Need help with tweaking a few things on ASV

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tuzacat
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Need help with tweaking a few things on ASV

Post by tuzacat » Sun Nov 23, 2014 10:30 am

I have had a couple of miserable nights in a row. I'm a new ASV user and have had some problems getting situated with the right mask when I switched from BiPap probably due to the increase in pressure. I got an Airfit F10 last week and have been working at trying to get rid of leaks, chipmunk cheeks and grunts and dry mouth. Basically, liners helped with the leaking, a chinstrap helped with the chipmunk cheeks, and raising the EPAP pressure from 8 to 10 (where it was on Bipap) helped with the grunting. So far the heated hose is doing wonders for my nose but nothing for the dry mouth. I've got a desert in there.

I have some questions that some of you might know the answers to.

1) The settings on the heated hose in the clinical menu say: System One Resistance - 0; Heated Tube Temp -5; Heated tube humidity -3. I have been switching the knob on the outside of the machine from 4-5 to see if I can see any difference. I have been reading in this forum that some people use a passover technique to get more moisture but I am not sure how to do that. I don't see any way to do that in the setup menu or the clinical menu. Also are these the right settings to get optimum moisture? I have tried Biotene but it doesn't really do much for me.

2) After I thought I'd gotten everything worked out with the mask fit, chinstrap, and leakage I had one of the those miserable nights where I started grunting again. When I looked at my leak rate the next day it just seemed high even though there were no large leaks. One of the things that's hard to figure out for me with a FFM is whether it's really leaking in the eye area or it just feels that way because of the vent air and because the is air so close to the eyes underneath the mask. To stop the grunting I raised the Epap to 10.5. To get the leak rate down instead of putting the chinstrap under the mask as I had been doing I attached a strap on the bottom of the mask that M'ohms explained in one of her posts. I tried the cervical collar but it wasn't comfortable enouch for me to get to sleep with it. That was last night. After several hours of fooling around with all this stuff I finally fell asleep. The leak rate was down and with the higher Epap pressure I grunted minimally, moving the chinstrap away from my cheeks meant I had a little puffing but it was minimal. I am still snoring over the machine and having hyponeas. Do you think it would be safe to raise the Epap pressure to 11? Do you think I should give it a couple of days at 10.5? It was set at 8 initially with the high to be 12. If I raise the bottom number on Epap should I raise the top number, too? I don't think it ever went up to 12.

3) The other question I have has to do with telling the machine what mask I'm wearing. I can't find a place to do that yet I understand that it might help. Does anyone who uses my type of machine have info on that? When it was set up initially I was using a nasal mask.

Thank you in advance for your help!

Best,
Tuza

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Pugsy
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u

Post by Pugsy » Sun Nov 23, 2014 11:05 am

Question 1.
Passover humidity is going to be a lot less moisture from what you are using. It definitely won't help your dry mouth though.
You are already maxing out your humidity delivery at 3...that's 90% with your PR S1 machine with the heated hose.
The settings of 1 through 5 on the knob on top of the blower when not in the clinical setup menu is strictly for air temp in the hose which is mainly comfort and condensation prevention. You can use a lower temp if it feels better to you and have it still deliver the 90% humidity if you wish. The hose air temp settings 1 through 5 start with your bedroom air temp and a setting of 1 will increase that temp by 4 degrees....a setting of 5 will increase that air temp by 16 degrees and the other settings in between.

Dry mouth with a full face mask comes from mouth breathing and some peoples' mouths dry out more and more easily than others and often maximum humidity delivery simply is not enough to fix it. The mouth needs to stay shut which is easier said than done...and that's likely why you are using a full face mask in the first place.

Question 3..
Your machine doesn't require mask selection process...the resistance control feature as to do with mask resistance built in to each mask and doesn't affect performance or leak. If you are using a non Respironics mask the setting Respironics says to use is 0 which effectively turns off resistance control. It isn't a make it or break it setting with or without a Respironics mask.

Question 2...
I have no idea what to offer. So sorry. I don't know what the grunting issue is caused from.
Cheeks puffing...that's chipmunk cheeks because the tongue is allowing the air to enter the mouth but lips are closed.
Snores usually mean the airway is trying to close still yet and may or may not progress to the point of collapsing to a point to become a hyponea.
Yes, usually a little more EPAP for this situation.
In terms of safety to increase it...I can't comment because that's beyond what we can know but given that with your machine it is already going a lot higher for the centrals and if that increase should happen to cause centrals...your machine will deal with them anyway.
If you opt to increase EPAP minimum...I would go in 0.5 cm increments to see what happens...go small and slow..I wouldn't change EPAP max unless I was seeing EPAP being maxed often or for long periods of time. If EPAP is never hitting 12 even now...raising it won't accomplish anything because the max isn't a factor now.

ASV therapy....have to have more patience with it than with standard pap therapy because the body really has to have time to adjust with it.
If you have a bad night due to leaks..then the therapy as in pressure terms can't really be evaluated because we don't know if it was bad because of pressures or simply the leaks.
And leaks don't have to be in the large leak territory to make things bad...if leaks (even tiny) disturb your sleep then they are unwante.

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JDS74
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Re: Need help with tweaking a few things on ASV

Post by JDS74 » Sun Nov 23, 2014 11:39 am

A chinstrap with a FFM can cause more obstructive events which the system will respond to with more pressure.
You might try a soft cervical collar that holds your jaw up without pulling it back. Chipmunk cheeks are a result of pressure trying to exit through your mouth while you are primarily breathing through your nose. It may be that the higher pressures from the ASV machine while it responds to a central event could cause the same thing even though you are mouth breathing at the time.

Be very careful with adjusting the EPAP min as this will impact air exchange when in ventilator mode. At your current EPAP you aren't close to any problems along those lines. You should work closely with your sleep doctor as you tweak so as not to get into troublesome territory.

Welcome to the club.

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Last edited by JDS74 on Sun Nov 23, 2014 6:11 pm, edited 1 time in total.
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tuzacat
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Re: Need help with tweaking a few things on ASV

Post by tuzacat » Sun Nov 23, 2014 12:31 pm

Thanks, Pugsy and JDS74, I appreciate you taking the time to help me with this stuff. What I can't understand is how things seem to morph. One night I'll have a pretty good therapy and the next night with everything the same I bomb out. For instance, when I changed my Epap setting from 8 to 9 I stopped grunting for a night but the next night it started again. I then raised it to 10 and had quite a few nights with no grunts. Last night I bumped it up to 10.5 and they virtually disappeared. I don't snore every night but I had a slew yesterday. What concerns me is I really don't want to go too much off the original settings - presumably these people have some expertise and I don't want to mess something else up as you were talking about JD.

I have tried the cervical collar but it's pretty uncomfortable - not conducive for sleeping - maybe what I got is just not soft enough. At present I am having 0 centrals and 0 OA's a couple nights in a row with AHI btween .7 and 2. Then for a couple of nights it will be rough between 4 and 7.9 mostly hypopneas with a sprinkling of OA's and CA's. The positive thing is I seem to be breathing on my own more.

I think tonight I will try taping my mouth under the mask and see if that does anything for the dry mouth issue.

Thank you both for your explanations! Maybe the grunting is also the result of the tongue dropping and some nights it stays put and other nights it doesn't. I definitely understand that this going to take time but it is hard to drag this 60 year old body into work on the little sleep I get some nights and when I get a really good night the energy I have the next day is so wonderful and surprising I'm anxious to repeat it!

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M'ohms
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Re: Need help with tweaking a few things on ASV

Post by M'ohms » Sun Nov 23, 2014 4:41 pm

When I use the f10 mask, I usually end up with dry mouth waking me all night long. I went to the drug store and asked the pharmacist about this and he suggested Quantum OraMoist tabs. I also bought XyliMelts for Dry Mouth. Between the two, I prefer the OraMoist because one tab will last all night. It has a orangey taste. The XyliMelts are more minty, but only last a few hours. Both do a good job of keeping my mouth moist.

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tuzacat
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Re: Need help with tweaking a few things on ASV

Post by tuzacat » Sun Nov 23, 2014 5:25 pm

Thanks, M'ohms, I'll look for those.

JDS74
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Re: Need help with tweaking a few things on ASV

Post by JDS74 » Sun Nov 23, 2014 6:10 pm

It may be that the collar you got is too stiff. I had one like that and its no joy trying to sleep with it.
I got mine through Amazon and it is really soft. Too often, the collars you can get locally are intended to immobilize the head and neck and need to be stiff to do that. But, that makes them uncomfortable.

You have the same machine as I do. One of the quirks that is different from the Respironics Auto BiPap, is its sensitivity to unstable breathing. Folks who use ASV machines have, among other things, unstable breathing patterns and this machine seems to be very sensitive to that. Mine reports quite a few hypopneas that are associated with it trying to adjust to my instabilites.

_________________
Mask: Oracle HC452 Oral CPAP Mask
Humidifier: DreamStation Heated Humidifier
Additional Comments: EverFlo Q 3.0 Liters O2 PR DSX900 ASV
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DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
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M'ohms
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Re: Need help with tweaking a few things on ASV

Post by M'ohms » Sun Nov 23, 2014 8:30 pm

Another option that might work for you is similar to the cervical collar. That is a very small pillow (like a straight neck pillow-think peanut) tucked under your chin. I use this method every night when I use a bed pillow that is too high for cervical collar-use. It holds my chin/jaw up and also keeps my mask from moving around. It's like pulling the covers up to your chin when you are lying down. Comfy.

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tuzacat
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Re: Need help with tweaking a few things on ASV

Post by tuzacat » Sun Nov 23, 2014 8:49 pm

I am planning on doing some online shopping again this week, JDS74. First, for a Pad-a-cheek liner for the mask and I'll try to find a collar on Amazon that is softer. I tried stuffing a pillow under my chin to get an idea how the collar might work so I think there is a possibility there - just didn't get the right one. Do you know the brand you bought? Another thought I had was to cut down the collar I bought and wrap it with something softer but haven't quite figured out what yet. I have been throwing a lot of money at this problem lately so it would be nice to be able to recycle.

Did you get your neck pillow on-line, M'ohms, or at a place like Bed, Bath, and Beyond?

I am sort of wondering if the machine is registering the grunts as hypopneas. Of course, I am only aware of them when I'm awake - not quite sure what's going on while I'm sleeping except for the snoring.

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cnaumann
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Re: Need help with tweaking a few things on ASV

Post by cnaumann » Sun Nov 23, 2014 8:52 pm

. What concerns me is I really don't want to go too much off the original settings - presumably these people have some expertise and I don't want to mess something else up as you were talking about JD.
While I am totally unqualified to given medical advice and would certainly tell you check with you doctor before making any adjustments, do remember the source of that 'expert' data. Basically, during a sleep study they try a pressure and see what happens. It is pretty much trail and error. That is not a bad thing, but at most, they may have a couple of hours of data on how you respond to a certain pressure setting. That is not the same as having a whole night, or a whole week at a pressure setting and then making a small adjustment to see if things are better or worse. My prescribed numbers for bipap are completely different than what I am actually using for ASV.

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cnaumann
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Re: Need help with tweaking a few things on ASV

Post by cnaumann » Sun Nov 23, 2014 8:53 pm

How do you know you are grunting? Does this happen when you are awake or is someone telling you about it?

tuzacat
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Re: Need help with tweaking a few things on ASV

Post by tuzacat » Sun Nov 23, 2014 9:13 pm

The grunting keeps me awake. It's very strange, but from the responses I've had on here it's not unheard of. Usually happens as I'm dropping off to sleep and wakes me up. Good point about how they go about determining the pressures - I don't think I was asleep long enough the first time they tried to figure it out.