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ASV - At last
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DonC Offline

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Posts: 75
Joined: Oct 2015

Machine: ResMed AirCurve 10 ASV
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: ResMed AirCurve 10 ASV
CPAP Pressure: Unsure
CPAP Software: SleepyHead

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Sex: Male
Location: Massachusetts, USA

Post: #1
ASV - At last
Hi Everyone,
Yesterday I took possession of an AirCurve 10 ASV machine. This is after a host of issues with Titrations, Doctors, Insurance Companies and last but not least the machine supplier. I went to pick the machine up yesterday and as I am paying for and expecting a new machine (there were a couple of things that made me question this but they swore blind that it was new) you can understand my anger when I got home and started setting things up in Sleepyhead to find that it had been used as a loaner for almost a year. I had returned my CPAP machine and had to fight to get a promise of a new machine after it came off back order and that I could keep the "loaner' until then.
Anyway I woke up this morning after 6 hours sleep with no OAs or CAs. I did have an AHI of 3.6, half of which were Hypopneas and the others were UAs. My settings were ASV (not ASV auto) - EPAP 6 and then PS min 4 max 10.
I am happy with the progress but what tweaks and tips can you give me so I can move forward.
Thanks,
Don

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Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time.
Thomas A. Edison
03-23-2016 09:29 AM
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Sleeprider Offline
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Posts: 3,400
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

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Sex: Male
Location: Where they make Respironics

Post: #2
RE: ASV - At last
Sounds like a good start other than the supplier trying to sell you his loaner. Dare I say typical.

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03-23-2016 09:47 AM
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bwexler Offline

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Posts: 563
Joined: Mar 2012

Machine: PRS 1 BiPAP autoSV Advanced, with Heated Tube humidifier
Mask Type: Nasal mask
Mask Make & Model: Sleepweaver Élan
Humidifier: Resperonics Heated Tube humidifier
CPAP Pressure: Max pressure 25.0 cm H20, Max
CPAP Software: SleepyHead EncorePro

Other Comments: CMS 50i with Software for SpO2

Sex: Male
Location: San Marcos, CA, USA

Post: #3
RE: ASV - At last
I assume you may have a chat with your supplier this morning.
I would not like to be him.
That is exactly the reason we always suggest you check the blower hours on the machine BEFORE you leave the DME.
Why aren't you using ASV Auto?
I have been using my PRS1 for 2 1/2 years in Auto mode. It took a while to get it dialed in and to train the machine to breathe when I breathe, Instead of fighting me.
03-23-2016 10:30 AM
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Asjb Offline

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Posts: 173
Joined: Oct 2014

Machine: Aircurve 10 CS Pacewave ASV. Before 11/2015 Airsense 10 Auto
Mask Type: Full face mask
Mask Make & Model: FP Simplus & Remzzzs liner
Humidifier: Integral
CPAP Pressure: Current info in this post
CPAP Software: ResScan SleepyHead

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Sex: Undisclosed
Location: France

Post: #4
RE: ASV - At last
Hello Don.

Quote: Yesterday I took possession of an AirCurve 10 ASV machine.

I've been using the Aircurve 10 ASV since November and am delighted with it. Average AHI of less than 1 and very good quality sleep. I've even had *six* smiley face zero AHIs (childish of me I know but they do cheer me up!). Wish you good luck to reach that too.

Quote: you can understand my anger when I got home and started setting things up in Sleepyhead to find that it had been used as a loaner for almost a year].

That's really cynical of them, what a disappointment for you. Do they not know that the 'run hours' of a Resmed machine can't be re-set to zero?, so any user can establish if a machine is 'used' - and just through the machine information menu, don't even need Sleepyhead.

Quote:Anyway I woke up this morning after 6 hours sleep with no OAs or CAs. I did have an AHI of 3.6, half of which were Hypopneas and the others were UAs. My settings were ASV (not ASV auto) - EPAP 6 and then PS min 4 max 10. I am happy with the progress but what tweaks and tips can you give me so I can move forward.]

I was advised on this forum (I think it was vsheline, who knows a lot about ASV and, with others, was really helpful to me when I first started) that the Resmed ASV moves so fast, on a breath-by-breath basis, to correct an apnoea or hypopnoea that it doesn't have the time for a test puff to see if the airway is clear or closed. So, your 'obstructive' and 'central/clear' results will always be zero (as mine have been). The 'unknown apnoea' index therefore means 'centrals + obstructives' and the only way you can tell which is by looking at the flow wave form in Sleepyhead. However, they are more likely to be obstructives as the machine is so fast and effective at 'blowing through' centrals. If you confirm that they are indeed obstructives on your wave forms then you should consider raising your EPAP to a level that treats obstruction, maybe increasing by 0.6 (the increments on my machine are 0.2 at a time) every few days until you're at the right level.

You also might want to try the ASV on auto (in which case increase your minimum EPAP if you are still having obstructives) and just experiment with the best min and max EPAP for you. I tried both fixed and auto and found auto to be 'smoother' in some way and more effective in reducing the AIH. Your PS settings look perfect for starters.

Just a small thing - I find the ASV gets through more humidifier water than my Airsense APAP, even on the same humidity and temperature settings. You may find you need to fill the tank each night to nearly max.

Hope it goes well.
best wishes, asjb

My current settings: Auto-ASV. EPAP 11-14, PS 3-10
03-23-2016 11:25 AM
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DonC Offline

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Posts: 75
Joined: Oct 2015

Machine: ResMed AirCurve 10 ASV
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: ResMed AirCurve 10 ASV
CPAP Pressure: Unsure
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Massachusetts, USA

Post: #5
RE: ASV - At last
Thanks for the responses guys.
My conversations with the supplier have been quite lively. I even scared the dogs into leaving the room and the wife went outside for a while. It was just so stupid. They had tried to clear the info but the changes to the setting over the months were still there.
Because of this I have to believe that the machine was set up for a previous customer (I am checking with the doctor for the prescription he sent). No matter what I am going to make some changes. I am happy with the start but want to get the UAs under control; so, I will go to ASV Auto, increase the minimum EPAP to 6.6 as suggested with a maximum of 14 and leave the PS at 4 to 10.
Then I will fill the tank and wait for the first smiley face zero AHIs to appear. I so want to have a childish reaction to that.
I have to say that I have felt fantastic today and am looking forward to going training with the dogs this evening instead of dreading it because I just want to go to bed.
Thanks again everybody. Perhaps I am getting close to being able to help others on the forum rather than being the one asking for help. Wouldn't that be nice.
Don

I-love-Apnea-Board

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Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time.
Thomas A. Edison
03-23-2016 02:27 PM
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trish6hundred Online

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Posts: 6,453
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #6
RE: ASV - At last
Hi DonC,
Good luck with your ASV machine. It’s unfortunate that they gave you a “USED” machine instead of a new one.
Other than that , it sounds like you're off to a pretty good start, CONGRATULATIONS.!

trish6hundred
03-23-2016 07:47 PM
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DonC Offline

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Posts: 75
Joined: Oct 2015

Machine: ResMed AirCurve 10 ASV
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: ResMed AirCurve 10 ASV
CPAP Pressure: Unsure
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Massachusetts, USA

Post: #7
RE: ASV - At last
The second night was good again. I slept for 6 hours 40 minutes.
Total AHI 1.19 / UA 0.41 / HYPO 0.78
I changed to ASV Auto / EPAP 6.6 to 14 / PS 4 to 14.The results were great after I made the changes. Asjb - thanks for the guidance.
The only problem I had was that the pressure felt really high and woke me up three times pushing the mask away from my face. But, as it caused a big drop in the UAs do I just need to suck it up and get used to it or are there any more adjustments I can make? I didn't go as low as Asjb on the PS. Could that be the problem?
I have the mask pretty tight, to the point that it leaves marks on my face for an hour after I take it off.
Don

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Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time.
Thomas A. Edison
(This post was last modified: 03-24-2016 09:35 AM by DonC.)
03-24-2016 09:34 AM
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Asjb Offline

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Posts: 173
Joined: Oct 2014

Machine: Aircurve 10 CS Pacewave ASV. Before 11/2015 Airsense 10 Auto
Mask Type: Full face mask
Mask Make & Model: FP Simplus & Remzzzs liner
Humidifier: Integral
CPAP Pressure: Current info in this post
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Undisclosed
Location: France

Post: #8
RE: ASV - At last
(03-24-2016 09:34 AM)DonC Wrote:  The second night was good again. I slept for 6 hours 40 minutes.
Total AHI 1.19 / UA 0.41 / HYPO 0.78
I changed to ASV Auto / EPAP 6.6 to 14 / PS 4 to 14.The results were great after I made the changes. Asjb - thanks for the guidance.
The only problem I had was that the pressure felt really high and woke me up three times pushing the mask away from my face. But, as it caused a big drop in the UAs do I just need to suck it up and get used to it or are there any more adjustments I can make? I didn't go as low as Asjb on the PS. Could that be the problem?
I have the mask pretty tight, to the point that it leaves marks on my face for an hour after I take it off.
Don

Hello again Don - those are great AHI results and sleep hours but a nuisance you were woken up.

Do you have last night in Sleepyhead? If so, can you relate the times of being woken to bursts of particularly high pressure? as your current settings will of course give you a max IPAP of 24 (max EPAP 14, max PS of 10) which is quite a 'shock to the system' if you are not used to pressures that high but need them. It took me several weeks with ASV to get used to the high pressures I need (up to IPAP 25) having previously experienced pressures that I found tolerable at only up to 14 with APAP.

You could look at the Sleepyhead daily graph that gives y-axis 'time spent' and x-axis 'pressure' - if you see that you have not spent much time during the night at IPAPs of, say, more than 20, then I'd suggest you reduce your maximum EPAP to 10, or even perhaps 9, and try that for a few nights. Your obstructive apnoeas on the flow waves in SH (expressed numerically within 'unknowns' with the Resmed ASV) and hypopnoeas may increase slightly but I think that is a small price to pay for slow acclimatisation to the pressure settings that are right for you.

But even if you did spend quite a lot of the night at IPAPs in the twenties (and they 'blew your mask') and so you are probably going to need those sorts of pressures in the future, then 'slowly does it' would still be my advice. I don't think you need to adjust your pressure support now - but other people may think differently and I hope they, mostly much more expert than me, will join in on this thread. PS Edit: Sorry - just noticed you wrote today that you had increased your PS last night to a max of 14. I'd suggest you reduce that back down to the 10 you had the night before.

What were your median and 95% pressures? as those figures will help you to arrive at the right settings and to smooth out some of 'pressure bursts' that could wake you. And you used APAP or BiPAP before the ASV? - at what pressures?

You're only on Night #2 with ASV and many people have described that they needed some time to adjust to the different way the pressure feels compared to APAP and BiPAP. You'll get there!

There are many previous threads on the Board about mask adjustment, best masks for high pressures and leaks, and similar, that you might want to look at. I found that over-tightening was counter-productive but at high ASV pressures I was frequently being woken by the noise of brief 'mask farts'. This I finally solved by using a mask liner. The very short bursts of high leaks (my overall 95% leak stats are good) are still there on the SH leak graph but they don't (I assume) make such a noise now with a liner as I routinely now sleep undisturbed right through the night.

A number of people on the Board have mentioned that they find the mask I use (FP Simplus) to be particularly comfortable and effective with high pressures - you might want to try one some time if it turns out you will actually need such pressures.

What's the right phrase? - oh yes, 'onwards and upwards'!

best wishes, asjb


................................................................................​.......

My pressures currently: Auto-ASV. EPAP 11-14. PS 3-10
(This post was last modified: 03-24-2016 11:14 AM by Asjb.)
03-24-2016 11:08 AM
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DonC Offline

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Posts: 75
Joined: Oct 2015

Machine: ResMed AirCurve 10 ASV
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: ResMed AirCurve 10 ASV
CPAP Pressure: Unsure
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Massachusetts, USA

Post: #9
RE: ASV - At last
Onward and Upward for sure. I really feel better so that is the reality of the situation. Loaner or new I will get used to the machine as it is doing what I wanted it to do.
I will adjust the max EPAP down but what you are saying just proves my ignorance.
I used Auto CPAP only before the jump to ASV and the settings were 8 to 15. You said "your current settings will of course give you a max IPAP of 24 (max EPAP 14, max PS of 10) which is quite a 'shock to the system'". I thought these were separate pressures and happened when breathing in or breathing out.
The blowouts did happen at peak pressures so I will adjust the Amara View to try to make it work. If it doesn't I will try the Simplus. I just happen to have one in the collection of masks I have accumulated over the past few months.
You know, I have only been at this for for just under six months. I have gone from a sleep study with AHI of 72 and Oxygen level of 74% to where I am now. I have met every road block you can imagine (read my other posts) down to being conned when I picked up this last machine. But because of Apnea Board I am here now. I was told very early on that I needed an ASV machine and they were right.
I just want that first zero smiley face Smile but I am happy with where I am. I say again
.I-love-Apnea-Board
I am going to write the story in the correct segment of the forum but I will get a few good nights sleep first.Sleep-on-pillow
Don

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Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time.
Thomas A. Edison
(This post was last modified: 03-24-2016 12:52 PM by DonC.)
03-24-2016 12:51 PM
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Asjb Offline

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Posts: 173
Joined: Oct 2014

Machine: Aircurve 10 CS Pacewave ASV. Before 11/2015 Airsense 10 Auto
Mask Type: Full face mask
Mask Make & Model: FP Simplus & Remzzzs liner
Humidifier: Integral
CPAP Pressure: Current info in this post
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Undisclosed
Location: France

Post: #10
RE: ASV - At last
Hello Don,

I've now had a chance to look through your previous posts. Full of admiration for how you've finally won against the system and at last have the machine you needed right from the beginning with your test results, AHI of 72, 43% centrals, and very striking desaturations. Congratulations.

My understanding (and I'm still hoping a Board expert will also chime in and offer their opinion) is that a pressure support max setting of 10 should be enough to 'breathe for you' when you have central apnoeas, and so get rid of those. The PS will also resolve hypopnoeas.

Buy you also had a noticeable obstructive component in your test night and to treat those you need an adequate EPAP. I think you've previously alluded to the fact that your obstructives were dealt with pretty well with APAP 8-15? Have I got that right? If so, you may well eventually need an ASV-auto EPAP setting of something similar to 8-15.

But if you go immediately now to 'theoretically perfect' settings that will mean you having an IPAP max of 25 (i.e. Max EPAP plus PS), and that is quite a jump from your APAP max of 15 and will take a while to get used to, and will likely give you mask leak and adjustment challenges initially.

So, I'd suggest you consider trying the settings we discussed in our posts earlier today, don't change anything for at least a few nights and have a good look at each night's data in Sleepyhead. If those settings aren't holding things, then if the flow waves show that any apnoeas are centrals, creep up the PS max for a few days and review again.

If you are still having significant Unkown Apneas but the flow waves are obstructive in nature, then creep up the minimum EPAP for a few nights, and review again.

I found an immediate benefit (centrals, obstructives) with starting ASV, and, like you, immediately slept better and was less fatigued but it took me nearly 3 months to get to my current 'I am very happy with everything' settings. I really like the way the ASV 'breathes with me' and I'm sleeping better than I have for decades. I'm sure you will get there too.

Best wishes, asjb
..................................................................

My cuurent setting unchanged from my post above
(This post was last modified: 03-24-2016 03:36 PM by Asjb.)
03-24-2016 03:34 PM
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