Optimizing S9 VPAP Adapt (ASV)

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Papit
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Optimizing S9 VPAP Adapt (ASV)

Post by Papit » Sun Mar 29, 2015 8:00 pm

Hi S9 VPAP Adapt users. I'm using ResMed's model #36037 VPAP Adapt in the ASV mode with good results for well over a year now. This model has three operating modes: CPAP, ASV and ASV Auto. I'd like to experiment with the ASV Auto mode. My lab tests indicated that an EPAP setting of 7 should give me good treatment.

Based on my doc's PS recommendations and making adjustments only to EPAP,
my best machine settings in the ASV mode have been:
EPAP 6.8, IPAP 16.8 Max
PS Min 2, PS Max 10

After switching to the ASV Auto mode, I notice the
Machine Default settings are:
EPAP Min 4, EPAP Max 15
PS Min 3, PS Max 15

How would you go about making adjustments to optimize treatment?

I will be monitoring AHI, HI and Flow Limitations. Anything else I should be watching?
My typical numbers have been AHI = 0.1 to 2.0, HI = 0.1 to 2.0 (My usual AI is close to zero.)
My detailed Flow Limitations graphs show 20 to 50 full scale spikes (Y=1.0) and more spikes at 0.5 or higher.
Thanks.

_________________
Mask: DreamWear Nasal CPAP Mask with Headgear
Additional Comments: Machine: AirCurve 10 ASV (37043), Software:ResScan 5.7.0.9477, SleepyHead V1.00BETA2, Oximeter:CMS-50i
Machine: AirCurve 10 ASV, Mask: AirFit N30i
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robysue
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Re: Optimizing S9 VPAP Adapt (ASV)

Post by robysue » Sun Mar 29, 2015 8:38 pm

Papit,

You write:
I'd like to experiment with the ASV Auto mode.
...
How would you go about making adjustments to optimize treatment?

I will be monitoring AHI, HI and Flow Limitations. Anything else I should be watching?
My typical numbers have been AHI = 0.1 to 2.0, HI = 0.1 to 2.0 (My usual AI is close to zero.)
My detailed Flow Limitations graphs show 20 to 50 full scale spikes (Y=1.0) and more spikes at 0.5 or higher.
Thanks.
My first question is: What do you want to accomplish by switching from ASV non-auto to ASV Auto? How are you feeling in terms of sleeping well, waking up rested and refreshed, and having enough energy to get through the day without problems? Do you have any residual symptoms that you're dealing with in spite of your good AHI data?

There's not much room for improvement in terms of the AHI and HI, and the question is whether there's any reason to believe that the spikes on the flow limitation graph are significant and/or will respond to additional pressure.

But if you really do want to experiment with ASV Auto, I'd suggest that you start with settings that are not too far away from what you already know works in the ASV non-auto mode.

As I recall the main difference between ASV and ASV Auto is that ASV has a fixed EPAP value while ASV Auto adjusts the EPAP based on what kind of obstructive events are being recorded. So I'd keep the EPAP in a pretty tight range at least at the start.

You write this about your current settings and lab results:
Papit wrote:My lab tests indicated that an EPAP setting of 7 should give me good treatment.

Based on my doc's PS recommendations and making adjustments only to EPAP,
my best machine settings in the ASV mode have been:
EPAP 6.8, IPAP 16.8 Max
PS Min 2, PS Max 10
The default settings in ASV Auto are:
After switching to the ASV Auto mode, I notice the
Machine Default settings are:
EPAP Min 4, EPAP Max 15
PS Min 3, PS Max 15
I think you need to tighten the EPAP range to something not far from what you have found to be working in ASV non-auto mode. I'd suggest starting with something like a min EPAP somewhere between 6 and 6.8 and a max EPAP somewhere between 7 and 8. Exactly what EPAP range to use is going to depend on what you are trying to accomplish with the switch to ASV Auto.

Once you have the min EPAP and max EPAP settings chosen, you will then need to change the default PS settings so that they also behave close to your current settings. The min PS setting is easy: You should use min PS = 2 just like your current min PS setting.

The max PS setting is going to require a bit more thought. The max PS setting indirectly controls the max IPAP setting in ASV Auto. As I recall, in ASV Auto, the max IPAP = max EPAP + max PS. In the default settings that would theoretically allow the machine to increase your EPAP to 15 and increase your max PS = 15, which would lead to a max IPAP = 30, which is far, far greater than you current max IPAP = 16.8.

You'll need to make a choice: Is it more important to keep the max IPAP to your current level of 16.8 or is it more important to keep your max PS = 15?

If it's important to limit max IPAP = 16.8, then you need to adjust max PS so that max EPAP + max PS = 16.8. In other words, if you set max EPAP = 7, you'd want max PS = 9.8; but if set max EPAP = 8, then you'd need to set max PS = 8.8.

On the other hand if it's important to maintain a max PS = 10, then you'll have to tolerate a bit more IPAP pressure when the machine is operating at the extreme upper end of the pressure ranges: If max EPAP = 8 and max PS = 10, then it is possible that you might see IPAP pressures as 18cm.

Personally I don't see any need to increase the max PS beyond your current max PS = 10 because that could lead to significantly more IPAP pressure than you really need.

_________________
Machine: DreamStation BiPAP® Auto Machine
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Additional Comments: PR System DreamStation and Humidifier. Max IPAP = 9, Min EPAP=4, Rise time setting = 3, minPS = 3, maxPS=5

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Papit
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Re: Optimizing S9 VPAP Adapt (ASV)

Post by Papit » Sun Mar 29, 2015 11:25 pm

robysue wrote:Papit,

You write:
I'd like to experiment with the ASV Auto mode.
...
How would you go about making adjustments to optimize treatment?

I will be monitoring AHI, HI and Flow Limitations. Anything else I should be watching?
My typical numbers have been AHI = 0.1 to 2.0, HI = 0.1 to 2.0 (My usual AI is close to zero.)
My detailed Flow Limitations graphs show 20 to 50 full scale spikes (Y=1.0) and more spikes at 0.5 or higher.
Thanks.
My first question is: What do you want to accomplish by switching from ASV non-auto to ASV Auto? How are you feeling in terms of sleeping well, waking up rested and refreshed, and having enough energy to get through the day without problems? Do you have any residual symptoms that you're dealing with in spite of your good AHI data?

There's not much room for improvement in terms of the AHI and HI, and the question is whether there's any reason to believe that the spikes on the flow limitation graph are significant and/or will respond to additional pressure.
. . .
hi robysue,
In answer to your questions: I'm one of those xpap patients who unfortunately has not felt refreshed by either CPAP or ASV treatment, even though my S9 VPAP Adapt in the non-Auto ASV mode has done an amazing job of ridding me of virtually all AI (both obstructive and, finally, the centrals as well); leaving me with some low level Hypopnea and a lot of very high Flow Limitation spikes on the graph. And so I keep on looking for possibilities, grateful as I am for the dramatic improvements in my night time breathing health.

: I don't know whether the detail graph Flow Limitation spikes are meaningful or not. They might well simply be artifacts of what is already being treated. Who knows? But there they are. Squid tells me he's using the same machine and by switching from ASV non-Auto mode to ASV Auto, he saw a significant reduction in the amount of high Flow Limitations on his detailed graph -- AND he feels better. So that gives me some hope. Even if changing to the Auto mode removes the FL spikes for me, it remains to be seen whether these changes in treatment settings will leave me more alert and refreshed. We'll see.

Thank you for your guidance in how to proceed. I can see you thought through your instructions carefully and they make good sense.

I wonder: Are there others here who first used the non-Auto straight ASV mode who experienced lots of high Flow Limitations and saw them disappear or get reduced by switching to the ASV Auto mode???? Also, is there anything else I should be monitoring as I optimize new settings in the Auto mode?

_________________
Mask: DreamWear Nasal CPAP Mask with Headgear
Additional Comments: Machine: AirCurve 10 ASV (37043), Software:ResScan 5.7.0.9477, SleepyHead V1.00BETA2, Oximeter:CMS-50i
Last edited by Papit on Sun Mar 29, 2015 11:31 pm, edited 1 time in total.
Machine: AirCurve 10 ASV, Mask: AirFit N30i
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palerider
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Re: Optimizing S9 VPAP Adapt (ASV)

Post by palerider » Sun Mar 29, 2015 11:29 pm

Papit wrote: I wonder: Are there others here who first used the non-Auto staright ASV mode who experienced lots of high Flow Limitations and saw them disappear or get reduced by switching to the ASV Auto mode????
the very high spiky FL chart is something that seems common to the adapt, I've seen it lots.

increased pressures will sometimes tame them... but it depends on where they're coming from.

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JV1967
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Re: Optimizing S9 VPAP Adapt (ASV)

Post by JV1967 » Mon Mar 30, 2015 8:14 am

OT, but Papit, your kitty is so cute.
AirCurve10 ASV Bilevel, with Humidifier. F&P Simplus FFM. Using Sleepyhead software.

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STL Mark
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Re: Optimizing S9 VPAP Adapt (ASV)

Post by STL Mark » Mon Mar 30, 2015 8:57 am

I would try the machine at the defaults with ASVAUTO for a night and see what the data looks like and how you feel the next morning.

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Mask: AirFit™ F10 Full Face Mask with Headgear
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Additional Comments: Machine: S9 VPAP Adapt (eASV) 36037

Mode: ASVAuto, Min EPAP: 4, Max EPAP: 15, Min PS: 3, Max PS: 15, Ramp: Off - Original Titration: 18

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Papit
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Re: Optimizing S9 VPAP Adapt (ASV)

Post by Papit » Mon Mar 30, 2015 2:22 pm

STL Mark wrote:I would try the machine at the defaults with ASVAUTO for a night and see what the data looks like and how you feel the next morning.
Hi, STL Mark. I notice you let your machine remain in the ASV Auto mode's default settings, or perhaps you returned to those defaults after experimenting with others. Matter of fact, last night I tried those settings (EPAP Min 4, EPAP Max 15; PS Min 3, PS Max 15). The results this morning after 9 hours' sleep are a typical AHI=1.02 with 29 full height (y=1.0) Flow Limitation spikes on the detailed graph. Here's SH's breakout:
Large Leak 0.00%
Clear Airway 0.00
Unclassified Apnea 0.11
Obstructive 0.00
Hypopnea 0.91

The machine settings verified by SH were:
Mode ASVAuto
Min EPAP Lower Expiratory Pressure 5 cmH2O (vs. the default setting of 4), hmmm.
Max EPAP Higher Expiratory Pressure 15 cmH2O
Min IPAP Lower Inspiratory Pressure 8 cmH2O
Max IPAP Higher Inspiratory Pressure 31 cmH2O (vs. a design-limited blowing output of 25 cmH2O), hmmm.
PS Min Pressure Support Minimum 3 cmH2O
PS Max Pressure Support Maximum 16 cmH2O (vs. the default setting of 15), hmmm.

Here are SH's Statistics:
Channel. . . Min . Med 95% Max
EPAP Expiratory Pressure (cmH2O)
W-Avg:5.14 4.06 5.22 5.92 6.50
IPAPInspiratory Pressure (cmH2O)
W-Avg:10.82 4.40 9.84 17.48 21.50
Minute Vent.Amount of air displaced per minute (L/min)
W-Avg:6.84 0.00 6.25 9.75 30.00
Resp. Rate Rate of breaths per minute (Breaths/min)
W-Avg:11.83 0.00 12.20 14.60 21.00
Flow Limit.Graph showing severity of flow limitations (Severity (0-1))
W-Avg:0.02 0.00 0.00 0.00 1.00
Leak RateRate of detected mask leakage (L/min)
W-Avg:4.10 0.00 3.60 10.80 38.40
SnoreGraph displaying snore volume (?)
W-Avg:0.00 0.00 0.00 0.04 0.10
Insp. TimeTime taken to breathe in (Seconds)
W-Avg:1.95 0.00 1.78 2.76 8.42
Exp. TimeTime taken to breathe out (Seconds)
W-Avg:3.25 0.00 3.06 4.84 8.92
Target Vent.Target Minute Ventilation? (L/min)
W-Avg:5.97 4.00 5.62 7.75 10.38
Tidal VolumeAmount of air displaced per breath (ml)
W-Avg:597.24 0.00 500.00 1080.00 2480.00
Total time in apnea 00:02:36
Time over leak redline 0.000%

While I still do not feel "refreshed" or more alert, if I gave the machine a week or two in this mode and at these settings maybe it would work its 'magic' on me. After I try some other experimental settings I intend to do just that.

_________________
Mask: DreamWear Nasal CPAP Mask with Headgear
Additional Comments: Machine: AirCurve 10 ASV (37043), Software:ResScan 5.7.0.9477, SleepyHead V1.00BETA2, Oximeter:CMS-50i
Machine: AirCurve 10 ASV, Mask: AirFit N30i
PulseOx Data-transfer to OSCAR4-23-12http://tinyurl.com/nzd64gu
Wireless SD Card Data-transfer to OSCAR 8-14-15http://tiny.cc/z1kv8x