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Just tried ASV and I hate it. Help?
#21
RE: Just tried ASV and I hate it. Help?
(05-26-2019, 06:46 AM)Broomstick Wrote: 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.

Blowback is a method of blowing with some force back into the machine. It seems to give best results for users with full face masks. The purpose of this blowback is to reset the current pressure the machine has selected; typically this is used when an ASV user encounters the disturbing high pressure when the machine inaccurately believes a Central Apnea is occurring.

Based on my research, one does not breathe at all during Central Apnea events.

My experience taught me very fast that Ramp was not my friend. It’s been turned off for over one and a half years, just short of the total time the ASV has been in my possession.

Best wishes on getting used to therapy quickly.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#22
RE: Just tried ASV and I hate it. Help?
I got it working much better. But this is STILL unacceptable.

ASV or ASV auto. They both suck.

Min EPAP: 8.0
Max EPAP: 8.0
Min PS: 0
Max PS: 8.0

Reasons I set it this way:

CPAP of 8cm was enough to prevent most/all obstructives. Max PS of 8cm brings the pressure to 16cm which was enough to knock out most centrals and keep my AHI below 4.

I'm held hostage to the stupid machine blasting me with high pressures while awake and with no ramp/timer; so I can't raise the Max PS because it will hurt me. And I can't lower the min EPAP because the overall high pressure won't be enough.
 
Notes: 

The machine doesn't hurt my lungs as much as the CPAP constantly pushing against them with continuous force. I would be feeling a huge relief in my chest right now if I just took off the CPAP mask. So thats good. And it comes CLOSE to what XPAP SHOULD be. 

But this machine is DUMB.

I've been practicing with it by sitting in front of my computer and playing a game. This puts my in the most consistent mode of breathing I'll ever be in.

The machine keeps raising the pressure to unnecessary levels that are hurting my face and my ears. Imagine how much worse it would be if I raised the max PS greater than 8. This machine is dumb enough to go all the way to whatever the maximum is. Too bad that can't be lowered until you fall asleep (ramp). If you need a high max PS for sleeping, you must be prepared to get hit with it while awake.

Then theres the backup rate. I can bear the higher pressure when I'm ready to breath in. I could bear a little unexpected pressure (backup rate) when I'm not ready. But both is ridiculous. 

It does NOT, and SHOULD not be this way. I see no medical reason why the max pressure, and/or the backup rate can not be put on a timer. Prove me wrong. If the CPAP has a ramp for higher pressures, why the hell shouldn't this???

There appears to be a survivor bias on this site. 50% of people quit CPAP. The stalwarts of this forum are obviously going to be the lucky 50% who were eventually successful. If you are able to use your treatment as-is, congratulations and thank your lucky stars. But understand that not everyone can tolerate the same things that other people can. I know that I will never get used to heavy metal music or mushrooms.

I'm certainly not giving up and plan to do everything I can to not end up in that bottom 50%. In fact, I'm thinking about starting my own CPAP company (go ahead and laugh). I have a lot of ideas and am certain that I can design a much better CPAP machine.

Edit: 

In the mean time, I plan to try the Phillips Respironics version of this machine which may have a way to mitigate the backup rate, as mentioned in a reply to my post here.

Additionally, I am interested in trying a conventional BIPAP and pray that I don't really need the ASV since the doctor mentioned that the CPAP DID treat my centrals, as indicated by the low AHI.
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#23
RE: Just tried ASV and I hate it. Help?
Please consider the following settings:
EPAP min 8.0
EPAP max 12.0
PS min 3.0
PS mzx 12.0

Here is why: Your EPAP min will maintain your airway against obstructive events most of the time, however when needed, the EPAP will rise and prevent obstructive events with higher exhalation pressure up to 12.0. It will only rise above 8.0 when it detects obstruction, and so the EPAP max is an insurance policy against obstruction.

PS min 3.0. By using a minimum PS greater than zero, you will have some pressure support on every breath. For most people, this is more comfortable, can help with flow limitation, snores and hypopnea, and more importantly, it desensitizes you to the higher pressure support needed during a central apnea or other event.

PS max 12.0. Normally, I would say use the default 15 cm PS max, but you have complained about high pressures. A PS max of 12.0 usually is sufficient to resolve central apnea, and mitigates the pressure spikes somewhat for your comfort. There are a few individuals that will trigger a breath with PS max at 8.0, but chances are good you need something higher. If you don't use enough pressure support to treat centrals, there is no point in ASV anyway.

Your didn't mention IPAP max, but with the settings above the highest pressure your machine can reach is 24/12, but the highest starting pressure is 20/8. The machine is the most intelligent positive pressure therapy device available for complex and central apnea. You can make it "dumb" by operator error in setting it up so it cannot do the job it is designed to do. That is where we apparently disagree, and what you have done.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#24
RE: Just tried ASV and I hate it. Help?
Please read the following with recognition that I'm trying to help and not making light of your predicament.

One thing about breathing patterns you must not forget when combined with an ASV, sleep breathing vs awake breathing are vastly different from a consistency/regularity aspect. Your awake breathing pattern will give the ASV many more opportunities to give inadvertent high pressure. But realize this supposed problem is not the machine's fault; it is doing what it designed to do with the breathing pattern it's getting. I faced the same surprising high pressure jolts while attempting to get used to the machine, mask, etc. when new to ASV. FWIW, eventually that is, unless you actually don't need the ASV, equal settings in EPAP & PS do away with almost all the advantages ASV provides. IMHO you're not doing yourself any favors. Please note I've been there and got the T-shirt regarding where you are now with the ASV; this info isn't just coming from a user that hasn't experienced what you're going through.

With sincere wishes you will succeed. Sarcastic Dave doesn't allow less than success on the AB.

Coffee

PS Can you edit your user profile so as to reflect the correct machine and associated info? It helps us help you.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#25
RE: Just tried ASV and I hate it. Help?
(05-28-2019, 08:51 AM)Sleeprider Wrote: Please consider the following settings:
EPAP min 8.0
EPAP max 12.0
PS min 3.0
PS mzx 12.0

Here is why:  Your EPAP min will maintain your airway against obstructive events most of the time, however when needed, the EPAP will rise and prevent obstructive events with higher exhalation pressure up to 12.0.  It will only rise above 8.0 when it detects obstruction, and so the EPAP max is an insurance policy against obstruction.

PS min 3.0.  By using a minimum PS greater than zero, you will have some pressure support on every breath. For most people, this is more comfortable, can help with flow limitation, snores and hypopnea, and more importantly, it desensitizes you to the higher pressure support needed during a central apnea or other event.

PS max 12.0. Normally, I would say use the default 15 cm PS max, but you have complained about high pressures.  A PS max of 12.0 usually is sufficient to resolve central apnea, and mitigates the pressure spikes somewhat for your comfort.  There are a few individuals that will trigger a breath with PS max at 8.0, but chances are good you need something higher.  If you don't use enough pressure support to treat centrals, there is no point in ASV anyway.

Your didn't mention IPAP max, but with the settings above the highest pressure your machine can reach is 24/12, but the highest starting pressure is 20/8.  The machine is the most intelligent positive pressure therapy device available for complex and central apnea.  You can make it "dumb" by operator error in setting it up so it cannot do the job it is designed to do.  That is where we apparently disagree, and what you have done.

Friendly reminder SR, ResMed ASV algorithm sets IPAP Min & Max, not user settings. You probably remember this. Just SD94ism. Agreeing with you wholeheartedly with all the above.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#26
RE: Just tried ASV and I hate it. Help?
(05-28-2019, 08:51 AM)Sleeprider Wrote: Please consider the following settings:
EPAP min 8.0
EPAP max 12.0
PS min 3.0
PS mzx 12.0

Here is why:  Your EPAP min will maintain your airway against obstructive events most of the time, however when needed, the EPAP will rise and prevent obstructive events with higher exhalation pressure up to 12.0.  It will only rise above 8.0 when it detects obstruction, and so the EPAP max is an insurance policy against obstruction.

PS min 3.0.  By using a minimum PS greater than zero, you will have some pressure support on every breath. For most people, this is more comfortable, can help with flow limitation, snores and hypopnea, and more importantly, it desensitizes you to the higher pressure support needed during a central apnea or other event.

PS max 12.0. Normally, I would say use the default 15 cm PS max, but you have complained about high pressures.  A PS max of 12.0 usually is sufficient to resolve central apnea, and mitigates the pressure spikes somewhat for your comfort.  There are a few individuals that will trigger a breath with PS max at 8.0, but chances are good you need something higher.  If you don't use enough pressure support to treat centrals, there is no point in ASV anyway.

Your didn't mention IPAP max, but with the settings above the highest pressure your machine can reach is 24/12, but the highest starting pressure is 20/8.  The machine is the most intelligent positive pressure therapy device available for complex and central apnea.  You can make it "dumb" by operator error in setting it up so it cannot do the job it is designed to do.  That is where we apparently disagree, and what you have done.

I will consider those. But heres why the machine is dumb:

The ridiculous increases in pressure. The backup, upon holding my breath (that was my instinct and I'm stopping doing that now) will not take the hint and, instead, blow again, harder. This "smart" machine should absolutely know that I'm not having a central and that I am fully awake based on my inconsistent and deeper breathing pattern. I see this as 100% inexcusable. I shouldn't have to blow back hard (screwing up my breathing). And blowing back does NOT reset the thing for 3 minutes as someone previously posted. It just suspends it briefly and then its right back at it.

If this machine was really that advanced, it would know not to blow such ridiculous pressures and know not to base its calculations off garbage data. Its also rather arrogant to put out a machine with no settings for the backup rate, as if they are that confident that the machine knows best. It obviously doesn't!


(05-28-2019, 08:56 AM)SarcasticDave94 Wrote: Please read the following with recognition that I'm trying to help and not making light of your predicament.

One thing about breathing patterns you must not forget when combined with an ASV, sleep breathing vs awake breathing are vastly different from a consistency/regularity aspect. Your awake breathing pattern will give the ASV many more opportunities to give inadvertent high pressure. But realize this supposed problem is not the machine's fault; it is doing what it designed to do with the breathing pattern it's getting. I faced the same surprising high pressure jolts while attempting to get used to the machine, mask, etc. when new to ASV. FWIW, eventually that is, unless you actually don't need the ASV, equal settings in EPAP & PS do away with almost all the advantages ASV provides. IMHO you're not doing yourself any favors. Please note I've been there and got the T-shirt regarding where you are now with the ASV; this info isn't just coming from a user that hasn't experienced what you're going through.

With sincere wishes you will succeed. Sarcastic Dave doesn't allow less than success on the AB.

Coffee

PS Can you edit your user profile so as to reflect the correct machine and associated info? It helps us help you.

The answer to this is similar to the one above. Yes, awake breathing is completely different. Why is the machine basing its calculations off garbage data. It should know that you're awake based on the inconsistency and deepness of the breathing. It should know better than to send out incorrect pressure. It should know to hold off erratic pressures. Recognizing that you are not sleeping should be obvious to the machine. This is why it is important to have manual control of awake time pressures. 

The machine should automatically be able to flip to sleep mode when it starts to see multiple consistent and shallow breaths.

Even though the machine is designed to fix sleep breathing, it MUST be comfortable for awake breathing. Especially for someone like me who struggles to sleep and will spend a LONG time awake with this.
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#27
RE: Just tried ASV and I hate it. Help?
(05-28-2019, 11:10 AM)Broomstick Wrote: The machine should automatically be able to flip to sleep mode when it starts to see multiple consistent and shallow breaths.

I use the same machine and my asleep breathing pattern is not that much different from my awake breathing pattern. I would not want the machine to attempt to tell whether I am awake or asleep based on my breathing pattern.

BTW, I struggled mightily getting used to ASV, it took me 2 to 3 months of wrestling with it every night until I finally adapted to it.
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#28
RE: Just tried ASV and I hate it. Help?
For any xPAP device to “know” you’re awake, wouldn’t that require being wired up like on a PSG test where brainwave activity is read?
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#29
RE: Just tried ASV and I hate it. Help?
Many users of the ASV say that it took a while for the machine to "learn" their breathing. As far as I know, no CPAP, Bilevel or ASV has adaptive or artificial intelligence. None of these machines change their programmed behavior over time, but the patients using them do learn and adapt. Maybe a future generation of PAP therapy will incorporate AI to improve results, but imagine how this would work under a FDA regulatory system that is not friendly to inconsistent or adaptive outcomes. I think it is a long way off.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#30
RE: Just tried ASV and I hate it. Help?
yes, I'm quite sure my asv has whipped me into shape such that it I don't have this problem anymore. we frequently talk about wrestling or fighting the machine when it increases pressure. therein lies the problem. and the answer. the whole point of the increase in pressure support is to get us to breathe when we're not. who doesn't want to breathe? but I do remember disliking this aspect of asv treatment intensely the first couple days to a week, thinking no, I don't want to breathe just now, don't wake me up, leave me alone. the obvious solution is to breathe, stop fighting, relax, do what it 'wants'. breathe at the first sign of pressure nudging you to do so before it gets unbearably high. when you do, it'll quickly ease back the pressure.

if your asv doesn't respond to the blow back method and it doesn't ease up when you breathe with it, maybe it should be checked out.
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