ASV waking and hypopneas

[Zzzs please]

I have been using an ASV machine (Philips) for a couple of months now to treat complex apnea. It is doing a great job (no centrals! And much less O2 drops.), but I would like to try to improve some things. 

I've noticed that while using this new machine, I wake up many times a night. I can also see this on the oximeter data as many heart rate increases and motion detected. (The heart rate is not a smoother wave-like pattern that would indicate better/less interrupted sleep.)

I'm having some hypopneas and flow limitations which account for some of the waking and heart rate increase.

Are there settings I can change to help me sleep better? (Or any other advice?)  

(Oscar pictures in wrong order. 2 pics to show all of the settings on the left.) 

   
   
   

[SarcasticDave94]

Welcome to Apnea Board,

One thing that jumps out first is the Flex setting of 3. I'm basing this in comments from others, that setting can become disruptive. Try Flex 2.

Regarding Hypopnea, I think this indicates a need to increase EPAP Min from 6. I would try 7.

Also with a Philips Respironics machine, they're notorious for slower response, which may be more comfortable to some users. However the negative is it's slower to catch the event. This means you may be forced to use settings higher to address events, costing comfort.

It's also a reactionary device, that's all Philips Respironics machines. Conversely a ResMed is predictive, and stops more events effectively for most users.

I had a ResMed AirCurve 10 ASV for 2 years. It took my test result 124 Central and 24 Obstructive Apnea to zero to 3 AHI for all of the 2 years.

[Zzzs please]

Thanks for your suggestions. I had to buy the asv myself (with prescription) because it's not covered at all in my country. The hospital I bought it from said that resmed does not have an asv machine (I asked, as I've used a resmed cpap previously). This is disappointing. I would have preferred a resmed. 

Is the flex issue regarding centrals? I've heard that too. Centrals seem to be well controlled at the current setting. But, as you said, maybe the machine is slow to react to them, which could cause some of the issues I'm having. Perhaps I'm having shorter events (not flagged), but events none the less.  

I'll also try adjusting the epap min from 6 to 7. 

Thank you!

[SarcasticDave94]

ResMed certainly does have ASV, for what it's worth now.

Flex as I recall can be a bit disruptive on 3. I don't know exactly where it becomes a hindrance, I would guess it's overall and not just focusing on Centrals. I'm thinking it adds an erratic aspect of some sort that Flex 2 reduces.

[Zzzs please]

Good to know, thanks

[cexer]

hey zzz,

i have the resmed asv.
with it my breath is still shallowing cause of hypopnea and then i wake up.
do you experience similar stuff ?

your graphs look somewhat familiar to me.

i guess the problem is caused by the algorithm,
setting the target flexible according to the last few minutes
and no setting can change this.

maybe the lumis 150 vpap st or another ivaps capable device
could help you not waking up. this is also what i'm aiming for.

from there you can go down the rabbit hole,
if you want to learn more about my condition.
does it somehow match yours ?

[SarcasticDave94]

An ST or AVAPS/iVAPS isn't necessary here, nor is it at all indicated for Zzzs please. They're only needing to focus on Central Apnea treatment and making the current Philips Respironics SV Auto work better.

[Zzzs please]

Cexer,

Thanks, I'm not sure. I do notice (when I'm half asleep) that my shallow breathing doesn't always trigger a breath/ inhale via the asv. I must breathe a bit more forcefully to trigger the machine to inhale. But it does inhale after a few seconds on its own. My previous resmed bilevel machine had a more sensitive inhale trigger, which I preferred, but it didn't help with centrals.

I'm not able to get a different machine. This one will have to do. 

I'm sorry that you have had a long road for getting proper help. It took me years to get a machine that allows me to sleep. Some doctors are not very good, unfortunately. I'm wishing you luck going forward.

[SarcasticDave94]

Here's a bit of info that may help the transition to inhale.

See images of Bi-Flex and rise time, both seem to be available, but both can't be active together. You may want to trial turning off flex and editing rise time.

You might want to use Apnea Board resources and order a clinical manual for your ASV. I think I have this correct. You can access the menu via first using the dial to highlight the My Info square, click hold both Ramp and Dial for 5 seconds, it should take you to a green Therapy square, then you may edit the clinical settings a needed.

There may be other timing settings to help too.

   

   

[Zzzs please]

Thank you, this is great to know. 

Does the rise time affect the effort needed to trigger an inhale? Or just the time it takes to occur.  

Regarding biflex (I'm trying to understand), does this setting kind of round out the transitions between breaths. Whereas the pressure support/ ipap/ epap will allow me to exhale against less pressure? So, even without biflex, I would still be able to exhale against a lower pressure than my inhale? 

I very much appreciate your help.

(I'm not able to read manuals or search a lot due to migraines, etc. Hopefully this may improve with better sleep.)