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I need help with my new Aircurve 10 ASV
#1
Hi!
Newbie - 1st post!
I am so grateful to have found you guys!

History: I have been on CPAP therapy for 10 years treating OSA. In August '15, I did a new sleep study and it was determined that I needed to be treated with BIPAP S/T 11/7cm H2O with RR=8 and T1 max 2.8 seconds and T1 min 0.1 seconds. After a few months, I was still tired in the morning, etc.

On 3/29 I did a new sleep study and found that I have Central Sleep Apnea as well as OSA. After unsuccessful ( AHI 20+) use of Bi-pap ST I was swithed to Aircurve 10 ASV.

The recommended settings with autoASV: Max pressure 25, Max EPAP 5, Max PS 15, Min PS 3, Biflex off, Rate 14. Timed insp 1. 4. Rise time 3.

I am usung a laptop from work and need the administrator to allow me access to SH.

My new AC10 is not displaying the correct data for the amount of time I slept last night. (Last week, there was a day where the data was also screwy.) I slept 7hrs. It says 2. I thought I slept well and didn't feel tired when I woke up this morning, but the display shows that I had 11.2 apnea events last night. My first week (last week) my AHI ranged from 1.1 to 14 later in the week.

I went into the Clinical Settings (thanks!) and the highest Max EPAP it can go and was set by the tech is 15. Is this right?

Is my machine screwy? Should I get a replacement?

Where can I adjust the Max pressure to be 25? The settings are: mMin EPAP 5.0,
Max EPAP 15, Min PS 3.0, Max PS 15.0.

I'm using ResMed's My Air for data right now.

Thanks,

Jeffo1





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#2
Hi Jeffo1,
WELCOME! to the forum.!
Hang in there for answers to your questions.
I don't know a whole lot about ASV machines, but there are quite a few who use them here on this forum.
Much success to you as you continue your CPAP therapy and also with getting your machine adjusted to meet your needs.
trish6hundred
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#3
G'day Jeff, welcome to Apnea Board.

With ASV machines there is a "magic" formula: EPAP + PS = IPAP, where

EPAP is the expiratory pressure (when you're exhaling)
IPAP is the inspiratory pressure (when you're inhaling)
PS is the pressure support - the amount by which pressure is increased when you switch from exhale to inhale.

You're right that the maximum EPAP is 15, and you are not likely to ever need more than that. The maximum pressure you will experience is the IPAPmax, which is EPAPmax + PSmax. In your case with EPAPmax = 15 and PSmax = 15, you could conceivably experience IPAPmax = 30. But the machine will shut down as an overload protection if it gets that high. The usual IPAPmax is 25 in ASV and ASVAuto modes.

Regarding the time, check that it is set correctly on the machine. It uses a 24 hour clock, so if (for instance) it was set at 2:00 in the afternoon rather than 14:00 then the time will be off. Also, the CPAP day starts at 12 noon. If you sleep through the day, the data will be split into separate sessions at noon, which will also (obviously) throw things out of whack.
DeepBreathing
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#4
(05-01-2016, 06:37 PM)Jeffo1 Wrote: History: I have been on CPAP therapy for 10 years treating OSA. In August '15, I did a new sleep study and it was determined that I needed to be treated with BIPAP S/T 11/7cm H2O with RR=8 and T1 max 2.8 seconds and T1 min 0.1 seconds. After a few months, I was still tired in the morning, etc.

On 3/29 I did a new sleep study and found that I have Central Sleep Apnea as well as OSA. After unsuccessful ( AHI 20+) use of Bi-pap ST I was swithed to Aircurve 10 ASV.

Your story is similar to mine. Veteran CPAP user, "graduated" to ASV.

Quote:My new AC10 is not displaying the correct data for the amount of time I slept last night. (Last week, there was a day where the data was also screwy.) I slept 7hrs. It says 2. I thought I slept well and didn't feel tired when I woke up this morning, but the display shows that I had 11.2 apnea events last night. My first week (last week) my AHI ranged from 1.1 to 14 later in the week.

When you say you "had 11.2 apnea events last night", do you mean your AHI was 11.2? AHI is the average number of events per hour, and I don't think you can have a .2 event. If you only had 11 events in seven hours, your AHI would be 1.8 for last night.

In any case, there are things that can be throwing your AHI off. My first night on ASV gave me an AHI of 15. I wasn't used to the nasal pillows or the occasional higher pressures, so I had some mask leaks, mouth leaks, and other disturbances. Since then (over a month now), my AHI has been pretty consistently under 5. My April average was 3.3. So, before trying to change settings, I'd first make sure you're not getting major leaks, positional obstructions (rolling onto your back, which is a bad idea for some of us), or mouth breathing.
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#5
Complex apnea (both OSA and CA) is difficult to treat. Controlling the OSA events can aggravate CA and periodic breathing. See if you can get Sleepyhead installed and post some screenshots of your data. Various Board Members can make suggestions based on their own experience with ASV treatment.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

Download Sleepyhead
Organize your Sleepyhead Charts
Post from Imgur


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#6
(05-02-2016, 12:48 AM)trish6hundred Wrote: Hi Jeffo1,
WELCOME! to the forum.!
Hang in there for answers to your questions.
I don't know a whole lot about ASV machines, but there are quite a few who use them here on this forum.
Much success to you as you continue your CPAP therapy and also with getting your machine adjusted to meet your needs.

Hi!

Thanks!

Jeffo1
Post Reply Post Reply


#7
(05-02-2016, 06:52 AM)DeepBreathing Wrote: G'day Jeff, welcome to Apnea Board.

With ASV machines there is a "magic" formula: EPAP + PS = IPAP, where

EPAP is the expiratory pressure (when you're exhaling)
IPAP is the inspiratory pressure (when you're inhaling)
PS is the pressure support - the amount by which pressure is increased when you switch from exhale to inhale.

You're right that the maximum EPAP is 15, and you are not likely to ever need more than that. The maximum pressure you will experience is the IPAPmax, which is EPAPmax + PSmax. In your case with EPAPmax = 15 and PSmax = 15, you could conceivably experience IPAPmax = 30. But the machine will shut down as an overload protection if it gets that high. The usual IPAPmax is 25 in ASV and ASVAuto modes.

Regarding the time, check that it is set correctly on the machine. It uses a 24 hour clock, so if (for instance) it was set at 2:00 in the afternoon rather than 14:00 then the time will be off. Also, the CPAP day starts at 12 noon. If you sleep through the day, the data will be split into separate sessions at noon, which will also (obviously) throw things out of whack.

Hi Paul,

Thank you for suggesting that I check the time clock. It is at 24 hours, but it's strange that it splits the sleep cycle!

I saw my sleep doc yesterday regarding the five high AHI spikes that I had over the past 14 days (14, 10, etc.) since I started ASV therapy and she suggested that since my sleep study was titrated using a Respironics Auto ASV, which she ordered, my DME (Lincare) gave me a ResMed Aircurve 10 ASV. (This is the third time where Lincare has given me a machine that was different from what the doctor ordered - but that's another story!)

Could the different ASV algorithms of the Respironics Auto ASV vs. ResMed AirCurve 10 ASV account for spikes in my AHIs since the presdure settings might be different?

Thanks,

Jeffo1




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#8
(05-04-2016, 01:48 PM)Jeffo1 Wrote: Could the different ASV algorithms of the Respironics Auto ASV vs. ResMed AirCurve 10 ASV account for spikes in my AHIs since the presdure settings might be different?

I'm no expert but I don't see why this couldn't be the case, since the algorithm is what determines the way the machine actually works. Complex apnea is a subtle beast, as has already been mentioned, so differences that might otherwise be minor could have large effects.

Now that I think of it, I don't know what they used for my own titration study. I think the tech said it was a machine that could be set to simulate other kinds of machines (CPAP, BiPAP, APAP, ASV). But since those algorithms are proprietary, I don't suppose it behaved exactly like the PRS1 they ended up prescribing for me...

So yes, I think it's very possible that your titration study on one machine should only be considered a "rough draft" for your best settings on another.
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#9
Jeff, Resmed and Respironics ASV machines operate in ways that feel different to users, and we have seen people respond better to one machine than the other, but it's not something you could predict based on a single night sleep study. What was the exact pressure prescription by your doctor?

All pressure settings are easily accessible by pressing the control knob and home button at the same time to enter the clinician settings. You are not quite ready for that until you fully understand what you want to accomplish and why. Once you have over 8 posts you will be able to post data that may help us to help you more accurately. A max EPAP is quite high, and I doubt you need to adjust that; however if you are experiencing a lot of obstructive events (snoring, flow limitation, hypopnea, and OA), then you would need to increase the minimum EPAP. We need a little more detail on your results to advise.
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#10
(05-04-2016, 01:57 PM)tmoody Wrote:
(05-04-2016, 01:48 PM)Jeffo1 Wrote: Could the different ASV algorithms of the Respironics Auto ASV vs. ResMed AirCurve 10 ASV account for spikes in my AHIs since the presdure settings might be different?

I'm no expert but I don't see why this couldn't be the case, since the algorithm is what determines the way the machine actually works. Complex apnea is a subtle beast, as has already been mentioned, so differences that might otherwise be minor could have large effects.

Now that I think of it, I don't know what they used for my own titration study. I think the tech said it was a machine that could be set to simulate other kinds of machines (CPAP, BiPAP, APAP, ASV). But since those algorithms are proprietary, I don't suppose it behaved exactly like the PRS1 they ended up prescribing for me...

So yes, I think it's very possible that your titration study on one machine should only be considered a "rough draft" for your best settings on another.
Hi!!
Thanks for your thoughts! I greatly appreciate it.
It's so good to know that I'm not alone in dealing with these issues!
All best,
Jeffo1

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