ASV settings, Handicapped with CSA+OSA

[sickwithapnea17]

I'm experimenting with ASV settings. I set the EPAP to 6 and had the PS max on a lower 16cm with PS min 0, max IPAP 25cm, auto and I demasked and woke up feeling sick and tired kind of foggy.

I don't know how to keep the mask on. My sleep study showed centrals and obstructive. I have severe obstruction of the soft palate

[ChicagoGranny]

sickwithapnea17 and xxyzx talking to each other. That's good.

[tmiker]

My understanding is EPAP is primary control for upper airway patency. Do you have variable EPAP? (What model ASV?) I'd probably start there raising 0.5 to 1cm (either the fixed EPAP value or the EPAP max) to start if I were in your shoes --trying to find just enough pressure to keep the upper airway open. My machine will hit near max but only a few times a night for brief periods if I can keep the obstructives under control with the EPAP.

[sickwithapnea17]

I had 2 strokes and am horribly handicapped. my oxygen was dangerously low so they titrated me on a bipap of 18/14 to raise my O2 to the 90s.
On the resmed ASV I was on 5-15cm PS I think but it didn't work that well. I feel better on the Phillips I'm thinking of going with an EPAP of 8-14cm it seems ok, but how about 4cm for EPAP min? I have severe obstruction of the soft palate. I had surgery but it didn't seem to be effective
so you'd set the epap max at the highest like 20cm?

I keep taking the mask off while asleep I think I unhook the clip while asleep. It's terrible because then my oxygen becomes really low and I get brain damage.

[tmiker]

You should have another study on ASV. Don't set EPAP to max. If you're intent on ttweaking then base it on your titration. 4 would be unusually low and probably will feel uncomfortable. If you had a bipap study done the lower number relates to the EPAP. What machine are you using? If its not one of the new models a study would likely help you get one as they have features to make it more comfortable.

[tmiker]

I'm not a doctor and you really should see one to get an ASV study. Also check the alarm on the machine is on for when your mask comes off and you can get a pulse oximeter with alarms for pretty cheap. If you insist on tweaking the ASV, then only tweak around the margins of your BIPAP titration as otherwise the results could be unpredictable. Based on your BIPAP settings, your previous post of 8 - 14 EPAP is reasonable though I would start at 10 or 11 for EPAP min and work down 1 cm at a time if successful to find your minimum. If 8 - 14 EPAP then Min PS is 4, Max PS is 10 based on your BIPAP settings. If you use a higher EPAP minmum instead of 8, then lower the Max PS by the difference between that new Min EPAP number and 8. So if you use 10 - 14 EPAP, Min PS is 4 and Max PS is 8.

[tmiker]

Remember the BIPAPlower number is the minimum to keep your airway open over the night, so its better to work slowly down from there than jump way below right away. Did you use the Flex settings on the Respironics? It makes a huge difference to me. I'm not sure what the Resmed equivalent was called but they have a similar comfort feature. Its the best place to start before fiddling with exhalation pressures.

[sickwithapnea17]

how do I get oxygen??
my sleep surgeon is really nasty and won't give me the oxygen even though I had it prescribed before. the insurance may require 88% during the day which seems ridiculous but I did have a reading lower than that

[49er]

Please check the archives regarding sickwithapnea's postings so you see what type of posting history he/she has. Any responses should suggest that he/she see a doctor regarding the issues expressed. His/her needs are really beyond the board's pay grade.

49er

[Julie]

Yes, stop engaging with him - it will only end badly (again).

[ChicagoGranny]

Yes, stop engaging with him - it will only end badly (again).

+1

[chunkyfrog]

I see an arm reaching out of the bowl to pull the lever one last time.

[ajack]

I would use chin straps across the clips, without blocking vents. Or stretch bandage. worse case would be to put a pillowcase over my head, to stop access to clips. however you do it, it needs to fix it.

please don't adjust on what I say and see a dr or dme to set it up..but could you piggyback on your previous settings. 18/14 ... have min 12 ipap and min 4 PS and let the auto take it from there?