Can ASV cause fatigue? Need BiPAP instead?

[justinjustin]

Hi all. I've been on ASV for 3 months now and I feel more fatigued using it than without.

I've tried it in just CPAP mode and I'm still fatigued. I also tried APAP mode and noticed that I'd clearly wake up whenever it increased pressures.

Last night I had 7.5 hr sleep with the ASV, no leaks, no awakening, 0.0 AHI and I'm still as fatigued as ever. So, I got suspicious....

I've been reviewing my ASV data and noticed something interesting:

Whenever the pressure is stable around 18cm IPAP (PS+EPAP) my flow curves look great.
Whenever the pressure is variable on IPAP, my flow curves look ragged and 'snipped' off.

Does anyone think this could mean that I should use BiPAP?
My guess is that ASV could be intensifying the problem with it's wild pressure swings and causing microarousals?

Some graphs for your viewing pleasure. These are very typical representations of other nights.


This is what perfection looks like (ha). No events and no major leaks.





Stable IPAP pressure, with oh-so-pretty and consistent waveforms.





Variable IPAP, with ratty-looking waveforms.

[Wulfman...]

How long did you try it in CPAP mode and at what pressure(s)?

I'm always suspicious about the changing pressures disturbing sleep and leaving the user feeling unrested.


Den

.

[JDS74]

So how did you get to an ASV machine?

If you are having centrals, you just stop breathing and in straight CPAP or BiPap mode, the system will just sit there waiting, and waiting, and waiting for you to start breathing again.

ASV will switch to ventilator mode and help you breathe until you start on your own.

[palerider]

So how did you get to an ASV machine?

If you are having centrals, you just stop breathing and in straight CPAP or BiPap mode, the system will just sit there waiting, and waiting, and waiting for you to start breathing again.

ASV will switch to ventilator mode and help you breathe until you start on your own.

see: viewtopic.php?f=1&t=99026&p=920512#p920512

[justinjustin]

So how did you get to an ASV machine?

If you are having centrals, you just stop breathing and in straight CPAP or BiPap mode, the system will just sit there waiting, and waiting, and waiting for you to start breathing again.

ASV will switch to ventilator mode and help you breathe until you start on your own.

I tried CPAP without feeling better for months, then got on to ASV by visiting Krakow.

The weird thing is that I 'failed' BiPAP because they caught 5 centrals in the first few mins, but *I rarely have more than 5-10 centrals per night*.

[palerider]

*I rarely have more than 5-10 centrals per night*.

I presume you mean when you were on cpap.

or are you seeing centrals show up in the mask pressure?

[Wulfman...]

So how did you get to an ASV machine?

If you are having centrals, you just stop breathing and in straight CPAP or BiPap mode, the system will just sit there waiting, and waiting, and waiting for you to start breathing again.

ASV will switch to ventilator mode and help you breathe until you start on your own.

I tried CPAP without feeling better for months, then got on to ASV by visiting Krakow.

The weird thing is that I 'failed' BiPAP because they caught 5 centrals in the first few mins, but *I rarely have more than 5-10 centrals per night*.

Well, that explains a WHOLE LOT.


Den

.

[palerider]

Whenever the pressure is stable around 18cm IPAP (PS+EPAP) my flow curves look great.
Whenever the pressure is variable on IPAP, my flow curves look ragged and 'snipped' off.

I have to wonder if you've got a chicken and an egg scenario.

are your curves great with a fairly steady ipap at 18, and crappy at 12.6/6 because of the lower ipap, because of the steady vs varying pressure, or....

is the flow great at 18/6 because it's enough to keep keep your airway open past the flow restrictions so the machine is happy with it, and crappy at 12.6/6 because it's not enough pressure, and because it's crappy, the machine is trying to find a pressure that works.

unfortuately, the closest you can get with the adapt is 12/6 trying to get it to pretend to be a plain bilevel. (setting minps 6 maxps 6.

[justinjustin]

So how did you get to an ASV machine?

If you are having centrals, you just stop breathing and in straight CPAP or BiPap mode, the system will just sit there waiting, and waiting, and waiting for you to start breathing again.

ASV will switch to ventilator mode and help you breathe until you start on your own.

I tried CPAP without feeling better for months, then got on to ASV by visiting Krakow.

The weird thing is that I 'failed' BiPAP because they caught 5 centrals in the first few mins, but *I rarely have more than 5-10 centrals per night*.

Well, that explains a WHOLE LOT.


Den

.

Go on about Krakow ??

And yes, I meant CPAP. I was seeing 5-10 centrals on CPAP. I've never recorded a central on ASV. When I lower my maxpressure, it seems to want to go hit my max. Across all my nights, whenever the IPAP is stable, I see good waveforms. It looks best at stable 18. Whenever it's variable, the waveforms look crappy.

I can't get 12/6 bilevel with adapt. It won't let me set the maxIPAP less than minPS +5.

[palerider]

I can't get 12/6 bilevel with adapt. It won't let me set the maxIPAP less than minPS +5.

hmm, manual says minps=0-6. maxps=5-20

wouldn't be the first time the manual's been off in a minor way.

[Wulfman...]

Go on about Krakow ??

And yes, I meant CPAP. I was seeing 5-10 centrals on CPAP. I've never recorded a central on ASV. When I lower my maxpressure, it seems to want to go hit my max. Across all my nights, whenever the IPAP is stable, I see good waveforms. It looks best at stable 18. Whenever it's variable, the waveforms look crappy.

He was a member of the forum some years back.
I pretty much stayed out of those threads, but casually observed some. Most of those discussions were "over my head" and/or not relevant to my own therapy.

memberlist.php?mode=viewprofile&u=22280

search.php?author_id=22280&sr=posts

I'm not about to make any judgments about him. Some people were impressed and some weren't. I think he got pissed off and left based on some folks challenging him on certain issues.

You can decide for yourself.


Den

.

[justinjustin]

I can't get 12/6 bilevel with adapt. It won't let me set the maxIPAP less than minPS +5.

hmm, manual says minps=0-6. maxps=5-20

wouldn't be the first time the manual's been off in a minor way.

That information is correct, but not complete. It should add that maxps can not be set lower than minps+5.

Ex. setting Minps 4 would allow maxps a lowest limit of 9.

[JDS74]

Across all my nights, whenever the IPAP is stable, I see good waveforms. It looks best at stable 18. Whenever it's variable, the waveforms look crappy.

is it possible that you are misreading the data and that the crappy waveforms come first and the machine is responding next?
I have no experience with a ResMed ASV machine but the Respironics 960 ASV will behave that way. If my breathing is very stable, the pressure stay constant. As soon as any instability occurs, the machine reacts within on breath cycle and changes pressure, sometime dramatically.

[Citation4444]

What are your settings? Which version of the Adapt do you have? Have you tried using it at its default settings? You can see my post of earlier today that I achieve fantastic results with my VPAP Adapt, but not everybody is as fortunate as I have been.

[justinjustin]

Across all my nights, whenever the IPAP is stable, I see good waveforms. It looks best at stable 18. Whenever it's variable, the waveforms look crappy.

is it possible that you are misreading the data and that the crappy waveforms come first and the machine is responding next?
I have no experience with a ResMed ASV machine but the Respironics 960 ASV will behave that way. If my breathing is very stable, the pressure stay constant. As soon as any instability occurs, the machine reacts within on breath cycle and changes pressure, sometime dramatically.

No it clearly stabilized at 18cm, then for some reason after a while the ASV will drop the pressure and then the waveform gets scrambled.

I feel like yelling 'ASV you idiot, just keep the pressure there! You're going to ruin it!"