ASV users: the everything ASV thread.

[ameriken]

Thanks Kody. I'm hoping this isn't a fluke. And I do feel a lot better today. A little bit tired, but far more alert and conscious than I've been. No fog today.

[ameriken]

A second night with a 3.0 on the higher pressures. This may not be a fluke, I may have finally found the pressures I need.

[moresleep]

It's great that you continue to feel good with lower AHI's. Sounds like you're on to something. Please let us know how it goes.

[pharm30]

My sleep has been horrible last 2-3 weeks. Previous 6-8 weeks I was sleeping great 6-8 hrs a night. Was starting to feel like I was sleeping too much.
Today driving to work I felt similar to pre-treatment, thought I was going to nod off at a stop light.
I have been working out more lately, but usually that makes me sleep great.

This morning I woke up w/o mask on, checked the data - apparently I slept with it on for 90 min. I have NO recollection of waking up or taking it off.
Similar deal 2 nights ago, was on <4 hrs. I am still getting leaks, but not as major. Not sure what is going on.

[ameriken]

Except for taking off the mask, it sounds like me. How long have you been on the machine? I had a decent start in June/July, then in Sept/Oct I found I was getting tired again and my AHI's went up (double digit). A few days ago I increased my min PS and min EPAP and have had an AHI of 3 for 3 nites in a row. Might be worth a try?

[pharm30]

since June/July for me as well.

I might have to save some $$ and try that hybrid mask or something.

Got another 8 hrs of work to go, feel like I could fall asleep at desk right now.

[ameriken]

Have you tried increasing your min Epap and min PS?

I increased mine and haven't had a bad night yet and I'm feeling far better.

What are your settings now and have you tried any pressure changes?

[NJSleepless]

Hi all! This is my first time posting in the forums here. I am also somewhat of a newbie when it comes to sleep machines.

Last night was my second attempt at treatment for my sleep disorders.

I apparently only used the device my first night for 1.6 hours and woke up choking and unable to breathe while laying on my side. I removed the mask and turned off the machine. I honestly thought I removed the mask at least 4 hours into my sleep. My AHI for last evening was 11.4.

Under Settings I read that 90% epax was 9.0 and my Average PS was 5.3 I checked the settings and my maximum pressure is 25. The Epap min. is 8.0 and Max. is 15. The BPM is set to Auto with the PS mim at 5.0 and max at 15.

(I haven't the slightest idea what this means - nor what half of my machines numbers mean for that matter; I obviously know what AHI stands for).

I am hoping that someone can help me understand what happened last evening with my first experience and if any suggestions could be provided to assist me in benefiting greater from my machine. I do not want to fall out of compliance and I would like to get through the weekend prior to contacting my new provider if possible. I am able to edit my Bi-Flex and RAMP settings but not the others.

Has anyone else experienced what I did when they first started treatment?

Some info about my treatment to date: I originally was using a Fisher & Paykel Sleepstyle 200 (Auto-Pap) with a ResMed Swift FX Nasal Pillows System but found that the pressure was not strong enough and I was not receiving any therapeutic benefits from the machine. The provider I was working with at the time was horrible as well so I went back to my doctor and requested a new prescription and a new provider.

After two more sleep studies I was prescribed a Phillips Respironics BiPAP autoSV Advanced System One with Bi-Flex & RAMP enabled.

[ameriken]

Hi all! This is my first time posting in the forums here. I am also somewhat of a newbie when it comes to sleep machines.

Last night was my second attempt at treatment for my sleep disorders.

I apparently only used the device my first night for 1.6 hours and woke up choking and unable to breathe while laying on my side. I removed the mask and turned off the machine. I honestly thought I removed the mask at least 4 hours into my sleep. My AHI for last evening was 11.4.

Under Settings I read that 90% epax was 9.0 and my Average PS was 5.3 I checked the settings and my maximum pressure is 25. The Epap min. is 8.0 and Max. is 15. The BPM is set to Auto with the PS mim at 5.0 and max at 15.

Welcome, you've got one of the best machines on the market. Would you perhaps be able to post the report from your first night? There might be something there that could help in finding out what is going on.

I've never experienced the choking, so I'm not sure what it could be. My initial guess is you stopped breathing and the auto kicked in and really increased the pressure up toward the max PS and it may have caused some difficulty breathing with that kind of high pressure and woke you up.

As for your settings, those look fairly normal.

PS min= 5 is the inspiration pressure support minimum
EPAP min = 8 is the expiration pressure support minimum

The max's are the highest those can go to. Our machine follows our breathing patterns for the few minutes prior to the present and then it increases the pressures as it recogizes changes in those patterns.

Your settings are close to my prescription, my min PS was also 5 and my EPAP min was 7. I increased both because I was not getting enough support and my AHI's ran into the teens. I am now using min PS= 7 and min EPAP= 9 and since I changed to those settings, my AHI's have been 3's and 4's consistently. But it takes a little getting used to those settings.

When you say you were choking, did it happen just that one time? Did you fall asleep ok and sleep well until then? Was this the only night on this machine? I sure as heck hope you don't give up and if it happens again, try not to keep the mask off. Start it up again and use the ramp feature. The ramp lowers the pressure for aobut 20 or 30 minutes to allow you to fall asleep and then it goes up to normal pressures.

If you can post your report, that may help in knowing what is going on. Hopefully some others will chime in as well.

[pharm30]

Have you tried increasing your min Epap and min PS?

I increased mine and haven't had a bad night yet and I'm feeling far better.

What are your settings now and have you tried any pressure changes?

At work, I'll get back to you on that.
Have not tried any pressure changes, unaware how to change. I think my girlfriend would kill me if I messed with it, she knows a sleep study
doctor and had him look at all my data after my two sleep studies for second opinion.
Last night was another bad night, <4 hr sleep with mask. I had a hard time getting the mask adjusted correctly at first, was leaking around chin or around eyes. I adjusted the nose part to tighten it a little, work up with the bridge of my nose really hurting.

The problem was all this happened after my last pulmonolgist appt when I told him everything was great, next appt in 6 months.
The DME doesn't seem to know what they are talking about.

I'm wondering if this would have anything to do with getting off antidepressants? I've been off Cymbalta for 2+ months and Wellbutrin for 3-4 weeks.

[ameriken]

At work, I'll get back to you on that.
Have not tried any pressure changes, unaware how to change. I think my girlfriend would kill me if I messed with it, she knows a sleep study
doctor and had him look at all my data after my two sleep studies for second opinion.
Last night was another bad night, <4 hr sleep with mask. I had a hard time getting the mask adjusted correctly at first, was leaking around chin or around eyes. I adjusted the nose part to tighten it a little, work up with the bridge of my nose really hurting.

The problem was all this happened after my last pulmonolgist appt when I told him everything was great, next appt in 6 months.
The DME doesn't seem to know what they are talking about.

I'm wondering if this would have anything to do with getting off antidepressants? I've been off Cymbalta for 2+ months and Wellbutrin for 3-4 weeks.

As for the leaks, I have the same problems, trying to get mask fit is more art than science. One thing you can try is www padacheek com, they have a mask liner that makes the mask more comfortable to wear and it can help with the leaks, plus an anti-leak strap which holds the mask more evenly to your face. I'm not sure about the anti-d's, I would think that by getting off them you'd see an improvement, so I'm at a loss. Either way, you should be able to improve it by changing some of the settings.

As for the sleep study, what was the 2nd opinion of that doc? Did you agree with his opinion? A doc can say 'looks great' to a report, but if you feel like crap, then it's not great.

A sleep study only has one night, maybe two to hone in on the right settings, and if you need an ASV it means you've got centrals and other breathing issues and I don't think one or two nights is enough. As for me, I'm not going to wait on someone else...the medical community has a tendency to freak out at the thought of a patient changing their settings but they don't see what's going on every night. It's my life and my health if I can improve my breathing and my sleep, then why not. Besides, we're talking about changing the air we breathe, not anesthesia or some other powerful drug.

Anyhow, I'd like to see your settings and if you want to know how to change them on this machine I'll let you know. I struggled for months until I changed the pressures and that made all the difference in the world. The RT from the DME told me how to adjust the settings on this machine and so I changed my PS, EPAP and rise time. After battling for 4 month with AHI's ranging form 5 to 20, I finally have them down to 5 and under. So, I'm wondering if you may need to do the same.

Post those settings and a couple of reports if you can.

[pharm30]

Min EPAP 6
Mx EPAP 15
Min Pres support 2
Max Pres support 14
max pressure 20
Backup 12
Flex 3

Avg Pressure support 2.9
90% EPAP 6.6

major leak rates. Last night I only used mask ~3 hrs, woke up in middle of night with air blasting into my eye.

[ameriken]

You've got to figure out those leaks and perhaps mess with the straps to get a better adjustment. I've had bad leaks with the Quattro FX in the past, but I finally got it so it leaks no more. Pad a cheek liner helps a lot as well as their anti-leak strap.

As for your pressure, the minPS seems really low. Mine was at 5 and it wasn't enough, so I bumped it to 7, and min EPAP which was at 7, I bumped to 9 and got my AHI's down to 3. I was running 7 to 20 before those increases.

But it probably makes no sense to increase your pressures until you've got the leaks under control.

[Kody]

I have a question regarding Patient Triggered Breaths. Lately I've noticed mine have been getting better and better, without the huge dips I used to see. My AHI's have been improving also, and I haven't adjusted the pressure yet as I'm meeting with the Sleep Dr. next week. I think I remember someone saying it takes time for your body to get used to breathing with the ASV and to not fight it. So would this be the reason for the improvement in the PTB's, like the machine is teaching my body to breath on a more regular basis?

Below is a much better than average night, as I forced myself to sleep on my side most of the night, but the 99.9 was what really caught my eye.
Thanks for any insight on the PTB question.

[JohnBFisher]

I have a question regarding Patient Triggered Breaths. Lately I've noticed mine have been getting better and better, without the huge dips I used to see. My AHI's have been improving also, and I haven't adjusted the pressure yet ... I think I remember someone saying it takes time for your body to get used to breathing with the ASV and to not fight it. So would this be the reason for the improvement in the PTB's, like the machine is teaching my body to breath on a more regular basis? ...

All I can say is that seems to be my experience. However, don't think this is a permanent change. What I've seen is that as I use the ASV, my breathing issues decrease with time. I tend to have an AHI that is between 0 and 2. But if I am unable to use my ASV unit for a night or two (odd circumstances), I find that I have LOTS of problems with central apneas when I restart using my unit. It keeps my breathing well regulated when I use it, but it deteriorates when I don't use it.

Again, this is just my experience ... I don't know if this has been studied clinically.