Snoring with ASV

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
SnoringPugs
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Snoring with ASV

Post by SnoringPugs » Mon Nov 20, 2017 10:50 am

I started CPAP in March and after a few months my sleep doctor said I needed either a bipap or asv. I finally got a dreamstation bipap asv but when I use it, my husband says I am back to snoring.

With the cpap machine I was using the amara view mask and was feeling much better than before treatment. No waking with headaches, no drowsing while driving, not getting up multiple times a night.

The 5 nights I've tried using the new machine I found that I can't use my mask because it leaks too much and I snore. I tried using nasal pillows but those aren't comfortable. I also am having a hard time breathing and falling asleep with this one. Twice I switched back to my cpap and slept much better. I can't seem to get used to the way this machine works, I think I like the steadiness in the cpap.

I guess my question for experienced users is.... Is it wrong to say I don't want the 'better' machine?

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Pugsy
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Re: Snoring with ASV

Post by Pugsy » Mon Nov 20, 2017 11:02 am

Why were you put on the ASV? Most likely central apneas were happening and if that's the case the way the ASV deals with centrals is with a rather large and rapid pressure increase so it's not unusual to be having leaks with the pressure changes.

Talk to your doctor about your problems and see just how important it was for you to switch to the ASV machine in the first place. Were you having just a few centrals or a truckload of centrals?

If you are still snoring then most likely the minimum EPAP isn't quite up where it needs to be.
The leaks with ASV...common complaint because the pressures can and will vary widely as the machine breathes for you so you have to try to fit the mask at the beginning of the night at something closer to where the machine is wanting to go.

There is a mask fit feature on the machine that you can use and it will blow a higher pressure for a short period of time so that you can better fit for pressures that are higher.
If you don't know about this feature go here and request the clinical manual for your machine and it's all explained in the manual.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

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SnoringPugs
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Re: Snoring with ASV

Post by SnoringPugs » Mon Nov 20, 2017 11:13 am

Pugsy wrote:Why were you put on the ASV? Most likely central apneas were happening and if that's the case the way the ASV deals with centrals is with a rather large and rapid pressure increase so it's not unusual to be having leaks with the pressure changes.

Talk to your doctor about your problems and see just how important it was for you to switch to the ASV machine in the first place. Were you having just a few centrals or a truckload of centrals?
The pressure was increased to 9 on my cpap because my AHI was still over 10 most nights. After that, the doctor said my AHI was still too high and I was having some centrals. During the titration for the ASV my AHI was still 5.4. I had lower than that at home with my cpap.

I'll check the mask fit feature and talk to my doctor again. When I told the tech I snored after the first night using the ASV, he said we needed to increase pressure. I worry that if I'm having a hard time adjusting to this pressure, the higher pressure will be even harder. Maybe not, Maybe that's what I need for it all to work.

Thanks Pugsy.

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Pugsy
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Re: Snoring with ASV

Post by Pugsy » Mon Nov 20, 2017 11:23 am

What are all your current settings now on the ASV?

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SnoringPugs
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Re: Snoring with ASV

Post by SnoringPugs » Mon Nov 20, 2017 11:34 am

xxyzx wrote:why did the doctor say yuo needed a bipap

if you have centrals and stop breathing then you do need the ASV

you should be able to adjust the ASV to feel more like the cpap and still have the benefit of backup rate for centrals
Before cpap I would have shallow breathing and snoring, not sure I would actually stop breathing. I thought cpap was helping with those since I felt better and hubby said I wasn't snoring anymore.

I am seeing the sleep tech this afternoon to discuss my options since when I called the office said "It is very important for you to keep using the ASV and not use the cpap". But this person couldn't tell my WHY is was important. If they can explain why it is important that I continue using the asv, I will keep trying to make it work.

SnoringPugs
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Re: Snoring with ASV

Post by SnoringPugs » Mon Nov 20, 2017 11:36 am

Pugsy wrote:What are all your current settings now on the ASV?
When the machine turns on it has 6 and 10. I'm not sure if those are the settings or what

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Re: Snoring with ASV

Post by Pugsy » Mon Nov 20, 2017 11:45 am

The 6 is EPAP or exhale pressure and the 10 is IPAP or inhale pressure so that means the PS starts at 4 (PS is pressure support which is nothing more than the difference between inhale and exhale).
Now there are other settings involved that you can't see that the machine can go to or do as it senses the need. You are likely asleep when that happens so you won't know what the other parameters are unless you went into the clinical setup menu to see what the other settings are.

Like PS...of 4...there's actually a minimum and maximum setting for PS...we know the minimum is 4 but we don't know the max...and it's PS that gives you the big inhale to breathe for you when you have a central apnea and don't breathe.

There are also some other settings available...get the manual and go into the clinical setup area and just look.
Not saying change something...just look so that you know what the machine settings are.

This may be a bit technical for you but it explains how the ASV is set up to deal with the obstructive stuff and the central stuff.
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf

Talk to the doctor and have him explain why you need this machine...I know the leaking is frustrating but people who need these ASV machines have special needs and you are doing yourself a disservice by going back to the cpap. In the long run it could really have a negative impact on your body to have the untreated central apneas happening and causing problems.

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MaxINTJ
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Re: Snoring with ASV

Post by MaxINTJ » Mon Nov 20, 2017 12:07 pm

SnoringPugs wrote:I started CPAP in March and after a few months my sleep doctor said I needed either a bipap or asv. I finally got a dreamstation bipap asv but when I use it, my husband says I am back to snoring.

With the cpap machine I was using the amara view mask and was feeling much better than before treatment. No waking with headaches, no drowsing while driving, not getting up multiple times a night.

The 5 nights I've tried using the new machine I found that I can't use my mask because it leaks too much and I snore. I tried using nasal pillows but those aren't comfortable. I also am having a hard time breathing and falling asleep with this one. Twice I switched back to my cpap and slept much better. I can't seem to get used to the way this machine works, I think I like the steadiness in the cpap.

I guess my question for experienced users is.... Is it wrong to say I don't want the 'better' machine?
Firstly, if you don't want it, I'll take it if the VA doesn't prescribe one for me in a week or two.

Secondly, I was on CPAP/APAP that wasn't working for me and I tried an ASV for about a month. I HAD to use an Amara View, and I can vouch for the fact it WILL seal fine up to 25 pressure. Make sure it's the correct size for you and don't make it too tight. And like someone said, use the mask fit so you can fit it at high pressure.

For me, with pressures going to 25, nasal pillows didn't work - the Dreamwear sealed just fine with mask fit, but my mouth would always blow open when pressure went above 15 or so (most of the night ).
Phillips 960 AutoSV Paving Brick, Phillips Dreamwear Mask - Nothing is working.
Diagnosis of crappy sleep, desats under 80, maybe UARS

SnoringPugs
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Re: Snoring with ASV

Post by SnoringPugs » Wed Nov 22, 2017 9:40 am

MaxINTJ wrote:Firstly, if you don't want it, I'll take it if the VA doesn't prescribe one for me in a week or two.

Secondly, I was on CPAP/APAP that wasn't working for me and I tried an ASV for about a month. I HAD to use an Amara View, and I can vouch for the fact it WILL seal fine up to 25 pressure. Make sure it's the correct size for you and don't make it too tight. And like someone said, use the mask fit so you can fit it at high pressure.

For me, with pressures going to 25, nasal pillows didn't work - the Dreamwear sealed just fine with mask fit, but my mouth would always blow open when pressure went above 15 or so (most of the night ).
The DME is patiently waiting for me to decide which machine to keep and which they will take back

It's good to know that the Amara View can seal at higher pressures.

I met with the sleep tech and that was a complete waste of time.
For the mask fitting part, he had me put it on and said "yep, it fits. If it leaks, just tighten it up".
When I asked WHY they wanted me to use the ASV machine he said "You failed at cpap and need this". I had to keep asking questions before he finally got my chart and then just read the numbers to me and what the recommendations were.

They were comparing my cpap titration to the asv titration, not the results of being on cpap for a few months. During the cpap titration my AHI was 12.6 and after using it for awhile (and the pressure raised) the numbers dropped to between 3 and 8, rarely over 10. During the asv titration, the AHI only dropped to 5.6.
My CAHI was 5.9.

Last night I used the ASV, hubby woke me after an hour to say I was snoring and my mask was leaking. Tightened up the mask, still kept leaking so I switched back to cpap with same mask (loosened) and slept peacefully. The combined usage AHI was 2.9, 0 clear airway apneas,3 obstruction apneas and 17 total hypopneas.

Today I am going to see if the DME can be more helpful than the sleep place.

SnoringPugs
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Re: Snoring with ASV

Post by SnoringPugs » Wed Dec 13, 2017 1:07 pm

I don't want to create a new topic so I'll ask it here...

Can pain increase AHI?

It seems like it would since sleep is definitely affected.

I went back to using my APAP and my AHI was between 2.4-3.8 with 1-4 centrals recorded. I broke my shoulder 2 weeks ago and now everything has shot up. Last night AHI 7.5, clear airway 10, obs 32 and hypopneas 13. I was in pain, couldn't get comfortable and woke up often.

Now I'm wondering if it's the injury or did I really need the ASV. The DME hasn't picked up the ASV yet...but I also don't have a mask that doesn't leak with it.

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Pugsy
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Re: Snoring with ASV

Post by Pugsy » Wed Dec 13, 2017 1:34 pm

Yes, pain can mess with the AHI and also any pain medications that a person might take can also mess with the AHI.
Anything that can cause us to wake often can cause the machine to sometimes misread awake breathing irregularities and give you flags that aren't real because you were awake.

So when in pain and awake often...greater chance of awake breathing flags that aren't real.
And also pain meds can sometimes make real asleep events worse. Strong pain meds can increase the chance of centrals or even just relax the airway tissues so more obstructives happen...muscle relaxant medications...even greater chance of making the obstructive stuff worse.

Some people highly sensitive to such meds and some people not so much. So one person might take a very light dose and see a big change and someone else might take a heavy dose and not see much change.

The nights that I would have a lot of back pain (history of arthritis) my AHI can often be higher than usual simply from the awake breathing confusing the machine.

These machines only measure air flow...they can't know if you are awake or asleep and our awake breathing is often very irregular (when compared to asleep breathing) and the machine will/can flag these irregularities as some sort of apnea event but they aren't real if we are awake and we have to mentally remove them from the overall AHI evaluation. Only the asleep events matter.

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