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Does anyone have an tips on self titration for the Resmed aircurve 10 ASV?
#1
I'm still new to this machine and wanted some tips on self titration and optimizing the pressure settings. Any feefeedb will be greatly appappreciated.

Thanks
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#2
easy peasy: just set it in autoasv mode with default settings and see what happens. raise min epap until unclassified (presumably obstructive) apnea are reduced as much as possible within your tolerance for pressure (like re leaks and aerophagia). raise min pressure support to try to reduce hypopnea and flow limitations and some residual ua. leave max settings at max while you see where the machine takes you. limit / lower max settings if intolerant to them.

fyi, max epap and ps settings can add to at least 33 cmw ipap but the machine won't go over 25. it's odd: I had difficulty with higher pressures on apap (e.g., 13 - 20 cmw) even with epr set to 3 but have virtually no problem with asv pressure support swinging up to 25. presumably because epap can be set to offset ipap by more than the equivalent of epr 3 and because ps rises and falls very quickly.

the resmed clinician manual provides a titration flow chart for asv and asvauto modes but is very slim on details. sleeprider has copied and posted it in a number of threads so a search should produce it as well.

I have all of about 4 months experience with asv. not much, but if you have specific questions I'll try to respond with whatever knowledge I have based on that experience.
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#3
(10-11-2018, 02:35 PM)sheepless Wrote: easy peasy: just set it in autoasv mode with default settings and see what happens.  raise min epap until unclassified (presumably obstructive) apnea are reduced as much as possible within your tolerance for pressure (like re leaks and aerophagia).  raise min pressure support to try to reduce hypopnea and flow limitations and some residual ua.  leave max settings at max while you see where the machine takes you.  limit / lower max settings if intolerant to them.

fyi, max epap and ps settings can add to at least 33 cmw ipap but the machine won't go over 25.  it's odd: I had difficulty with higher pressures on apap (e.g., 13 - 20 cmw) even with epr set to 3 but have virtually no problem with asv pressure support swinging up to 25.  presumably because epap can be set to offset ipap by more than the equivalent of epr 3 and because ps rises and falls very quickly.

the resmed clinician manual provides a titration flow chart for asv and asvauto modes but is very slim on details.  sleeprider has copied and posted it in a number of threads so a search should produce it as well.

I have all of about 4 months experience with asv.  not much, but if you have specific questions I'll try to respond with whatever knowledge I have based on that experience.

Thanks for the feedback! What do you set the min and max pressure support to begin titration?
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#4
I meant the min pressure support only not the max
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#5
if you can post some charts we can give more specific suggestions but this should get you started.

[Image: attachment.php?aid=4210]
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#6
I think default is 3 - 15. I think sleeprider often suggests limiting max to 12 on first try but 12 or 15 made no difference for me; the machine frequently goes to max ipap of 25. I assume it's stopping more apnea than it's allowing at those highest pressures but a few often remain. one reason to limit max ps is to allow a higher max epap under max 25 ipap (and vice versa). after a couple months of trying ps min 3-6, I finally dropped my min to 0 for a while to better isolate effects of epap while trying to find best epap setting and to try to better understand what min ps does. also, I found I need higher epap so I had to reduce min ps to limit min ipap to what I could tolerate - too much aerophagia otherwise. (I also switched for a while to asv mode in which epap is fixed, while trying to find best epap setting.) IDK if my method(s) are practical or appropriate, just my experience. it's all trial and error anyway, even in the sleep lab. BTW, it's conventional wisdom to make one setting change at a time, which I agree with, and also to go a week or more before making any other changes. there's some sense to that but I personally don't agree with that in all cases. in the sleep lab they change settings as often as after 5 minutes. I think it useful to go at least one more night after a setting returns undesirable results because sometimes we acclimate; it settles down for some reason. but more often than not I move quickly on from settings that produce lousy results. right or wrong, IDK; just my opinion and it appears to be a minority opinion. I guess the point is that there are few hard and fast rules, YMMV and with some exceptions we all should usually do what we individually learn works for us.
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#7
(10-11-2018, 05:33 PM)Sleeprider Wrote: if you can post some charts we can give more specific suggestions but this should get you started.

[Image: attachment.php?aid=4210]

Thanks and i will. I just started to use the machine 2 days ago so once I get more data I will post it. I read that titration guide and I was confused about the part that says if EPAP reaches Max EPAP and upper Airway obstruction persist progressively increase EPAP until upper Airway obstruction is eliminated but how can you increase EPAP if it already hit the max? Unless I read that wrong. And also why would you increase the pap if they're claustrophobic? Wouldn't one want to decrease it for people who are claustrophobic instead of increase it?

(10-11-2018, 05:47 PM)sheepless Wrote: I think default is 3 - 15.  I think sleeprider often suggests limiting max to 12 on first try but 12 or 15 made no difference for me; the machine frequently goes to max ipap of 25.  I assume it's stopping more apnea than it's allowing at those highest pressures but a few often remain.  one reason to limit max ps is to allow a higher max epap under max 25 ipap (and vice versa).  after a couple months of trying ps min 3-6, I finally dropped my min to 0 for a while to better isolate effects of epap while trying to find best epap setting and to try to better understand what min ps does. also, I found I need higher epap so I had to reduce min ps to limit min ipap to what I could tolerate - too much aerophagia otherwise.  (I also switched for a while to asv mode in which epap is fixed, while trying to find best epap setting.) IDK if my method(s) are practical or appropriate, just my experience.  it's all trial and error anyway, even in the sleep lab.  BTW, it's conventional wisdom to make one setting change at a time, which I agree with, and also to go a week or more before making any other changes.  there's some sense to that but I personally don't agree with that in all cases.  in the sleep lab they change settings as often as after 5 minutes.  I think it useful to go at least one more night after a setting returns undesirable results because sometimes we acclimate; it settles down for some reason.  but more often than not I move quickly on from settings that produce lousy results.  right or wrong, IDK; just my opinion and it appears to be a minority opinion.  I guess the point is that there are few hard and fast rules, YMMV and with some exceptions we all should usually do what we individually learn works for us.

Definitely a lot of good tips and knowledge in this post I appreciate that!
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#8
I am confused by same michaely6. very vague ambiguous language and lacking detail. like no mention of what to use ps for.
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#9
I agree. Hopefully sleeprider can you elaborate a little more on that.
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#10
Let's go one step at a time. Try the default autoASV settings and let's look where that takes us. Very few people need EPAP higher than 15 cm. Post some results and we can modify the approach if needed. We don't have any history on your case and what brought you to ASV or what your results were on CPAP or BPAP, so your concerns about exceeding the recommended default settings has no context.
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