Got my new ASV 960!

[Kiralynx]

Well, I got my new ASV (Respironics 960). It's much smaller and lighter than my old Beastie.

Set up went smoothly, although it was evident the RT isn't used to ASVs.

She was, however, very pleasant, and went over all the details one needs for the average patient.

I do not have the heated hose -- I had explained why I wanted one, because of the dryness with passover humidification, but getting moisture whistles in the Tap-Pap with even heated setting 1 on the old ASV. Her suggestion was to try the regular humidifier for a week or two -- if it works, great. If not, we can then go back to my insurance and point out that this is not merely a comfort issue, but necessary to my therapy. She said they would be much more likely to approve something which is normally considered a non-essential comfort item that way -- and I very much appreciate the point.

Of course, I got it home, and set it up, and just now went to crawl into bed. Turned on the new Beastie and dang near got blasted out of my mask.

Rolled over and saw it was blowing at 16.

Er, oops.

My pressures have been EPAP = 6, MinIPAP = 10, and MaxIPAP = 14.

So, I turned it off, trotted up front here, and pulled up my manual, the super secret one. And went into set-up.

The PRS1s have a different way of stating the above settings, and if I understand them correctly, it's pressure support on top of the EPAP.

MinPS was set to 10 and MaxPS was set to 14.

Hmm, 6 + 10 = 16.

Ah.

So, I dialed the MinPS back to 4, and the MaxPS back to 8, which OUGHT to yield my old settings.

Off to go try it... I suppose I ought to call their emergency number. My new DME has an RT on duty 24/7, unlike the unlamented Apria, who were only available from about 9a to 5p, M-F.

But, since I can solve it myself... I think...

[JDS74]

Welcome to the 960 club.
You'll find it to be very responsive and sometimes acting within a single breathing cycle.
I don't know about your previous machine, but my 960 seems to be a little more sensitive to Hypopneas, at least in reporting them.

I think you'll love it. It is a great machine.

[tattooyu]

Kira!

How did it go? Did you get everything dialed in?

[Kiralynx]

Welcome to the 960 club.
You'll find it to be very responsive and sometimes acting within a single breathing cycle.
I don't know about your previous machine, but my 960 seems to be a little more sensitive to Hypopneas, at least in reporting them.

I think you'll love it. It is a great machine.

Yes, I think I do -- it's SO much quieter than my old one, https://www.cpap.com/productpage/bipap- ... -cpap.html, and I always thought my Beastie was pretty quiet!

I definitely noticed, when I pulled today's data into Sleepyhead, that it had picked up more hypopneas. And of course, Encore Viewer for my old machine didn't show CAs or VSs.

Haven't yet tested the data with Encore itself.

And I need to figure out how to print a daily or weekly report (similar to the 11 page Encore Viewer report, which contained summaries and then 7 days of detailed data) to PDF from Sleepyhead.

[Kiralynx]

Kira!

How did it go? Did you get everything dialed in?

Getting there! I was sure glad I had my Super Secret Manual last night, because the settings weren't right, and darn near blasted me out of bed. Didn't take much to get them re-set correctly. (ASV settings would confuse a saint, I think, let alone an RT who's used to straight CPAP, Bipap, or Auto!) And the mistake was one which could easily be made.

I have changed DMEs -- finally ditched Apria! -- and the difference in dealing with these folks was astounding. Apria never took less than 2-3 weeks to get ANYTHING in; these folks were apologizing because they didn't have my not-all-that-common 960 machine in stock!

I know you're due for a new machine... how's that going?

[tattooyu]

Kira!

How did it go? Did you get everything dialed in?

Getting there! I was sure glad I had my Super Secret Manual last night, because the settings weren't right, and darn near blasted me out of bed. Didn't take much to get them re-set correctly. (ASV settings would confuse a saint, I think, let alone an RT who's used to straight CPAP, Bipap, or Auto!) And the mistake was one which could easily be made.

I have changed DMEs -- finally ditched Apria! -- and the difference in dealing with these folks was astounding. Apria never took less than 2-3 weeks to get ANYTHING in; these folks were apologizing because they didn't have my not-all-that-common 960 machine in stock!

I know you're due for a new machine... how's that going?

Damn that Apria! I'm glad I haven't had to deal with them. I have a local DME here in Los Angeles who has been my guardian angel. (Thanks, Arthur!)

I'm waiting on a new authorization from my medical group (small group HMO) for my new machine. I just sent a follow-up to Arthur to see if he's heard anything. I'm curious to see if they are going to require a new sleep study.

EDIT: Just got an email from Arthur. Nothing from the medical group yet.

[Kiralynx]

Damn that Apria! I'm glad I haven't had to deal with them. I have a local DME here in Los Angeles who has been my guardian angel. (Thanks, Arthur!)

Apria never, in 5.5 years, took less than two hours to place an order. This did EVIL things to my blood pressure!

Inevitably, they would always call a week later to confirm that I really ordered what it took their operator two hours to grasp. They never got most orders correct. It typically took, as I said, 2 weeks, sometimes longer, to get the ordered items -- IF they will order them at all. (They repeatedly fought me over the Comfortlite 2 direct seal pillows, over the CL2 straps, over getting the Headrest mask and pillows, and flat out refused to get the Tap Pap mask.) My final straw with them was their refusal to provide a replacement part for one broken while I was traveling, when there was a Apria office less than 30 miles from my hotel, and I could have picked up the part easily.

Luckily, I had a spare at home, so once I got home, I was okay. And the new DME, even though I'd only purchased a few incidentals from them for cash, not only remembered my name, but what type of machine I used, AND had the parts I needed in stock so I could pick them up that day. They even had the humidifier chamber for my old machine IN STOCK. Apria took (you guessed it) two weeks to get one to me.

Also interesting is the way Apria overcharges. The humidifier chamber I got from them cost me $13.65 co-pay, and they collected $35.65 from our insurance. The new DME was half that.

I'm waiting on a new authorization from my medical group (small group HMO) for my new machine. I just sent a follow-up to Arthur to see if he's heard anything. I'm curious to see if they are going to require a new sleep study.

My insurance didn't require a new sleep study, for which I'm thankful. They just required a copy of the original ones -- both diagnostic and titration. Hopefully, that will be the case for yours.

I'm amazed at how much smaller the new machine is, and how much quieter!

[sawinglogz]

So, I dialed the MinPS back to 4, and the MaxPS back to 8, which OUGHT to yield my old settings.

Yup, that's right. Glad you figured it out so quickly!

See some of my previous posts for taming the 960 when it thinks it knows better than you do. In particular (1) the ramp button is great when you wake up and it's blowing at the top of its range and keeping you from going back to sleep, and (2) it seems to measure your breathing time by the gap between exhale and inhale. So if pressing the ramp button isn't enough to reassure it that you're still awake and breathing, and it's trying to make your breathe too fast, you can just exhale very slowly to keep a small pause between exhale and inhale. That seems to convince it that it's safe to let you slow down. After a few breaths like that it usually tracks my preferred breathing rate.

[JDS74]

Kira,

Have you checked the back up breathing rate?
If it is set to Auto, the problem of the machine forcing you to breath too fast pretty much goes away.
Sometimes the DME will set it to a number like 15 or so because it is not specified in the scrip.

Cheers

[Kiralynx]

Yup, that's right. Glad you figured it out so quickly!

See some of my previous posts for taming the 960 when it thinks it knows better than you do. In particular (1) the ramp button is great when you wake up and it's blowing at the top of its range and keeping you from going back to sleep, and (2) it seems to measure your breathing time by the gap between exhale and inhale. So if pressing the ramp button isn't enough to reassure it that you're still awake and breathing, and it's trying to make your breathe too fast, you can just exhale very slowly to keep a small pause between exhale and inhale. That seems to convince it that it's safe to let you slow down. After a few breaths like that it usually tracks my preferred breathing rate.

Actually, I've never really used the ramp -- because my EPAP is pretty low, anything lower was Suffocation City. So I don't even have the ramp set.

What was blowing me away was the fact that the settings were quite a bit higher than they should have been.

The RT set the MinPS to what my MinIPAP should have been and the MaxPS to what my MaxIPAP should have been, which meant the IPAP range was 6 cm above my normal. Once I corrected that, no problem. And I can't really blame her for the mistake -- if I hadn't been studying everything ASV on the board for the last 5.5 years, even if I didn't say much, I wouldn't have caught the change in the way they defined the settings -- 'cause when I set up my back-up machine, it had EPAP, MinIPAP and MaxIPAP as the settings, not EPAP, MinPS and MaxPS.

You're right about the slow exhalation reminding the machine that you aren't doing a sprint. My old Beastie responded to the same thing.

Have to go back and re-read your posts. There are rather more of us ASV users on here than there were in 2008!

[Kiralynx]

Have you checked the back up breathing rate?
If it is set to Auto, the problem of the machine forcing you to breath too fast pretty much goes away.
Sometimes the DME will set it to a number like 15 or so because it is not specified in the scrip.

It's set on Auto -- it was just the confusion between IPAP and PS. IPAP = EPAP + PS, not IPAP = EPAP + IPAP!

[JohnBFisher]

Sadly too many respiratory therapists have no clue on how to set up these devices. I also had to change the settings on any ASV unit I've received from my DME. Based on the price they SHOULD get it right. But they just don't deal with that many of these units.

[Sir NoddinOff]

Kiralynx (or anybody else for that matter): If you start to get that beeping just before you fall asleep or any other unwanted nighttime LOUD beeps that display no error message whatsoever, send me a PM and I'll tell you how to fix it in two minutes. Yes, the newer PR autoSV 960p machines do have that unwanted feature, as do the old 950 models. PR has built in a fix, however you have to know the trick AND you have to know how to safely do it. (that's the reason for the PM)

[Kiralynx]

Sadly too many respiratory therapists have no clue on how to set up these devices. I also had to change the settings on any ASV unit I've received from my DME. Based on the price they SHOULD get it right. But they just don't deal with that many of these units.

Too right -- when I got my old Beastie, the RT was knowledgeable enough to recognize that I needed it, and arranged for me to get it, but then didn't really know how to set it up. (Insurance wouldn't cover an ASV titration, though it covered the machine.)

Thanks to knowing that I needed data, and going over that data with her and with my doctor, we got things dialed in so it worked perfectly for me for 5.5 years.

I'm seriously grateful to Jedimark and others who provide things like software for us, and Super Secret Manuals so we CAN set things up to optimize our therapy!

[Kiralynx]

OK... my 960 is driving me nuts. Not, mind you, the pressure settings. Got those worked out okay. What IS driving me nuts is... the on/off switch!

One of the things I did when getting the settings for EPAP, MinIPAP and MaxIPAP rearranged was turn OFF the AutoOn setting.

I hate, hate, hate having to put on the mask and then suck air in through my nose, half-suffocating, while I wait for the machine to decide it really ought to turn on.

I figured maybe the reason the on/off switch wasn't working correctly was Autostart. But that didn't help.

My old Beastie just had an on/off switch on the side. I pushed it in, then pushed a button on top to turn on humidification.

This one seems to take a half-dozen tries before I can get it started, which is VERY annoying.

I like it... it's quite quiet -- but there's a big difference between QUIET and OFF!