New BIPAP user recommended to ASV

[mpfields17]

Hi everyone

I am a new BiPAP user.  After complaints about a chronic sore throat, I was referred to an ENT who then referred me to a sleep study.  The home study said that I had obstructive sleep apnea with a rate of 24 AHI an hour.  It was considered moderate however my oxygen had gone below 88 at one point so they felt it was essential for me to get treatment.

I went in for the overnight sleep study, and it was pure torture for me, I was so anxious. I almost walked out of it.  It was the first time I had ever had a mask on or experienced a CPAP machine.  I did stick it out, but only slept about a total of 90 minutes and they determined that I needed a BiPAP machine because the constant pressure of the CPAP made it difficult for me to exhale 

So I have been on a ResMed Air curve 11 for about five weeks. I started on a face mask, but just switched five days ago to a nasal pillow because I just could not tolerate the face mask.  I feel much more comfortable in the nasal pillow mask and so far I’ve done OK keeping my mouth shut.   But since the beginning, I’ve been experiencing too high a number of AHI’s an hour, and most of them are central type.  In fact, I have a really hard time getting to sleep because every time I start to drift off, I jump awake with an apnea event.  Very frustrating because I’m not sleeping much and honestly, this is worse than it was before I ever tried a dang machine!!!! 

The sleep medicine practice tried changing my pressure setting, but it didn’t really impact it so now they want me to go back in for another overnight sleep study to get titrated for an ASV machine   

So my question to all of you is, anyone else on an ASV? Is it difficult to get adjusted to if you had been on a BiPAP? Pros and cons?

To be honest, I’m really debating whether to chuck this whole process and forget about it or to go in for the second sleep study.  

Thank you for any feedback.  

Marcy

[Sleeprider]

Marcy, we have many members using ASV and it is simply a smarter bilevel machine that triggers IPAP pressure support that provides the comfort of your previous bilevel and is capable of causing you to take a breath when you don't spontaneously initiate a breath on your own. It doesn't breath for you (although it can), but the increase in pressure when it's time to take a breath can stimulate you to take a breath. We can accomplish the same trick with a Resmed Aircurve 10 S or Vauto.

It would be really helpful if you could download the free OSCAR program and post a chart of your current therapy. Instructions to organize charts and attach image files are linked in my signature. It appears you were using 13/9 pressure, but we're not sure what device you are using or if there are any other settings we should be aware of. Anyway, If you access your settings, look for Trigger Sensitivity and set it to very-high. This can cause your machine to trigger IPAP with minimal spontaneous airflow. This often resolves the problem of sleep onset clear airway apnea that you seem to be describing.

[mpfields17]

Thank you for your response!

I am using a ResMed aircurve 11 Vauto
I started with a airfit f30i mask but really struggled with being irritated by it and when I slept on my side, it created leaks. So I started with a nasal pillow five days ago it’s a Phillips dream maker nasal pillow mask   

And yes, it’s on BiPAP setting so 13 inhale and 9 exhale is my pressure setting

I don’t see on the machine is setting for trigger sensitivity.  But is that something I should be able to access? Or do I need to download OSCAR?

[SarcasticDave94]

Agreed with getting OSCAR. I'd suggest making sure you request your detailed sleep study, the script, any Titration results.

If you do need ASV, ResMed is the best there is.

[Sleeprider]

The trigger sensitivity settings is in the clinical menu. For Setup Instructions with pictures, click here. While looking at the main screen, simultaneously press and hold the two buttons (labeled "My Options" & "My Sleep View") for 3+ seconds until the screen transitions to the "Clinical Home" screen. For a short video of this procedure, click here.  

Changing trigger sensitivity to Very-High will resolve many or most of your CA events. This will not show up in your compliance reports and your doctor and supplier will probably be unaware of this setting. I would still like to see charts of your therapy to see if we might be able to reduce pressures or suggest a range.

[mpfields17]

Oh!  Ok.  That is helpful to knowx. I would’ve never known that’s how I could get to that setting  
I will give that a try when I get home this evening.  It makes this “doctor/medical compliant sensitive” person a little nervous to break into the clinical settings, but I will do it!!!!  Lol. Anything to be able to get to sleep each night!!

So do I need to download Oscar to be able to show you the charts of my therapy?
This will take me a little bit longer, to be honest we don’t even have a personal computer at home anymore.  I have a work laptop, and an iPad and iPhone!!!  It appears I will need a non-work related windows computer to download the Oscar program.   We probably need a home computer at this point anyway, so something to work on!!!

[SarcasticDave94]

As best as you're able, yes try to get OSCAR.

One way to approach to you accessing the clinical menu, and the settings within, you're trying to make your therapy the best possible with minimal money. You access the settings free. You know what your therapy feels like, and it follows that when you change setting X, you'll pretty quickly associate this with change to feel and results.

My way to approach it with the doc was that I changed settings to gain better therapy. Then show the results. They typically argue less if you show the positive results in doing your own settings.

If/when you get ASV, it's probably easier to tune it yourself than the VAuto. There's actually less manual settings available. I had a ResMed AirCurve 10 ASV for about 2 years and therapy was quite good. I had to set it myself from day 1. DME supplier told me they didn't know how to set it.

[Sleeprider]

I don't like recommending SleepHQ because they have taken the Oscar shareware and adapted it to their pay for service product. However there is a free account and the "dashboard" is able to upload and display the data from your machine using your iPad or IPhone, assuming you are not allowed to install Oscar on the work laptop. Anyway, it allows us to see what is boing on. Wish we would develop a similar capability for Oscar.

[mpfields17]

Thank you so much!   I will check all of this out 

What will setting the trigger to very high do exactly ?  

Thanks so much

Marcy

[SarcasticDave94]

The Trigger setting on the VAuto is the sensitivity setting to trigger the inhale (IPAP). Trigger High or Very High means the sensitivity is increased to fire off the inhale increase with less inhale "signal" as the machine senses flow via your mask.