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[CPAP] Beyond ASV with Overlap Syndrome! - Printable Version

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Beyond ASV with Overlap Syndrome! - SarcasticDave94 - 11-19-2019

Up front, this is probably stretching beyond the realm of xPAP. Don't shy away from helpful comments on this title subject. I still desire input from those with knowledge in AB land. My striving to be super unique lands me in the way out there-ish territory of Overlap Syndrome. Yes I already knew I have this, but it hasn't been an issue until very recently. I don't have the numbers, but I think it's fair to say it's kinda rare population percentage wise.

I've researched a bit lately on various other machines beyond what my ASV can supply for therapy. Why should I consider a change if it's helping? As I've already mentioned, I have a rather rare status of being in the group that is called Overlap Syndrome, that is not only do I have sleep apnea but I also have COPD. Mine is even rarer due to my high CA content. I'm increasingly facing difficulty breathing while awake and asleep, hence it's likely either a COPD or oxygen level based issue IMO.

Feel free to educate me a bit. I know I have had the need for the ASV; my sleep study numbers scream that this is the right device as it treats CA. I stand by my own decision to have fought for this device. Up until very recently, my ASV was providing excellent therapy. However, after my latest bout of bronchitis, which it seems my COPD is leaning towards susceptibility to or equalling chronic bronchitis, my ASV and I don't get along as well. I can't breathe well either with or without mask, and there's no setting tweaks to help my issue of hard to breathe that I'm aware of while on the ASV. The ASV and mask seem to add to my breathing restrictions at this time.

I don't think it's just a SA situation I'm dealing with. I think COPD has gotten worse. My info fishing has a goal. I'm going to my pulmonary office today to get the medical take on this BTW. If there's a medical necessity, is there data out there on a machine like the ASV that combats CA but assists in difficulty breathing like what I'm in combat with here lately? Is it a Stellar or Astral, specifically the 150 of either, I should target? Or an ST-A? I only mentioned ResMed above, but include Respironics devices or others into the conversation. I may need the portable oxygen concentrator (POC), so that could be in the mix too. If it exists, which device is most like my ASV while providing the added support COPD may require? How should I expect these machines to feel and act different than my ASV? Maybe these questions are redundant, but there they are anyway.

I'll be questioning the nurse practitioner I see today to find out which tests we can do such as for oxygen levels to consider a POC or if I need to change from the ASV to an actual ventilator. Things are far from boring in the land of SarcasticDave94.


RE: Beyond ASV with Overlap Syndrome! - Sleeprider - 11-19-2019

Dave, I think you are already on-track with considering the ST-A in iVAPS mode. It has advantages over the ASV, particularly in the presence of COPD, because it actually maintains the minute vent and respiration rate at a set value, while your ASV relies on your baseline vent and RR. This can result in a "fading" respiration rate. The ASV is intended for individuals with a healthy pulmonary system and it the best treatment for central apnea and periodic breathing, but when we start to bring pulmonary dysfunction into the equation, the iVAPS/AVAPS are really intended to address that.

You might want to go back over your results and track the tidal volume, respiration rate and especially the minute vent to see if there have been changes over time (long-term), or if those are highly variable through the night. The VAPS has the capability to not only stabilize minute vent, but to increase it if needed.


RE: Beyond ASV with Overlap Syndrome! - SarcasticDave94 - 11-19-2019

Copy Sleeprider and thanks. I’ll be mining as much info as I can on iVAPS. Has there been conclusions drawn via discussions with best results via Brand similar to ResMed ASV tends to provide better results when iVAPS is considered?

PS do iVAPS work on combatting CA in any way?


RE: Beyond ASV with Overlap Syndrome! - Gideon - 11-19-2019

Dave my gut says you need to try more COPD and less ASV, much as SR states above. Keep in mind that in the past, the ONLY CA option was the timed treatments for COPD.


RE: Beyond ASV with Overlap Syndrome! - Sleeprider - 11-19-2019

Like ASV, iVAPS and AVAPS both provide adaptive pressure support and will cause a breath if there is no effort. Unlike ASV, you can set a minimum respiration rate and minute vent. We talk a lot about the different machines in this thread http://www.apneaboard.com/forums/Thread-Bi-Level-S-ST-ASV There is a video in the second to last page you want to take a look at.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383083/
https://www.resmed.com/epn/en/healthcare-professional/research-and-education/clinical-papers/ivaps-algorithms.html
http://www.krcs.org/PDF_Files/2015/State_Meetings/2015WKS_PAP_Therapy_Devices.pdf






RE: Beyond ASV with Overlap Syndrome! - SarcasticDave94 - 11-19-2019

Copy, bonjour and thanks. ASV has done excellent things but COPD might force a machine transition. Who knows what I’ll be on in the near future.

Breathing is never boring. ESPECIALLY when you’re in sarcasticdave94 land. Coffee


RE: Beyond ASV with Overlap Syndrome! - SarcasticDave94 - 11-19-2019

Thanks again SR. AVAPS or iVAPS seems like what I’m after sooner than later. That V60 AVAPS with large screen certainly is different. OK that’s just orange or squirrel Dave.


RE: Beyond ASV with Overlap Syndrome! - Michaely6 - 11-19-2019

Does resmed have an AVAPS machine? What is the difference between AVAPS and ivaps?


RE: Beyond ASV with Overlap Syndrome! - Sleeprider - 11-19-2019

The Resmed volume assured pressure support is the Aircurve 10 ST-A iVAPS. The main difference between the two machines is the same one that differentiates the ASV from the SV. Resmed targets aveolar volume by measuring minute vent, and Philips targets Tidal Volume. My unqualified opinion is that the Resmed approach is more sophisticated because minute vent is a product of respiration rate times tidal volume, while Tidal volume is simply the volume of expired air in a single breath. Since both have set backup settings (breaths per minute) and volume targets, they are similar. The newest innovation is automatic adjusting EPAP (AE) similar to the ASV models.


RE: Beyond ASV with Overlap Syndrome! - Michaely6 - 11-19-2019

Got it! Thanks