[Pressure] Increased pressure cycle with ASV machine

[Steve47]

I was diagnosed earlier this year with Central Sleep Apnea. At the start of April, I began using a ResMed Air Curve 10 ASV. For most of that time, I used an Airfit F20, but that mask irritated my nose bridge (I tried various pads without success). A few days ago, I switched to an Airfit F40. I like the machine—a good part of the time I can relax into the experience—but sometimes the machine increases the air pressure to the point where the mask leaks—this has happened with both masks—in a fluttering manner, and I find myself swallowing air. I try to breath calmly hoping to reverse the increase in air pressure, but I haven’t had much success. I’m wondering if anyone has an explanation of what’s going on and a suggestion for how I might better deal with the increased air pressure.
 
These are my settings:
 
Min EPAP       5
Max EPAP      15
Min IPAP        8
Max IPAP       30
Ps Min             3
Ps Max            15
 
I have attached a screen shot of an OSCAR daily file from last night.
 
Thank you for your help.


   

[mlmollenkamp]

I started with ASV not long ago after having used APAP for many years.  I have complex apnea that's dominated by central apneas.  Your settings are basically the defaults for the AirCurve ASV.  I had issues with excessive pressure at the default settings, I get lung pain with any pressure above 15 cm and I couldn't fall asleep because of high pressure during transitional sleep.  I believe the maximum pressure is the sum of the maximum EPAP and maximum Pressure Support.  I reduced both the maximum EPAP and the maximum support.  Your charts show your EPAP running 10 to 12 most of the time, and then support peaking at about 20 cm which is a lot of pressure.  I ended up with maximum EPAP of 10, and support of 5.  That keeps me below 15 cm total and the therapy has been very effective. Since you don't seem to have obstructive apneas your maximum EPAP can probably be quite low as long as there is enough support available to treat the central apneas.  Try reducing both the max EPAP and max support.  I think you'd want a lower EPAP than I use with a bit more maximum support, but I'm not an expert.  As long as the AHI and flow limits remain low you can find what's comfortable.

[Steve47]

Thank you for sharing your experience and advice. I will look into making those reductions. I appreciate your help.

[SarcasticDave94]

Try this, edit EPAP Max to 10. After seeing this following chart setup, we may suggest another edit.

Your next OSCAR chart include only the following graphs, Events, Flow Rate, Mask Pressure, Leaks, and the left panel summary side. Skip Flow Limits graph, you'll have some FL on ASV which you can't really do much about.

[Steve47]

Thank you for this recommendation and for the advice about what to include in screenshot data. I am looking into making a reduction in the pressure that your post and a previous post have suggested. I appreciate your help.