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Newbie with setup questions for AirCurve 10 ASV
#31
RE: Newbie with setup questions for AirCurve 10 ASV
(11-16-2019, 12:05 PM)WillSleep Wrote:
(11-16-2019, 10:37 AM)WildSteelhead Wrote: 4.  It seemed like when I was awake and trying to doze off and breathing normally, the machine was mostly breathing in rhythm with me, which was comfortable.  However, then it would kick up in some pressure AND have a longer respiration rhythm than I was actually breathing.  Not sure why it would do that.  Could it have been that I actually DID doze off and maybe was starting an event and it kicked in?  I really don't think I dozed, but who knows.  Would that be clearly depicted anywhere on the graphs?  I even tried the "Blow Back" when it would do that, which may have helped a little, not sure.

5.  As far as air going into the stomach, do we know how that happens mechanically?  I noticed something last night.  In those instances when the machine was providing longer inhalations at higher pressure, I was still doing my normal rhythm of breathing.  So I felt like I would breathe in, and at the peak of my breath when I would normally exhale the machine was still blowing in at me for a little longer of a breath before the machine would exhale.  Could it be that period of the "extra breath length" that it gets pushed down into the stomach?

Morning.  If you want to have a look to better understand what is going on search for examples to use when your Flow Rate chart has sudden changes in density (In the example you posted above your Flow Rate chart goes from solid black to gray) and times when your Resp. Rate chart shows a sustained drop (not just a spike down for one breath). 

If you want we can have a look.  Post 2 minute and 30 second long charts starting 23:40, 23:56 and 0:39 

WillSleep


Thanks for the posts.  
 
In the first post of images most of those are zoomed in so far they are hard to read.  2min and in this case about 2mins 30 secs (180 seconds) is about the right zoom.   Once you have zoomed in too far just tap the "Down Arrow" to zoom back out. 
 
Still in the first and second batches each had one image that was pretty good to work from.  If you look at these times you will see failed inspirations which might tie out to the issues you spoke about in #4 and #5 above. 
23:40:05
23:40:30
23:41:45
00:40:09
00:40:32
 
Every time you were trying to take two breaths the ASV was holding you back to one breath.  
 
I have not yet found a fix for this "feature" of the ASV.  The ASV does not grant us access to settings like Backup Rates or Trigger Sensitivity (like a VAuto) would.   I would bear in mind that if the ASV's dis-synchronicity with you and unusually low respiration rates continue to be a problem you may want to try a different machine like the Philips version of the ASV the DreamStation AutoSV or try to see if a ResMed VAuto will meet your needs.  
 

As far as next steps for tonight I think Dave and RayBee gave you good inputs.
 
WillSleep

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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#32
RE: Newbie with setup questions for AirCurve 10 ASV
Hi WillSleep,

Thanks for the insight.  I kind of stumbled through the zooming process, hope to get it better next time.  

With regard to your comment about the DreamStation, are there significant differences in the way the AirCurve and DreamStation provide their therapy?  For lack of better terms, is one more aggressive than the other?  Do they both have the same full range of adjustments of settings?

Thanks
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#33
RE: Newbie with setup questions for AirCurve 10 ASV
Note this caveat, I've not used both just the ResMed ASV:

I don't know the full extent of other settings on a Respironics DreamStation ASV, but there are other settings for timing etc. We do know a ResMed 10 ASV will have 4 pressure settings running in ASV Auto. I also don't have the info on adjustment ranges on the DreamStation. I'm not certain if this applies in ResMed vs Respironics ASV, but in CPAP APAP BPAP levels, I believe a ResMed is quicker to respond, some might say that's more aggressive. Not a lot of info from me, maybe others can fill in the blanks.
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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#34
RE: Newbie with setup questions for AirCurve 10 ASV
(11-16-2019, 07:36 PM)WildSteelhead Wrote: Hi WillSleep,

Thanks for the insight.  I kind of stumbled through the zooming process, hope to get it better next time.  

With regard to your comment about the DreamStation, are there significant differences in the way the AirCurve and DreamStation provide their therapy?  For lack of better terms, is one more aggressive than the other?  Do they both have the same full range of adjustments of settings?


Forum member C0mbe wrote a great review of the DreamStation AutoSV and contrasted it against the ASV.   The last line of his review has always captivated me.  "Sleep second to none."    Still in the end he chose a ASV.

Dreamstation Bipap AutoSV vs ResMed ASV  


"are there significant differences in the way the AirCurve and DreamStation provide their therapy?

No, in some ways they are similar: 
  • These two machines are the only xPAP machines designed to deal with CSA and complex Sleep Apnea (treatment emergent CAs).  
  • These two machines just two others more complex and $$ are the only xPAP machines designed to raise Pressure Support rather than EPAP to deal emerging apnea events.
  • They are both stellar and both have a few weaknesses, both pretty dates with issues.

Yes, there are significant differences:  
  • In concept, the ASV more intelligently measures and drives your therapy off of Minute Vent (thats good).  This is great but this implementation of the concept can fail stupendously as the ASV lets some 200 lb men drop down to Minute Vents of 2.3L/min, a level of ventilation appropriate for a seven year old child (thats bad).
  • The ASV has no backup rate and actually likes to push some people to respiration rates below levels they would reach naturally (maybe you saw this above) (this is bad).
  • People not seeing those issues seems to like the ASV experience better than the AutoSV and watching the ASV run is sometimes a sight to behold.  (both good).
  • The AutoSV drives your therapy of the less academically advantageous Tidal Volume  (Ok, not great) but provides visibility to more settings giving you much better control (thats good).  
  • The AutoSV has a Breaths per minute backup rate of 10 bpm (good).  The ASV has no Backup Rate (bad). 

  • The ASV's pressure climb rates are MUCH more responsive and will likely take out more CAs and events from a lower starting pressure level (thats good).  However, the chaos, drama and trauma to your cardio, ECG, etc is higher from this responsiveness, and does not recover from leaks well (that's bad).
  • The AutoSV will not move as fast to respond to new events (thats bad), but responds better to leaks and will bring less chaos, drama and trauma to your cardio, ECG, etc (thats good).       


It might be that we are pushed away from one machine by how a certain weakness hits us rather than we run to one of these machines because it is a better choice.  Like ....
  • People with true CSR, not 'treatment emergent CAs', might see the ASV as a much better solution.
  • People with just 'treatment emergent CAs' who are more sensitive to pressure changes might find the Dreamstation AutoSV and the VAuto a better choice.
  • People trying to get their night-time average heart rate lower might find the Dreamstation AutoSV and the VAuto a better choice.    
  • People who are seeing the ASV force them into un-naturally low Respiration Rates (RR) and seeing Minute Vent drop scary low because Tidal Volumes are not rising to match the low RR and other dis-synchronicity might find either the Dreamstation AutoSV or the VAuto a better choice, depending on how much true help they need with CSR.
  • People who see no negative impacts from using the ASV might be really, really, really happy using the ASV.


Hardly a straight-forward choice unless/until you start seeing or feeling an impact.


WillSleep

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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#35
RE: Newbie with setup questions for AirCurve 10 ASV
Hi,

I have attached below two nights of data.  What I seem to be experiencing consistently is the air being pushed into my stomach.  So, what happens is I get some going down, I feel like it is kind of stuck going down, and I have to force a burp to clear it.  Needless to say, that wakes me up and is preventing me from sleeping.  Seems like I need the pressured air to be able to do its thing, but not to the extent of causing this, which wakes me up and defeats the whole purpose of using this.  This is why I've only gotten about 3 - 3.5 hours the last two nights in using this because I'm just not sleeping well and need to be able to get SOME sleep before going to work.

Does this required some more reduction in pressures?  Really appreciate your help.

Thanks.


Attached Files Thumbnail(s)
           
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#36
RE: Newbie with setup questions for AirCurve 10 ASV
Yes likely to address aerophagia, pressure drop would be the way to go. I think you're running EPAP 5-10 with PS 2-7. Is that right? If so, try dropping PS max down to 5. Run that overnight and post feedback and OSCAR chart equal to your most recent first one. You could always squish the chart segments some and fit more into a single screenshot as an alternate.

Also if you can, I'd drop Ramp altogether. It's a drop off that places you at minimum machine EPAP. If it's a comfort thing, at least you've got it on minimum timing, so it's not a big deal.
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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#37
RE: Newbie with setup questions for AirCurve 10 ASV
Hi Dave,

Yes, those are the settings I am using.  I’ll drop the PS max to 5. I’ll start with the new settings tomorrow as I really need to get sleep tonight. 

Thanks.
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#38
RE: Newbie with setup questions for AirCurve 10 ASV
Dave, it appears the machine won’t let me set PS Max below 7. Does something else need to be changed first?

Thanks.
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#39
RE: Newbie with setup questions for AirCurve 10 ASV
PS min can be set in a range of 0 to 6, and PS Max is 5 to 20. It may be that the machine requires you to set PS Min to 0 in order to access the lowest PS Max. These are extraordinary low pressure for pressure support and will defeat the purpose of ASV. In your last chart, the PS was pegged at 7.0 most of the night. I need to go back and review why you are using ASV.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#40
RE: Newbie with setup questions for AirCurve 10 ASV
Probably too late for this eve for you. I'll look at my machine and see what it forces on settings for PS. What Sleeprider says is actually something to consider in that edits like this would mitigate the power behind the ASV.

OK the PS range must be a minimum of 5 such as 2-7, 3-8, or very low like 0-5, 1-6 etc.
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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