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Terrible mask leaks and high ahi on ASV

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RedPorpoise +0 points · 22 days ago Original Poster

My 80-year old mother was recently diagnosed with obstructive and central sleep apnea. She began using the Resmed Air Curve ASV on September 24, 2018 and I believe her highest pressure is 25. We’ve tried AirTouch F20, Simplus, and Amara View with little success. They all leak horribly, disrupt her sleep, and her AHI ranges from 10-13 on a regular basis. Some have been as high as 16. Her DME has become disinterested since we tried the third mask but I am very concerned about her AHI. Can anyone help me with this? I’m at my wits end.

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Sierra +0 points · 22 days ago Sleep Enthusiast

The ResMed AirCurve ASV has two modes that can be used. One is the standard ASV mode which uses a fixed EPAP (exhale) pressure and a variable pressure support (so variable inhale or IPAP pressure). The other option is the ASVAuto mode. It uses a variable EPAP and variable pressure support. The purpose is to potentially allow for lower mask pressures. You could ask the sleep doctor about using the ASVAuto mode if it is not already being used. The higher the pressure the harder it is to get the mask to seal.

You have tried some good masks, and I can't really make any other suggestions. I could not get the F20 to work for me either. Perhaps others could suggest other masks.

Last, the AirCurve ASV is a very complex machine and typically only used for a complex apnea case. Is there any option to see a different sleep doctor or technician to see if the machine has been optimized for her?

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RedPorpoise +0 points · 22 days ago Original Poster

Unfortunately, her primary doctor referred her to a clinic that does not have a doctor who sees patients. They only conduct the studies. Her primary doctor is useless with this issue. Her neurologist wanted to try reducing her pressures but changed his mind after seeing her sleep study which revealed just how bad her apnea really is. I don’t know what to do at this point. Any mask she tries practically blows off her face when the high pressures begin. Her machine is set on auto.

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Sierra +0 points · 22 days ago Sleep Enthusiast

On the mask leakage issue, she has tried 3 of the better and more popular masks. There are a couple of newer ones of the minimal contact style. My thoughts are that the higher the pressure the more force the mask puts on the face and on the straps. If the mask size is minimized then the area this pressure acts on is reduced, and conceivably the force in the straps is reduced.

I believe the Phillips DreamWear mask was introduced early this year. This mask frame can use a minimal full face, a nasal, and a nasal pillow type insert. The full face version might work better than the three she has tried. Here is some more information on it.

DreamWear Minimal Contact Full Face Mask

More recently ResMed has come out with one they claim is better, and in a test was preferred two to one over the DreamWear mask.

ResMed AirFit F30 Minimal Contact Full Face Mask

But, really until she tries the mask, you don't know if it will work. Some people have had success with using a mask liner where the mask fits to the face.

Mask Liners

With respect to the high AHI about all you can do is work with the provider. You could ask whether it is central apnea that is driving it up or obstructive apnea. If it is obstructive then she probably needs more EPAP pressure and the machine may already be at the maximum. If it is central apnea then the pressure support may need to be adjusted. There is a free software program called SleepyHead which will download the data from the SD card in the machine so you can view it. If you want more info on it just ask.

Here is a link to a document from ResMed which includes some basic details on what the machine is supposed to do and the basic setup paramaters for ASV mode, and for ASV Auto. See pages 27 through 31. SleepyHead will allow you to see the same level of detail as is shown on page 31 for flow rate, pressure and minute ventilation. You should be able to see if the machine is working as it is designed.

Sleep Lab Titration Guide

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