switched to ASV - Feeling better but still struggling with aerophagia

[Alghamdi]

Hey everyone,

i used to be on APAP/CPAP but switched to Vauto. Recently, i wasn't really happy with the therapy. too many arousals.

So, i adjusted my settings and switched my machines to ASV mode. Honestly, it feels better now.
The settings were kinda tricky, but i think i got them right.

the only issue i still have is aerophagia. any advice?

[Sleeprider]

Your pressures are pretty low with ASV and the only place you have room for lowering pressure is in the EPAP max of 10.  Some people find aerophagia is reduced or eliminated by raising the head of the bed. This is not a wedge pillow but using 3-inch blocks under the bed frame to build up an angle of 3-6 inches. https://www.amazon.com/s?k=bed+raising+b...%2C127&ref

[Alghamdi]

Thanks, Sleeprider, for your insightful response.

Honestly, high pressure sometimes gives me palpitations and vivid nightmares, so I prefer to keep it lower as long as it’s effectively treating me.

Regarding the max EPAP, do you think setting it to 9 would be a good idea?

[Sleeprider]

I recommend lowering EPAP max until you see an unacceptable level of UA or H events occur. EPAP is used to stent the airway to prevent obstruction, while PS is used for ventilation and to help you trigger breaths if needed. I like your PS range of 2-7, so really the only place you have to cut is in the EPAP.

[SarcasticDave94]

If this happens to be a hacked machine like AirBreak, the machine might not respond exactly as the dedicated ASV should.

[Alghamdi]

If this happens to be a hacked machine like AirBreak, the machine might not respond exactly as the dedicated ASV should.

I thought so.

I took both machines apart and compared them chip by chip.

Literally, the only difference between the two is the outer casing.

I don’t use AirBreak. I completely removed its firmware from my machine and replaced it with the PaceWave (ASV) firmware.

But can you explain why it might not respond as expected, even though the hardware is exactly the same in both machines and the only difference is the firmware?

---

I recommend lowering EPAP max until you see an unacceptable level of UA or H events occur. EPAP is used to stent the airway to prevent obstruction, while PS is used for ventilation and to help you trigger breaths if needed.  I like your PS range of 2-7, so really the only place you have to cut is in the EPAP.

I’ll try lowering it by one and share my results with you in a few days.

I appreciate your concern!

[ahuman]

One can just swap the firmware? Similar to Airbreak but using regular ASV firmware?

[Alghamdi]

The legend of 0.0 is real 

[SarcasticDave94]

Your numbers can't seemingly get better. Congrats.

As for the question of Airbreak, etc. responding or acting differently, it's what I've seen from others' OSCAR charts where there's some pattern or discrepancy in reacting to events. To me there's something there that's seeming off just slightly, like an OSCAR chart comparison that just seems slightly different. And I myself have had my own ASV charts when I used an ASV for 2 years to have noticed some things slightly different from what I know I had.

Yes I know each time an OSCAR chart is posted, it'll be different. Honestly it's hard to describe, just some slight variations, possibly a mix between a bilevel and ASV combined. Not really sure what it is, but it can look very slightly different. Then the person feeling seems not to exactly match up with true ASV.

That's the best I can in an attempt to explain.

[ahuman]

Machine calculated AHI is one piece of information. How do you feel? What does the flowrate look like as from the zoomed out view the top of the curve seems a little jagged?