Brand new to ASV for Central Apnea. Need encouragement

I’m making this post for my husband... to show him there is hope. I’d like to get started and then turn the profile over to him. He has been tired for as long as he can remember. 6 months ago we started the sleep study journey after an oral surgeon had concerns. Sleep studies confirmed that over 50% of apnea’s are central. It was a shock to learn that it is not your average obstructive sleep apnea. Received the ResMed AirCurve 10 ASV October, 1 2018. Used a few nights and was woken up after one hour with feeling of air being pushed into lungs... too much.., like they could burst. Feeling continued when trying to wear mask again. Went to DME provider and some adjustments were made. Given ambien. Still woke up by feeling of too much air. Don’t want to be dependent on ambien. Longest length of sleep with machine is 2 hours and 45 minutes, and that was on ambien.

Sleep Dr tells us this is the only only treatment for Central Sleep Apnea. How can I help him get used to this machine? Who has success with an ASV machine? We keep hearing how rare this is. He wants to give up. I want him to keep trying and give him a shot at feeling good. In summary: How can he prevent being woken up by this awful feeling of too much air in lungs? How can he fall back asleep with the mask feeling like it did when he went to bed? He doesn’t use the ramp feature. Turns machine off and on once it starts fighting him. Thank you!!! - wife of TheOtherApnea

TheOtherApnea wrote: ↑

Sun Nov 04, 2018 12:31 pm

Used a few nights and was woken up after one hour with feeling of air being pushed into lungs... too much.., like they could burst. Feeling continued when trying to wear mask again. ... Still woke up by feeling of too much air.

Ok, maybe this wasn't explained, or explained properly.

First the maximum pressure that ASV can generate is far less than what it takes to blow up a balloon. Stick a straw into a tall glass of water... blow bubbles... that's more than the pressure the ASV can create. The max the ASV can create is 25cm of water pressure, that's the pressure it takes to push down 25 cm of water, say through a straw. 25cm is about 10 inches... it's very little pressure, a fraction of one PSI. It's easy to get psyched out, since we're not used to breathing against pressure, or having something blow air in our lungs... but there's no danger, really.

Second, an ASV overcomes central apnea, which is where his airway is open, nothing blocking it, but he's not trying to breath, by increasing pressure enough to force some air into the lungs (even though, remember, it's a small pressure). If it didn't force the air into his lungs, effectively breathing for him, then it wouldn't do any good at all. It's entire purpose is to make him breathe when he's not trying to .

TheOtherApnea wrote: ↑

Sun Nov 04, 2018 12:31 pm

Sleep Dr tells us this is the only only treatment for Central Sleep Apnea. How can I help him get used to this machine? Who has success with an ASV machine? We keep hearing how rare this is. He wants to give up. I want him to keep trying and give him a shot at feeling good. In summary: How can he prevent being woken up by this awful feeling of too much air in lungs? How can he fall back asleep with the mask feeling like it did when he went to bed? He doesn’t use the ramp feature. Turns machine off and on once it starts fighting him. Thank you!!! - wife of TheOtherApnea

It's not the *only* treatment for CSA, but it's the *best* treatment. The other alternative is an older technology that just forces air in every breath, whereas the ASV adjusts itself every single breath, little or no help when not needed, and breathing for him when he stops doing it.

The reason I went through the stuff above is so you can tell him that ... well, basically, it's all in his head. yes, there's a lot of air at times, life giving air., it has to be,

That said, read the sticky post, viewtopic/t172378/Sticky--Newbies-PLEAS ... e096169a5a and post some charts, could be the doctor has the machine set wrong... happens all the time.

a tip for your husband (I use an ASV) if it seems to be forcing a breath on him blow back at the machine forcefully when the machine is blowing at you and it will back off for 3 minutes and hopefully will then fall in sync with him. ASV does take time to get used to I find it best if i breath gently evenly as I try to fall asleep and the asv will follow my lead mostly.

Thank you both! I’ve already learned a lot. Starting to feel more excited than nervous about tonight’s sleep.

TheOtherApnea wrote: ↑

Sun Nov 04, 2018 2:17 pm

Thank you both! I’ve already learned a lot. Starting to feel more excited than nervous about tonight’s sleep.

my housemate has an ASV... as do a number of other folks here, they're not as rare as was maybe made out to y'all.

If you post your SleepyHead charts and current settings, more than likely someone here can be of great assistance.

I use an ASV machine. Maybe trying different masks will help. I tried several until I found one that I could tolerate. Dreamwear works for me but some need full face if they can’t keep their mouths shut.

I switched from a cpap to an ASV about a week ago. Best thing I ever did.

greenall wrote: ↑

Sun Nov 04, 2018 5:06 pm

I switched from a cpap to an ASV about a week ago. Best thing I ever did.

Great! Could you expand on your experience?

I've been on a Respironics ASV machine (PR) for just over 5 years. The algorithm is somewhat different from the ResMed machine in how it handles the transition from inhale to exhale and back.

What you are describing is the ASV machine trying to deal with what it classifies as central apnea event. This happens frequently in the period immediately after an arousal in which pseudo CSA events occur. On my machine, I just breathe normally which action 'tells' my machine that I am breathing on my own and to return to a normal breathing cycle. That stops the 'forcing air into my lungs' action.

Because my machine is different, I can't tell you what parameters you can set (or have the DME set for you) but here are a couple that might be looked into:
1) Backup Breathing Rate - set it to either Auto or to some lower number (look in the sleep study report to see what average breathing rate they reported and set it lower than that. This will help to reduce the number of times the machine goes into this mode responding to a lowered breathing rate not associated with any CSA event.
2) Look into the parameters that control the rapidity of the transition between exhale and inhale. I believe that there is a way to slow it down a little to increase the comfort level. For some patients who are a little slow at the end of and exhale, the machine kicks in that starts increasing the pressure for inhale before the patient has completed their exhale cycle. From reading discussions about the differences between the PR and ResMed algorithms, it seems as if this phenomenon is more common on ResMed than PR machines.

JDS74 wrote: ↑

Sun Nov 04, 2018 8:19 pm

Because my machine is different, I can't tell you what parameters you can set (or have the DME set for you) but here are a couple that might be looked into

That is very helpful... I will bring that up with the DME company.

Jas_williams wrote: ↑

Sun Nov 04, 2018 2:05 pm

a tip for your husband (I use an ASV) if it seems to be forcing a breath on him blow back at the machine forcefully when the machine is blowing at you and it will back off for 3 minutes and hopefully will then fall in sync with him. ASV does take time to get used to I find it best if i breath gently evenly as I try to fall asleep and the asv will follow my lead mostly.

Thank you. He tried that last night and unfortunately it didn’t help. I wonder if the machine we have behaved differently? ResMed AirCurve ASV. He did sleep for 2hr 40 minutes, but he can’t get that high pressure to back down. There has to be another way to make it feel like when he’s going to bed. Would turning it off for longer help? Maybe turning on the ramp function if he wakes up? I’ll try to get his sleep data from his App too.... and explore if settings are wrong or maybe the machine itself has issues

Can you download Sleepy head and post a daily graph it could be that the machine is not setup correctly or something else going on.

Palerider just made a post that might be useful.
Here is the link:
viewtopic/t173578/explanation-needed-fo ... Timax.html

JDS74 wrote: ↑

Wed Nov 07, 2018 4:14 am

Palerider just made a post that might be useful.
Here is the link:
viewtopic/t173578/explanation-needed-fo ... Timax.html

That's not relevant for ASV.