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Just tried ASV and I hate it. Help?
#11
RE: Just tried ASV and I hate it. Help?
It isn't insanity to have a PS20. the machine may need to use that sometimes. The machine works by making breaths for you and increasing pressure up to 25 when needed.

I agree to turn your ramp off, have a bad week to a month and get use to it. It is no sense blaming the machine for doing what it is supposed to do.

You need to learn to breathe steady going to sleep and if it pressures up too much, blow back hard to reset it.

Or go back to cpap. Though the charts I looked at only had about 2 hours use and stopped. So it is no wonder you are having trouble on ASV, you didn't get use to cpap. You were about 3ca per hour. If that is your average, ask your dr. You have cpap mode on the ASV, use that till you can sleep all night with a mask.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#12
RE: Just tried ASV and I hate it. Help?
(05-25-2019, 07:47 PM)ajack Wrote: It isn't insanity to have a PS20. the machine may need to use that sometimes. The machine works by making breaths for you and increasing pressure up to 25 when needed.

I agree to turn your ramp off, have a bad week to a month and get use to it. It is no sense blaming the machine for doing what it is supposed to do.

You need to learn to breathe steady going to sleep and if it pressures up too much, blow back hard to reset it.

Or go back to cpap. Though the charts I looked at only had about 2 hours use and stopped. So it is no wonder you are having trouble on ASV, you didn't get use to cpap.  You were about 3ca per hour. If that is your average, ask your dr. You have cpap mode on the ASV, use that till you can sleep all night with a mask.

I wonder if my body simply rejects any XPAP at all. 

I couldn't breathe after waking up on CPAP. High pressure = can't breathe out enough. Low pressure = can't breathe in enough. 

I wanted the best of both worlds. 

Had CPAP EPR set to 3. If I set the ASV PS to 3, how is that any different? I'm back to where I started. 

I would like a big volume of air breathing in and a low resistance breathing out. And nothing interrupting me until I sleep. I don't know why that's too much to ask of a machine. 

And the CPAP mode of this machine seems to have no EPR option at all. Why can't I just have a CPAP with an EPR greater than 3?
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#13
RE: Just tried ASV and I hate it. Help?
Quote:I couldn't breathe after waking up on CPAP. High pressure = can't breathe out enough. Low pressure = can't breathe in enough. 
This is what we are trying to establish.  
Low pressure to exhale out against. Min EPAP = 4
Higher pressure for inhalation.  Min PS = 3, Ok try Min PS = 4  We have to find where you are comfortable.

An ASV uses a high PS to initiate a breath when you are having a central.  Your Max PS should be as high as possible.

Instead of ASV, could you try ASV Auto mode?  This tries to keep the pressures as low as possible.
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#14
RE: Just tried ASV and I hate it. Help?
I think the problem is that you haven't gotten use to pressure and your body is fine. Step one. Don't sleep without you mask on. No excuses. Exhaustion from waking up every 90-120 minutes, as you sleep cycle. Can help you get use to XPAP a lot quicker. When you wake up, blow hard to reset the machine, adjust your mask and go back to sleep. Learn to breathe steady, going to sleep. So the machine doesn't see a problem, that it needs to fix.

Most have trouble at first and you are jumping into the deep end with ASV. It sounds like you are choking back the max PS, that is up to you. It won't stop the backup breaths or rises up to the max PS set. It's the way the machine works. The problem with choking back is that you may not return to effective treatment pressure. The machine will only use what it needs.

You will get use to breathing out and the sensation that your lung doesn't fully empty. You don't try to breathe out, you just let it happen. You only need to look at your tidal volume. to see that you are getting enough air. The minPS3 maxPS15+, will reduce your breathing effort to about half. Higher inhale, lower exhale base of 3cm may give a more natural feeling. As bonjour said, try ps4 if ps3 isn't enough.

Hopefully at the next sleep study. You may not have CA with o2 desaturations and can return to CPAP. From your charts, you started off with a lot of CA, that quickly resolved to a few. These may be pressure emergent CA and will resolve for most people within 12 weeks.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#15
RE: Just tried ASV and I hate it. Help?
I reset everything (tried to clear any garbage data on my breathing pattern).

Min EPAP 4.0
Max EPAP 15.0

Min PS 3.0
Max PS 20.0 (supposed to want that to fight centrals according to ajack)

Sitting upright and using my computer which puts me in a completely different (better) breathing mode compared to laying down and thinking about breathing. 

Oh god is this awful. I'm gonna continue to try, but I know there is no way in hell I will ever get used to this. 

Its blowing at me with different random pressures. 7...15...20 and it really hurts the inside of my nose. I just felt the pressure on my face at the titration. With this, it is really blowing up my knows.

I don't understand the blowback trick. Blowing back with any force really screws me up. I don't really have much air in my to blow back with too much force. And when I do, it just comes right back again 5 seconds later.

Why won't this machine sense that I'm breathing out at all. If I'm breathing out just a little bit, obviously I am having a central.
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#16
RE: Just tried ASV and I hate it. Help?
It's a pointless exercise in complaining the machine is doing what it is supposed to do. Yes it will cycle again, it just stops the present cycle. The irregularities of awake breathing will tell the machine to change pressure on each breath, to stabilize your minute vent.

You have a choice to choke it down, till you see your doctor. You can choke it back to apap if you want to. It will still have a backup breath, but it won't be therapeutic. It may help you get use to pressure.
min epap 4
max epap 6
min ps 3
max ps 4
The pressure isn't going to rise above 10cm
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#17
RE: Just tried ASV and I hate it. Help?
Default settings are ASVauto EPAP min 4, EPAP max 15, PS min 3, PS max 15.  In ASV mode EPAP is started at 5.0.  Ramp is not recommended on ASV.   You need PS max to be at least 12.0 cm to trigger a breath. That is as low as I would go.

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#18
RE: Just tried ASV and I hate it. Help?
I'm not an expert and new to this whole thing, but it was explained to me that there are two types of ventilation features. One is fixed and provides support at a preprogrammed breaths per minute and breath duration. The other device is adaptive and adjusts those factors based on events.

I wonder if while in your sleep study that it was set one way and the device may have been set up the other way?
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#19
RE: Just tried ASV and I hate it. Help?
(05-26-2019, 12:26 PM)Roadspill Wrote: I'm not an expert and new to this whole thing, but it was explained to me that there are two types of ventilation features. One is fixed and provides support at a preprogrammed breaths per minute and breath duration. The other device is adaptive and adjusts those factors based on events.

I wonder if while in your sleep study that it was set one way and the device may have been set up the other way?

There is no adjustable backup rate on the Resmed ASV  its all automatic it can take time to get used to sleeping with ASV.


The best way of getting used to it is turn off RAMP breath evenly and consistently with the machine, if it starts providing pressure blow back at it and it will back off for 3 minutes and tune to your breath rate during the 3 minutes, if your still not asleep blow back again, over time you will get used to it. It is Wrong to limit the pressures on the machine it will only go there if it needs to and if your having centrals then the pressure pulses are needed.



But nobody said it was going to be easy
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#20
RE: Just tried ASV and I hate it. Help?
I would like to offer some encouragement for you based on my own rocky start with ASV.  My first week was pretty brutal, but now a little more than a month into it, things have fallen into place and I am doing well with the ASV.  This is a very good forum. The advice from other caring members really helped!  A few tips:  Yes;  do turn off the ramp.  We discovered that a lot of my issues were happening during the ramp period.  Yes, it does take some getting used to when the ASV cranks up and forces you to breathe.  I was a little freaked out at first, but now find it comforting to know its there when needed.  The other major stuff that helped get my AHI events down below one was positional.  I absolutely  have to sleep on my side now and getting there comfortably took a while and the addition of a side sleeper mattress topper, a c-pap pillow and a cervical collar.  Best wishes to you.  Be patient - it will get better.
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