ASV machines

[Lost53]

Hi everyone.  I'm back again.  I have had Sleep Apnea with many Central Apneas until switching to the ASV machine.   I have been on the top of the line ResMed s9 ASV machine for over 18 months now and my AHI index is almost 0 with no Central Apneas.  The problem is that I still wake up tired in the morning and I am still waiting for that excellent sleep that everyone talks about on CPAP.  My Sleep Dr. says everything looks good and he is stumped.  Asked him about trying lower pressures and he said go ahead and try but he did not think it would help.  Presently set on EPAP of 8 and I believe the IPAP is maxed at 23.  Need to see if I can set the IPAP to max at about 18 but do not know how to reset it.  I have the S9 setup manual but do not know if the ASV machine uses the same manual and procedures. Sometimes during the night when I shift, the pressure will shoot up to 23 and that wakes me up.  I do not have any heart problems or high blood pressure but the mask is starting to irritate me also.  Going to switch to the newer pillow P10 mask and see if that helps.  Another Dr. suggested that I try an oral device in combination with the ASV machine and maybe the pressures could be reduced that way.  Any suggestions or help would be appreciated.

[DeepBreathing]

G'day Lost53.

The VPAP Adapt has its own manual, which you can obtain via the link at the top of this page. Basically your pressure options are: Min EPAP, Max EPAP, Min PS and Max PS (see P16 of the manual). Your maximum IPAP is Max EPAP + Max PS, up to the limit of the machine's capability. eg if Max EPAP = 10 and Max PS = 8 then your max IPAP will be 18.

You mentioned you have a set EPAP, in which case you're not making the best use of the machine. Auto EPAP allows the EPAP to rise and fall as needed and helps smooth out peaks in the PS. You might find this gives you a more relaxed sleep.

Please go into the clinical menu on your machine (p15) and let us know what settings are shown there. In addition, please post some SleepyHead screenshots so we can see what's actually happening. Until we get that information I don't think we should speculate on any other changes to settings.

Finally, there are of course many other conditions besides sleep apnea which can cause headaches, drowsiness and fatigue. I assume you've had all the normal things checked like vitamins, thyroid, haemoglobin etc etc?

[Lost53]

Thanks for the info DeepBreathing.  I have had a complete physical and it was determined that my testosterone levels were way down but everything else was good.  I have had replacement therapy for 8 months now but still the same problem.  No restful sleep.  I ordered the manual and when I can figure out the screenshot I will post my results from machine.  Thanks again.

[Lost53]

[attachment=3653]
Don't know if this worked DeepBreathing.  We will see.

[Lost53]

[attachment=3655]
Sorry DeepBreathing.  Wrong screenshot.  That one was old.  Will try to send one from this year.

[DeepBreathing]

Looking at that chart, it's obvious the machine is working hard to protect you against apneas, and obviously quite successfully. You're on straight ASV mode rather than auto, and your max EPAP and Max PS together will give you a maximum IPAP of 23. This is pretty high, and may be part of what's causing the disturbance. However your 95% IPAP is only 16.86, so occurrences higher than that are uncommon.

My suggestion would be to go onto ASV Auto mode, and limit the PS (which in turn will limit your maximum IPAP). I'd try the following:

Min EPAP: 8
Max EPAP: 11
Min PS: 3
Max PS: 7

My thinking is that allowing the EPAP to float up a bit will reduce the amount of pressure support you need to achieve a useful IPAP to treat events. Your max IPAP under these settings would be 18 (11 + 7) which is a little above your 95% and should catch the great majority of events. There will be a few sneak through with these settings, but that's not a problem - it's a trade-off between a comfortable sleep and having one or two apneas / hypopneas.

Let us know how that goes.

[Lost53]

Thanks DeepBreather.  Reset machine as you said but, just a note, max PS could not be set any lower than 8 so we will give it a try for a few days and see.  Thanks again!!

[Lost53]

OOPS!  Sorry DeepBreathing!!!!

[Sleeprider]

I am in support of DeepBreathing settings with some minor differences. First you need to be in auto mode, and the min EPAP at 8 and Max EPAP at 11 look fine; however you have no apnea with the current EPAP min of 8.0, so I would suggest trying a minimum of 6.0. . I would keep min PS to 0 and see if that actually helps to reduce some of the CA the machine is working to stop. So min PS 0 and max PS 11.0. You need the higher PS to induce a breath when needed, and I'm not sure what that minimum threshold is, but 7.0, and even 8.0 is pretty low and may leave you with hypopnea.

In summary:
Min EPAP 6.0
Max EPAP 11.0
Min PS 0.0
Max PS 11.0

[Lost53]

Thanks Sleeprider.  I will try both ways and see which one feels the best!!!