ASV Machine?

[Julie]

I think you've gotten a case of high anxiety, far too conscious of your breathing (it happens) and need to work on forgetting about it when awake. Talk to your doctor about referral to a psychologist or some therapist who will teach you CBT (cognitive behavior therapy), which can be done quickly and works quickly. There may also be a short term medication that would help, but I'd want to be careful about which ones would not interfere with Cpap.

[joeljjk11]

I think you are right, I have been focusing on my breathing a lot lately. It is definitely odd. I am going to try to relax and take deep breaths just to chill out.

[Julie]

Be careful of hyperventilating - it can make you pass out and is still a conscious effort... not that helpful .

[Pugsy]

I have no idea why your breathing may feel "odd" during the day.
Getting used to the ASV way of breathing does take a while but that's usually for nighttime breathing stuff.

Only thing that remotely comes to my mind as for potential respiratory discomfort is if the machine is often hitting 25 IPAP to deal with the centrals and your chest wall muscles are getting a little bit or an extra work out and that could maybe make daytime breathing feel a little weird or uncomfortable until those muscles got used to the extra work load.

In general daytime breathing is not normally related to what goes on during nighttime breathing.

Do I just have to adjust to the machine?

Don't know yet because we don't know what settings are being used but if it's set to what I think it is set to...maybe increase the minimum EPAP a little bit.
Can you get me a image of a detailed report?

Like right now my breathing feels strange and just not normal, almost like my heart rate is elevated or my blood pressure is off.

Check your pulse and blood pressure and see if it is "off" or not.

The mind is a powerful thing...sometimes it's a good thing and sometimes it's a not so good thing.
I think you know where I am going with this.

[joeljjk11]

I apologize for the delayed response but here are my settings:

EPAP: 6.0
Min PS: 5.0
Max ps: 10.0

My numbers are generally horrible on this ASV machine, usually around 10 or 11 AHI so any help would be appreciated!

Joel

[Pugsy]

What is the max IPAP?

You need to post a detailed report from the software so that we can see what you are seeing.

[joeljjk11]

Hi I don't have that setting on my machine so I don't know. It is the Resmed Aurcurve ASV.

[klv329]

Looks like the machine is not in ASVauto, just ASV. So epap is fixed at 6, and ipap varies from 11 to 16.

If you can post charts perhaps someone can help to determine what adjustments might help. The charts would show what types of apneas you are having and at what pressures, and a lot of other information.

Cpap auto between 16 and 20 to treat obstructive apnea?

If so, perhaps epap should be higher than 6. Graphs would be great.

[Pugsy]

Is the reason you are on ASV because of centrals?
Is the bulk of your high AHI central or something else?
Please post a typical report so we can have a better idea what is going on.
Your max PS of 10...with minimum EPAP of 6 is limiting the max IPAP to 16. I forgot that's how the Resmed does max IPAP.
Max IPAP is tied to max PS and EPAP.
Do you have a minimum and maximum EPAP or just EPAP?
What mode does the machine show you are using? If you don't have a minimum and maximum EPAP setting then it sounds like plain ASV mode and not auto adjusting ASV mode.

[joeljjk11]

The machine is on regular ASV but has an auto ASV setting. I don't know anything about what these settings mean, but I would assume that the pressure is not high enough because I needed pretty high pressures on my CPAP machine. I also don't have access to Sleepyhead right now so I can't post any charts. Any suggestions for how to properly increase the pressure. I would guess that this is the problem. My AHI numbers are pretty much always around 10.

[joeljjk11]

I also have complex apnea according to my sleep study.

[Pugsy]

Well....the max IPAP of 16 isn't enough to deal with the centrals and it may not be enough to deal with the obstructive stuff if you needed nearly that much on regular cpap for the obstructive stuff.

Who came up with these settings? Did you have an in lab titration or what?

Your machine's little hands are tied and it can't go to where it needs to go to really deal with either the OAs or the centrals.

You might want to read this document. While it is put out by Respironics the basics on ASV titration are the same no matter which brand.
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf

Your EPAP needs to be close enough to what you need to hold the airway open and prevent the obstructive stuff...and IPAP needs to be able to give you the burst of IPAP to breathe for you when the centrals happen.

Without seeing the reports it's hard to have an idea what is needed but for sure EPAP needs to be higher and you need to increase PS max to the max of 15.
The PS minimum of 5 is probably fine.
If staying in regular ASV mode...I would move EPAP to maybe 8 or 10 ...leave PS minimum at 5 and increase PS max to 15 and that will allow the machine to give you a substantial boost when a central happens. It won't do it unless it has a good reason.

[klv329]

ASVAuto mode allows your epap to vary as needed between Min Epap and Max Epap. I think the purpose of this setting is to treat obstructive apneas and the machine adjusts automatically.

The Min PS and Max PS do the same as in straight ASV mode, and this is the inhale pressure that fluctuates in that set range over and above whatever the current epap pressure might be for a breath.

So some like to show this as an equation for the Ipap range:

Min Ipap = Min Epap + Min PS

Max Ipap = Max Epap + Max PS

So much for math.

Someone with more experience may be able to help you if you can provide data and graphics from sleepyhead.

Edit:+1 on Pugsy's comments!

[Pugsy]

I don't know that AutoSV mode is all it is cracked up to be.
I have used both modes with my S9 Adapt and got the same results with either.
It just adds another setting to fiddle with.
Since having a max EPAP setting available potentially ties the machines hands a bit...and since we don't have any reports to evaluate to see what is actually needed in terms of EPAP for the obstructive stuff....I don't know that I want to be tieing it's little hands just yet.
I don't think it is a critical issue to make the change to auto EPAP at this time and auto EPAP is pretty much the main difference between the 2 modes.

[joeljjk11]

Thanks pugsy! I'll try those settings and see if it helps, I'll let you know. I'd like to see my doctor but that isn't happening until October - ugh so frustrating.