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New to ASV (Last night 1st Night) Need Help
#1
My DME delivered an old 2012 ASV ADAPT with 189 run hours on it to me yesterday, and passed it off as brand new......"See no user hours", they said. It wasn't until after they left that I looked at the "run hours" and realized what they had done! I called Resmed and talked to them in length about this just to make sure that in fact I had NOT received their newest machine. Resmed looked up the history on the machine did confirm that it was sold to the DME early last year. They also confirmed that the machine they passed off on me was in fact used. So I called the DME and told them that I would not accept this machine because it was not Resmed's latest ASV, and that it had been used for almost a month. They said Ok, we will see what we can do about that and get back to you
I am going to keep fighting for this until I get the right machine or change to another DME. When I was talking to the doc about my sleep study and getting the ASV machine I told him that I wanted the newer model and I believed that it had auto epap added to it....and he said oh that is not the machine I want for you....your RX is not auto......so that is a problem. I guess he doesn't realize that the auto is optional to use or not use. So I am going to tell them that I have to have "ramp", as that is not a feature of the older ASV machines.[/font][/size]
That is what happened during the day yesterday, however last night I tried the ASV for the first time and it was miserable. I stayed on it from 10:00 PM to 1:00 AM and then I had to get up and hook up my S9 Autoset. What happened with the ASV was, my whole abdominal cavity filled up with air....plus I just simply could not breath without a lot of effort. Also had a terrific headache and had significant nocturia. I never did get into any kind of sleep with it at all. My pressure settings are: EPAP 6, PS min. 4, PS max. 15.

I guess I need to know if this sounds normal for a first night on ASV or is something wrong. I really do not want another 3 hours like that ever again!! Or........is it that I should wait for the new ASV with auto and ramp to arrive.....that is assuming that the DME will bring me the machne they should have brought yesterday?

Any suggestions or help will be very much apreciated!

Thank you,

Love Dog

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#2
It sounds like you got a much higher IPAP than you were used to. If I read your profile correctly, using the S9 AutoSet, you have the pressure range set from 8 to 15. Let's also assume that you have an EPR setting of 2. This means that your EPAP ranges from 6 to 13, while your IPAP ranges from 8 to 15.

Now, with your ASV setup, you have a fixed EPAP of 6, but a PS range from 4 to 15. The Pressure Support (PS) is the difference between EPAP and IPAP, so it means that your IPAP is now allowed to range from 10 to 21. That additional IPAP pressure can feel like you are starting CPAP therapy all over again.

Try running your ASV unit with PS min at 4 but lowering PS max to 9. That will limit the IPAP to the same pressure that your AutoSet upper limit. Once you get more used to it (it does happen), you can start slowly increasing the PS max value to where the doctor wants it.
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#3
I don't think an ASV is anything but an auto due to the nature of the beast. And nearly all machines come with the ramp feature as it has been standard for a very long time. It can be turned off completely and not viewable to the user, however, and that may be what happened with the machine you have now.

I would not work at all with the DME that sold you the used machine. I'd give them this one back, switch to another, and contact the better business bureau. What they did is more than just bad business.

Why are you switching to an ASV from the Autoset you have now? Do you have central apnea?

The ASVs are, from what I understand, tough to get used to. You may need to start out lower than your prescribed treatment pressure then slowly increase it as you adjust.
PaulaO2
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#4
Thank You Ron and Paula for your responses. Ron Your Idea of starting out with lower pressure makes

complete sense. I will try your numbers tonight. My numbers were 8/15 on the Autoset S9 with a EPR

of 3. More recently (last two weeks pressure 10/15, EPR 3, a little better for me). I have

complex sleep apnea, which the doc told me was hard to treat....he told me that I could not be treated

with Cpap or Apap, that it just would not work for me, that I needed ASV.

Paula I spoke with Resmed yesterday specifically to ask what the differences were between the older

model ASV (2012) Item #36007 which was brought to my house yesterday. It is a little bit different

than the newer model item# 36057 ASV (2013) in that the older model does not have ramp, and the

newer model, even though the machine itself is auto, they added an auto feature to the EPAP. That is

what I understood from the man I spoke with. In any case I want the newest model ASV that Resmed

makes and I told them so when they were here. She (the DME) told me that what she delivered was

just that. I also asked her to show me the used hours, which she did and they were zero. It was after

she left that I looked for mysef at the run hours and found that they were at 189 and that prompted me

to call Resmed...... they gave me the whole history on the the machine that was delivered here. I was

fuming and I want to do what you have suggested.....Get a new DME, as now there is a trust issue. If it

were not for the new competitive bidding law as of 7/1/13, I would probably do just that. If I do that

now I will be stuck with Lincare, who in my opinion are not any better than American Home, because

they did the same thing to me a year and a half ago, sold me a machine (Autoset S9-paid for out of

pocket) as new with run hours on it. I didn't discover it until it was too late so I never got to do

anything about it.

As I told Ron I have complex sleep apnea. I stop breathing all night long for up to 107 seconds at a time

with my desats going down very low and I am at high risk for heart attack or stroke or worse.

Thanks again for your help!

Love Dog
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#5
Good luck Lovedog.
You are a few days ahead of me.
I also have complex apnea, newly discovered. Came home from my Sleep study this morning. Last night was my first night on ASV, all be it in the lab. It was an interesting experience. I don't know what my pressures were until I get my copy of the study. I don't plan to start pushing for it until tomorrow and may not get it until Friday or even Monday. Ya I know it takes a week or two but I am not good with numbers.
When the machine starts puffing, and trying to set your respiration rate, it is a very new and different experience. Since I was fully wired and on camera all night I just went with it. It was not THAT bad.
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#6
Well good luck to you too B. I am about to go into my second night tonight and I am really not looking forward to it, as last night was not fun! At my sleep study I slept pretty well actually, nothing like last night......So as suggested by another forum member I will lower my PS tonight and see what happens. I know quite a bit about Cpap but this ASV is so foriegn to me....ah well like everything else I will probably get used to it and evenually adapt.

I will keep you posted and will probably be back asking for help. Thank you for the good wishes and please let me know how you do!

Take Care,

Love Dog
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#7
(10-17-2013, 12:04 AM)LOVEDOG Wrote: Well good luck to you too B. I am about to go into my second night tonight and I am really not looking forward to it, as last night was not fun! At my sleep study I slept pretty well actually, nothing like last night......So as suggested by another forum member I will lower my PS tonight and see what happens. I know quite a bit about Cpap but this ASV is so foriegn to me....ah well like everything else I will probably get used to it and evenually adapt.

I will keep you posted and will probably be back asking for help. Thank you for the good wishes and please let me know how you do!

Take Care,

Love Dog

It is a hard road for a lot of people but it is better than the alternative once the adjustment period is completed. I would suggest to try anything legal that you can to develop a love relationship with your machine. Tell yourself that you love this machine and that it is going to help you be more healthy, sleep better, enjoy life more, etc. etc. Whatever it takes to get you through the night with a good sleep.

Please keep us updated as to how it goes.
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#8
Thank you, thank you, thank you.......To have the support of all of you is priceless and very much appreciated!! Last night, (my second night on ASV) was much better. I actually slept for 6 hours! I felt more rested this morning than I have in a while. I used the numbers: epap: 6. min. PS 4, max. PS 12. My RX is max PS of 15, so I will slowly work my way up to that. Again thank you to Ron for suggesting a lower pressure to start with.......huge help! it was also interesting to see the results on Sleepyhead this morning......I was not sure if Sleepyhead would work with ASV, but it does!

Anyway all is good for now. I am still waiting to hear from the DME about getting me a"new machine" and come and get this used one they passed off on me. All of that remains to be seen.......wish me luck!

Have a great day!

Love Dog
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#9
Hi LOVEDOG,
Great to hear that you had a better night last night, WOO HOO,! now just hang with it, you'll get used to it.
Good luck dealing with your DME to get a "new" machine.
trish6hundred
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#10
Glad I could help. I'm also happy that you didn't reduce PSmax all the way down to 9 to replicate your previous maximum pressure exactly, but are actually exploring higher pressures already. Keep it up, and give yourself time to adjust.

With the higher pressures, you will need to keep on top of mask adjustments to keep the leaks under control. Specifically, make sure you wash the mask cushions that contact your face frequently with warm water and mild soap, rinsing them thoroughly. The accumulated oils and stuff on the cushions will create a poorer seal against your face, so the leaks will increase. Also, depending on your skin condition, you might want to start developing a habit of washing your face before you go to bed each night. Personally, I combine washing my face with washing the mask cushions, typically every second or third night, since I have rather oily skin.
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