First night with new ASV (AirCurve 10 ASV)

[Steerpike58]

Last night I had my first full night with my newly issued RESMED AirCurve 10 ASV machine. I didn't get a great night's sleep, but this was my first night with a mask / device for months, so there was unfamiliarity at play here. I loaded the data into OSCAR, and observed that the information looked quite different from what I saw with the previous RESMED AirSense 10 CPAP. Can the friendly folks here tell me what data I should start concentrating on?



The good news seems to be, my AHI was down to 3.68, compared to an average of 18 with the CPAP, and there are no Clear Airway (Centrals) or CSR events noted - though there doesn't even seem to be a 'slot' for such events with this machine.

I got up to pee twice, which accounts for the gaps.

The ASV does have a totally different 'feel' to it, and overall, it's much nicer for me. The weird part is, it seems to 'surge' every now and then for no apparent reason - after multiple breathing cycles that are gentle, it will really ramp up and deliver high pressure, just for one 'cycle', and this doesn't seem to correlate with anything obvious in terms of my breathing.

Anyway - is there anything obviously in need of attention or more details? The current settings were recommended by the sleep lab.

For reference - I was diagnosed with OSA earlier this year (home test revealed an AHI of 31) and issued a trial CPAP (RESMED Airsense 10) for a month. During that trial, a high number of centrals was observed and it was determined they were 'treatment initiated centrals', and that I needed an ASV. I then had an in-lab sleep study where they determined the settings for the new machine (and those settings were: Min EPAP 4, Max EPAP 15, min PS 0, max PS 15).

[bwexler]

My AHI is often below 1.0. Last night was 0.13.
I set EPAP mode ASV
EPAP 6.0 PS 3.0-12.0
This works well for me for the past 5 years. There are certainly exceptions.
I don't have the technical expertise of many of the members here, but have learned the basics.

[Steerpike58]

...
I set EPAP mode ASV
...

Can you elaborate on this? My Oscar report shows "Mode: ASVAuto". On the device itself, in the menu, it offers Modes of 'CPAP', 'ASV', 'ASVAuto'. Is that the setting you are referring to, and you you have any idea what the difference is?

Thanks!

[Pugsy]

'ASV', 'ASVAuto

you have any idea what the difference is?

ASV mode has a fixed EPAP with variable PS

ASVAuto mode has a variable EPAP along with variable PS

[bwexler]

I just learned something.
I will have to check my machine.

[Pugsy]

there are no Clear Airway (Centrals) or CSR events noted - though there doesn't even seem to be a 'slot' for such events with this machine.

The ASV machine won't/can't flag any central apneas separately so you won't ever see any central apneas flagged separately.
OAs and central apneas will go under the "apnea event" category.
Hyponeas are still flagged separately though.

Now it will still flag periodic breathing or CSR if it happens.

[Steerpike58]

there are no Clear Airway (Centrals) or CSR events noted - though there doesn't even seem to be a 'slot' for such events with this machine.

The ASV machine won't/can't flag any central apneas separately so you won't ever see any central apneas flagged separately.
OAs and central apneas will go under the "apnea event" category.
Hyponeas are still flagged separately though.

Now it will still flag periodic breathing or CSR if it happens.

I looked at Oscar for an 'Apnea Event' item, but didn't see one. However - when I hover with the mouse over the 'UA' event flag, it says "Unclassified Apnea (UA): An apnea that couldn't be determined as central or obstructive" so the fact that I only see 3 such items, and the 'score' for Unclassified Apnea (UA) is 0.39, would suggest I'm not getting many Centrals - so a big improvement over my time with the CPAP?

Where would it flag a CSR event, since there's no CSR line in the 'Event Flags' section?

Last night (my second full night) 'felt' better, but AHI was still over 3 (3.37). I tightened the mask a bit but still got woken a few times with 'mask farts', so I may need to try another mask solution.

[Pugsy]

Sorry....I forgot to add the "unclassified" part to the apnea part.
My mind isn't all here. Obstructive apneas and central apneas go in the same apnea basket...the unclassified category.
ASV machines don't seem to do the FOT thing to figure out central vs obstructive so that's why it's called "unclassified".

Where would it flag a CSR event, since there's no CSR line in the 'Event Flags' section?

It would be up there on the top of the Events graph next to large leak line IF you had any.
Meaning if you don't have any then it won't show up. It will still do the green thing if you had it as well.
We wouldn't expect to see any/much CSR but I have seen it on a few ASV reports....

This is where no news is good news. If not flagged then it didn't happen which is a good thing.

[Steerpike58]

Sorry....I forgot to add the "unclassified" part to the apnea part.
My mind isn't all here. Obstructive apneas and central apneas go in the same apnea basket...the unclassified category.
ASV machines don't seem to do the FOT thing to figure out central vs obstructive so that's why it's called "unclassified".
...

The wording on the report ('flags' section) is confusing.

There's a dedicated line for 'OA' - Obstructive Apneas. But then the wording also suggests that the 'UA' (Unclassified Apneas) line includes both OAs and CAs.

So the way I interpret that is, "there are some events that we KNOW were OAs and we count them in the OA row; but then there are some events that we don't know whether they were OAs or CAs, so we count those in the UA row. They COULD be OAs but they might also be CAs". So the total of both rows together (OA and UA) gives you the total of all OAs and CAs, but you'll never know exactly how many OAs you had.

For me, the distinction seems moot because I'm getting only from 0 to 3 total combined for both in the whole evening. It looks like the vast majority of my events are Hypopneas; not sure if that's a relatively good thing or not. Last night I survived over 8 hours with the machine (longest so far) and my AHI was down to 2.18 (lowest so far). Only got up once to pee. I had zero OAs ('definite OA's) and 1 UA.



Are there any more relevant charts I should be posting in my screen-shots - should I re-order the Oscar presentation to show different charts? The Oscar view for an ASV seems quite different from my last CPAP machine.

[Pugsy]

If you ever see a flag in the official OA line on that event graph please let me know.
I expect to see something in the UA line and the hyponea line.

So......how are you sleeping in general and how are you feeling?

One pee break...was it a painfully full bladder break or a "I'm awake and might as well go pee" break?

No need to re-arrange the graphs...at least for me anyway.

Ignore the not so pretty FL graph....ASV machines just do that and you can't compare it to the other machines' FL graphs.

You just need time and experience with the new machine. Give it a solid month or two.

Remember every time you see the PS jump up quickly and down just as quickly...the machine was breathing for you because you weren't from a central apnea.

[Steerpike58]

If you ever see a flag in the official OA line on that event graph please let me know.
I expect to see something in the UA line and the hyponea line.

So......how are you sleeping in general and how are you feeling?

Well, I have been sleeping badly for a very long time, and almost never wake refreshed, and I don't think it's been wholly due to SA, so I don't expect perfection from the new machine! Also, as reported elsewhere, I only scraped by with 2 hours of sleep during TWO overnight sleep studies, so that suggests I don't sleep well in unusual surroundings, so dealing with the new machine and mask is taking some getting used to (I had a 5-week trial with a standard CPAP back in Sept, and that's been it so far). BUT - last night I did manage a full 8 hours in bed and with the machine on, so I feel like that is progress! Last night was the first night where I wasn't totally aware of wearing the gear. I still woke feeling sleepy, but that's 'normal' for me.

One pee break...was it a painfully full bladder break or a "I'm awake and might as well go pee" break?

Definitely the latter, but I have been diagnosed with Nocturia and it used to be a lot worse, so I consider 1 event to be pretty good.

...
You just need time and experience with the new machine. Give it a solid month or two.

Remember every time you see the PS jump up quickly and down just as quickly...the machine was breathing for you because you weren't from a central apnea.

Can you elaborate on this? From everything discussed above in this thread, a 'central apnea' would be counted in the 'UA' Flag row, and there was only 1 last night (at most 1, since it could be OA or CA). And I don't see anything unusual in the 'Pressure' graph corresponding to that one event. But I do see a whole lot of 'spikes' in the red line for 'Pressure' throughout the night, so are you saying all those spikes are corresponding to CA's, and if so, why aren't there more CAs reported in the UA flag row?

[Pugsy]

why aren't there more CAs reported in the UA flag row?

Best I can tell you is that the machine is reacting pre-emptively and not letting the cessation of breathing to get to the point where it meets criteria for a central apnea. The algorithm is complicated and I will be honest in that I don't understand all the little pieces of data that make it work.

So the machine is working to prevent the centrals from ever really materializing so if it doesn't materialize then it wouldn't ever earn a flag. Remember there is a certain set of criteria that needs to be met to earn any flag of any sort.

Prevention is the name of the game.

[Steerpike58]

why aren't there more CAs reported in the UA flag row?

Best I can tell you is that the machine is reacting pre-emptively and not letting the cessation of breathing to get to the point where it meets criteria for a central apnea. The algorithm is complicated and I will be honest in that I don't understand all the little pieces of data that make it work.

So the machine is working to prevent the centrals from ever really materializing so if it doesn't materialize then it wouldn't ever earn a flag. Remember there is a certain set of criteria that needs to be met to earn any flag of any sort.

Prevention is the name of the game.

Ah, that makes sense! Thanks for the explanation.

Last night, I got another 8+ hours of machine time, and my AHI was below 2 - so trending in the right direction (3.68->3.37->2.18->1.85). Last night was much less 'comfortable' though. I was conscious of 'burping air'; the machine was forcing air into my system and I was obviously swallowing it and then burping it back. This was definitely the case in the morning, and I felt like I was awake more than asleep, constantly burping the air.



Also, my nose was quite blocked - I had difficulty breathing. This is a problem I've had for some time, possibly due to allergies or other issues, but it seems exacerbated by the machine. I'm using flonase but it doesn't seem to be helping.

I see from your signature that you have a similar machine - AirCurve 10. Are they the same machines or are there model variations out there? Your sig refers to 'VAuto', which I don't see on my machine.

[Pugsy]

I see from your signature that you have a similar machine - AirCurve 10. Are they the same machines or are there model variations out there? Your sig refers to 'VAuto', which I don't see on my machine.

There are multiple models within the AirCurve 10 model line.

https://www.resmed.com/en-us/sleep-apne ... 0-bilevel/

Yours is different from mine.

And yes....PS pushing air can cause some aerophagia issues. You need the ventilation but it comes at a price.
You may end up needing to limit PS a bit but you don't want to limit it too much because that is what is breathing for you when you don't breathe. Talk to you doctor about this problem if it continues.

[ozij]

I don't know much about ASV therapy - but I do know a bit about automatic settings and prevention.

It looks to me as if your machine is at default, or almost default setting. Min EPAP 4, max IPAP 30 max PS15?
I'm looking at that roller coaster of flow limitations and thinking: That doesn't make sense. The whole point of ASV for TECSA is solving the problem of CA's that appear for some people when the pressure is high enough to eliminate the obstructive events. And its very clear that your flow limitations and hypopneas appear when the pressure is lower.

If you have obstructive sleep apnea, with TECSA, wouldn't it make sense to have the machine's minimum set closer to a level when flow limitations/hypopneas don't happen, preventing them, and then adding the higher PS that ensures your breathing doesn't stall when the airway is open?

It seems to me they sent you out with a wide open ASV - with a minimum EPAP that does nothing to treat your obstructions.

I remember you were getting those periodic breathing period on non-ASV therapy, but please check, and remind us, what pressure eliminated your obstructive events.

If it were me, this is what I'd say to myself:
Letting my EPAP revert to pressure that is low enough for those tremendous flow limitations doesn't make sense. I want to see how my obstructions (FL's, H's OA's whatever) behaved on non-ASV, and I'd like to try raising my EPAP to a level that doesn't drop to where I get flow limitations.