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Trying ASV Dangerous?
#1
Trying ASV Dangerous?
Hi All,

Recently got my hand on a trial ASV. I continue to struggle with treatment emergent centrals, however if i reduce my pressure support I get flow limited (flat tops on the curves followed by an arousal). So it seems like I need pressure support when i need it, and for the machine to back off with the pressure support when i don't need it, hence ASV. 

However, before I go and hook this up to myself, I wanted to ask. If i get a treatment emergent central (if that is even possible during ASV), will the ASV provide a breathe and therefore with already low CO2, ventilate me further thus causing me to pass out in my sleep? (serious question, sorry for my potential lack of knowledge on this subject). 

tldr; is ASV dangerous to use if you had treatment emergent centrals when using a BiPAP.

Kind regards, 
N.
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#2
RE: Trying ASV Dangerous?
Not a problem. The ASV will use your last 90 seconds of breathing to set targets for breath rate and volume, and the adaptive pressure support is used when, and as needed to maintain normal respiration. For most users, the stimulus of pressure support is sufficient to cause a spontaneous breath. The Resmed Sleep Lab Titration Guide describes how ASV works, I think starting at page 28 https://document.resmed.com/en-us/docume...er_eng.pdf

ASV usually results in near-zero AHI for most users. It prevents the initial start of periodic breathing by preventing the hypopnea or hypoventilation that leads to a CA or hyperventilation and the ensuing feedback loop. Once you try the ASV, we can help to coach you to more comfortable settings and correct any problems you might encounter. The big thing is, the ASV allows for spontaneous breathing when you are in control, and prevents missed or low-volume breathing. It's important to give yourself time to settle before masking up because if you are breathing deeper or faster as you mask up, that will set the target respiration and will feel unnatural. Anyway, no risk to you, but it may take some time to get used to the ASV therapy and feel rested.
Sleeprider
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#3
RE: Trying ASV Dangerous?
Correct. This ASV is no more dangerous than sitting in your recliner while you're enjoying a big coffee. It cannot blow up lungs. It probably isn't addictive unless you like breathing during sleep without Central Apnea.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Trying ASV Dangerous?
Hmm. So what your saying is, if I start off in ASVAuto mode on default settings for the first night, I won't die in my sleep? 

P.s. how good is the ASVAuto algorithm? im guessing like all PAP devices it will need some fine tuning. 

Kind regards,
N.
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#5
RE: Trying ASV Dangerous?
It's best to tune it a bit, yes. The goal is maximize the balance between therapy effectiveness and comfort.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Trying ASV Dangerous?
Norman2195 - I think the ASV has gotten your thought process reversed. If you were prescribed an ASV, then you should be more concerned about dying by NOT using it as opposed to using it.
- Red
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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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#7
RE: Trying ASV Dangerous?
For more reassurance, I have used ASV and 2 ventilators.  The ASV will auto titrate (it will find your specific best pressures for you; all you have to do is sleep).  

The only major problem I encountered was with the ST (A) when I first started therapy.  The pressure support was too high, and I felt soreness in my chest/lungs from too high pressure.  This is about the only possible bad thing I can see, and it has an easy solution:  turn down the pressure.   Aerophagia (air in the stomach can occur with some pain, but, again, pressure can be readjusted).  

I hope this helps also.
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#8
RE: Trying ASV Dangerous?
Hi thank you for the replies. I guess what im worriee about is that if im having centrals, it means ive reachee a hypocapnic state. Now ordinarily this will lead to a loss in respitaory drive from my brain stem. If im correct though, the ASV should im this instance supply me with a breath, however in doing so, it may cause me to remain in a hypocapnic state for the reminder of the night. Is it safe to remain in a state of low blood CO2 and allow the machine to breathe for you if you loose your respatory drive?
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#9
RE: Trying ASV Dangerous?
I guess that I can't speak to your specific situation, but I can explain mine for an example.  I have failed some Capnography (CapOx) tests.  They showed that the air that I exhale contains too much CO2.  So...

This ventilator that I am currently using does the same thing at night to me that you are describing.  Some aerophagia in the morning is the proof that I have.  But the object of it all is to get more CO2 out of my lungs using this particular mechanism.  Even though it is reducing my spontaneous respiratory rate most likely and breathing for me, it is getting rid of excessive CO2 that has built up in my lungs by increasing my ventilation tremendously.  

I feel good during the day.  No problems with breathing at all during the day.  No negative effects from using the ventilator except some aerophagia that varies.  

If I would have seen major negative effects of using this method, I would have quit.  I have been using it almost 2 years now, all night every night.

The ASV should keep SPO2 levels higher during sleep also by preventing CA's also.
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Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies. 

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.  
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#10
RE: Trying ASV Dangerous?
Ok first night graphs are in for the ASV, does anyone feel like at times it really slows down your breathing? At one stage I was like pretty sure that i stopped breathing but the ASV had actually just slowed down by breathing (and increase pressure support). I feel like I just need a bit of time to get used to the machine. Let me know if i need a settings change.


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