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Need ASV Tips/Advice
#11
RE: Need ASV Tips/Advice
Thats whats interesting Jesee, I've heard others say that too but after reviewing information about the machine from ResMed, they made it sound like the breath to breath changes that occur with the aircurve ASV can totally control and stabilize ones breathing, from basically doing not much of anything besides applying minimum BIPAP pressures when breathing is normal to raising it to initiate breaths, to actually enlarging shallow breaths, and increasing the frequency of slow breathing. I was skeptical. I myself wondered exactly how close the machine would come to breathing for me. So, I experimented! I laid down and got good and relaxed with the mask and machine on let it measure breath rate and volume for a while, then, I intentionally relaxed my chest and airway and concentrated on giving absolutely no respiratory effort. I laid there and tried to do my best vegetable impersonation. It was hard for the first few seconds, fighting that instinct to breathe, but then the machine kicked in high gear. the first breath didn't feel like enough and I was still fighting hard not to initiate a breath, I did not feel my lungs inflate at all and felt like I was suffocating. But just then as the pressure went to EPAP, I felt the air go OUT of my lungs. The next, breath the machine felt even stronger. I still felt very little going in but I watched at my chest and as machine switched again to EPAP a surprising amount of air came out through my mouth and my chest dropped a noticeable amount. At this point it was still difficult and unnatural to just be lip but I now longer felt like I was suffocating. I let this continue for a few breaths and once I relaxed I could definitely tell that a substantial amount of air was being pumped in and out of me.  This got me wondering if I lowered the pressure too much if the machine would loose this capability.  Furthermore, it got me wondering how much the machine was initiating breaths opposed to how much the machine is actually breathing for me. So I looked at my experiment on sleepyhead and noticed that no even flag occurred, no central, no hyponea, no nothing.  Thats what got me wondering how to know how low is to low. It appears to me now like this amazing machine actually will come pretty darn close to breathing for me even at my lowered pressure.  Now im curious what data to look at to decide the lower end of the "effective" spectrum. Will it get to the point that it doesn't cause me to initiate a breath? will it get to the point it can't keep the tidal volume up on shallow breaths? will it get to the point it isn"t able to keep my minute ventilation close to the target? Just not sure which parameter would chance first if pressure were to get too low. Sorry if I'm geeking out but I'm a huge fan of experimenting and fully understanding details.
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#12
RE: Need ASV Tips/Advice
Here is a screenshot of my test, At 21:35:50 I took my last breath and the rest is pretty much all machine with a large breath initiated by me at the end before hitting the off button on the machine. Pretty impressive and interesting IMO. The machine decided the timing and the volume during that period.


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#13
RE: Need ASV Tips/Advice
That's awesome! There is a reason it's considered the flagship of mixed/central apnea. I'm glad I'm not the only one that got a little stoked playing with it.
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#14
RE: Need ASV Tips/Advice
Thanks for that chart sleeprider! I'm already below those settings on everything besides my min EPAP. I will probably drop that tonight a little bit and then lave the settings alone for a few days and try to settle in. Seeing that I'm already below default I think I'm as low as I should go for now, but I'm still interested to see if any others have any data and/or anecdotes related to the subject or finding or calculating the lowest effective values for ASV technology. Also, tips concerning my original post of actually falling asleep and combatting aerophagia are of course still hugely appreciated!
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#15
RE: Need ASV Tips/Advice
It truly surprised me Jesse! I plan to test out a couple more scenarios to see how the machine will react. I will update when I do. I fix things and problem solve/ trouble shoot to take my mind off things all the time so hopefully it will allow me to lower my anxiety level while falling asleep. If anything seeing what happened when I stopped breathing effort has increased my trust in the machine.
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#16
RE: Need ASV Tips/Advice
Sorry, I staggered off the original intent of the thread as well. I've only experienced aerophagia while on the ASV machine. My experiment was only 2 days long and I certainly had no time to acclimate to ASV. Hopefully once you get dialed in the air swallowing will subside. I just read a post about positional changes reducing aerophagia, specifically keeping proper head/neck alignment and preventing chin tuck. Collar?

The biggest offender to me, other than having no therapeutic need for ASV, was the conscious breathing. I became so tuned in to capture a steady RR to avoid getting unexpected IPAP that sleep was a far reach and difficult. Cost me 2 nights of sleep but well worth the experience.
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#17
RE: Need ASV Tips/Advice
The machine can definitely be "aggressive" when it decides to make a move. I've actually gotten much more comfortable with the pre-sleep feeling of the machine and find it is taking me less and less time before I start to doze off, which is encouraging, but that first sleep transition centrals seems to get me almost every time. I'm hopeful that will change soon too, but until it does I know I'll stay tired.
    I will pay more attention to what position I'm in when I wake up with a belly full of air and see if there is a pattern there. Also, so far I've been using the air touch f20 which I've been pleased with.  I find it comfortable and don't have many leak issues.  Still I decided to order the P10 to see if I might prefer a different flavor of mask. Is either style more or less likely to cause aerophagia? I do tend to mouth breathe some with the FFM and wondered if that might contribute to swallowing air. When the p10 gets here I plan to make a chin strap out of an ACE bandage I have and try it out.  Even if I don't prefer the nasal pillows I would be willing to use them anyway if it would help to keep the air going down the right pipe.
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#18
RE: Need ASV Tips/Advice
I have next to zero experience using nasal pillows and my wife strongly suggested that I not go trying again. My aerophagia was experience while using a Simplus FFM and it was occurring while I was half asleep. Specifically, for a brief quarter second when the machine triggered IPAP. The first quarter second of IPAP was a direct connection from the hose to my stomach, and I am terribly sympathetic for anyone that suffers aerophagia.
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#19
RE: Need ASV Tips/Advice
Hi TheMacGyver,

Glad you got your ResMed ASV and sorry I got to the party a bit late. I had to get donuts and coffeee to DeepBreathing to pay for use of his term blowback. Smile

FWIW: my experience on aerophagia... 1) I had it at the start too, 2) given time went on it got less until it became a non-issue to me.

In my time on ASV, the blowback does work to assist in getting to sleep. I am sure the ASV is not "remembering" things "I tried to teach it" for days, weeks, months, but I felt that after several days of the initial usage, I had to blowback less with each passing night.

Note that I cannot truthfully claim to know much about settings, so my help will be limited. Nevertheless, Sleeprider and I set my machine according to my script initially; the RT at my DME had no real clue how to set my ASV up (no surprise I suppose). As I remember, he suggested a few settings, some helped and some did not. We did try to see the effects, and as per usual, if it gives good results, keep it.

What I really like about the ASV settings is in Auto (which I think is what you're on as well) is that you have 4 parameters to deal with. These of course are EPAP Min and Max plus PS Min and Max. IPAP is determined by addition of EPAP to PS at that moment. So what we have are 2 sets of manually adjusted ranges that you manipulate via the settings. Both ranges affect the third range called IPAP.

My understanding of your current goal is to maximize comfort. Good goal BTW, I started there myself, but I was limited in knowledge 6 months ago, and didn't know what actions to take to achieve that goal. I know a bit more now, so old dogs can still learn.

This is only generalized setting advice, apply it as you wish, and if your experience goes contrary, stick to your own judgement...and remember we only have 4 settings to play with so it should be fairly easy to nail the results in relatively short order. After each setting change, BTW only change these by relatively small steps, a max of 1.0 is what I have in mind, possibly edits of .2 are better IMO but that's just me...

1. going off Sleeprider's suggestion, edit PS max to something less than 15, this changes max IPAP also, see results after 1 or 2 nights, judge if good change, bad change, or no change in report then decide to go further or not...

2. you could edit EPAP min next as I did for myself, I started on 8 EPAP Min due to past CPAP and BPAP settings and titration info, eventually, I had to bump EPAP min to 9.8 in steps as mentioned above, I had to increase my overall Min as I felt a bit starved for air...As you probably are aware, EPAP Min is the absolute minimum the machine will give you (excluding Ramp which I do not use anymore)...

3. from there, it really depends upon if comfort has been reached, but you only have EPAP Max or PS Min to edit from here, sorry but this is where I don't really have suggestions because I had not needed to edit these to keep comfort or therapy needs on track from my initial settings, seriously...

Coffee
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

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#20
RE: Need ASV Tips/Advice
Wise words ScarcasticDave, do you have any donuts and coffee left this morning? Happy Saturday!

Macgyver, I just noticed your profile doesn't reflect your new equipment and settings. It may be helpful for others to have current info. Good day to you too!
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