Elderly back sleeping mom, new ASV

[cpvtnh]

OK, I’ve posted about my 88 year old mom before. The saga continues. (I use an APAP myself but rarely need to post on my own behalf. My therapy is going great)

So mom’s apnea is REALLY bad when she back sleeps. My sister lives with her so she can manage her meds and the PAP. My sister got a big surgery, so I’ve been here for the last month helping both of them. Mom takes off her mask in the night and/or ends up on her back, so both of those need vigilance. As I’ve posted before, her apnea is so bad on her back, on OSCAR it looks like solid blue chunks of OA.

With the APAP we ended up lowering her pressure a bit in the trade off between compliance and efficacy. But even 20 max pressure on the APAP (air sense 10) wasn’t blowing through the back sleeping. We’ve been running it with max pressure of 16, compliance (ripping off the mask in the night) is so so.

Her overnight sleep study last fall was a disaster. She didn’t want to be there and spent almost the whole night being grumpy and awake.

So we got the ASV yesterday. Yay? The DME person was very nice, but kinda like, “Yeah, let’s just put some numbers in here.” I guess the doc gave a big range. We kept telling her we probably need a lot of pressure, but she made clear she was setting it to not be too high. She’d say stuff like “we don’t want to blow her away…” She said we could change the numbers but “promise you won’t go crazy in there.” (She was setting up the new machine, and I noticed it looked just like her old machine, and I looked hard and saw she was about to give us another Airsense 10 instead of the ASV. So, low confidence…)

Last night we let her back sleep (which will be inevitable) as an experiment with the new ASV. Disaster. Lots of OA while on her back in the OSCAR data.

So, new to ASV, not sure what’s going on, here’s the settings on the Aircurve 10:

Mode: VAuto
Max IPAP 20.0
Min EPAP 10.0
PS: 10.0
Ti Max 1.7s
Trigger: Med
Cycle: Med

On the paper she had, I guess the scrip was:
EPAP 10-15 CWP
PS 4-15 CWP


It looks great on her side, but is there any hope we can get better for the back sleeping with tweaks?

[ozij]

https://www.resmed.com/en-us/healthcare ... ve-10-asv/

They look the same. Did she have two machines and you could point out her error?

[cpvtnh]

Yeah, I read the print on the back of the Machine: Airsense 10. She had an Aircurve out in her car. They look the same except black/white.

She often takes a morning nap on the sofa, which is on her side — always the nicest OSCAR data we ever get. The ASV in this situation looks actually worse than the APAP usually does for her. Weirdly, the ASV shows a lot more centrals. I thought it should be better for centrals? Though I think I read somewhere that an ASV can’t distinguish between different kinds of events? In Oscar it seems to be calling out OA vs CA.

Mom’s apnea is bad and “complex” — at her worst she’ll go into Cheyenne Stokes sometimes. With the APAP get some centrals popping up for sure if she’s been on her side and hasn’t had many OA events, but mostly she gets a lot of OA — in big chunks if she’s not perfectly on her side.

Reading about the ASV a bit, I see mentions of min and max PS, but this has just one number for PS, and it’s at 10.

On OSCAR her pressure peaks at 20 now, so I guess we’ve got some room to get more out of it?

She says this machine feels comfortable to her, more comfortable than the old machine maybe, she thinks, so we are not blowing her away.

[Pugsy]

Reading about the ASV a bit, I see mentions of min and max PS, but this has just one number for PS, and it’s at 10.

She's got it in some sort of fixed PS mode if you don't see a variable PS setting offered or being used.
Not sure but that might be cpap mode because the other 2 ASV modes available (auto and ASV) I think have the 2 variable settings option.

Can you confirm the mode of operation on the ASV machine and what other options for modes might be available?

[cpvtnh]

Mode says “VAuto”

I looked at the modes in the setup menu, and the other choices were “CPAP” and “S” so I think the mode is correct.

I tried clicking on PS in the setup menu and it doesn’t give any option besides setting one number, not a range.

[Pugsy]

Mode says “VAuto”

I looked at the modes in the setup menu, and the other choices were “CPAP” and “S” so I think the mode is correct.

I tried clicking on PS in the setup menu and it doesn’t give any option besides setting one number, not a range.

That mode machine is NOT an ASV model machine.
It is an AirCurve 10 VAuto machine. ResMed just released the AirCurve 11 model line this past week but I doubt your supplier has one of them yet.
Those model machines only offer fixed (single) PS.
You have to have the ASV model to have a variable PS.

Exactly what does it say for settings in VAuto mode?
Minimum EPAP....??
PS....is that really 10???
Maximum IPAP.....???

[cpvtnh]

Oh damn.

The DME rep who delivered the machine was very nice, but it seemed perhaps minimally knowledgeable. Maybe that’s why we’ve got more CAs than ever!

It’s going to take weeks to get her back out here I bet.

So the settings she set it up for were:

mode: VAuto

Max IPAP 20.0

Min EPAP 10.0

PS 10.0

Ti Max 1.7s

Ti Min 0.3

Trigger Med

Cycle Med

[cpvtnh]

Yeah, on the front of the machine it says “Aircurve 10 VAuto”

[Pugsy]

PS 10.0

Maybe that’s why we’ve got more CAs than ever!

The PS of 10 is most likely causing the centrals. Way too much PS. It's most likely causing hyperventilation which blows off too much carbon dioxide so the carbon dioxide doesn't get high enough for the brain to tell the human to breath....so the human doesn't breathe and a central apnea happens.

Max IPAP 20.0

Min EPAP 10.0

PS 10.0

These settings essentially make the machine a fixed pressure machine....it can't do anything but EPAP at 10 and IPAP at 20.
Can't/won't go anywhere.

It's likely triggering centrals and it can't go higher than 20 cm which she probably needs when on her back.

Sigh....totally inappropriate settings for some with OSA and some centrals thrown in.
They are trying to make it work like a ventilator but that's not going to fix her problem and is obviously making the problem even bigger.

You want to have them re do it or re do it yourself?????
She needs much less PS and a higher max IPAP.

To be honest...my first thought was that the person setting it up pulled the numbers out of his/her butt. Dumb ass.
Was this the doctor's idea or the person delivering the machine?

The AirCurve 10 VAuto is nothing more than the AirSense 10 AutoSet except it has a higher than 3 PS (EPR on the AutoSet) and it can go to 25 cm instead of the 20 cm limit that the AirSense has.
It won't do a damn thing for any centrals except make more of them to do nothing about.

[cpvtnh]

Bloody hell. And damn these DMEs.

She definitely just pulled the numbers out of her butt.

I took a photo of the papers she had, and the scrip was this:

“Auto ASV

EPAP 10-15 CWP

PS 4-15 CWP”

It took weeks and weeks to get her out here to deliver the wrong machine (wrong machine twice in the same visit).

[Pugsy]

You want me to go cuss them out for you? I got quite a potty mouth.

Well hell....we can't get anything done this weekend anyway so how about doing something with the machine that might help with the OAs/hyponeas she gets when she is on her back?
We most likely can't do a damn thing about the centrals (with this machine) but maybe we can fix it so she isn't having a truckload of them from the PS.

How about these setting?

Mode....VAuto
Minimum EPAP ....try 10 or whatever she was using on the AutoSet that she was comfortable with.
PS....try 4....that may or may not be a problem triggering centrals but gotta start somewhere and it might be comfortable enough that she can at least use the machine.
Maximum IPAP....25
Leave all the other settings at the factory defaults.

Do you have the clinical/provider manual for the VAuto machine? If not...go here and request it via email
https://www.apneaboard.com/adjust-cpap- ... tup-manual

[cpvtnh]

I think we’ll drop back to the Airsense 10 APAP until we get the ASV machine. Then we’ll no doubt need to figure out the settings ourselves.

[Julie]

Would she be willing to try wearing some kind of backpack (even a fanny pack thing) to keep her from flipping when asleep?

[cpvtnh]

We have a ball that comes apart and can clamp on the fabric. One night, back when she was willing to try it, she woke up in the night, got some scissors, cut the fabric around the ball, and put the shirt back on with a hole in it.

We’ve got a “noodle” pillow, but that’s minimally effective. We just got some Velcro tape, and next we’ll try to tape down a steeper backed pillow that might be more like a sofa back. For some reason she’ll side sleep on the sofa absolutely reliably, but in bed it’s a dice roll. She’s also taken to getting up to pee and then flopping on her back in any possible configuration on the bed — sideways, head toward the foot of bed, diagonal.

So far waking up to check on her has been the only reliable thing. Even if we had a machine that could push through the apnea back sleeping, she might take the mask off or not put it on after peeing. But obviously it’s unsustainable for us to check her all night. My poor sister had been checking her all night. I’ve been staying with them for a month, so we split shifts checking on her.

We can see from Oscar that it’s just terrible when she’s on her back with the mask on. When we find her without the mask she looks like a corpse — just so conked out and not looking good.

It’s a bad situation, because we care, and we can see a bad difference in her the next day if she does it.

[ozij]

Wild - possibly impractical idea:
Get her a sofa for the bedroom?
Just a thought. And one reason against it is she may fall when wanting to turn. But you know do best.
It's also possible that with an ASV's EPAP keeping her airway splinted again the obstructive apneas, and making sure she inhales when centrals appear, she may get better.
PAP machines don't "plow through apneas" they can only realize they happen and prevent them by creating a stronger air splint.
What was your minimal APAP pressure? And what did you lower when you "lowered the pressure for the sake of copliance?"

What was the maximum IPAP you ever used?