Newbie to CPAP

[Pugsy]

When you start the night and are awake you will be using these settings.

EPAP 7 (minimum)

PS of 5 (minimum)

that makes IPAP 12

now the machine can go up to 10 PS if it needs to and it can go up to 25 IPAP if EPAP plus PS puts it up there.
There's lots of potential combinations of numbers but in general the EPAP takes care of the obstructive stuff and if the machine thinks you need more EPAP then it will increase EPAP and it will always have at least 5 cm (PS) difference. So maybe you would see 12 EPAP and 17 IPAP...that for the obstructive stuff.

Now when the centrals happen the machine might decide to do 10 cm PS....so if EPAP was 12 and a central happened it might do 10 PS so IPAP would be 22.
It's relatively brief spike to 22...done and over with in maybe 30 seconds. Fairly quickly...this "burst" of air usually will jump start your own respiration so that your breathing kicks in and at the same time it is breathing for you.

Auto back up rate.....when you first start the night the machine makes a mental note of the number of respirations you are experiencing in the first few minutes on the machine and calculates an average...and once you go to sleep if you don't breath enough on your own because of the centrals to keep up with that average back up rate the machine will breathe for you with that little burst of pressure.
This back up rate average is the only thing the machine will learn about your breathing and it starts a new average every time you turn the machine off and back on again. It can't remember what your back up rate for last week was...heck it can't remember last nights.

[Farmboy]

Received my ResMed Aircurve 10 ASV today. I'm both excited and nervous to use it.

I went to the clinical menu settings to verify my pressures and they are not matching what was written on the script.
Here are the script pressures again from my doctor:

Max Pressure: 25 cm H2O
Expiratory Pressure: 20/7 cm H2O
Pressure Support: 10/5 cm H2O
Backup Rate: Auto

Here are the current settings on the machine:

Mode: ASV Auto
MIN EPAP: 7
MAX EPAP: 15
MIN PS: 5
MAX PS: 10

I tried to change the settings on the MAX EPAP to 20 but the machine stops at 15. What in the hell am I missing? Are these pressure settings correct?

[Pugsy]

Those settings will work fine. If you ever hit 15 EPAP you will have either 20 IPAP (that's with PS of 5) or 25 (with PS of 10) or any combination in between. It's the big PS that breathes for you. Only thing I am surprised is that they limited PS to 10 instead of 15.
I don't think max EPAP will go higher unless you lower PS and you don't want to do that because you need higher PS burst for the centrals.

You should be fine for tonight. You might try the machine for a short time while awake watching TV or something. It won't do much while awake but will get you into the feel of the rhythm and everything.

[Farmboy]

Thanks everyone for all the help and support.

Pugsy,

A special thanks to you for all the information and suggestions these past 4 months. You have been a huge help every time I have asked a dumb question. You are truly an exceptional person! I will keep you all posted as I move forward with what I'm hoping will be the machine I have needed.

[Farmboy]

I have completed my 12th night on the ResMed Aircurve 10 ASV. I know it is early in the treatment but I'm still waking up tired as hell in the mornings. Here is a screen shot of last night, can someone take a look and give me some feedback. Hopefully this is the correct info you need. Thanks

http://imgur.com/a/PuDkD

[Pugsy]

I see a couple of breaks in therapy where you turned the machine off and then back on again...so awake. How many other wake ups are you having?

[Farmboy]

Pugsy,

I remember waking 1 time last night to remove my T-shirt, not sure what time it was (didn't look at the clock). Then I woke up around 5am tossing and tuning so I shut the machine down. My AHI has looked really promising from day 1 of starting this machine.

[Pugsy]

I don't see anything on the report that is just screaming fix me.
Obviously the apnea is being well treated. Maybe you just need to give it more time....like you have much choice in the matter anyway.
While giving it more time you can of course investigate other potential culprits for the fatigue and if it persists get with your doctor.
Other things can cause fatigue besides sleep apnea.

Sleep apnea is just one of many things that can cause fatigue and while the machine can do a great job with the sleep apnea stuff it doesn't do such a good job if the problem is something else.

And there is some truth to the "give it time" thing. Sometimes improvements are very, very gradual and you don't really realize they are happening until maybe you have to do without the machine for some reason or other and then you get a rude reminder of just how bad you used to feel.

I don't remember if you are on any meds or not but it seems like you weren't....medication side effects is always one thing we look at.
Another thing is hours of sleep and are those hours fragmented with multiple wake ups and if so...why?
Other health issues come into the picture too...when was the last time you had a good work up with the usual labs along with the unusual labs like testosterone or Vitamin D?

I know that both hours of sleep and sleep quality (how many times I wake up tossing and turning) play a huge factor in how I feel each day.
I need both optimal hours of sleep and to have those hours not be very fragmented or else I don't feel the good numbers that I always get.

I don't see anything on the report though. Wish I did because then you would have something tangible to relate to and work on but nice clean reports don't guarantee anything but a good pat on the back. There's so much more to good restorative sleep than AHI and so much much more in the way of causes for not feeling the good numbers than what is available on the software reports.

The 2 known wake ups...I don't know how much of a factor they played but if you had a bit of trouble getting back to sleep they could have played a part in not getting the needed sleep cycles. It's the only thing that I see on the report that might...stress the might part...impact how you feel during the day because they might have impacted the sleep cycles.

I have known people who say it took them 6 months on ASV to feel any better and some feel better almost from day one. Don't know why though. You gotta use the machine anyway so might as well do some detective work as to other potential culprits while you are "giving it time"...not like you have much choice in the matter.

[palerider]

if it were me, I'd raise the minepap to 9, and lower the minps to 3.

you've got a very active pressure support line (the variation in IPAP trace)

[Farmboy]

Pugsy,

I had a physical and full blood panel done May 16th. The only thing my Doc (PCP) noted were my Vitamin D levels being low, on a supplement for that. No other issues or medications. Not sure why, but my sleep doctor has decided to refer me to a Cardiologist, appointment is Thursday for an echocardiogram. I'm guessing to cover his backside now that I'm using an ASV machine.

I'm still wondering if I should look into the low O2 saturation for the residual tiredness. During my ASV sleep titration they noted low oxygen saturation of 89% with a residual AHI of 1.8 and my Diagnosis was COMPSA with oxyhemoglobin desaturation to 85%. Not sure how long I was at that level but if it happens frequently during sleep, wouldn't it cause some problems?

Palerider,

I'm all for trying different settings. Can you clarify how changing the settings would help. I have read and read but still do not understand how this ASV machine works.

[palerider]

I'm all for trying different settings. Can you clarify how changing the settings would help. I have read and read but still do not understand how this ASV machine works.

raising the minepap would help to counter the obstructives and hypopneas you're still having, though they are few, it would also increase your oxygenation. (bilevel rule of thumb, increase epap to increase oxygenation, increase pressure support to reduce carbon dioxide).

the relatively high pressure support may be over ventilating you, causing you to blow off too much co2, which would exacerbate the central apnea (low co2=no desire to breath) so it's *possible* that lowering the pressure support could even out your breathing, and give you a less active pressure line.

[Farmboy]

Looking for some help on choosing a new mask. I currently use the Quattro air full face mask but switching to the ASV machine has upped my pressure causing leaks. I'm finding to keep a good seal I have to really tighten the straps down causing cutting and bruising on the bridge of my nose. I tried my nasal pillows last night and ended up going back to the full face mask because I'm a mouth breather.

What are some of the mask brands that you find comfortable and that seal good with higher pressures.

[Pugsy]

You might start a new thread about the mask search...it will get more attention. Don't know how many will be following this thread now.

But I can tell you this...people will tell you that they use so and so mask and it works well for them but that doesn't guarantee that it will work well for you. It's just the way it is with masks because we are all different and have different facial structure and different wants and needs and preferences.
You have heard about one man's trash is another man's treasure....that's the way it is with masks.

Though you might look at the ResMed F20 AirFit and AirTouch...see what you think about them...they are probably the latest and greatest in the full face line from ResMed.

Have you thought about mask liners? They seem to help a lot of people at higher pressures.
You can make your own or buy some ready made. Padacheek.com has some really nice ones that last months and months with common sense care.