ASV - Low Quality Sleep Due to Overbreathing

[DoktorSpengler]

I am getting low-quality sleep on my ASV.

One of my problems is that I find it hard to fall asleep. The machine forces too much breathing (too deep and too frequent). This causes physiological arousal because inhalation is stimulating.

So, I lowered my EPAP and PS
Min EPAP: 5.6
Max EPAP: 7.4
Min PS: .4
Max Ps: 5.4

This SORT OF worked, but NOT REALLY. The ASV allowed me to sleep, but it was weak, unrefreshing sleep:

https://imgur.com/user/doktorspengler/posts

I was doing better in November when I had a pattern setup:

The machine would force a deep breath, but then would keep up enough pressure that I couldn't really exhale all of it.
I would exhale a bit, slowly... this was relaxing.
Then the next breath would not be quite as much because I was still holding some air. (so less inhalation = less stimulation)
I would exhale a bit, slowly.... become more relaxed.

But, when it got COLD I couldn't do this anymore. Here are some comparisons:

https://imgur.com/a/FZQUsW5

I *think* you can see me hitting some kind of limit, and bracing up against that limit in the "better sleep" example above.

But, maybe what i need is for the ASV to let me take LESS breaths per minute? At least early on?

So, if you have any settings advice: please lay it on me.

If NOT, does anyone know what kind of ASV machines permit some more flexibility? I need a machine that lets me take less breaths per minute early on, or otherwise i need to decrease the total time I spend inspiring (at least early in the night) without giving up pressure. Right now, I am trading away pressure to get less total inspiration, but I think my ideal pressure is a bit higher than where it is at.

THANKS! I AM LEARNING ABOUT THIS STUFF (I THINK) SO ANY RESOURCES ON THE MECHANICS OR JUST UNDERSTANDING WHAT ASV IS DOING ARE ALSO APPRECIATED SORRY FOR THE CAPS I AM TIRED.

[Pugsy]

When you start the machine at the very beginning of the night try making very slow and smaller breaths for about 5 minutes or so.
When you first start the machine is when it does the initial average breath that the machine will try to maintain (it will likely reset that average later during the night but hopefully you will be asleep first) and maybe this nice slow and low average will be less annoying to you. If the machine isn't thinking you need a deep breath then maybe it won't try to give you one.

5 minutes is probably overkill but I forget the exact amount of time that the machine needs to help it figure out your own breathing pattern so that it can maintain that pattern.

During the night if you wake up do the same thing....nice slow shallow breaths for 4 or 5 minutes or so.

[Pugsy]

BTW why were you given ASV??? If it was because of central apneas being a problem
this setting

Max Ps: 5.4

is shooting yourself in the foot. Not nearly enough PS to deal with central apneas which might be part of your problem.
If you did have a problem with central apneas they can't be dealt with effectively with that little amount of PS.

[DoktorSpengler]

Hello,

Thanks for that. I had no idea that the machine is calibrating each time you start using it.

When you say: PS of .4 is not enough to help with central apneas. Well,that is probably why I didn't sleep well last night. I specifically lowered the PS trying to reduce the pressure differential between inhaling and exhaling becuase the machine has been forcing me to take deep breaths in and then long breaths out.

To address your question "why do you have ASV?" the doctor said I had CS respiration that came on later in the night.

[Pugsy]

I once ask a RT just how much of a minimum max PS is needed to deal with central apneas (which essentially means that it breathes for you when you aren't breathing) and I was told a bare minimum of 8 PS and that was a very bare minimum and ideally one should have available at least a 10 cm PS max.

It's not so much the minimum PS as it is the max PS. The max PS allows the machine to give you that rapid big burst of air for that one breath so that it forces you to breathe.

Most of the time the max PS setting is left at 15 cm...the machine probably won't ever try to deliver that much but it's available if needed. The machine won't deliver more than it thinks you need.
If not having a central apnea it won't increase the PS.

So....increase that max PS so the machine can do its job more effectively..
and
try teaching the machine at the beginning of the night that nice slow breathing is your normal pattern.

[zonker]

try teaching the machine at the beginning of the night that nice slow breathing is your normal pattern.

not quoting this for your benefit but for the op.

this, right here, is key. and it's going to take some practice. or at least, that was the case for me. took several nights to get it and lots of frustration, but well worth it.

good luck!

[DoktorSpengler]

>So....increase that max PS so the machine can do its job more effectively..,

last night I changed settings to:
Min EPAP: 6
Max EPAP: 9
Min PS: .4
Max PS: 9

The biggest change was Max PS. I left Min PS fixed because my central apneas don't kick in until late in the night, so I don't always want PS there.

>and
>try teaching the machine at the beginning of the night that nice slow breathing is your normal pattern.
>[/quote]

Done.

I was able to get 5 uninterupted hours of CPAP use last night, which was an improvement from my monthly average of 3 (for December, January). And I avoided a premature awakening, remaining asleep until around 5:15 when I usually get up for work. So this was a big improvement and I think it bodes well for the strategies you've recommended here.

I cannot thank you enough for your help. I have been sending my doctor emails for four months describing these kinds of issues and she was not familiar enough with the equipment or ASV to give me any useful assistance. Your willingness to invest time in understanding my predicament and providing genuinely useful guidance has made a world of difference.

Thank you from the bottom of my heart for your assistance. I truly appreciate your help more than words can convey.

[Pugsy]

You are most welcome.

Give things at least a week with the new settings and see how you do with your sleep quality and comfort.