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ASV question
#1
Hello, This is my first post on this forum. I will have my third sleep study if this year done this Saturday, first one only slept for 27 minutes, second one was for BiPap titration, this third one is because they were not able to find a suitable pressure due to BiPap induced Centrals? So my new study will be to titrate on the ASV machine. Not sleeping has been addressed so I should be able to get some results this time around.
My question is What is an ASV and how is it different to an Auto Cpap? 
I have been struggling to be compliant  with Cpap set at 20, since about 2012. Last December I went into AFib and really do not want to go through that again, have been told by Doctor that being compliant with pap therapy should help with this. 
Thank you for any help you can give.
Shift Worker
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#2
G'day Shift Worker. Welcome to Apnea Board.

ASV is short for adaptive servo ventilator. It's a PAP machine which monitors your breathing on a breath-by-breath basis and adjusts the pressure to keep your ventilation fairly constant. The Resmed algorithm, which I'm familiar with, calculates a rolling average of your minute ventilation (ie the amount you've breathed in over the last minute). If the Vm starts to fall, the machine will increase pressure support to help keep the breathing constant. If you have a central apnea, the machine will give you a big kick of pressure to get you breathing again.

There are a number of settings - EPAP is expiratory PAP and is the baseline pressure while you're exhaling. IPAP is inspiratory PAP and is the pressure while you're inhaling. Pressure support (PS) is the extra pressure added to EPAP to give you IPAP. If you're breathing normally, EPAP will be at its minimum, as will PS and IPAP. If you experience an obstructive event or precursor (eg snore or flow limitation) EPAP will go up to overcome the obstruction. Otherwise PS will be adjusted on each breath to keep everything nice and steady.

If you are using a constant pressure of 20 cm H2O you'll probably find that the ASV will give you a lower average pressure and should be more comfortable. Once they're dialled in properly ASV machines pretty much eliminate all apneas, central and obstructive.

My personal preference is the Resmed machine rather than the Philips. The Philips has a lot more settings to personalise the treatment - which means a lot more settings to get wrong. The Resmed does most of it by software and adapts to the patient.  These machines are pretty expensive but in the great majority of cases they work extremely well. You can download the Resmed product brochure here: http://www.resmed.com/au/en/consumer/sup...rtDownload Note that it's called Aircurve ASV in the States, CS Pacewave elsewhere.
DeepBreathing
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#3
The problem of "Complex Apnea" is more common that you might think. Estimate are that between 5 and 15 in 100 individuals put on CPAP for obstructive sleep apnea (OA) will develop central apnea (CA). The combination of CA and OA is complex apnea. DeepBreathing is one of those who uses an adaptive servo ventilator (ASV), and there are many more on this forum.

His explanation is very good, and for most of them ASV treatment becomes very natural and they are well treated. I also agree the Resmed machine seems to be much more readily accepted, while many U.S. doctors seem inclined to prescribe Philips. The two major machines in question is the Resmed Aircurve 10 ASV, and Philips Respironics BiPAP Auto SV Advanced. If after researching the machines, and hearing from those that use them, you have a preference, you may have to request it up-front. The problem with titration studies is that they will try to find the EPAP (exhale pressure) that stops obstructive apnea, and the pressure support (PS) needed to induce a breath during a central. The auto ASV machines, and especially the Resmed actually use an auto-adjusting EPAP and PS to maintain your breathing rate and volume. The most comfortable setting will probably be automatic, but your prescription will probably try to recommend a set pressure. Kind of a waste.

Read up on ASV machines, and especially the AutoASV mode of the Resmed Aircurve 10 ASV, and I think you will see a compelling reason to specifically ask for, if not insist on, that machine.
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#4
I'm in the same boat (Complex Sleep Apnea). I have the ResMed ASV machine. It's constant pressure changes wake me often. I have been using it for over a week now and about the change the mode setting to "auto". My biggest problem is trying to find a mask to handle the extreme pressure changes and still be somewhat comfortable. Good luck.
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#5
Try the ResMed F20 mask.  I used to use the F10, but do to the ASV higher pressures, I had a constant leakage problem.  The F20 is much better at handling the higher pressures without leakage.
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#6
My caution on masks is all of our faces are different, what works for one does not equate to working for you. If you have not already please read the Mask Primer.
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#7
Hi Shift Worker,
WELCOME! to the forum.!
I wish you good luck with CPAP therapy and getting the machine you need.
trish6hundred
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#8
(05-17-2017, 06:48 AM)Shift Worker Wrote: Hello, This is my first post on this forum. I will have my third sleep study if this year done this Saturday, first one only slept for 27 minutes, second one was for BiPap titration, this third one is because they were not able to find a suitable pressure due to BiPap induced Centrals? So my new study will be to titrate on the ASV machine. Not sleeping has been addressed so I should be able to get some results this time around.
My question is What is an ASV and how is it different to an Auto Cpap? 
I have been struggling to be compliant  with Cpap set at 20, since about 2012. Last December I went into AFib and really do not want to go through that again, have been told by Doctor that being compliant with pap therapy should help with this. 
Thank you for any help you can give.
Shift Worker

at least they found the centrals and will do an ASV titration

my doctor said this
cpap = yugo fiat 
bipap = mercedes bmw 
ASV = maserati lamborghini 

ASV is what treats CA as best as can be done 

you do not want to use cpap with CA
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#9
I concur with the suggestion of the F-20. It is a super mask (also having been an F-10er and Quatro before). But, it is highly individualistic. Both the ResMed and Philips ASVs are great machines. Getting used to BiPap from a CPaP (with A-flex) was more of a jump for me than going to the BiPap ASV. The ASV really made it so much more comfortable and natural - and goodbye to the centrals. I use the Philips Respironics 950 - which was an early System One. About due for a new one - and they have finally released an ASV in the DreamStation model line. Bottom line - I think (hope) that you will be amazed at the difference with the ASV, be it either brand.
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#10
I'm a new ASV user myself, almost three months now. The one thing I can say for sure is the ASV AUTO mode is the way to go.
My first few nights were at a set rate an it was miserable. But once I switched modes (thanks to the fine folks here) an a suggested settings tip from Sleeprider. I've been able to dial in my pressures slowly to where I'm comfortable an my AHI has never been over 1.2 in the last two months. An the higher nights are me just being a little sleeper an waking up often.

As for masks, it's like everyone here will tell you. You'll probably have to try a few an find what's right for you. I have a Amara view an it does ok at my pressure, high average is about 14cm, so I know I go higher than that. But YMMV.
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