Central & Obstructive - AHI always around 10 with ASV. Tweak Settings?>?

[Pugsy]

We have had other people who had significant weight loss ending up needing more pressure and not less like people might think.
They get a rude reminder that not only does their OSA not go away liked they hoped for...they end up needing more pressure.
No one really knows why though. I have often wondered if the airway tissues just sag more after any fat loss that might be going on in their and the extra saggyness makes it harder to hold the airway open.

[Jas_williams]

Should I let the dr know I would rather go with another Resmed Aircurve ASV and have a diff DME get me one or special order one?

I am sure she won't mind...... I am either going to sell (depending on how much I might be able to get) or give my wife whatever one I do not like as she can use the Cpap Auto feature of either machine...

Thanks too everyone for your replies - pugs / pail....!!

I would stick with the Resmed

[beautifuldreamer]

I agree, stay with the ResMed, I just switched from Respironics ASV to ResMed ASV, and I am doing so much better with ResMed, - The respironics, I felt like it was such a struggle to breathe, whereas for me, breathing using the ResMed is so much easier for me . . .

[metsfan302]

I don't think you are going to like the Resprionics ASV algorithm. When I was using one...I needed a lot more EPAP with it than I did with the ResMed ASV. Respironics is not nearly as quick to respond to anything.

Any chance sleeping position is now a factor in pressure needs?
Change in any meds?...anything that might make the airway tissues floppier?

Come to think about it I have added a new medicine. Testosterone 1.62% (40.5mg in 2.5 grams of gel) X 4 packets daily. This was added as I started to see an Endocrinologist - She ran some tests and also a an MRI on my brain. There was a Tumor on my pituitary gland and also a separate sac or something attached to it. That has thrown off my Hormones and well my Testosterone level was way below the avg woman/ 90 year old man. Not sure if any of those things can effect sleep/ my therapy.

I have also noticed that I seem to wake up nightly a few times a night., While I have had this ASV for 3+ years now, I think when my machine jacks up the pressure in the high/mid 20's I awaken. I think this might show it below? I dunno if this is the proper screenshot that's needed to show it.

Screenshot 1


Screenshot 2

[Pugsy]

Did you ever think that maybe it isn't the pressure increase that is causing the wake up but instead the apnea event causing the wake up and the pressure increase had nothing to do with it? You are having much higher and faster increases in pressure every time your machine deals with a central apnea.

I have no idea if the testosterone is a factor in pressure needs or not. Sorry. Does make one wonder though.
When something changes in terms of our therapy it is usually because something changed in our life or sleep some how.

[metsfan302]

never thought it might just be the apnea events vs the pressure waking me up......

Well, guy from the local dme place that I got my Resmed ASV from is coming to the house tomm to show me and let me use and check out / trial this Dreamstation,...... wish me luck! lol we will see

[metsfan302]

Well that was strange. It turned out to be a diff. DME that came yesterday then I orig thought and they had a brand spanking Resmed Aircurve ASV - he said it was the last one they had since they switched to only carrying Philips products for machines etc. So now I have two of em, sort of wanted to "test" the dreamstation out....

Now what the heck settings do I need to lower this dang AHI. The tech actually set it up not correctly or shall I say was orig set on my other ASV. My orig settings were ASVAuto - Min EPAP - 13, Max Epap - 15 (Highest it will go it seems) Min PS - 3 , Max PS - 12

He had it set on ASV EPAP - 13 Min Ps - 3, Max Ps - 12

Am I correct in thinking that ASVAuto would be a better setting and let the machine decide or should I try the Reg non auto ASV setting above?

[ajack]

These are obstructive events, in general you raise the min epap till they go. However in your case, I think you may have positional apnea and would benefit from using a foam neck collar to see if that is the case. I also note that the max pressure is often used and also points to possible positional.
the min epap 10 and ps 5-15 should be fine and similar to what I would use on the chart on page one.
The other thing is mask fit can cause issues with ASV, If the mask leaks during the ipap it can ramp up pressure. The machine leak function often doesn't show this ipap leak. To test this you hold your breath and let the machine ramp up pressure, you can tell if its defusing under the seal.

[metsfan302]

Last night was horrible as far as AHI goes and I actually had mask leaks - I use the Resmed P10 and have so for about 2-3 years now with no issues. I just wish there was a way I could set it and forget it like most people seem too on pap therapy and have wonderful ahi numbers below 5. I wonder if I went to a diff mask if it might help my AHI?
I do have a cervical collar - I need to use it every night, It's just so hard to get use to wearing it as its uncomfortable.

Here is a screenshot of last night, not sure what needs to be shown to be helpful or if it is possible to share some sort of file so if one wanted to view my data on there sleepyhead? Let me know what is needed screenshot wise to show whats needed - leaks, pressure or?

Thanks so much in advance for helping, it means a lot!

Screen 1



Screen 2

[metsfan302]

That 95% number on sleeyhead etc, is that or does it mean that is the pressure the machine is at 95% of the time?

If so my machine seems to be always maxed?

[Pugsy]

95% numbers mean at OR BELOW for 95% of the time.

Change back over to auto ASV mode.

[metsfan302]

This is with the ASVAuto setting

I will do the reg ASV setting tonight or whenever,   I have no problems changing up etc.   Willing to try anything.   Guess it would take more then a single night to see whats what?    Ok here is a screen of a section of a cpl mins.... when I do the reg ASV vs ASVauto just do the settings the tech guy put in ? EPAP - 13 / Min ps 3 / max ps 12? do you think a diff mask might change things?

screen 1


screen 2

[Pugsy]

You need more pressure...specifically EPAP to hold the airway open better and the machine has the max EPAP of 15 and that's only if PS is limited to max of 10. PS of 10 might be enough to deal with the centrals.
You need more pressure for the obstructive stuff and at the same time need the PS for the central stuff.
Turn off the damn pie chart so I can see what the PS is doing in the statistics column. Preferences/Appearance tab...remove check mark.

I don't see how changing masks will change anything.
The other factors...
Sleeping position....supine is worse. Are you doing much sleeping on your back?
Neck position...cervical collar might help but of course isn't all that comfy for some people.

[metsfan302]

I always sleep on my right side. /Sorry about the pie. I like pie , jk......

The Epap is topped out at 15 no? I cant seem to get it any higher

I did buy a cervical collar, i am going to have to get use to wearing it

ugg I guess no other machine goes above 15?

[metsfan302]

without pie i think around the same time