Another set of questions about the Aircurve 10

[sjlowens]

I was diagnosed with sleep apnea in 2007,and have been using an Apap machine for 10 years. In the past year. I have worked with a sleep therapist to replace the old APAP with a new one.  After an in-home sleeptest that showed an AHI of 16, I was given a new APAP machine that produced an AHI of 10.84. compared to 6.6 on the old machine.   The therapist diagnosed complex apnea in December, and authorized. successively,  a BIPAP machine (AHI 17.76) a BIAP-ST machine (AHI=12.7) amd most recently, a BiPap ASV machine  which I have had for 5 nights.  I have continued to experience mild to debilitating fatigue with all of these machines, including the ASV.

I use Zolpidem each night to get me back to sleep.  I am 5'7" and 170lbs.

My problem with the Bipap ASV machine is that it wakes me up.  Each time I wake up, I see in the data that the machine has used about 25 units of pressure to attack an apnea.  Several of these high pressure attacks have awakened me.   The prescription for the machine has a range of 5.0-10.0 fo EPAP, 10-20 for PS, and a max of 25 for IPAP.  The I{A{ is set to automatic ASC, so the actual maximum IPAP is not set or reported. 

I've attached a screen print of OSCAR data from August 27.  I got a remarkable AHI of 1.1, woke up once due to high pressure, and felt highly fatigued all day.

So the questions:

1)  Do those of you using these machnes eventually adust to the high pressures, to the extent of not being awakened?

2)  Is there  setting in the Resmed BiPAP ASV that I haven't found that would allow me to at least temporarilt reduce the maximum IPAP to 20 till I get used to it?

3)  Does the Respironics Dream Station ASV have a way to set the meximum IPAP?  Does the Dream Station cause this or any other problems?

Thanks for the help,

Steve Lowens
Alameda, CA

[DeepBreathing]

G'day Steve. Welcome to Apnea Board.

I admit to being a bit confused by your post - could you clarify which machine you're currently using?

• Resmed Aircurve 10 ASV, or
  
• Philips Respironics DreamStation BiPAP autoSV

Although both are ASV machines they require quite a different setup to achieve maximum efficacy and comfort. Please note BiPAP is a Philips trademark and shouldn't be used with Resmed machines as it confuses people like me.

With both machines you can adjust the pressures to limit the maximum IPAP if it proves troublesome. While you'll probably get used to higher pressure over time it's probably better to start off with it throttled back somewhat until you get used t it, then increase pressure incrementally.

Could I also ask you to post an Oscar daily page (complete page, not just a close-up). You should format the page according to the instructions here: http://www.apneaboard.com/wiki/index.php...ganization

[DeepBreathing]

Steve, I've re-read your post and I see you're using the Resmed - is that right? There is no Max IP setting on that machine, but you can reduce max EPAP and / or Max PS to reduce the top pressure produced. But let's see the data before we start talking about changes.

[Sleeprider]

Default settings on the Aircurve 10 ASV are EPAP min 4, EPAP max 15, PS min 3, PS max 15. Your machine is compatible with the free OSCAR software. If you will download a copy of the software and post a chart (instructions in my signature links), we can help you to resolve problems. The ASV is the right machine for complex apnea, but getting it setup and optimized can take some experimentation, and it can be a disruptive sleep experience until you adapt to the pressure swings that are used to treat central apnea. We can help you, but need to see some data to be effective.

[sjlowens]

Thanks to both of you for your willingness to help and for enduring my 3AM post.  I don't write lucidly when under the influence of zolpidem.

Yes, I have the Redmed Aircurve 10 ASV.  You have confirmed what I thought, that the maximum IPAP cannot be set directly.  As I am working within the Medicare system and may be able to swap out machines, as I have done 3 times already, my question about the Dream Station was to find out if the maximum IPAP could be set on that machine.  The Resmed is doing quite well on the AHI, which is the therapists golden mark.  But it is very inconsistent for me on the resultant fatigue.  I don't expect you guys to diagnose the fatigue - that's the therapist's job.

As requested, I have attached two screenshots representing Monday and Tuesday nights' experience.

So, I'm hoping you could tell me if the DreamStation might be a viable answer to the high pressure problem, plus any other advice of your choosing.

Thanks for the help.

Steve Lowens
Alameda, CA

[jaswilliams]

I have had a look at your graphs and your doing pretty well. I think you will get used to the pressure over time. How long have you been sleeping with the machine ?


If you feel the machine blowing at you you can try the blowback method (blowing hard at the machine) or the inhale method (Take a deep beath) either of those activities will reset the ASV algorithm so for the next 3 minutes it will back off and try and learn your breathing pattern. Over time you will get used to sleeping with the machine. but the ASV's are specialist machines that will force you to take a breath by increasing the PS to the max as you have found.

[sjlowens]

Jason,

Thanks for the tip.  It should have come from my therapist, but she doesn't communicate well.


I've been on the machine for a week.  I'll give it a month, as has been the case with the previous machines, and then we'll figure out the next step.

Steve Lowens

[sheepless]

folks in the 'business', including doctors, respiratory therapists and dme providers, don't seem to know about a number of things we learn here from other cpapers. I doubt many know about the asv blow back method.

[Gideon]

I'd bet that they are not ASV users and as such have no "NEED" to know. On the other hand we have a lot of active ASV users here. . . .

[SarcasticDave94]

Yeah those ASV users...

You’ll likely get used to the pressure over more time on the ASV. Let’s see what others say, but your PS range may benefit by modifications. Currently I’m seeing PS 0-20. What about a range of 3-15 instead? The PS MIN of 3 might make inhaling a bit easier and the PS Max of 15 should cap your IPAP Max to 25.

The fatigue issues will clear up with therapy time as well.