Air Curve ASV after two years use

[LindanHotAir]

My sister’s doctor prescribed the Philips Dreamstation ASV precisely because he believed the Resmed algorithm is unsuitable for her severe central apnea (AHI 72). The Philips machine has a programmable backup rate that can be set close to the patient’s normal respiration rate. Her treated AHI is now below 1. He says any health risk from the machine is far lower than the risk of central apnea, desaturation and AFIB.

The only suitable alternative appears to be a Chinese machine (iBreeze BiPap) from a major ventilator manufacturer that appears from its specifications to have the same operational properties as an ASV machine that has a programmable backup rate.

[SarcasticDave94]

It's true the Respironics SV Auto has manual controls while the ResMed ASV doesn't. Normally that's not a problem unless you're an extremely rare case with other respiratory needs like me with my COPD. Manual timing and respiratory rate is helpful in those cases, but it's likely not needed for most.

Call me skeptical but I think doc's ego wants to maintain full control of the therapy, or he's subsidized by Respironics to choose their machines. I say this in part because look all over this forum and see patients that the doc can't be bothered to adjust a CPAP from 6 to 8 unless you wait a month and get an appointment so he can script new numbers.

[TSVanwinkle]

 

Well,   I may have spoken too soon re things getting better.  Two decent nights, then it fell apart.  Same mask, same settings, two really bad nights.  I am beginning to wonder if something is wrong with my Aircureve ASV.   The issue is that the pressure starts ramping up to pressures that the mask simply, nor me, can handle.  I've tried the blowback procedure and it resets the machine, but only briefly and the same cycle starts again.  And the ramp up happens while I am fully awake.  What seemed to have helped previously was to go to a medium cushion for the Respironics Dreamware, but that is no longer working.  I pulled out a Resmed full face mask with a fresh cushion and had no better results, so that's two different cushions and one brand new Resmed mask that aren't able to handle the high pressures coming from the ASV.  Prior to this July and going all the way back to Oct 2019, I had good therapy and no problems with the very same mask and settings.   So, the mystery seems to be what changed?  Here are three charts from last night's experience.  Thanks in advance for the help and guidance! 

- Van Wink

[Sleeprider]

I'm going out on a limb and saying this is mainly positional. Higher EPAP may help but keep your chin up and I think it will get better. The machine is responding with appropriate pressure support, but little or nothing is getting past the obstructive block.

[TSVanwinkle]

Thanks for the reply.  I do wear a cervical collar without fail.  I agree with you that positional stuff is major factor and not to be discounted.  The spooky thing is that I'm fully awake and breathing just fine when starting a session --until the ASV starts to kick in.  In each instance where I am awakened and then re-start the session, the same thing happens after a short interval of time; anywhere from 3 to 10 minutes.  And once again, I'm fully awake and was breathing comfortably before the ASV kicked in.

[SarcasticDave94]

My Fisher and Paykel Vitera can handle the ASV. BTW that ASV maxes at IPAP 25 cmH2O. My RT said when I graduate to an Astral I'll use my F&P VITERA. The Astral Max IPAP is 50 cmH2O. If your mask is adjusted correct, right sized, and all that, whatever mask you've got will handle all the ASV throws out. Your Max leaks were 12. My last ASV usage had leaks at 10. Hence non-issue IMO.

I do ask "Do you need Max IPAP 30?" I say probably not. Your IPAP Max was 22.62. Conclusion? Drop IPAP Max. I think you could take 2-3 cmH2O off both EPAP and PS Max. Maybe it'll be a bit more comfortable. If not, I'll refund your money and you can change settings back to astronomical.

[LindanHotAir]

In my sister’s case it took over a month to get the other machine and the Resmed ASV was not a successful solution for her central apnea because keying off an average respiration rate of 0 didn’t do the job. The lack of a programmable backup rate was a seriously poor design choice that makes the machine unsuitable to treat her. The programmable backup rate, rise time, and Ti work well for her, while the Resmed was not a proper fit for her condition.

[SarcasticDave94]

In a case like that then there's likely other conditions at play. I had the ResMed ASV working fine with the Auto time controls until my COPD stepped up after bouts of pneumonia and bronchitis.

An average respiration rate of zero? My average is down from most others, at 10 most times. A zero average though is suspect.

And you do mention "condition" without stating what that is. ASV is typically for 1 condition, Central Apnea treatment.

[LindanHotAir]

My sister has serious central apnea AHI 72 and AFIB and has successful results with the DS ASV and a programmed backup rate of 11. Treated AHI is 0 to 1. Her DME initially provided a basic Resmed CPAP that did nothing for her. That tech was fired. They then got her the Resmed ASV machine as that’s their preferred product line. They then had to order the DS ASV replacement machine to get the programmable backup rate. With the Resmed ASV she had problems with extended central events that were not successfully treated with the machine’s guestimate backup rate.