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+--- Thread: ASV questions (/Thread-ASV-questions--30623)
ASV questions - Karlin - 10-12-2020
Hello all,
This is my first post in this board. I've been using pap therapy for several years now, but recently switched to an ASV after a recent sleep study identified my CSA. My adjustment to the ASV has been difficult.
A little about me. I'm 6 feet tall and wight about 160 lb. No OSA, just CSA. I don't have other major medical conditions that would seem to be causes of CSA. In remission or cured of prostate cancer.
I have a few questions:
1. What is the difference between the "ASV" and "ASV Auto" settings?
2. I'd like to learn about settings. The machine came with the recommended settings from my doctor of an EPAP of 9 and max pressure of 16. The pressure seemed to high and the machine blowing at me when I breathed incorrectly woke me up. So I reduced the pressure to 12, which seems to work somewhat better. I don't think the doctor's settings were good, but how do you know what they should be? For example, where should the EPAP be set? How do you decide what the max pressure should be?
3. I currently have the ramp at 30 minutes. It was shorter but I wasn't fully asleep when I'd stop breathing and the machine would roar to life and blow a minor hurricane into my nose. This woke me up. So I increased the ramp in the hope that I'd be deep asleep when it started blowing so hard at me. Is there any issue with having a ramp of 30 minutes?
4. Is there anything I could do to get used to the way it blows on me?
Thanks for your help!
John
RE: ASV questions - Gideon - 10-12-2020
1. ASV Auto varies the EPAP pressure in addition to the pressure support.
2. That is not a setup to treat Central Apnea. the following is much better
Mode = ASVAuto
Max IPAP should be machine Max
Min EPAP = 4 Because you have no OSA
PS = 3-15
3. Minimize or eliminate the ramp and read 4 below
4. An ASV tends to get out of sync when you are awake, the trick is to blow back forcibly which as you haven't synched with me so reset and try again.
RE: ASV questions - SarcasticDave94 - 10-12-2020
Try what was suggested and give us OSCAR data to know where your therapy is headed. I'd suggest getting the Ramp to off ASAP. It tends to handcuff your machine.
RE: ASV questions - Karlin - 10-13-2020
I set the ramp because I tend to stop breathing as I drift off to sleep. I found it extremely frustrating and upsetting to have the machine blow hard at me when I was nearly asleep, thus waking me up. The first nights I had the machine this happened repeatedly. So I set up the ramp. I never used a ramp with my prior cpap and bilevel machines because I never had this problem of being woken up as I was nearly asleep.
I'lll try the settings you suggest, and see what happens. I'll report back soon.
RE: ASV questions - Gideon - 10-13-2020
Don't forget the blowback technique.
The ASV is the hardest to adapt to because of the large additional pressure support to keep your minute vent up when you have an apnea.
RE: ASV questions - Sleeprider - 10-13-2020
(10-13-2020, 12:16 AM)Karlin Wrote: I set the ramp because I tend to stop breathing as I drift off to sleep. I found it extremely frustrating and upsetting to have the machine blow hard at me when I was nearly asleep, thus waking me up. The first nights I had the machine this happened repeatedly. So I set up the ramp. I never used a ramp with my prior cpap and bilevel machines because I never had this problem of being woken up as I was nearly asleep.
I'lll try the settings you suggest, and see what happens. I'll report back soon.
You should never sense that the machine is "blowing hard". ASV like all PAP machines operate on positive pressure, and if you ever feel air actually blowing, that suggests a leak. If you are sensitive to the rapid change in pressure, then that is another matter, but if your machine is causing air to swirl out of your mask, that is another problem.
RE: ASV questions - SarcasticDave94 - 10-13-2020
Just my personal findings, both CPAP and BPAP were harder for me to get used to. Very likely due to the high CA counts. ASV wasn't too bad to learn it. Blowback does have merit and is helpful in this learning curve on getting used to a new machine and it's unique delivery. I was on the ASV for a bit over 3 years. If set right, it'll squash all aprea events and will be quite comfortable. Sleep will be lots better than ever before. Still waiting on the OSCAR. I know what the ASV can do IF set right.
RE: ASV questions - Karlin - 10-14-2020
Here is my Oscar data from last night. It is broken into two parts, with two masks. I started with a Resmed Mirage Quattro, but that lasted only an hour or so before it woke me up. During the first period you will see very low events and no large leaks. I was too awake to get back to sleep then, so I was up for while and then went back to bed with a Resmed Mirage FX mask. The machine does not wake me up with that Mirage FX, but it has huge leaks and a high rate of events. I've been trying to make the Quattro work, but I have trouble sleeping with it.
I used the settings recommended by Bonjour.
What do you see in the data?
RE: ASV questions - SarcasticDave94 - 10-14-2020
I see an ASV that is letting a lot of Hypopnea sneak past and that there's a lot of leaks that must be addressed. If the ASV is not in ASV Auto mode, then a weapon of the ASV is removed, that being variable range EPAP.
I've found that the ASV is sensitive to leaks, and it can mess up the therapy. It would also be helpful to include the left panel data area minus calendar and pie chart. Info there is very helpful to the data puzzle. I'd also consider shrinking the height of the charts to show several instead of the few that were there. If it's needed, we can ask for zoomed in time segments to get more detail on it.