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ResMed ASV - Problems and Inquires
#1
ResMed ASV - Problems and Inquires
Question one: ResMed Bi-level PAP, Aircurve S10 ASV, what is the difference between Auto ASV and ASV?
 
Question two: My guess is with leaks these machines (ResMed and Phillips) do not read correctly??
 
Question three: I take it that a PS of only 1 to 6 is the total range of the ResMed ASV and there are no ways to go higher??
 
Details:
 
This is seemly insane.
 
So the more I fix the worst things get. 
 
My first three nights showed LOW AHIs like .60, .88 etc.
 
Not once have I shown any obstructions, just hypopnea and Unclassified Apneas
 
Problem one was I found out that I need to really tighten my AirTouch F20 Mask to stop a leak and to stop the breeze I was getting along with runaway out of control air flow and pressure. (Both on Phillips ASV and ResMed ASVs)
 
So that was fixed.
 
My AHIs rate started to up…Sunday I had a AHI of .90, Monday 1.60 Tuesday 1.36.
 
Again Not once have I shown any obstructions, just hypopnea and Unclassified Apneas
 
Last night I found a leak in my hose right at the end that plugs into the machine…
 
Before I found the hose leak I was reading 4AHIs for 3.5 hours of sleep.
 
I was running Auto ASV, and pressures were seemly running away again, mask pressure as I was trying to go to sleep was hitting IPAP of 20+….
 
I then turned it off and ran just ASV….still running high so I set the lowest MAX PS at 11, and PS was 6. Its max setting.
 
This seemed to work for while…
 
Then the straps let go, so I dug out a new spare set of straps.
 
I then found the leak and dug out my only spare hose.
 
OMG the noise I thought was normal got a LOT quiet, so I have had that leak for some time??
 
Along with that repair I switched from an almost too tight med mask to a large which is more confinable.
 
Things just got worst, …last night after all the fixes things got even a lot  worst.
 
I ended with a 10.15 AHI and things were a lot worst AFTER the fixes for the last part of the night.
 
This is the insane part. My guess is with leaks these machines (ResMed and Phillips) do not read correctly??
 
Here I now hit a wall with the ResMed ASV. With It’s VERY Limited settings.
 
The Highest PS I can add it limited at 6.
 
By Titration rules as I am having NO Obstructions and LOTs of Hypopneas and Unclassified Apneas (Centrals) my EPAP is good but I need more PS for a higher IPAP.
 
With my Phillips ASV I can run a low 6 to 12 EPAP and a HIGH PS as I want all the way to 30 if I want it….it is NOT limited to a spread of ONLY 6.
 
Seems to control my Hypopneas and Unclassified Apneas (Centrals) I will have to jack up my EPEP along with my PS to raise my IPAP pressure.
 
I take it that a PS of only 1 to 6 is the total range of the ResMed ASV and there are no ways to go higher??
 
 
Rich
 
   
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#2
RE: More problems with ResMed ASV
The maximum pressure for the Resmed ASV is 25 cm. I believe the Philips BiPAP Auto SV Advanced can go to 30 cm. In your chart above, with EPAP 10- and PS min 6.0, you are at 16-18 cm before you even add adaptive pressure support. That doesn't leave much room.  I think you are not interpreting your data correctly. Let's look at this:

Quote:By Titration rules as I am having NO Obstructions and LOTs of Hypopneas and Unclassified Apneas (Centrals) my EPAP is good but I need more PS for a higher IPAP.
With my Phillips ASV I can run a low 6 to 12 EPAP and a HIGH PS as I want all the way to 30 if I want it….it is NOT limited to a spread of ONLY 6.
Seems to control my Hypopneas and Unclassified Apneas (Centrals) I will have to jack up my EPEP along with my PS to raise my IPAP pressure.
I take it that a PS of only 1 to 6 is the total range of the ResMed ASV and there are no ways to go higher??
  • Your chart shows clusters of UA and H events. These appear to be obstructive and are most likely positional. If you can resolve the positional issues, you can probably reduce your pressure to a more reasonable level.
  • You are using your ASV to force air into your lungs with PS min 6.0. This is rarely needed for people with CSA and issues treated with ASV, but is more common with ST and AVAPS.
  • Your chart shows an inverse I:E ratio, with inspiration of 2.04 and expiration time of 1.84
  • With a Resmed
  • ASV (like Philips) you can run 6-12 EPAP, but with Resmed you are limited to 25 cm, so we need to get your pressures and PS min down or reconsider the machine you're using.
    Clearly you are using the ASV incorrectly and your statement a PS of 1 to 6 is the total range, is simply incorrect.

You have been on this forum for over 10 years. I think you need to revisit your diagnostic and any titration studies and go back through your extensive history of data to see what actually worked best. You are chasing this ASV down a rabbit hole using settings like I have never seen before, and are outside the range of what this machine is intended to deliver. In my opinion, you should restart titration with default values, and deal with your positional apnea and chronic leak problems first.
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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#3
RE: More problems with ResMed ASV
Thanks for your help sleeprider,

My sleep studies have mainly been crappy wasted things.

The main problem is I have a very hard time sleeping with all the hard ware on me and add in noise place, bad temperature controls (three were real cold), and a Sleep doctor(s) that do not even care (and one that could NOT) to read the machine's reports from the SD Card...

So I have been left to fend for my self.

I did find and use a titration chart from Phillips for use with a ASV machine;

It was fairly simple, raise my base pressure EPAP until obstructions and snoring stops and then raise IPAP to control Centrals and Hypopneas.

Even my first titration reported it took a base CPAP pressure of 9 to 10 to stop snoring and obstructions, BUT that pressure then caused centrals, that I suffer from complex apneas.

Following this instructions I have manged to almost totally stop obstructions and the keep my centrals and hypopneas low and my normal AHIs under 5 per night.

Even the ResMed show no obstructions. And has done so all along as I have been using it. In fact I lowered my EPAP to around 8 BUT saw a increase in my Unclassified Apneas and hypopneas, so tried to raise the IPAP and found that I was unable to raise the PS to control them, so had to raise the IPAP to bring the total pressure up so my IPAP was higher and closer to my Dreamstation's running pressures of 11.5 and 17.5.

As for you commits please allow me to respond point by point:



  • Your chart shows clusters of UA and H events. These appear to be obstructive and are most likely positional. If you can resolve the positional issues, you can probably reduce your pressure to a more reasonable level.
I do not understand this, Does the ResMed system report correctly?? It shows NO obstructive APNEAS..none, is this not correct??  And if so then as has the Dreamstation also reports I have nearly no obstructive apneas either. And all my sleep studies also have reported that at 10/11 PAP pressure I have nearly no Obstruction Apneas.
So I believe I am having almost no Obstruction Apneas.

Can you please explain how/what your seeing that saids I am having Obstruction Apneas and or positional apneas.
  • You are using your ASV to force air into your lungs with PS min 6.0. This is rarely needed for people with CSA and issues treated with ASV, but is more common with ST and AVAPS.
This is bothersome news....I hope you incorrect as I have no good sleep doctor nor any hope for a good sleep study....to have this tested for or found.
  • Your chart shows an inverse I:E ratio, with inspiration of 2.04 and expiration time of 1.84
I cannot figure out where and how you came up with that info, it seems my inspiration and expiration times change all over the place and I cannot find any chart that shows any kind of a steady reading.

  • With a Resmed ASV (like Philips) you can run 6-12 EPAP, but with Resmed you are limited to 25 cm, so we need to get your pressures and PS min down or reconsider the machine you're using.  Clearly you are using the ASV incorrectly and your statement a PS of 1 to 6 is the total range, is simply incorrect.
And lastly please explain HOW I can be using a ASV incorrectly, it is basely a Bi-PAP machine and I have followed a titration chart from Phillips for use with a Bi-PAP and ASV machine.

The ASV part is there to react to any time I should stop breathing, as in it will then start trying to help restart my breathing and try to breath for me...the adaptive servo-ventilation part of the system.

Lastly I have it on AUTO ASV which my understanding is that it should adjust its own setting based on my breathing and set the best settings for me and it has not over written my settings.

Lastly the Two ResMed ASV machines I now have will ONLY adjust the PS settings from 0 to 6...that is the total range so to get a 17IPAP I need to run a EPAP of 11.

Rich

Here is copy of the page from the ResMed Clinician Manual:

   
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#4
RE: More problems with ResMed ASV
Resmed reports all obstructive apnea as UA because it does not have FOT to determine apnea type. We assume, if the pressure support was unable to penetrate the airway to cause a breath that the apnea is obstructive. Only central (clear airway) apnea can respond to pressure support, and it is always visible in the flow rate and mask pressure zoomed view.

Using ASV with minimum PS of 6.0 suggests an obstructive pulmonary disorder or hypoventilation better treated with AVAPS or iVAPS. Individuals with central apnea would typically be over ventilated with PS min 6.0 which would aggravate the central apnea disorder by reducing CO2 and consequently respiratory drive.

In your last chart your median Insp time is 2.04 seconds and exp time is 1.84 seconds. Normal ranges from 1:1 to 1:3.  Yours is approximately 0.9:1.

Your minimum pressure is 16/10 and you have capped IPAP at 21 cm.  There is only 5 cm available above PS min to assist respiration, even at minimum pressure settings, and less when EPAP rises. ASV cannot work with these settings.

Just reduce the PS min to 3.0, PS max to 15.0 and you'll be fine. I really don't think you understand the range vs titration.

[Image: attachment.php?aid=4210]
Philips BiPAP AutoSV Titration
[Image: attachment.php?aid=12708]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#5
ResMed ASV fails to IPAP
On top of my current adjustment to using a ResMed Bi-level PAP, Aircurve S10 ASV from 10 years running Phillips ASVs ending with a few Years on Dreamstation Bi-PAP Auto SVs.
 
I ran into mask leaks and a small hose leak as well.
 
So here is the new odd happening…
 
My lightly used ResMed Bi-level PAP, Aircurve S10 ASV seems to stop being a Bi-PAP function…I was trying to go back to sleep this morning when it was NOT switching to the higher pressure on IPAP, it just sat at the low pressure of EPAP setting.
 
This showed up both in how I felt the air flow/pressure and on the face plate display.
 
IS this in any way a normal function?? A part of the Auto part of the AutoASV system??

OR is it a malfunction….

 

Rich
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#6
Is there any place to buy main parts for sleep machines?
I am looking to buying the main boards and fans, especially ResMed Bi-level PAP, Aircurve S10 ASV. 
 
After all we are allowed to do our own settings etc.
 
We should also be allowed to repair them as well…after all a repair is basically just two things, replace fan and or replace main board.

Especially as both ResMed and Phillips machines seemly only last 2 to 3 years and Medicare will ONLY replace a machine every 5 years....(I have talked with a number of service techs at a number of sleep machine repair shops...) They barely out live their warrantee


There is NO troubleshooting these systems. No repairs other that replacing the parts. I have the repair manuals and that is it.
 
Rich
Post Reply Post Reply
#7
RE: ResMed ASV - Problems and Inquires
I have merged your last 3 threads into one, since they all are about your Resmed ASV. Please keep all further posts about it in this thread.

I have sent you a PM advising the same message as in this post, too.

- Red
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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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#8
RE: ResMed ASV - Problems and Inquires
And again thanks for your help.

So you say: "Your minimum pressure is 16/10 and you have capped IPAP at 21 cm.  There is only 5 cm available above PS min to assist respiration, even at minimum pressure settings, and less when EPAP rises. ASV cannot work with these settings.

Just reduce the PS min to 3.0, PS max to 15.0 and you'll be fine. I really don't think you understand the range vs titration."


So how did I do that and how do I undo it?? 

Here are my reset settings:

Mode: ASV Auto

Min EPAP 11.00

Max EPAP 15

Min PS 3. 

Max PS 14   NOTE 14 is the highest setting possible.

Those are the ONLY settings possible...next is Mask type, then Comfort settings.

You also said: "Resmed reports all obstructive apnea as UA because it does not have FOT to determine apnea type."

OSCAR Shows a band for obstructive apneas, is that a waste of space and nonworking??

"We assume, if the pressure support was unable to penetrate the airway to cause a breath that the apnea is obstructive. Only central (clear airway) apnea can respond to pressure support, and it is always visible in the flow rate and mask pressure zoomed view."

I see the bar graph that shows the base pressure (my 11) and it raises  or sweeps over showing pressure being applied to what I have set in my case 17, and some times higher or lower.

Is that your " flow rate and mask pressure zoomed view."

If I read you correctly ALL the chart will show is ALL APNEAS  obstructive AND Centrals as Unclassified???

And yet is does show Hypopneas...which is said to be weak Obstructions...and Centrals are a totally different type of a problem and I for one whould like them picked out of the Herd....as treatment for them IS different kind of apneas.

So looking up ResMeds reports of Unclassified Apenas means? I found a report showing Stats:

So I checked my stats and found:

Last Night       Last wk  Last 30  6 Mo         Year
AHI         .04    .84         2.31         3.53      3.86
OB          .00    .00          .36           .96       1.31
HP          .61    .61         1.47        2.26       2.18
UN         .00     .21          .34           .06         .03
CA         .00     .00          .14           .25         .34
FL          .00     .00          .36          .70          .82
95%      .19     .00          .00          .00          .00
REBA     .00     .00          .00          .00          .00

Seems I have been doing a good job??

Of Note is I have only been on the Resmed for 5 nights....And I was seemly having problems with my Dreamstations thus my switching to a ResMed systems.

Which it seemed the newer ResMeds had similar problems I figure something else was the cause, either ME or my other equipment, and it turned out to be a leaking mask and hose.

What blows my mind is how the ResMed seems to either fail to report my apneas, or fixes they so fast there is nothing TO report, OR the slow raise of IPAP pressure is better and causes less reactions and thus less apneas...

WISH I could find out which.

Rich
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#9
RE: ResMed ASV - Problems and Inquires
Efficacy seems good enough. My suggestion is, assuming you need EPAP min 10.0, then these settings will obliterate any non-obstructive CA and hypopnea.
EPAP min 10.0
EPAP max 15.0
PS min 3.0
PS max 15.0

If you are willing to try a lower EPAP to see how much the machine raises it, start with EPAP min 7.0 and everything else the same. The machine should raise EPAP if required, and that will be useful information.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#10
RE: ResMed ASV - Problems and Inquires
First is to see how well things go for the first night...

Then I WILL lower the EPAP to see what it goes to.

Rich

Now if only there was/is someplace to buy parts....
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