AirCurve ASV 10 Settings

I'm considering switching from ASV mode to ASVauto mode on my machine to see if it'll help with the bloating (aerophagia). Right now my settings are as follows:

Mode: ASV
Start EPAP: 5.0
EPAP: 5.0
Max IPAP: 25.0
PS Min: 3.0
PS Max: 15.0

With these settings my AHI is very low, usually less than 0.5 (many nights even 0.0) but I wake up bloated every morning and sometime even over night with abdominal cramping.

From the reading I've been able to do, the ASVAuto mode should automagically adjust the EPAP pressures. I'm hoping that not fixing the machine to an EPAP of 10 will help with the bloating. Am I making some correct assumptions? Any other suggestions? I can pull some sleepyhead data tonight if that'll help.

Thanks for any guidance.

I am afraid that if you allow EPAP to go higher that the aerophagia will worsen if it's the EPAP that is the culprit.

Why are you on ASV? Centrals????

If not centrals you might do better in terms of the aerophagia stuff if you limited IPAP and max PS...depending on how high they are going now.

Can you post a typical night detailed report so we can see just what the machine is doing?

I have both central and obstructive apneas. Right now the pressures rise during events anyways and on a typical night they peak around 25 once or twice a night.

I will post some sleepyhead data when I get home tonight.

It's centrals you need high PS and high IPAP for...and unfortunately those same higher pressures are likely the cause of feeding the aerophagia monster.

Going to auto EPAP really only affects the machine's response to the obstructive stuff you are having...

You could give it a try though and see what happens.
You will still need what you need for the centrals...now you may not even be using the full max PS or max IPAP...which is why I would like to see what the machine is actually doing and then see if maybe we could limit PS or IPAP a little and take some of the food away from the aerophagia monster and not compromise the central part of your therapy.

Weagle wrote: ↑

Fri Jan 04, 2019 4:29 pm

EPAP: 5.0
not fixing the machine to an EPAP of 10 will help with the bloating.

Huh?

palerider wrote: ↑

Fri Jan 04, 2019 6:00 pm

Weagle wrote: ↑

Fri Jan 04, 2019 4:29 pm

EPAP: 5.0
not fixing the machine to an EPAP of 10 will help with the bloating.

Huh?

Sorry, I had recently tested running my EPAP at 5 instead of 10 and copied/pasted the wrong set of data. I use the ramp feature which starts out at EPAP of 5 but goes up to EPAP of 10 in about a 20 minute span of time. That is why I mentioned the Start EPAP also.

While I did change the EPAP to 5 I was still having multiple Central events throughout the night (not as many as being completely untreated, but still some). With the EPAP set to 10 the Centrals go away almost completely. I'm hoping that setting the machine to AutoASV will manage the EPAP and hopefully settle somewhere between 5 and 10 to limit some of the pressures throughout the evening yet still effectively treating my Central events.

Due to some unforeseen circumstances over the weekend, I was not able to sit down at download the sleepyhead data. I will get to it as time permits. So far no further changes have been made because I'm trying to get through this cold I picked up over the holidays. I didn't want to make any changes until I'm back to my normal health.

EPAP doesn't do squat for the centrals unless the centrals are post arousal and an obstructive event causes an arousal.
Preventing the OA might prevent the arousal and the subsequent SWJ central.
PS is what is used to deal with centrals.

Can you post some sleepyhead charts so we can see how your ASV is behaving as of now?

Doesn't the PS sit on top of the EPAP? So if my EPAP starts lower, and the PS stays the same then ultimately my IPAP would also be lower?

Correct me if I'm wrong, but I thought EPAP was the lower pressure, the PS is the support on top of that pressure which combined makes the IPAP.

So if my EPAP was 5 and my max PS is 15, then my IPAP would be 20.
And if my EPAP was 10 and my max PS is 15, then my IPAP would be 25.

If that's the case, then lowering my EPAP (starting pressure) would ultimately lower my IPAP also, limiting my overall pressure?

raisedfist wrote: ↑

Mon Jan 07, 2019 11:41 am

Can you post some sleepyhead charts so we can see how your ASV is behaving as of now?

Yes, I will gladly post that once I have some spare time at home to download that data.

You are assuming you always get max PS of 15...and that's rarely the case.

It's PS that deals with centrals....not EPAP. Might need only 6 PS...might need only 10 PS might need 12 PS...or maybe the max of 15...it's going to vary.

EPAP is for the obstructive stuff.
Baseline for obstructive stuff has no bearing on what is needed in terms of PS for the centrals unless someone is restricting PS in some fashion.
Using higher minimum EPAP potentially restricts PS.
The PS causing higher IPAP for central treating...very brief...like one breath and it's not the same as prolonged IPAP as a result of PS that is not moving around because there is no need.

Really need to see what your machine is actually doing or wanting to do.

More prolonged EPAP and IPAP (not the central treating IPAP) can cause aerophagia issues in some people and using more EPAP isn't helping the centrals but it is probably feeding the aerophagia monster.

Weagle wrote: ↑

Mon Jan 07, 2019 11:45 am

Doesn't the PS sit on top of the EPAP? So if my EPAP starts lower, and the PS stays the same then ultimately my IPAP would also be lower?

Why would PS stay the same? PS varies breath by breath in an ASV.

Perhaps some bloating occurs if severe pressure swings are happening throughout the night? The ResMed iVAPS I own will rapidly change the PS as needed (for different reasons) and it can be quite disturbing.

Yes, the PS varies breath to breath and yes I'm maxing it out at 15 occasionally throughout the night. Sleephead shows a few times where the pressure is up to 25. I promise I will get the data and post the graphs.

Maybe that's why lowering the EPAP from 10 to 5 showed more apneas, 5+15 maxed out at 20, where I needed the full 25 to control the central events.

Thanks for all the insight and helping me think through all of this.

Weagle wrote: ↑

Mon Jan 07, 2019 2:53 pm

Maybe that's why lowering the EPAP from 10 to 5 showed more apneas, 5+15 maxed out at 20, where I needed the full 25 to control the central events.

Obstructive apneas happen at epap.

That's why we need data.