ASV set to bipap mode? and a couple of questions

[tuzacat]

Hi, Folks, I have lost close to 70 pounds in little over a year and as I have done so I also have been doing Bikram yoga and getting personal training. As a result I am getting healthier and have been able to reduce the handful of meds I was taking to 1 pill - 5mgs. of lisinopril. My last RA factor test came back normal and all my bloodwork is good. This is a miracle! I also reduced the pressure on the ASV machine to the settings listed below. Last night I had another sleep study and all my centrals have disappeared with the reduction in medications. The technician said I was at straight bipap no ASV all night. Her conclusion for setting was 10 over 6. She said my flex setting was 4 because that was what I waas used to. It must say that on the original prescription because when I checked my machine it says off. She also said the ASV could be set to BiPap mode but that it wasn't ideal. They are going to order me a new bipap machine.

1) Even though I will be getting a new machine it will probably take a while so I was thinking if I could change the ASV to Bipap mode I would be getting better therapy sooner. I know how to get into the clinical setup but I don't see anything that says BiPap mode. Not only that on the flex button it either says off or Bi-flex -no numbers. Is there another super secret place I haven't found yet? Can anyone help me with this?

2) Is the recommendation for BiPap still AirCurve10 Vauto?

3) I am going on Medicare August 1 with a supplemental plan as well. Currently, my DME is Apria which is the only one my HMO provides. If I start doing the rental thing with them what happens when my HMO stops paying will Medicare kick in? Does anyone know how it works when transitioning?

Thanks in advance for any help you can give me!

Best,
Sandra

[Pugsy]

Actually all you need to change to get your ASV working like a regular bilevel machine is your PS (pressure support).
There is no Flex setting of 4...it only goes to 3 and it's separate from PS on the Respironics bilevel machines.
You have to turn BiFlex on to see the setting options.
I don't know where the tech got Flex of 4 unless her special in lab machine offers different settings.

At any rate....do you want auto adjusting bilevel or fixed bilevel mode?

Your current settings have PS with a big range...the big part of the range is what deals with the centrals. Since you no longer have problems with centrals you won't need a big range which is where the max of 12.5 comes in.

Settings:epap min. 6, epap max 12, pressure support min 6, ps 12.5

PS is just the difference between inhale and exhale. IPAP is just EPAP plus PS.
right now with the way it was....you start out the night with minimum EPAP of 6 plus the minimum PS of 6...so you are using EPAP 6 and IPAP of 12 but it can range anywhere up to 12 EPAP plus PS of 12.5 which gives you IPAP of 24.5. Lots of room to roam around.
It hurts nothing to have lots of room to roam around...the machine won't do any roaming without a good reason.

If you want to tie its hands and make it work like a regular bilevel machine...easiest way is just limit the PS range.
Maybe 4 min and 6 max PS.
Respironics bilevel machines offer PS with a range...ResMed bilevel (AirCurve 10 VAuto or S models) don't offer a PS range..it's a fixed PS choice.

If you want to change the settings to what would be comparable to bilevel auto settings on a Respironics BiPap Auto in Auto mode.
Minimum EPAP 6
PS minimum 4 and max to 6...nice little range that is commonly used.
Maximum EPAP...depends on how high the machine wants to go to deal with the obstructive stuff but I would set it high...like 15...it won't ever go near that without a good reason.
Flex...if you have been using it off..you can leave it off or turn it on and just play with the various settings to see if one setting simply feels better than the other and use it no matter what the number. It's a comfort feature.

There's no urgent reason to get a new machine. These small tweaks essentially makes the ASV work, respond and function like a regular bilevel machine.
Main difference with regular bilevel vs the ASV bilevel is the machines ability to respond quickly with that high PS burst when a person has a central apnea. Regular bilevel machines can't respond that fast.
Personally I think ASV and it's quicker response is better than the slower to respond bilevel algorithm even for just plain obstructive stuff. People can use lower baseline pressures with ASV because of the faster response in general.
Regular bilevel auto adjusting algorithm is just slower than the ASV auto adjusting algorithm.
ASV can be just as easily used to treat only obstructive stuff as the regular bilevel models....even better IMHO.

Been there myself...played with both ResMed regular bilevel auto machines and Respironics auto bilevel machines and
both brands of ASV machines. With the ASV machines I could use about 4 cm less EPAP starting the night than I needed with the regular bilevel to essentially get same results. I used the ASV for obstructive apnea...I don't have a problem with centrals...it can be done and quite effectively I might add. If I could bet my muggy little paws on an AirCurve 10 ASV for dirt cheap...I would hop on it in a heartbeat.
Technically I don't "need" it but it sure was nice to have and use. My last ResMed ASV was the S9 adapt model...I would love to have the AirCurve 10 ASV.
Not so much the Respironics...Resmed's auto adjusting algorithms are simply more responsive (quicker) than Respironics so for that reason I just prefer ResMed machines...plus I think they are a little quieter in general.

[ajack]

The S9 has cpap but no bpap, I'd assume the 10 was the same. You could have cpap10, I don't know if there is any EPR, it isn't indicated in my manual

You could also have the asv, manual mode, max min ps4 and epap 6, it will just leave the backup breath rate

[tuzacat]

Thanks so much for your response and explanations, Pugsy! It's really helpful. Last night was the first time during a sleep study that I actually slept apparently for much of the night with a lot of REM. I woke up a lot but managed to fall back to sleep. This is my 5th sleep study over the years and being able to fall easily asleep during one is a first. One time I didn't sleep at all so the doctor had me come back free of charge and try again. I am anxious to duplicate a night of deep sleep - regularly - so I will try your suggestions and see how it goes - will try the auto one first. My machine is almost 5 years old with a Sandra repaired knob which broke off so I will qualify for a new one in October. However, with the new prescription I will qualify for a new one now - just not an ASV.

So - I set everything as you suggested except the max epap I left at 12 for now since lately much of the time it only goes up to 7 and once in a while up to 9. Thank you for pointing out where the Bi-flex settings are. I'm going to follow your advice and just leave it the way it is. Should I change the Maximum pressure which is set at 25 or just leave it?

One of the benefits of the study last night is she did a mask fit on me and sent me home with a different sized mask with the correct adjustments so I am really hoping for more comfortable nights.

Thanks, again, Pugsy!

Best,
Sandra

[tuzacat]

Thank you, ajack! I'm going to try the settings and see how it goes. It will be interesting to see what the doctor actually recommends - he's a cpap user himself so he has an understanding about this that I suspect most sleep doctors do not.

Best,
Sandra

[Pugsy]

The maximum pressure in IPAP is simply a function of whatever EPAP plus PS does.
It hurts nothing to leave it set at the 25 but you won't likely ever come close to it if your EPAP rarely ever went above 9 at the most anyway. Just because a machine can go somewhere doesn't mean it will and if it doesn't it sort of is a moot point.
The only real time anyone needs to limit IPAP max is when the machine goes there for some reason and the going there causes a problem of some sort.
If it never goes there...doesn't really matter if you limit it or leave it alone. It's kind of a non factor in things.

If you limit max EPAP to 12 (since it never went there anyway) and you have PS limited to 6...the most IPAP can possible go is 18 and it likely won't even go there. Doesn't really matter what the max is set at if the machine doesn't go near it.

[tuzacat]

Okay, that makes sense, Pugsy. Thank you!