My ASV settings vs. ABPAP settings?

I just got a series of sleep tests/titrations. I am about to get a new machine due to not tolerating CPAP and BPAP.
So after the tests I was recently given two options two consider.
ABPAP or ASV

However I am having trouble understanding the comparison of my two settings for the different machines. Does this make sense?
ABPAP set to:
Max IPAP 16, Min EPAP 9, PS 3
or
ASV set to:
max PS 9, min PS 3, EPAP 4

From my understanding my lowest allowed EPAP on ABPAP would be 9 and on ASV it would be 4.
I know these 2 machines have very different technology....
But why would my EPAP's be so different? It puzzles me. One of my conscious issues has been intolerance of exhaling against pressure.
Can anyone explain?

The ASV machine will respond so much more quickly than the regular bilevel machine or cpap/apap machine.
So it can be moving along at a lower EPAP (which will make it easier for you to exhale against) and still increase to where it needs to be to deal with the obstructive events.
If you still have trouble exhaling you might ask about increasing minimum PS from 3 to 4 as the greater the PS the easier it might be to exhale.

Pugsy wrote:The ASV machine will respond so much more quickly than the regular bilevel machine or cpap/apap machine.
So it can be moving along at a lower EPAP (which will make it easier for you to exhale against) and still increase to where it needs to be to deal with the obstructive events.
If you still have trouble exhaling you might ask about increasing minimum PS from 3 to 4 as the greater the PS the easier it might be to exhale.

to me, maybe the way to explain the difference to a relative newbie, between auto bilevel and asv is that the auto bilevel responds, over time, to an average of what you need, based on obstructive and other non-central events, raising pressure over a period of minutes.

the asv responds *per breath* to needs where you have reduced tidal volume, ON THAT BREATH, to treat primarily central apneas, forcing air into your lungs when you're not trying to breath on your own.

auto asv's can raise the pressure, much like the auto bilevel, in addition to that breath by breath monitoring, but their main function is maintaining a level of air flowing in and out of your lungs, even if you're not trying to breath.

(how's that?)

So I guess y'all are saying that these 2 settings that seem very different to me....could be comparable..(and not a mistake).... for the 2 different types of machines??
It just seemed strange to me that the EPAP would have been set so high on the ABPAP (when I have not been able to tolerate that high of a EPAP on a CPAP or BPAP)
I thought part of the reason for being on a ABPAP or ASV was the comfort and toleration.

Ada, Now you have two real experts, Pugsy and PailRider, helping you!

Do you mean an Auto BiPap (ABPAP??).
The two machines are quite different. ASV will detect and treat central apneas while the Auto BiPap will only detect them.
Both will treat plain obstructive apneas, hypopneas and so forth.
Unless you have a diagnosis of complex or central apnea, the added cost of the ASV machine might be difficult to justify. It will be more than twice as much.
If, on the other hand, only patient comfort and not cost is the issue, the ASV is the better choice as it will react much faster to apneic events. On the comfort side, the PR1 ASV can be more comfortable for folks who have issues with the feeling of the machine forcing a breathing cycle before one is ready.

ada wrote:So I guess y'all are saying that these 2 settings that seem very different to me....could be comparable..(and not a mistake).... for the 2 different types of machines??
It just seemed strange to me that the EPAP would have been set so high on the ABPAP (when I have not been able to tolerate that high of a EPAP on a CPAP or BPAP)
I thought part of the reason for being on a ABPAP or ASV was the comfort and toleration.

the reason for being on asv is because it steps in immediately when you have an central apnea event, and it increases pressure dramatically to fill your lungs, then drops it so you exhale. it performs as a ventilator, actually making you breath when you don't breath on your own.

an auto-bilevel machine does NOT do this, it just keeps your airway open, and adjusts to your average (not breath by breath) needs during the night.

bilevel is often selected because it can make higher pressures more comfortable by offering a greater pressure difference between inhaling and exhaling. so that even if you have a very high inhale pressure, it feels much easier to exhale by dropping the pressure on exhale more than a cpap can.

ada wrote:I just got a series of sleep tests/titrations. I am about to get a new machine due to not tolerating CPAP and BPAP.
So after the tests I was recently given two options two consider.
ABPAP or ASV

Gosh. I would think your sleep medical team would say one or the other is best for your situation. They saw you sleep in the lab, titrated you and I hope interviewed you about your problems with your first machine.

Experts, would you not think the medical team would make this recommendation and not "throw" it to the patient to decide? What are they getting paid to do?

you have not indicated if insurance is paying or this is out of pocket.

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Marvin

ada wrote:... I thought part of the reason for being on a ABPAP or ASV was the comfort and toleration. ...

Ugh! Your medical team should make a SPECIFIC recommendation based upon your symptoms. If you have central sleep apnea or some variant, such as complex (or mixed) sleep apnea, then you should have the ASV prescribed.

Let me make it clearer the difference in how the two machines work.

An ASV is one step before a ventilator. Instead of always attempting to breathe for you, it only jumps in when you fail to breathe (that's the TIDAL VOLUME thing). If you fail to breathe, it ramps the pressure up VERY quickly to help you sustain your respiration until your normal breathing kicks in once again. Until you need it again, it acts as a normal CPAP and/or BiPAP device.

If you don't have central sleep apnea, then you would find an ASV as a potentially a very annoying therapy. If you have problems where you fail to breathe, then you would find it a godsend and welcome the therapy.

But in my own opinion, your medical team should not prescribe it unless you have symptoms that require it. Ask them. If they remain vague, it's probably time to get a second opinion.

Just my 2 cents worth. That might be all it's worth, since I clearly don't know your needs.

Susie Kay wrote:Gosh. I would think your sleep medical team would say one or the other is best for your situation. They saw you sleep in the lab, titrated you and I hope interviewed you about your problems with your first machine.

Experts, would you not think the medical team would make this recommendation and not "throw" it to the patient to decide? What are they getting paid to do?

JohnBFisher wrote:But in my own opinion, your medical team should not prescribe it unless you have symptoms that require it. Ask them. If they remain vague, it's probably time to get a second opinion.

You both seem to be spot on. It seems outrageous than the medical team would leave this up to a patient to decide!!

JohnBFisher wrote:If you don't have central sleep apnea, then you would find an ASV as a potentially a very annoying therapy. If you have problems where you fail to breathe, then you would find it a godsend and welcome the therapy.

Ada, Have your medical team discussed your diagnosis with you so that you know whether your problems are central apneas, obstructive apneas or both? Do you have a copy of the summary of your sleep study and recommendations that you could post here for people like John to look at? (Tape over name and other identify info to protect your confidentiality.)