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Newly diagnosed - Was this ASV titration typical?
#1
Newly diagnosed - Was this ASV titration typical?
Hey all, great forum and great people here. I wanted to see if my ASV titration experience was normal or if anyone can relate to it. 

Info about me:

Male
Age 33, 140 lbs
Diagnosed with idiopathic (primary) central sleep apnea 
Intolerant to CPAP/APAP due to treatment emergent centrals
Didn't try Bi-PAP, went straight from APAP to ASV 
My initial sleep study showed 13.5 AHI over 4 hours (25 centrals, 2 obstructive)

I went in for an ASV titration and couldn't make it through the night due to how the machine was behaving. I was under the impression an ASV should breath with you but it didn't seem to work that way with me. What happened is:

The first few breaths I took felt natural and the machine mimicked my normal breathing pattern. Shortly after that however, it kept increasing pressure on inhale and would not go back down on each breath. The way the machine was delivering the breaths felt very forced and unnatural. The breathing rate seemed too short, forcing a breath when I wasn't ready and also delivering too much of a breath on each inhale. I wasn't ready to take a breath, but it kept forcing it. The machine was still delivering a breath when I was already trying to exhale. I had to take the mask off to get a deep, satisfying breath. I tried the "blow back" method, which helped temporarily, but the higher pressure came back.

When I asked the tech about this, she said that the machine was set at the lowest inhale pressure it would go, which was 8. She also said nothing else could be done for comfort and that the machine should be auto-adjusting to my breathing, but it clearly wasn't.

I'm almost positive the machine used during the titration was a ResMed VPAP Adapt Auto. 

I wanted to ask and see if anyone could relate to this and see if my sleep study tech was correct. I suppose I'm not sure where to go from here. If this is indeed how an ASV is intended to function, I don't see myself ever getting accustomed to it. 

Does anyone relate to this? Does a Bi-PAP behave any differently? Any advice or insight is welcomed.
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#2
RE: Newly diagnosed - Was this ASV titration typical?
The Resmed Aircurve 10 ASV is very different from the iVAPS. It would help if you knew which one you were using. With the Resmed ASV, the minimum EPAP pressure is 4.0 cm, and the IPAP is "adaptive" and can range from zero to 5 or more cm. A typical initial settings is ASV auto mode with EPAP min 4.0, EPAP max 15, PS min 3, PS max 15. Most people that undergo titration end up making adjustment as they learn more about the machine and its response. There are a number of tricks and traps to using ASV that can make a big difference. First of all, it only provides pressure support when needed to maintain your respiratory volume and rate. The machine trys to match the respiratory rate and volume from the previous 90 seconds of therapy, so if you put on the mask but have not settled into a relaxed sleep-like respiratory pattern, the machine learns that higher volume and tries to maintain it. That doesn't usually work too well. Users learn they can take control by exhaling and inhaling assertively. This takes the machine back to initial settings (blow-back technique).

If your were dispensed a machine, you can download the free OSCAR program and record the data with a SD card and post it on the forum. We can tell on a breath by breath basis what is happening, as well as see the settings. I'm sure we can get you tuned in if you will do this. We have many members that successfully use ASV. Fantastic machine if it's what you need.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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