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New to me, ASV, Initial Questions
#11
RE: New to me, ASV, Initial Questions
the resmed asv calls all apnea unclassified. we tend to assume these ua's are usually obstructive but I haven't seen confirmation of that from an authoritative source. for those that need it, the asv will handle all types of events comfortably and well. it's not unusual to consistently achieve ahi below 1. it can be a little difficult to get used to as it blows hard against central apnea (and flow limitations). a related issue stems from the fact that max pressure support can't be set to less than 5 cmw above min because of how it responds to ca. rapid and relatively dramatic pressure swings can be disturbing/exhausting.
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#12
RE: New to me, ASV, Initial Questions
Latest Night in ASVAuto.
   
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#13
RE: New to me, ASV, Initial Questions
(02-19-2021, 07:03 PM)sheepless Wrote: the resmed asv calls all apnea unclassified. we tend to assume these ua's are usually obstructive but I haven't seen confirmation of that from an authoritative source. for those that need it, the asv will handle all types of events comfortably and well. it's not unusual to consistently achieve ahi below 1. it can be a little difficult to get used to as it blows hard against central apnea (and flow limitations). a related issue stems from the fact that max pressure support can't be set to less than 5 cmw above min because of how it responds to ca. rapid and relatively dramatic pressure swings can be disturbing/exhausting.

That would make sense in that I haven't see any Obstructives since using this ASV unit, but did have them with my Autoset 10 unit.
Hypopneas are "new" to me, but perhaps they were not highlighted so much in the Autoset 10? The chart I uploaded was a bit "wilder" than the ASV mode I started with. It's a balance of maintaining a good nights sleep and getting wider data at this juncture for me.

I noticed your mention of the minimum 5 cmw "range" right away, hence my limited pressures to begin.

Thanks for your input.

Jim
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#14
RE: New to me, ASV, Initial Questions
Well, that's not so pretty!  With EPAP min  7.0, EPAP max 12.0 and PS 0.00 to PS 0.50, your results frankly suck.  The problem is  your machine can't deal with centrals  or hypopnea as they occur because pressure support is too constrained by the 5.0 max.  I would be really curious to know what your previous CPAP settings were.  My immediate suggestion is to increase PS min to 3.0 and PS max to 12.0.  That will give us an idea if ASV is a workable solution for you, because this isn't what we're looking for.  If the run hours are not too high, I would suggest you try to trade this for a Resmed Aircurve 10 Vauto, which is more targeted at obstructive sleep apnea. Have you ever tried this at your old CPAP setting to get a baseline?.

[Image: attachment.php?aid=30156]
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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#15
RE: New to me, ASV, Initial Questions
SleepRider,

I'm not really surprised at your response to the graph, though I will also admit that interpreting these is not something I have yet learned to do.  I know its a limited range, and that's because I have yet (after 10 years) to find a mask (current is DreamWear FF over a triple taped mouth due to extreme dry mouth if left uncovered) that doesn't leak over 12.8 pressure. The last 2 years of  data  were erased when I mistakenly plugged in my Airsense 10 Auto machine's SD into the ASV the first time.

I've wanted to give up a few times here and there as it's been one obstacle after another, but I went down every hole with minimal luck in making any mask work for me. So, previous machine was run at 12.8 Fixed and I never could run Auto wide open to see what I could l find out as the act would wake me up. The trouble is,, I really lose days of life when I don't have pressure to sleep with.

This ASV likely has very few hours on it as the previous owner gave up due to the sleazy Sleep Doc writes an RX to the DME setup we all know about, and we get lost. I felt bad accepting it but did try to lower the pressure for him, which he gave up on also. I started out using ASV mode at EPAP 10 and min ps 0 with max 5 and was astonished with my lowest ever AHI of 3.6.

I've read some posts here about the Resmed Aircurve 10 Vauto which were enthusiastic, which is why I decided to join and ask.
I don't want to give up and if you think we can make some progress with wider ranges in Auto I will do so and post them. (after some decent sleeps under my belt with my meager ranges)

Appreciate your kind considerations toward real support. 

I know the mask problem has plagued me all along. Overbite, and thin chin aren't a traditional match for much anything.
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#16
RE: New to me, ASV, Initial Questions
With the Resmed ASV, PS max is required to be 5-cm over PS min, so you have the minimum amount of pressure support set. I don't know what the nature of your sleep disordered breathing is, and ASV is not normally the treatment of first-resort. Are we looking at obstructive UA or central UA? I think for starters, we need to zoom in on some of these events and see if we can figure them out, then decide how to proceed. Titration is really logical once you know what you're dealing with. The default settings for ASV are ASVauto mode with EPAP min 5, EPAP max 15, PS min 3, PS max 15. This is ideal for complex apnea, and the machine rarely leaves any apnea untreated. I am operating from the assumption that your apnea is mainly obstructive, and a closer 2-3 minute view of the flow rate chart should help us to see if that is so.

For obstructive apnea, we would look for higher EPAP to prevent airway collapse. One approach to finding out is to set the machine to nearly default settings, but with higher EPAP min pressure. It sounds to me like a minimum pressure of 10 worked pretty good, and your AHI Is higher with lower pressure. If true, then a logical place to be would be EPAP min 10, EPAP max 15, PS min 3, PS max 12. Hopefully with those settings, most OA and H will be treated without getting into the higher pressure support, and if an event is central, the higher PS will clear it. When ASV is unable to clear an apnea, the algorithm goes to maximum PS during the event, flags a UA event and increases EPAP under the assumption a CA would clear. In your case PS max is too low to rule out the possibility the UA or H event is central. We need to learn if events can be cleared by higher PS before lowering it and assuming events are obstructive.
Sleeprider
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____________________________________________
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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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#17
RE: New to me, ASV, Initial Questions
Agreed. You also must get the mask status resolved. I will broken record say look at a Fisher and Paykel Vitera. It's a full face that does not need to be tightly cinched. In fact it works better the lighter you have the straps.

IF you have CA, which has yet to be determined, you will have to take the handcuffs off the ASV or you'll get more trainwreck OSCAR charts. And this seems like you'll need to remove the handcuffs for any Apnea to be treated with that ASV. Those current settings are not going to work.
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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#18
RE: New to me, ASV, Initial Questions
Sleeprider,  I'm seeing this a bit clearer and do acknowledge titration is THE way to allow the machine to do its magic and disclose numbers to us to have a direction. Maybe you can clear something up that I have been mistaken on regarding how Pressure support min and max works in reality. I may be offbase and am sleep deprived so its not impossible by any means.
 
Please confirm how PS min and PS max are added to EPAP min and EPAP MAX to give levels of actual Inspiration Pressure levels to the mask. I have assumed that both EPAP and PS inspiration momentary totals are additive.   Example,  If EPAP MIN is 10 ADDED to PS MIN 3 say and you will have MINIMUM inspiration pressures of 13?
If   EPAP MAX is 15 and PS MAX is 12 so the inspiration pressure would be 27?  (In instances of momentary need) I may not be seeing this all happening dynamically with constant breath by breath fluctuations as is true, so the actual flow may not blow me out of the mask as it isn't likely to ever be at max inspiration pressures for very long?

My concerns of being woken by ultra high inspiration pressures may be unfounded in actuality. Let me know if I'm flawed in my thinking.
 
SDave,

Yes, Mask problem is key and I will order the Fisher and Paykel Vitera and have an F30I FF already on the way to try.

The machines max pressure is 25 correct?

All data from folks more experienced than I have is most appreciated.

Jim
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#19
RE: New to me, ASV, Initial Questions
Last night in ASV mode with EPAP up to 11 from 10, PS still 0 and 5

   
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#20
RE: New to me, ASV, Initial Questions
Max pressure for this ASV is going to be 25. If you're in ASV Auto mode, the way I've pictured the EPAP, PS, IPAP is this way, assuming you're in ASV Auto mode, all 3 are ranges which affect each other. Each of EPAP and PS range along between Min and Max according to event and algorithm. IPAP is a range as well, but is the sum of EPAP and PS that moment.
Dave

OSCAR
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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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