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"Minimalist" Approach to ASV
#1
"Minimalist" Approach to ASV
I would like to use ASV at the lowest pressures that would be reasonably effective. Has anyone posted, or can anyone offer, guidelines that might help me titrate ASV or ASVauto in this way? I have mixed / complex apnea. I am currently using Sleepy Head with an integrated Resmed oximeter. Thank you.
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#2
RE: "Minimalist" Approach to ASV
I’d probably set it in ASVauto with EPAP at 4-10 and PS at 1-15 and just work your way down.

I run mine at EPAP 5-7 and PS at 2-12. Occasionally I’ll get up to an IPAP over 15 so I haven’t dropped the max down. My EPAP usually runs in the 6’s.

John
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#3
RE: "Minimalist" Approach to ASV
Most of my self titration work was via SleepyHead. (I have posted a few OSCAR charts since I've got that)

My ResMed AirCurve 10 ASV was preset by the DME in her interpretation of the doctor script. Both the doc and DME had mine wrong in my opinion.

I am in ASV Auto mode, so EPAP has a Min and Max, as does PS. IPAP is the sum of those per ResMed algorithm.

I'm thinking on PS I just set a range of 3-15 and tried min up a bit but didn't like the feel. Numbers didn't really change I don't think. Ditto for PS Max.

EPAP Min I tried 4 but needed 6 to breathe like most adults. I eventually bumped it to 8 which is 2 below my median if I remember right. EPAP Max I think I just added 5 to EPAP Min, I'm thinking I could see EPAP ranging to about there anyway but my memory isn't perfect. About 6 months ago I added 2 more onto EPAP Max.

Not too scientific but that's my best recollection of it. I've always used ASV Auto mode to keep EPAP and PS as ranges.
Dave

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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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#4
RE: "Minimalist" Approach to ASV
Thanks to both of you for your posts. I'll keep experimenting and post again when I have more questions.
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#5
RE: "Minimalist" Approach to ASV
The lowest possible is ASV mode with EPAP 4.0 and PS 0 to 5. Beyond that, increase EPAP for OA and H events, increase PS for CA. My observation is that the minimum effective PS is about 8.0 cm, so 5-cm is unlikely to work well.
Sleeprider
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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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#6
RE: "Minimalist" Approach to ASV
Feel free to post up charts and include how you feel, good or bad, then we'll see if we could help you in getting set up ASAP.

BTW, that is also a thing for me, I edited 1 setting, tried it and gauged it by feel first, data second. If it felt worse go immediately back to what it was prior and try to edit another parameter.

PS my sleep study had originally indicated pressures something like EPAP 13-20 and PS 2-12...for me my home cooked is better for me, now at EPAP 8-13, PS 3-13.. Not discussing the negative COPD/ASV effect I'm dealing with...just mentioned for clarity.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#7
RE: "Minimalist" Approach to ASV
FWIW ResMed has an ASV titration guide you could look at and possibly follow it.

   
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#8
RE: "Minimalist" Approach to ASV
Ya gotta love the immense amount of detail Resmed has provided in that "one" page guide to titrating for ASV. With documents like that it is a wonder that anyone comes to AB for advice...lol.

I did hear that the original guidance was 12 minutes, instead of 20 minutes, to keep i line with with the 5 AHI rule. However, sleep techs complained that caused too many interruptions from their phones...

"Is the patient breathing?"

"I dunno. I'll check in 3 minutes."

John
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#9
RE: "Minimalist" Approach to ASV
The reason the titration is so basic is the Resmed ASV only has a few variables and is fully automatic and does a great job of treating complex apnoea, it only raises pressure if it needs to and returns a very low AHI I am regularly at 0 or 0.1
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#10
RE: "Minimalist" Approach to ASV
Thanks to all of you for those helpful comments. I appreciate it.

I will consider posting some charts, assuming I can remember how to take the images using SleepyHead on my Mac. Or maybe I can just use the "grab" function to take a screen or window shot? (If someone doesn't mind reminding me, I'd grateful.)

I had seen that Resmed guide before. If anyone knows of a more detailed set of titration instructions on line, whether in written or video form, perhaps something that goes into some of the subtleties and has images of waveforms, I'd be glad to know.

Does anyone have experience with using an integrated oximeter as part of their titration / use of ASV?  I'm at the early stages of the titration, of course, but so far my oxygenation has not been as good as I'd like, and I'm approaching O2 saturation as a major focus in my titration process.

Finally, and as kind of a side issue, and addressing something I've raised in the past in a different way: Does anyone share my concerns that the relatively high pressures during the IPAP phase of the respiratory cycle might impede cardiac return (i.e., the return flow of venous blood [i.e., blood in veins] back to the heart), and hence might reduce cardiac output, including that part of cardiac output that feeds back into the coronary arteries and supplies the heart muscle? This is something that, whether with good cause or not, concerns me somewhat and is a reason I'm leaning towards a minimalist approach with as low pressures as possible. (My own guess is that this mechanism might lie behind the negative results in the SERV study for heart failure patients, leaving aside issues like non-compliance, etc..)

Thanks again to all.
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