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AirCurve 10 in ASV mode
#1
AirCurve 10 in ASV mode
I have been learning a lot from the forum but find that many of the chart examples are not from the AirCurve or equivalent in ASV mode. The settings my Doctor prescribed were EPAP-12, PS 5-12. I use a ResMed P30 full face mask and recently experienced air pressure in my gut. I lowered EPAP to 10 and it seemed to help. I will soon raise EPAP and test how the increased setting work as I do not know if getting air into my gut was related to something transient. My chart shows many flow limits but they do not impact my SpO2 curve significantly. I am a back sleeper and am working to move to the side more. My AHI numbers are generally very good. Any suggestions on tweaking my settings would be appreciated. I use a 5 minute ramp so that I can get my mask adjusted more easily due to the high pressures the AirCurve ASV settings provide. My sleep study rated me in the severe range.


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#2
RE: AirCurve 10 in ASV mode
If you  have CSA , then your therapy seems to be working great. Your median oxygen levels are high and I am assuming that you sleep well with high pressures. (including all stages of sleep like REM for at least 20% of the time, includes dreaming).
If that is the case and you have no issues staying asleep with these settings., I would leave them as they are. Just note that your Dioc has set your device to ASV mode, not ASV Auto. So your IPAP min is masked.
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_______________________________________________________________________________________________________________________________
 "The power of community to create health is far greater than any physician, clinic or hospital.” – Dr. Mark Hyman
"The job of a great doctor is to keep the patient entertained while nature takes it course"-- A less known physician
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#3
RE: AirCurve 10 in ASV mode
Here is a more detailed time view from the chart I first posted.


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#4
RE: AirCurve 10 in ASV mode
Yes, doc set to ASV. I tried ASV Auto for four days. Worked great for 2 and then things went bad the next two. Not sure if the stats on the first two days were innacurate because the machine was "learning: my tendencies. Attached is a chart of the second "bad" day.


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#5
RE: AirCurve 10 in ASV mode
Your bad day did not have anything to do with setting, IMO, or the machine.  You show on that day a very high amount of positional apnea.  Positional apnea is when you sleep in a position that cuts off your own airway.  NO MACHINE OR PRESSURE can help this.  You have to find a way to stay out of that position.

Many times it happens while sleeping on your back or with to high of a pillow.  In  those positions (you can get there on your side also) makes you chin tuck.  Your chin is dropping down to your sternum cutting off you air.

If changing positions does not help you may need a collar.  PLEASE look at my link in the signature for a collar - it shows people without and then with a collar... huge difference!

You can see positional apnea when in the O (UL) or H row there are clustered events.  You have a huge amount of them on the last night you posted.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#6
RE: AirCurve 10 in ASV mode
I'm going to post the recommended titration protocol for the Resmed ASV. Most of your members that use the machine use it in ASVauto mode.  Your PS min is relatively high at 5.0 and the PS max of 12 is apparently effective in stopping CA events.  EPAP is high compared to most users, but we have seen it where there is a great deal of need to prevent obstructive events.  If you would like to experiment with lower pressure to avoid aerophagia, I'd like to take you to ASVauto mode with EPAP min at 7.0 EPAP max at 10.0, PS min 3.0 and PS max 12.0.  This will give us some insights as to whether your doctor's recommendation is actually necessary, or perhaps could be made more comfortable using the ASV auto mode.  This suggestion includes your current pressure range, and you will get effective therapy, but it may be worth exploring where comfort and efficacy meet.

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Sleeprider
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#7
RE: AirCurve 10 in ASV mode
I myself didn't like ASV mode due to the fact EPAP did not change. I'm thinking I tried ASV mode a single night at most.

I can see several reasons why ASV Auto seems to have failed, first up was what Stacey says, the probability of positional Apnea. Even so, you should try ASV Auto again sometime. The Titration info from Sleeprider shoulder help highlight how to adjust this correctly. I personally think the default range was too wide and started too low on EPAP. But remember if there's any Positional Apnea, not even the ASV can blow past that.

Something of note: if you are swallowing air, we could edit settings if absolutely necessary, but there's a few things I've learned that may help. Attempt left side sleeping if you can. Also elevate the head of your mattress to tilt your head and torso up a bit.

A positive is that your leak rates are nice and low. That eliminates a lot of headaches on proper setup right there. IMO consider forgetting about flow limits. As you know, the ASV is all geared towards Centrals, and flow limit control isn't the ASV's speciality.
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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#8
RE: AirCurve 10 in ASV mode
Many machine sleepers have issues with aerophagia which I understand is your only issue because otherwise you seem to have a great sleep with your new settings.
One of the main causes of aerophagia is mouth breathing. I have seen it recommended that tucking your chin (and thus keeping your mouth closed when you sleepo while ensuring that your nasal passages are fully open ,maybe by using some natural Salin spray or other natural solutions nasal sprays that do not produce a "rebound" effect, should solve a great deal of aerophagia, in particular because your prescribed pressures are very high.
Also as others suggest, try sleeping on your side to ensure open air passages.
.
.
_______________________________________________________________________________________________________________________________
 "The power of community to create health is far greater than any physician, clinic or hospital.” – Dr. Mark Hyman
"The job of a great doctor is to keep the patient entertained while nature takes it course"-- A less known physician
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#9
RE: AirCurve 10 in ASV mode
Thank you all for your insight. It will take me a little while to digest all your recommendations. One question I have is that when I was not using "Auto" ASV, I was not having a lot of positional obstruction problems. Why would I suddenly have positional blockage just because I changed my setting from ASV to ASV Auto? I cannot remember if there were any other sleep changes I made at that time that might have caused positional blockage. Perhaps trying it again with more careful documentation of my sleep setting may shed some light. The pattern that indicates positional blockage happened two days in a row. Other than those two nights, I have not had those patterns in my data. the first two days using ASV Auto were stellar days with no significant incidents. Attached is the first day charts when I used the Auto mode.


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#10
RE: AirCurve 10 in ASV mode
I am not an expert on the ASV machine. I have only used cpap, and bipap machines... With that being said your AHI is great!! But the Resmed does not include in this average the Flow Limits.

Flow limits are apnea also - look at my signature to see how apnea is categorized. FL are just smaller apnea that are not timed. You have a lot of them and they are large for FL. Could they have been caused by positional apnea? maybe... Take a look at your flow limit chart. There are many grouped together and they go on all night.

Again, someone with more knowledge in the ASV will come along but please don't discount these and the ones on the other nights.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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