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Machine and Issues regarding ASV support
#1
It has been a while since I was on the apnea board. Its been a very good source to gain information from experienced commentators. I have completed the use of CPAP and BIPAP therapy now and my pulmonologist has recommended that I move on to ASV. I basically have central sleep apnea (makes up about 90% of my AHI number) and have tried both CPAP and BiPAP for about 2 years now, both Resmed machines. I will undergo another sleep study at the hospital while using an ASV machine. Thereafter I assume they will prescribe an ASV machine to me.

I basically have two questions:

1. what machine is better at providing ASV support for central sleep apnea?? (I read the article regarding the CPAP machines but did not see much on ASV)

2. what issues or concerns should I be aware of when first starting with ASV? (other than the concerned heart ejection ratio as noted in Resmed's medical alert letter regarding ASV)






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#2
I have been using a Resmed Aircurve 10 now for a year with a Vauto setting. Tried A resmed airsense 10 for year before that. I have changed many settings, over time, in an effort to address central sleep apnea. My CSA make up about 95% of my AHI number. The only thing I have not done is change the mode setting. I was curious if switching from vauto mode to the "S" mode would help to address CSA. Has anyone tried this before?? I am getting ready to move on to ASV and will undergo another study next month to do so. IN the meantime, was just curious if I really have tried all I can with the current machine I have.

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#3
You have a great machine for treating obstructive sleep apnea, but a bilevel is not generally regarded as effective in resolving CA. If you want to post some charts, or offer some detail as to what your CAI is, and what your normal pressure range is, that would help a lot in responding.

In auto mode, your machine will maintain the fixed 2-cm pressure support you have set, and will range from 9/7 to 20/18. I'm sure you don't use that much range. In S mode, you will pick fixed pressures, so you would need to look at your data to see where your event rate is lowest. You could also try setting PS at zero in auto mode, and you would effectively have an auto CPAP.

How serious is the CA problem? How much time in apena / number of events per night? If it is quite high the answer may be the Airurve 10 ASV.
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#4
I just replied to your other new thread. I think these should have been combined. The correct machine would be the Aircurve 10 ASV. It should be set to a minimum EPAP pressure that avoids obstructive events (you currently use 7.0), with a minimum pressure support of 2.0 that you currently use. The maximum pressure support would be set to something in the range of 10-15 cm so there is adequate pressure to induce breaths. The machine is pretty good at matching your breathing in auto mode.

Provided you don't suffer from CHF, then there is nothing special to know. If the machine does not sync up at first, just take some forceful breaths to set the pace, and sleep well.
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#5
Thanks Sleeprider for your time in responses. Yes my CSA range from 9 to 19 a night at times. I have tried quite a bit to date and now my pulmonologist is recommending that I move on to ASV at this point. Putting the PS at zero will basically provide me with a full CPAP machine of which I tried a fixed pressure CPAP machine (resmed airsense 10) for 9 months and that did not help me at all. Do you think I will be able to use nasal pillows with an ASV machine??
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#6
I don't think the pillows will be a problem at all. Keep in mind you will be staying pretty close to your current pressure most of the time. The machine will increase IPAP pressure somewhere between 8-12 cm as needed for individual breaths. As long as you have good leak rates now, that should not change.
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#7
Moderator's note: I have combined these threads to keep the discussion in one place.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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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#8
Hi ckingzzzs,
I wish you good luck at your next sleep study, and also with your transition to ASV.
trish6hundred
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#9
Quote: Yes my CSA range from 9 to 19 a night at times.

Is that per night or per hour? There's a big difference. The number per night isn't really a meaningful measure as each night can be a different length. What we really need to know is the index - the total number of events divided by the number of hours.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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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#10
Both the Respironics and Resmed SV machines are excellent, and of course can be run in any "lesser" mode should you not need the auto servo vent type of support. The Respironics machine has a few more settings that can be manually tweaked. I am partial to it because it is the machine I know and use. (You know, when you have been sleeping with old girl for all these years there is a comfort factor.) I did find that as the treatment pressures became higher I needed to go to a full face mask. I also have ended up now using a fixed EPAP number with a PS of 4 and open ended (auto) IPAP. What we have thought of as an EPR # isn't really that on the Respironics ASV - more of a timing thing - which I have set minimally as the ASV Advanced really does a job of selecting each breath.
Good Luck. They can be a bit tricky in getting to the right settings - and the techs do not have a lot of experience with them.
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