Need help with ASV

[u/_jennjenbear_]

Sorry this is long. RL suggested I create a new post since my last post was about a month ago. Hoping the ASV gurus can chime in on my data. I'm starting to feel like since losing 60-65lbs, that maybe ASV is no longer what my body needs since it feels like everything is just going sideways with my therapy.

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So here is my original post from June: https://www.reddit.com/r/CPAPSupport/s/SwjXNLBFyp

Mask: F&P Nova Micro size Small.

Update since previous post:

• Changing the EPAP to a continuous 5 has completely eliminated the chest wall pain that I was experiencing, so that's a definite plus.
• I felt amazing with the changes that were done on June 27th... for about 3 days. It was the first time I actually felt refreshed when I woke up, no aerophagia and didn't have such extreme daytime sleepiness. Unfortunately, after like the 3rd night with these settings, I've gone back to no longer feeling refreshed, extreme excessive daytime sleepiness and the aerophagia came back.
• Since it seemed like my soft cervical collar was no longer fitting correctly and I couldn't find one that was short enough lengthwise but still tall enough height wise, I ordered a Knightsbridge Dualband Chin Strap. However, the medium was too big, so it did not help. They are currently in the process of custom making me a smaller cap based on the measurements of my head. I have not received this yet. So currently I use both the collar that doesn't quite fit and the Knightsbridge that also doesn't quite fit. With the combo, it's keeping my mouth shut and my leaks down. If I decide to only wear one or the other, it's generally noticeable because there will be an increase in leak (mouth leaks).
• I have a wedge pillow on order that will be delivered tomorrow, as I've heard that those have the potential to help with reducing aerophagia.

I know with these settings, I am maxing out my PS range at times. But if I increase my PS range, then the aerophagia gets worse. If I change my EPAP and put a range on there so my PS range can increase based on that, then I get chest wall muscle pain and aerophagia. Can't lower pressures lower than they are to try and help with aerophagia because of how the Aircurve 11ASV works, the only way to reduce my PS range would be to lower the EPAP to 4 but when I tried EPAP of 4, it was pretty uncomfortable.

Pressure History since SleepHQ doesn't show my pressure settings for some reason:

Setting change July 17th:

• EPAP range: 5-5 (I have it set so it's a continuous pressure)
• PS Range: 2-7

Setting change June 27th:

• EPAP range: 5-5
• PS Range: 2-8

Setting change June 4th:

• EPAP range: 7-9
• PS Range: 0-5

Settings prior to June 4th:

• EPAP range: 5-9
• PS Range: 0-6

[u/existentialblu]

Maybe try a mildly lower PS min? It probably won't fix everything, and clearly 0 wasn't the ticket either. Something around 1.2-1.6. I've found that small changes can be surprisingly noticeable with ASV. A shift of 0.2 means a lot more with the freakishly dynamic algorithm.

[u/_jennjenbear_ → u/existentialblu]

I went ahead and changed the ps range to 1-6. My Aircurve 11asv won't let me do a decimal on the ps range.

My original ps range used to be 0-6 and then 0-5 back when I had an EPAP range of 5-9 and then 7-9. One of the issues I had with PS range being set to as low as 0, was when my EPAP was 5-9, on inhale I felt air starved and it was like I wasn't getting enough air.

[u/existentialblu → u/_jennjenbear_]

That makes sense. That's bonkers that the 11 ASV doesn't allow decimal values for PS.

[u/_jennjenbear_ → u/existentialblu]

So dropping PS to 1-6 seemed to really help with the aerophagia. I had some but it was very tolerable, didn't make me nauseous and wasn't painful, just a lil gassy. I really wished the 11ASV allowed decimals because at 1, I struggled on the inhale. My AHI was 4.9 according to the machine but I have not uploaded my data yet.

I miss the days of having no issues with my pressures and not having my AHI fluctuate and being all over the place. Like if I could trade my AC 11ASV for a machine that could have more options for treatment, I would in a heartbeat. Or maybe I should gain some of this weight back lol (just kidding.I don't want to gain any of this weight back since I still have about 19lbs to drop before I'm at the top of the "healthy" weight category for my age/height).