New ResMed S10 AirCurve ASV - Need opinions on performance and settings

[The Sheikh]

Hi All!

I've been using a ResMed S9 AVS machine for 12 years. I have severe central sleep apnea without it. After a lot of adjusting I have been able to get an AHI of 0.0 for many years and am happy. (self-titration) I just upgraded to a ResMed S10 AirCurve ASV 2 weeks ago. I am using AutoASV and using wide machine settings, hoping the new machine will zero itself in. It appears to have done so. The first few weeks were bumpy, but I am now able to get the AHI to 0.0 most nights. I feel reasonably good when 100% xpap compliant.

A month ago I had a commercial sleep center do a sleep study. Not much has changed and I still have pretty severe central SA and now some obstructive SA, though we are not sure what is causing the OSA. I am 5' 10" and 175 pounds. The new S10 ASV is doing its job - that's what counts.

It time to fine tune things. I am hoping someone with more experience can look at the SleepyHead charts and suggest what may not look right. The first thing I do not understand is why the flow limitation chart regularly flat-tops at 1.0 ??? I do not understand what controls it. I also read that flow spikes can awaken us from sleep. I don't see other parameters that are affecting it on the charts. Maybe I am fooling myself with the great AHI numbers but secretly being awakened with air flow problems? Do you see any problems with the machine settings?


I don't understand how to post the chart pictures yet. I have five charts hopefully showing a good sampling.


Thanks!
T

[The Sheikh]

Hope this works:

[The Sheikh]

More data:

[Pugsy]

Get rid of Mr Smiley....he's hiding information by being there.

ResMed machines are notorious for making the flow limitations appear to be worse than they are. It makes mountains out of molehills.

[Respirator99]

ResMed machines are notorious for making the flow limitations appear to be worse than they are. It makes mountains out of molehills.

Not so much Resmed machines per se, rather it is the way non-invasive ventilators record flow limitations, which can include lower airway (lung) resistance. There is a good explanation here: https://www.apneaboard.com/wiki/index.p ... PS_and_ASV

[bwexler]

I was going to post my settings for you. I have been on ASV for about 10 years now and I am also using an Aircurve 10 ASV.
But after looking at your charts I am not going to bother. You are all ready doing much better than I am. I only get Zero 5 or 10 times a year. I still get a 5 or 6 occasionally. Usually I hover around 1 + or -.5.

[The Sheikh]

Thanks for the info, guys. I'm reading and learning.... Last night was another good one with AHI = 0.1 The strange thing is that the breathing waveforms don't look so bad during these events. It's usually from a 10 second stoppage of breathing; mostly remants of my CA Cheyes-Stokes breathing pattern.

In the past using a simple CPAP machine made my central apnea worse. The VPAP got me AHI=25... but the S9 and S10 ASVs are miracle machines with relatively consistent 0.0 scores..

I also did well with the Respronics BiPap AutoSV Advanced until the recall spooked me.


Back to the subject at hand: The S10 AirCurve ASV flow limitation is brickwalling hard at 1.0. I wonder what is causing that particular number to be the strict limit? All of the ASV flow limit charts I've seen of others' have ~ 0.1 to 0.30 "soft" limiting.... It doesn't seem to affect the other charts, however.

I have all of my peak machine AUTO settings set at max, 3-20, etc... The IPAP comes in at 35,though the internal machine limit is 25 I think. When I used manual 12-15 limits I started seeing AHI= 5-10 area - so I let the machine do the job in ASV Auto max range. Except for the idea that machine flow limitation readings could be inaccurate, the solid 1.0 flow limit makes me suspicious. That cannot be lung resistance or other human influence. All of my other general charts show plenty of headroom to move up and down without limits. I'm an EE, so please excuse my urge to overthink things...

Any comments on the machine settings or waveform structure are appreciated. When in expanded view, mask flow pressure waveforms get very raggedy looking at times. Guess that's normal. The price we pay when human meat does the job of breathing...

Tom

[zonker]

Thanks for the info, guys. I'm reading and learning....

pls do as pugsy suggests-

Get rid of Mr Smiley....he's hiding information by being there.