CPAP ASV Keeps me awake

[sleeplessi n Wy]

I am a new user of an ASV CPAP machine. I have tried for 3 nights and I cannot sleep when using it. It is mainly the pressure and the sound that bothers me. I have tried 2 to 3 hours each night and then I give up. Are you aware of people that have these problems initially but eventually become successful with the machine. How long does it usually take to see results. Do you have any tips to aid the process.

[JeffH]

foam ear plugs will help with the noise. A mask liner from Padacheeks will help seal the mask so it works better. I use both and sleep like a baby with my ASV


JeffH

[The Latinist]

People often struggle with CPAP, especially at first. You are by no means alone. Fortunately, you have found a great place to get advice on how to improve your therapy and make it work for you. The people here are great.

It might help us to know a little more about your equipment (your machine, your mask, your pressure setting), as well as your diagnosis. If you've been put on an ASV, that suggests you have complex or central apnea, in which your problem is not (or is not entirely) obstruction of your airway.

So pull up a chair. Sign up for an account and then, in control panel, choose your equipment from the lists. And let us know what, specifically we can help with.

[Pesser]

I have very bad insomnia. I can hear a crow walking 200 yards away from my house at night! To get used to the sound I took the machine and placed it as far away from the bed as I could. I took two six feet hoses and connected them (using a connector). This gave me 12 feet. I used a rubber band to hold the hosing on top of the bedding (with a safety pin). My next step would have been to get another 6 feet of hose and place the machine outside the bed room. I used earplugs but had to stop doing that because I found the sound worst (foam might work on earplugs I was using silicone). After a month I found the sound of my machine comforting. It is now a helping me to relax and it serves to block all other potential noise! I guess what I am trying to get across is this: do whatever you need to, get creative! It will get better and you will like the new air very much!

[RogerSC]

Yes, in addition to foam earplugs, I used Ambien for about the first week to get used to sleeping with all the gear. That really helped, and after a week, I just stopped using the Ambien, no problem. My sleep doctor prescribed it for me, he's heard it all before, I'd guess *smile*. Still using the foam earplugs, I find them very helpful.

You will get through this...ASV is a little different because of the potentially wider swings in pressure, so it may take longer to get used to. Depends on the person, pretty individual. Just don't give up. The idea of the Ambien is that you take it at bed time, go to sleep, and then wake up all rested in the morning *smile*. That's pretty much how it worked for me.

[archangle]

Quite a few people have reported having trouble at first with ASV. Your brain sort of fights the ASV wanting to make you breathe the way it wants you to, not the way your (central apnea addled) brain wants to breathe.

For many people, eventually something throws a switch after a few days or weeks in your brain and it suddenly becomes very comfortable.

If you don't get the ASV epiphany, you may be able to get your doctor to "tone down" the ASV for a while and then turn it back up once your brain adapts to it. However, don't skip the step of "turning it back up" once you learn to sleep with it.

[Todzo]

I am a new user of an ASV CPAP machine. I have tried for 3 nights and I cannot sleep when using it. It is mainly the pressure and the sound that bothers me. I have tried 2 to 3 hours each night and then I give up. Are you aware of people that have these problems initially but eventually become successful with the machine.

I do hear about that here. In addition I recently read a study comparing ASV and CPAP[1]. ASV is much easier to use than CPAP (treating CompSAS anyway) but in those who made it to the evaluation stage (they lost about the same number in both arms 36% of which were due to not using the machine enough but 54% made it to the end of the study which was 90 days).

People do take time to learn to use ASV or CPAP. Yes it is likely that it will get better.

How long does it usually take to see results.

In terms of keeping your brain more safe from apnea likely right away.

The study did not show but very small changes in quality of life or daytime sleepiness for either arm.

Do you have any tips to aid the process.

Likely it would be good to spend some time with the machine during the daytime. On your bed you can sort out mask fit, hose management, and other things as you move to all the usual positions.

Using it while listening to music, reading a book, or watching some light TV will probably help you to learn to “dance with the machine” as it works to help you.

I believe that anything you can do to reduce your life stress is likely to be helpful

I believe that those who become assigned to the ASV class of machines are dealing with some of the nonanatomic causes of sleep apnea[2,3]. Arousal threshold and high respiratory control loop gain are likely to be part of the mix. I think that both arousal threshold and loop gain could be related to a too low or too high vitamin D3 level. Where I live we get no UVB from the Sun from about August to April. Vitamin D levels drop all that time.

Those who are working with the D3 hormone (A.K.A. Vitamin D3) (e.g. Dr. Stasha Gominak, Michael F. Holick, Ph.D., M.D., Vitamin D Council) seem to be finding that the very low side of the “normal” range of 30-100 ng/L produces a range of symptoms including OSA, pain, and infection. All believe that a level lower than 50 ng/mL is not good and Dr. Stasha Gominak recommends 60-80 ng/mL for good health.

It would probably be wise to check your vitamin D3 levels. See “The Vitamin D Council” for assay details.

I think that all with any kind of OSA would do well to use a personal trainer to help facilitate the pursuit of an active lifestyle for at least three years. As well I believe that a dietitian used for at least the same period can help one learn to eat well which should be a life long pursuit. If eating well and moving well become part of the lifestyle a more healthy body is a predictable result. Sleep apnea is likely to be helped by many aspects of this pursuit of metabolic health.



[1] Morgenthaler TI, Kuzniar TJ, Wolfe LF, Willes L, McLain WC, Goldberg R. The complex sleep apnea resolution study: a prospective randomized controlled trial of continuous positive airway pressure versus adaptive servoventilation therapy. SLEEP 2014;37(5):927-934 Related article (commentary):833

[2] Danny J. Eckert, David P. White, Amy S. Jordan, Atul Malhotra, and Andrew Wellman "Defining Phenotypic Causes of Obstructive Sleep Apnea. Identification of Novel Therapeutic Targets", American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 8 (2013), pp. 996-1004. doi: 10.1164/rccm.201303-0448OC

[3] Sairam Parthasarathy M.D., Emergence of Obstructive Sleep Apnea Phenotyping. From Weak to Strong! American Journal of Respitory and Critical Care Medicine VOL 188 2013
-- critical closing pressure [Pcrit] - Arousal Threshold - ventilatory control Loop gain - and genioglossal Muscle responsiveness. Pcrit, Loop, Arousal, Muscle (PALM)--

[Sir NoddinOff]

The idea of the Ambien is that you take it at bed time, go to sleep, and then wake up all rested in the morning *smile*. That's pretty much how it worked for me.

All the tips are right on! I'd only suggest you use Slow Release Ambien or the generic called zolpidem CR. Regular Ambien has a half life of only several hours depending on your weight etc... IOW, it can lead to one waking up too early. The extended release versions should be good for all night I always take that for sleep studies too (three so far <sigh>).

[Dave007]

Try taking 2-5mg of Melatonin before bed. I specifically like "Source Naturals" found at any WholeFoods Market.

Also try using the "Ramp" feature to build up the pressure slowly. Set it to max ramp time.

[Sclark08]

It took me about 6 weeks to adjust to my vpap and I still struggle some notes. And I was on a Cpap for a year before that.
I have COPD so exhaling is an issue for me My Dr was nice enough to unlock my settings so I could play with the pressures.
16 Ipap and 10Epap is just about the best I can hope for. It's not perfect but I feel much better than I used to and that's the goal. Also my numbers are good. Guess Ill be OK

[library lady]

I have very bad insomnia. I can hear a crow walking 200 yards away from my house at night! To get used to the sound I took the machine and placed it as far away from the bed as I could. I took two six feet hoses and connected them (using a connector). This gave me 12 feet. I used a rubber band to hold the hosing on top of the bedding (with a safety pin). My next step would have been to get another 6 feet of hose and place the machine outside the bed room.

I would be concerned that increasing the length of the hose would reduce the amount of pressure that gets to the airway because of the greater distance it has to travel. Have you ever noticed the trajectory of a balloon that you've released after blowing it up?

[Todzo]

I have very bad insomnia. I can hear a crow walking 200 yards away from my house at night! To get used to the sound I took the machine and placed it as far away from the bed as I could. I took two six feet hoses and connected them (using a connector). This gave me 12 feet. I used a rubber band to hold the hosing on top of the bedding (with a safety pin). My next step would have been to get another 6 feet of hose and place the machine outside the bed room.

I would be concerned that increasing the length of the hose would reduce the amount of pressure that gets to the airway because of the greater distance it has to travel. Have you ever noticed the trajectory of a balloon that you've released after blowing it up?

In order to develop a pressure drop in tubing the air has to be moving. During the periods of when air moves little no drop.

When exhaling the pressure might go up slightly. However air is kind of springy so perhaps it would not. When I added about a gallon of “compressible air space” to my CPAP circuit breathing out gained a much more “natural” feel that I really like. I will never go back.

So that leaves the high volume times of inhale. Perhaps 25% of the inhale cycle?

Well you are "library lady" so I would guess that you can find out how much that drop would indeed be. Please do get back to us when you do the actual calculations and measurements.

[RogerSC]

Try taking 2-5mg of Melatonin before bed. I specifically like "Source Naturals" found at any WholeFoods Market.

I'm currently using .3mg of melatonin while I'm getting ready for bed. Works for me, helps me to get back to sleep when I wake up. Using more may or may not help, read the available articles on the internet. Lots of opinions, but the prevailing one that makes sense to me is to start with .3mg, and take that for a while. If that doesn't work, then up the dose by taking 2 .3mg pills, and so on. In the end, it may not help at all, but if it does, to be on the lowest dose that helps seems to me to be a good thing.

[Sir NoddinOff]

Try taking 2-5mg of Melatonin before bed. I specifically like "Source Naturals" found at any WholeFoods Market.

I'm currently using .3mg of melatonin while I'm getting ready for bed. Works for me, helps me to get back to sleep when I wake up. Using more may or may not help, read the available articles on the internet. Lots of opinions, but the prevailing one that makes sense to me is to start with .3mg, and take that for a while. If that doesn't work, then up the dose by taking 2 .3mg pills, and so on. In the end, it may not help at all, but if it does, to be on the lowest dose that helps seems to me to be a good thing.

Ditto from SNO if you decide to go the melatonin route. Test it out first to see if it works. Source Naturals is a good brand - it goes under the tongue until it dissolves, much better and faster absorption into the bloodstream than swallowing a pill. It's pretty expensive stuff tho.