ASV: bad nights before good nights?

[new-to-BiPAP]

It is normal to have bad nights (sleeping worse than before) before you get any good nights and feel better? I have been using ASV for a week and I feel the same or worse in the morning. I have had 3 nights out of 7 that I felt much more tired in the morning than before I went to sleep the night before! I put a call in to my dr's office and they are sending me for a mask fit at my DME since this one seems to leak (and then wake me up). I am getting so frustrated (and so tired)!

[2 B Sleeping Soundly]

Hi new-to-BiPAP,

It might help you get more responses to your post if you would change the Subject line in your post to say - ASV: bad nights before good nights? ASV's users are a smaller group here, but they are extremely generous with their help and sharing their experiences and information on this specialized machine .

John

[new-to-BiPAP]

Thanks for the suggestion! I just added ASV to the beginning.

[robysue]

Are you completely new to PAPing or is the ASV a replacement for a less fancy machine?

In general it takes a lot of newbies quite a while before the good nights outnumber the bad. After all there's a lot to get used to. And ASVs can be particularly challenging since they can rather drastically increase the IPAP pressure in an effort to break the overshoot/undershoot CO2 cycle that underlies CSA.

And it might help you get some better ideas on adjustment if you gave us a few particulars:

Why were you prescribed an ASV?

What are your pressure settings?

[Guest]

I tried BiBAP and VPAP in 2008 and it make my sleep worse (gave me central apneas). I had I think 5 sleep studies and tried 2 different machines at home that year. I did another 2 sleep studies this year and they said I have complex sleep apnea. I also have many flow limitations and arousals, UARS, GERD & reflux up to my vocal cords & non allergic rhinitis to complicate things a bit. So, I have not been sleeping with a machine for many years. My settings are: EPAP: 6.0, IPAP: 9.0-21.0, PS 3.0/15.0. I know what the EPAP and I think I know what the IPAP means but I don't know the PS. EPAP is expiatory pressure so it keeps a constant 6? IPAP goes from 9-21 depending on what I need so it starts at 9 and can go up to 21. I don't know what PS means. My problem seems to be that my obstructive apneas become central on a 'regular' PAP machine (tried 3 types). For a few days it seemed like I would wake up with either a leak or when the pressure shot up. I suspect that the higher pressure (to compensate for my bad breathing) gave me a leak and the leak woke me up but I'm not exactly sure, it could be just the pressure change waking me up. Will see if my new mask (should get one Monday) helps with the leaks. The leak rate is technical good according to the machine, it just wakes me up cuz it's so loud (and wakes up my hubby as well). I have ordered a CPAP pillow (since I am technically a stomach sleeper) to see if that helps me to get comfortable. I seemed to sleep fine once they started me on ASV in the lab. I don't remember waking up at all. It took care of my central apneas and reduced my hypopneas and apneas I think. Still have a fair amount of RERE on ASV in the lab but I was actually able to get a deep sleep when normally I don't. But, on the first week at home on the ASV I didn't dream at all. Last night, when I didn't use the machine, I did dream. I know I should have used it but I felt horrible & sick all day Saturday and didn't want to mess with the mask. It has been really stressing me out trying to get it to not leak before I go to bed. So I'm hoping Monday I can try again and see how things go. I might not be getting everything correct, above, since I am not sleeping well.

That's good to know (for me at least) that it can take a while to adjust. I thought it just wasn't working or I was too sensitive or something.

I'm not sure if I am hoping that this will work and I will sleep better, or hope that it doesn't work so I don't have to deal with the machine and mask and cleaning it and everything. Am I lazy or what? *sigh*

[oak]

no, you are just plain tired. there are lots of people here that can help. hang in there.

[JohnBFisher]

Unfortunately, it often takes time to adjust to ASV therapy. It's not at all normal to have the pressure doing flip flops. And that's about how it feels. From low pressure to high pressure (>20cm H2O is not unusual) within just a few breaths. If you didn't have problems with that, I would say you slept the sleep of the dead .. and not someone hunting for better sleep!

But you will adjust. It takes time for your body to adjust to ASV therapy. And as it does, you will find that your AHI value will drop. Typically ASV therapy often leads to an AHI of less than 5. So, hang in there. It can take several weeks to a few (three) months. It took me about three months before I slept through the night. But I now sleep much, much better than without it.

So, it's good you are here and asking questions. If you have specific problems, don't be afraid to ask. Sometimes there are simple solutions that help.

[new-to-BiPAP]

Thanks. It's good to know that it's ok to not feel great right off the bat trying the ASV.

I am currently having a mask "leak" problem, tho. They started me on the "Quattro Air Full Face Mask" and when the pressures would get higher with an event it would leak and wake me up. Plus it would leak air into my eyes and my eyes would be puffy in the morning. Plus I had trouble getting it not to leak into my eyes before I even laid down in bed. So I went back into the DME and they did a warranty swap(whatever that is). They gave me a "Quattro FX for Her full face mask" which looked like it would fit better. It was the only one of the 2 they recommended that they had one there to try on after disinfecting. Last night I could not even adjust it to not leak into my eyes right off (similar problem I was having with the Quattro Air). I don't know if I have it on too tight or too lose or too high or too low or if it just isn't a good fit. They tried it in the DME's office with pressure and did pretty good which I suspect means I don't have it fitted correctly. But I tried just about everything I could to get it to fit and not leak and gave up last night. It is a small mask but came with a medium headgear which seems a bit large. They had me try a small headgear but it didn't seem much better so I just took the medium that it came with. I have some old nasal masks that I am tempted to try if I can't get this one to fit, but that means getting a chin strap adjusted and I'm guessing I will have more leak problems only with my mouth with those. I am beyond frustrated with just the mask!

[sawinglogz]

What ASV machine are you using? Getting the data off can help folks here pinpoint things that are likely to help.

[new-to-BiPAP]

I am working on figuring out how to post data. But right now I am having trouble even getting the mask to not leak before I lay down. It is blowing in my eyes before my head even hits the pillow, hence my 3 day break from using my ASV.

[JohnBFisher]

Both the Quattro FX and Quattro Air come with instructions on how to "fit" them to your face. There is a trick to it. Below are the PDF "fitting guides". Essentially you place the mask at the bridge of the nose and swing the rest of the mask down onto your face. The other thing that is counter intuitive is that you need to have the mask a lot looser than you would expect. If it's too tight, it will leak. If it's really loose it will leak. It leaks more, since you have an ASV unit than if you did not have an ASV unit. Mask liners can help tremendously. They help the masks "stay put" and not slide around. Also, when the mask does leak, it's just a loud hiss rather than the dreaded face farts. .. Below are the links for various mask liners. I've used both the Pad-A-Cheek and REMzzzzs mask liners. I currently use the REMzzzzs. I make them last longer by changing the liner once a week or so and not daily.

http://www.resmed.com/us/assets/documen ... lo_eng.pdf
http://www.resmed.com/us/assets/documen ... er_eng.pdf

http://www.remzzzs.com/
http://padacheek.com/PAC_Maskliners.html
http://quietusliners.com/

Hope that helps.

[new-to-BiPAP]

Both the Quattro FX and Quattro Air come with instructions on how to "fit" them to your face. There is a trick to it. Below are the PDF "fitting guides". Essentially you place the mask at the bridge of the nose and swing the rest of the mask down onto your face. The other thing that is counter intuitive is that you need to have the mask a lot looser than you would expect. If it's too tight, it will leak. If it's really loose it will leak. It leaks more, since you have an ASV unit than if you did not have an ASV unit. Mask liners can help tremendously. They help the masks "stay put" and not slide around. Also, when the mask does leak, it's just a loud hiss rather than the dreaded face farts. .. Below are the links for various mask liners. I've used both the Pad-A-Cheek and REMzzzzs mask liners. I currently use the REMzzzzs. I make them last longer by changing the liner once a week or so and not daily.

Hope that helps.

Thank you so much for your reply. I got an apt with a sleep tech today and he gave me a sample of some RemZzzs mask liners to try. Thanks for the great instructions links. They are better than the instructions that I got with my masks! I have wondered if I might have it too tight. The first night I had a lot of leaks so I tightened the mask. My sleep tech said I could also make some of my own which I may try since these are fairly thin, but I will try these first. He also showed me how to see the leak number on the machine.

So, I have the Quattro FX right now. I will try that with the mask liners for a few days. The sleep doc will be sending over another Rx for the Quattro Air and if the DME doesn't give me too much of a hassle, I may switch back to that if I can't get used to the FX. I think the Air was more comfortable if I can just get the leak issue fixed.

[new-to-BiPAP]

Back to the Quattro Air but in an XS this time. Tried using the RemZzzzs but my homemade ones seem to help with leaks better (I'm assuming because they are thicker). I don't have enuf of them to try using 2 at a time yet. I should get some in about 2 weeks to try. Until then I will be making my own. It didn't sound like the RemZzzs have an extra small size anyhow so I will be most likely cutting them down to fit anyhow. It does appear that my mask leaks 3-4 times per night and appears to be waking me up each time. Looks like I need to do some fine tuning with the tightness or looseness of the mask yet. Sleeping 'ok' but not wonderful yet. Some night it seems I wake up a lot and other nights I don't remember waking up lots but still feel tired or groggy in the morning...