Help with ASV settings…

The doctor wrote on my sleep study EEP of 5 and pressure support 5-10. How would this apply to the Resmed ASV machine? Does this mean I should do EPAP of 5, PS min of 5 and PS max of 10? My breathing feels very strange and abnormal when I use EPAP of 5, PS min of 5 and PS max of 10, I do not find this comfortable so I feel like I am doing something wrong.

Your doc obviously hasn't read the manual! Assuming you have an ASV to treat central apnea (and why else would you have one?) the PSmax should be not less than 15.

In the absence of any other information I'd suggest the following settings to start with. Try them for a few nights then report back with an Oscar screenshot or SleepHQ link.

EPAPmin: 5.0
EPAPmax: 12.0
PSmin: 3.0
PSmax: 15.0

If you can give us some real information to work on (eg a copy of your sleep test report and/or Oscar charts) we will be able to give a more considered opinion.

I feel like all ASVs dont feel natural. I mean with Resmed youll probably adapt either but I can tell you Respironics was really difficult for me to get used to. But once you do it is amazing

Respirator99 wrote: ↑

Tue May 16, 2023 10:58 pm

Your doc obviously hasn't read the manual! Assuming you have an ASV to treat central apnea (and why else would you have one?) the PSmax should be not less than 15.

In the absence of any other information I'd suggest the following settings to start with. Try them for a few nights then report back with an Oscar screenshot or SleepHQ link.

EPAPmin: 5.0
EPAPmax: 12.0
PSmin: 3.0
PSmax: 15.0

If you can give us some real information to work on (eg a copy of your sleep test report and/or Oscar charts) we will be able to give a more considered opinion.

I have tried these settings for the past two nights. First night my AHI was 6.6 last night it was 10.9. I feel extremely tired in the morning with these settings and it takes a few hours and coffees to slightly wake up, I think the pressure is too high. How would I lower the pressure a bit? It is much more comfortable to breathe though than the other settings I had, I had been feeling like I was suffocating. I will send over the Sleep HQ link.

Sleep HQ Link:

05/18/2023: https://sleephq.com/public/c8bfb89f-863 ... f37b4dae1e

05/17/2023: https://sleephq.com/public/e38abaab-01a ... 994c0ee87c

Also FYI I take a sedative medication right before bed and I think this severely impacts my AHI and the ability of the machine to control apneas. It seems like once the effects of the medication wears off after a couple hours after taking it my AHI begins to lower. I may try taking the med a couple hours or so before I actually go to bed, I Just hope I can stay awake and not fall asleep on the couch or something.

Yeah, that doesn't look like a lot of fun. I think the apneas are pretty much all obstructive, but the machine is trying to blow through them without success. They're occurring in clusters, which is often an indication of poor sleeping position - most likely your chin is tucked down to your chest. This puts stress on the airway and can cause clusters of obstructive apnea,

If you sleep on your back, try sleeping on your side. You could try an orthopaedic pillow to keep your neck properly aligned, or else a soft cervical collar to support your chine and stop your head falling forward.

In the meantime, you could reduce PSmax down to 12 or so and see if that helps.

I use a MyPillow but I wonder if it is too firm and crunches my neck up. It seems like I always end up sleeping on my back but I do not even realize it. I have a My Pillow that has less fill and I am going to try using that one, I have not used it before.

joeljjk11 wrote: ↑

Fri May 19, 2023 6:55 am

Respirator99 wrote: ↑

Tue May 16, 2023 10:58 pm

Your doc obviously hasn't read the manual! Assuming you have an ASV to treat central apnea (and why else would you have one?) the PSmax should be not less than 15.

In the absence of any other information I'd suggest the following settings to start with. Try them for a few nights then report back with an Oscar screenshot or SleepHQ link.

EPAPmin: 5.0
EPAPmax: 12.0
PSmin: 3.0
PSmax: 15.0

If you can give us some real information to work on (eg a copy of your sleep test report and/or Oscar charts) we will be able to give a more considered opinion.

I have tried these settings for the past two nights. First night my AHI was 6.6 last night it was 10.9. I feel extremely tired in the morning with these settings and it takes a few hours and coffees to slightly wake up, I think the pressure is too high. How would I lower the pressure a bit? It is much more comfortable to breathe though than the other settings I had, I had been feeling like I was suffocating. I will send over the Sleep HQ link.

Hey @joeljjk11, how's your ASV experience so far?
I too started my ASV therapy recently. The doc prescribed EPAP 5, min PS 3, max PS 15. Mornings were terrible with these settings.
I'm still trying different settings, but found that lower max PS work better for me. My current settings are
Max epap 6.0
Min epap 4.0
Mode ASVAuto
Ps max 8.0
Ps min 3.0
and a 20 minute ramp.

Last night I slept like a baby and look forward to another one. Here's my SleepHQ

@Respirator99, why are you saying that max PS should be no less than 15? At 15, it blows so hard that it wakes me up!

Hrapovick wrote: ↑

Mon Jun 05, 2023 7:44 pm

I'm still trying different settings, but found that lower max PS work better for me.

If someone really has confirmed central sleep apnea or complex apnea....those centrals need probably a PS of at least 10 for the machine to breathe well for you. Limiting the PS could potentially cause sub optimal treatment when dealing with central apneas. Now if you don't have central apnea and a rapid high burst of air to make you breathe isn't needed then limiting the max PS probably hurts nothing.

Hrapovick wrote: ↑

Mon Jun 05, 2023 7:44 pm

Hey @joeljjk11, how's your ASV experience so far?
I too started my ASV therapy recently. The doc prescribed EPAP 5, min PS 3, max PS 15. Mornings were terrible with these settings.
I'm still trying different settings, but found that lower max PS work better for me. My current settings are
Max epap 6.0
Min epap 4.0
Mode ASVAuto
Ps max 8.0
Ps min 3.0
and a 20 minute ramp.

Last night I slept like a baby and look forward to another one. Here's my SleepHQ

@Respirator99, why are you saying that max PS should be no less than 15? At 15, it blows so hard that it wakes me up!

@Respirator99 -- if you want context for Hrapovick's handling of his therapy you may want to review his original thread
viewtopic/t186762/ASV-side-effects.html

@Respirator99, why are you saying that max PS should be no less than 15? At 15, it blows so hard that it wakes me up!

It's not me who says that, it's Resmed. From the ASV clinical manual: ResMed recommends that the Max PS should be set to >=15 cm H2O. You'll get used to it - mine regularly gives me a pressure support around 15 and it doesn't wake me.

Respirator99 wrote: ↑

Tue Jun 06, 2023 1:05 am

@Respirator99, why are you saying that max PS should be no less than 15? At 15, it blows so hard that it wakes me up!

It's not me who says that, it's Resmed. From the ASV clinical manual: ResMed recommends that the Max PS should be set to >=15 cm H2O. You'll get used to it - mine regularly gives me a pressure support around 15 and it doesn't wake me.

Pugsy wrote: ↑

Mon Jun 05, 2023 8:57 pm

Hrapovick wrote: ↑

Mon Jun 05, 2023 7:44 pm

I'm still trying different settings, but found that lower max PS work better for me.

If someone really has confirmed central sleep apnea or complex apnea....those centrals need probably a PS of at least 10 for the machine to breathe well for you. Limiting the PS could potentially cause sub optimal treatment when dealing with central apneas. Now if you don't have central apnea and a rapid high burst of air to make you breathe isn't needed then limiting the max PS probably hurts nothing.

Thanks for advice guys, I'll try higher pressure support, will see how it works!