ResMed ASV device - 2nd month, not working compared to first few weeks

[tfletch159]

Hello!

I have struggled with tolerating CPAP for the longest time. Never received a benefit with the different machines they gave me, so gave up trying. I finally got diagnosed correctly (Central Sleep Apnea instead of OSA). The first machine they gave me for CSA (bipap AutoSV) didn't work for me. But after the new machine I received 2 months ago (Resmed Aircurve ASV) it seemed to work pretty well for me the first few weeks. Every night wasn't perfect and took a while, but when I had a good night (maybe 50% of the nights), I felt very good, probably the best I have in a decade or two from a night's sleep. If I can only get 50% better nights of sleep with treatment, I will gladly take it compared to the alternative.

My apneas are all predominately in REM sleep, with maybe an outlier of one or two a night outside of that. Even with the treatment working I am still waking up during the apneas, not sure if I should be sleeping through them completely with optimal treatment (not sure if that matters).

The second month so far has been a step back for sure. I am not sure what is different, I am still using it about the same amount each night but I really feel no better than I did when I started. I really want to try and fix anything I can to get it working again. Looking for any advice, hopefully specific to the type of setup I have, on what I can check or try to get it working well for me again. Or if there are any specific's about my machine or mask that people have found that works for them after they have had a setback.

Thanks for any help you can give!

[zonker]

Hello!

howdy! might i suggest that you download the oscar software and start posting some charts? the experts will need to see some data in order to be able to help you.

please see the links at the bottom of my post.

without more info, the experts can only guess.

and they may guess wrong!

good luck.

[ajack]

are you in asv or asvauto? If I miss your post. As a default setting. See how different they are to the ones you have.
You will increase the min epap in asvauto, or epap in asv, by 1cm at a time till there are very few UA, H
min PS 3
max PS 15
asvauto will have max epap 15

titration guide
https://www.resmed.com/us/dam/documents ... er_eng.pdf

[Pugsy]

Welcome to the forum.

Without seeing detailed reports from maybe when you were feeling better and now to compare them we really have no idea why you aren't feeling as good now as you did initially and even then it's sometimes not easy to spot a reason.
Maybe you just experienced the end of the honeymoon that some people experience.
Maybe something changed to alter the results a bit.....new meds or change in dosage or change in sleeping position or change in anything.

We really need to see the detailed software reports to have any idea what might be going on...need to see the settings and what is happening in terms of apnea events. All available from easy to use and free software. Do you know about the software?
All explained in my "newbies please read" topic at the top of the Announcements section on the main forum page.

[tfletch159]

I am going to try and post a few images, the first two are bad nights were I didn't feel rested in the morning, the last a good night.

2 Bad nights:

[tfletch159]

A good night:

[tfletch159]

As far as which mode I am in, I am pretty sure I am in ASV mode, but if there is an easy way to check on the screen, let me know and I can confirm for sure. Thanks for any help you can give with reading the reports and pointing out any potential issues.

[NoOnesPerfect]

As far as which mode I am in, I am pretty sure I am in ASV mode, but if there is an easy way to check on the screen, let me know and I can confirm for sure. Thanks for any help you can give with reading the reports and pointing out any potential issues.

On the left side of the OSCAR screen, under the AHI, it shows the PAP mode - in your case, ASVauto

[Pugsy]

Go into the clinical setup menu to confirm which mode.
SleepyHead is showing Auto SV mode but your EPAP isn't varying at all which means regular ASV mode.
In Auto SV mode you have a choice for minimum and maximum EPAP.
In regular ASV mode you only have a choice for EPAP.
SleepyHead doesn't always get the settings shown on the left side correct which is why I ask you to go into the machine's clinical setup menu area to verify settings.
It's showing auto SV mode but minimum and maximum PS is set to 6....EPAP can't vary at those settings.
So even if it is in auto SV mode...right now it is functioning like regular ASV mode with no fluctuation in EPAP and you need more EPAP to deal with the obstructive stuff.

Your AHI is primarily hyponeas...either more EPAP is needed or the machine needs to be able to move EPAP higher or more PS is needed.
If it were me...I would keep the minimum EPAP of 6 and change maximum EPAP to maybe 15...it won't increase without a need.
See what happens and if that doesn't help reduce the hyponeas then increase minimum PS from 3 to maybe 4 or 5.

You are still having enough events for it to mess up how you feel the next day...even on your good days and very much so with higher AHI on the bad days.

On the bad days....leaks are really bad and frequent and very possible that they are waking you up and disrupting your sleep and the wake ups alone could be a significant reason for not feeling so great.
Are you waking often?

You are using the P10 nasal pillow....are you mouth breathing or is that mask movement leak we are seeing? I suggest taping lips shut for one night so you know if that's mouth leak or mask movement leak...then depending on the answer decide how to fix it.

Are you fighting leaks all night long?

[tfletch159]

As far as changing the min and max EPAP, is that something I can change on the machine or do I have to take in to clinic/doc?

Yes, I have been waking up quite a lot throughout the nite. I usually fall asleep with it, then wake in about and 1 1/2 - 2 hours, I assuming once i hit my first REM cycle, and then after that I am waking up a bunch more throughout the nite and morning.

I have had some leaks through the mouth so have tried taping my mouth shut a few nights, to no real noticeable affects. But I do feel I might be loosing some air through the mouth so will try to keep taping. I do move around a lot also, so maybe mask/pillows are leaking?

Thanks for the help!

[zonker]

As far as changing the min and max EPAP, is that something I can change on the machine or do I have to take in to clinic/doc?

you can do it yourself, once you get the clinician's manual, which you can find here-

https://www.apneaboard.com/adjust-cpap- ... tup-manual

good luck!

[Pugsy]

Mask movement leaks and mouth opening/breathing leaks look the same on the leak graph.
So the taping is done to give you an idea where the leak is coming from.
If you tape and the tape doesn't come off....and your leak graph is still ugly then obviously if the lips were taped shut then the mask must be moving around a lot.
If you tape and the tape doesn't come off and your leak line is magically nice and pretty with no leaks to speak of...you know where the leaks were coming from.

Kinda important to know where the leaks are coming from so you know what you need to do to fix them.
Sometimes people get told that they have to get a full face mask and it wasn't the mouth that was the problem...it was the mask fit.

This was a new mask and I was getting big leaks and needed to know if I was opening my mouth or I just didn't have the mask fitted correctly. So I taped my mouth....and the tape stuck....I ended up having to get a totally different size frame/headgear with the mask to get the leaks halfway managed.

[tfletch159]

Thanks for the help and the information. I can get in to clinician mode now and will try modifying the settings to see if it helps.

If I start getting things dialed in better, either controlling the apneas, less leaking, etc. What specific numbers in the Oscar images should be affected would you say, and which way should they be trending? obviously, the large leak numbers should hopefully be going down, but wondering about some of the other information (like big AHI num at top, etc), how should those numbers be trending, up or down, if I seem to be improving? (with the caveat that it all depends on how I really feel the next morning, of course). Thanks!

[SuperDave]

I had a recent experience where my AHI suddenly jumped from under 3 to over 10 for three nights in a row. My AHI had run in the 40's with CPAP and 20's with bipap. After obtaining an ASV, my AHI ran under 3.0 for two weeks and then suddenly went up!

Looking in OSCAR, I noticed the AHI was all hypopnias, no obstructives or centrals. Basic CPAP treatment involves several basic tenants: 1. You correct obstructives by increasing pressure; and 2. You correct hypopneas by reducing pressure. So I focused my attention to the OSCAR graphs showing mask pressure and machine pressure, comparing the graphs on good days with graphs on the bad days.

What I saw was the pressures were all much higher on the bad days, which made sense, since the high AHI's were due to hypopneas, which occur with too much pressure. But why would the mask and machine pressures suddenly go up, by a significant amount?

I guessed that something between my mask and the machine might be causing a restriction/blockage, obstructing the airflow from the machine to the mask. I was using a Respironics DreamWear gel pillow mask. I regularly change out the pillows, but have used the same face frame for several months. I replaced the face frame and the nasal pillow with a newer one, moved the machine a little closer, removed the flannel tubing cover from the tubing, and rerouted the tubing from the machine. I don't know exactly what may have caused a restriction in the airflow, but my AHI returned to under 3.

Another thing that may have affected the pressure was my chinstrap. It was in the wash so I Used a ladies' hairband as a chinstrap. The leakage graphs showed no significant leaks on the 3 bad nights, so I doubt if the chinstrap was a factor in the 3-night anomoly. I suspect the problem may have been a collapsed silicone frame, or an old nasal pillow. So my advice is to look for any possible restrictions in the machine, tubing or mask if your AHI suddenly increases from normal. And use your OSCAR or other software data as an integral part of your therapy/treatment.