use on the machine. But i had to reschedule my Dr apt from 3 weeks to 6 weeks after i started. If i had known about this, i would have changed it myself.

Any other suggestions from anyone now that i can change anything i want on the machine. I am excite to not be so tired all the time, but so far, my relief has not been very dramatic. I'm hopeful that with some tweaks, i will start to feel more awake during the day.


RE: New to ASV-Need help getting more symptom relief - jteetie - 03-20-2019

According to the guide, the min and max PS is the min and max difference between the permitted IPAP and EPAP. My Min/Max EPAP is 4/20 and my Min/Max IPAP is 4/25. Currently, my PS Min/Max is 0/12. Wouldn't i want to increase my Min EPAP and IPAP and lower the Max PS? The logic to me would be that if the EPAP was at an 8 and the PS Max was 8, the total pressure could go down to 0. So, i would need to make the max PS to be small enough to not get that # to 0. I think i must be misunderstanding this stuff. I need some more help understanding these things now that i'm going to adjust them.


RE: New to ASV-Need help getting more symptom relief - jteetie - 03-20-2019

This is from the guide.  Looks like i can only set the Max IPAP, Min EPAP and the PS Min/MAX.  So, if i wanted the machine to stay between 4 and 20 at all times, what should i set them at?  


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RE: New to ASV-Need help getting more symptom relief - Gideon - 03-20-2019

Do you see those black bars going across the Flow Rate chart? Those indicate "Forced Breaths" where a high PS was applied for one breath. The High range for PS is necessary because you had a large number of Clear Airway / Central Apnea events prior to your current machine. I'm thinking that it may need to be raised, we will see in the future.

Your Obstructive Apnea Events (OA) are virtually non-existent, so you have no reason to raise your min EPAP unless it is for comfort reasons.

You do have a large number of Snores and Hypopnea events thus the need to raise your minimium pressure support. I suggested by 3. Raising this may make your PS Max setting of 12 too low, we will see after you try.


RE: New to ASV-Need help getting more symptom relief - jteetie - 03-20-2019

I just set it. We'll see how this goes. They really should tell everyone how to get into the provider mode. There is so much more I can do.


RE: New to ASV-Need help getting more symptom relief - jteetie - 03-21-2019

The setting on my machine don't seem to match the settings that show in Sleepyhead from my machine.  Any idea why?  Below are the reports from 3/19 and 3/20.  On the machine, i went in and changed the PS Min from 0 to 3.  You can see below, that according to sleepyhead, the PS min is still 0 and all the other numbers changed.  What am i doing wrong?  


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