My First Machine (it's an ASV), Not Feeling Very Confident

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Rundgren
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Joined: Wed Oct 28, 2015 12:14 am

My First Machine (it's an ASV), Not Feeling Very Confident

Post by Rundgren » Mon Nov 30, 2015 1:51 am

This is my very first machine. During my titration study the doctor said I slept with the regular CPAP, but was having centrals that woke me up, so she prescribed an ASV machine which I just got the other day. I wish she would have started me on a regular CPAP, so that I could get used to it, but that wasn't the case. First I tried to take a nap with it, and it seems like as soon as I would start to doze off, the machine would think I was having a central, and give me a big blast which would wake me up. This happened a bunch of times. I realize that it could possibly be fixed by changing the BPM, however, later I tried to sleep with it and I couldn't even get comfortable enough to get to the point of dozing off. I adjusted the straps on my mask because it felt too tight, and from that point on, I could feel the mask kind of going in and out (like slightly collapsing and expanding) with each respiration. Also, I couldn't stop focusing on my breathing because it was like the machine wasn't quite in sync with it or something. And the noise bothers me too. Here are my settings:

Maximum Pressure: 20.0
Epap Minimum 10
Epap Maximum 10
PS Minimum 0
PS Maximum 10
BPM 10
TI 1.0
Flex type none
Rise time 2
Ramp 6
Humidity 3
Tube temperature 2

Off the bat, doesn't it seem that the Epap minimum should be lower? The way it's set, the pressure is constantly on 10 unless the machine thinks there is a central and then it blasts it up. Maybe it would be more comfortable if the constant pressure was lower until there was an apnea. Another thing is that I didn't/don't want a full mask, I want the nasal pillows, but the DME guy said that at these pressures I need a full mask. Anyway, thanks for any advice you can give.

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Additional Comments: REMstar BiPAP Auto SV Advanced
Last edited by Rundgren on Mon Nov 30, 2015 2:30 am, edited 1 time in total.

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zoocrewphoto
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Location: Seatac, WA

Re: My First Machine, Not Feeling Very Confident

Post by zoocrewphoto » Mon Nov 30, 2015 2:19 am

Welcome to the forum. I would suggest adding ASV to your subject line. Your type of machine is specialized and does have more issues to get used to. There are people here who will try to answer all posts about ASV machines since they know there aren't as many people to help with those.

I know I have seen your issue mentioned before and some advice with dealing with it. So, it is not unusual, and there should be some good advice coming along soon.

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Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
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Who would have thought it would be this challenging to sleep and breathe at the same time?

Rundgren
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Joined: Wed Oct 28, 2015 12:14 am

Re: My First Machine, Not Feeling Very Confident

Post by Rundgren » Mon Nov 30, 2015 2:27 am

Thank you, zoocrewphoto, I will.

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Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
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JDS74
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Location: South Carolina

Re: My First Machine (it's an ASV), Not Feeling Very Confident

Post by JDS74 » Mon Nov 30, 2015 4:58 am

Rundgren:

Welcome to the ASV club. We have the same machine. I've had mine for a couple of years now and I love it. As you can see, my pressures are higher than yours.

Here are my settings:
Min EPAP:_______________12.0
Max EPAP:_______________17.0
Min Pressure Support:______7.5
Max Pressure Support:_____13.0
Max Pressure:____________25.0
Flex Setting:______________1
Backup Rate:_____________Auto
Humidification Mode:______System One
Humidifier Setting:_________3
Ramp____________________Off


Looking at your settings, the BPM set to 10 may be part of the problem. Can you get to the clinician menu?
If so, you might try setting it to Auto so the machine can have a little more leeway in the breathing rate.

In the settings list, you show a Ramp of 6 (minutes) but no ramp time. What is the value? A higher one (20 minutes or so)may help the issue you are having with the machine jumping the pressure just as you are drifting off to sleep.

Setting the EPAP Max to the same as EPAP Min is odd. Generally, those values are different so that the machine algorithm has a little more flexibility. You settings look more like those for a ResMed machine so perhaps whoever decided on them was more familiar with that model than the Respironics one you have. That's the way I started out. My sleep doctor was completely unfamiliar with setting a Respironics ASV machine and provided parameters suitable for a ResMed machine. We got that sorted out and all is fine now.

Your pressures are not out of line with what people who use nasal masks experience. Depending on the mask, the max pressure would need to be quite a bit higher to make a nasal pillow mask unusable. If the DME's policy allows it, take the FFM back right away and insist on a nasal pillow mask if that is what you want. Be advised that there can be issues with a nasal mask with mouth breathing and therefore leaks. FFM's have less of that.

My machine came with a clinician manual. Some DME's include one, others don't.

It can take a while to get used to but it will come. Continue to ask questions. I and other ASV users will try to help.

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Mask: Oracle HC452 Oral CPAP Mask
Humidifier: DreamStation Heated Humidifier
Additional Comments: EverFlo Q 3.0 Liters O2 PR DSX900 ASV
Oracle 452 Lessons Learned Updated
DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
Sleepyhead and Encore Pro 2.21.

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Pugsy
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Re: My First Machine (it's an ASV), Not Feeling Very Confident

Post by Pugsy » Mon Nov 30, 2015 6:09 am

That old wives tale about people using higher pressures can't use a nasal pillow mask is nothing but bunk.
I see pressures to 22 every night and I use nothing be a nasal pillow mask.

Your EPAP at 10 with PS minimum of 0 might be more comfortable if you use a PS minimum of 2 or 3 or 4...

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M'ohms
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Re: My First Machine (it's an ASV), Not Feeling Very Confident

Post by M'ohms » Mon Nov 30, 2015 7:36 am

I agree with JDS. I use a Resmed when traveling and it forces me to breathe at a regular rate. This is hard to get used to. My 960 is a lot more flexible because the BPM is set to Auto. We don't breathe the same way all might long.

I also agree with Pugsy--a larger PS would be more natural.

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Mask: Quattro™ FX Full Face CPAP Mask with Headgear
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AutoSV 960 with heated hose. Settings: EPAP Min-12, EPAP Max-17, PS Min-5.5, PS Max-13, Max Pressure-25, Rate-Auto, Rise Time 1. Use Sleepyhead and Encore Pro.

Rundgren
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Re: My First Machine (it's an ASV), Not Feeling Very Confident

Post by Rundgren » Tue Dec 01, 2015 12:11 am

Thanks everyone for your help. I will set the BPM to auto. I called the DME about getting the nasal pillows and am waiting to hear back. I don't understand what the minimum PS does, but I will change it to 2 and see what happens. My ramp time is only 15 minutes, so I will change that to 20 or 25 minutes as well.

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Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Additional Comments: REMstar BiPAP Auto SV Advanced

JDS74
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Location: South Carolina

Re: My First Machine (it's an ASV), Not Feeling Very Confident

Post by JDS74 » Tue Dec 01, 2015 6:42 am

Minimum Pressure Support (PS Min) is the difference in pressure when first starting between the inhale pressure (IPAP) and the exhale pressure (EPAP). Unlike other types of CPAP machines, there is no direct setting for IPAP. The machine algorithm sets the EPAP to EPAP Min and the IPAP to EPAP Min + PS Min. It is a form of pressure relief that allows for the exhale effort to be less.

Over time, as your needs change during sleep, both the EPAP Min and PS Min can change to meet those needs but the difference remains. On Respironics ASV machines, they can change independently providing a variable pressure relief.

If a central apnea is detected, the machine starts ramping up the PS Min until patient initiated respirations resume or Max Pressure is attained. This difference is how the ventilator mode is implemented. That's why its important to maintain a significant difference between EPAP Min and PS Max / Max pressure. The higher pressure inflates the lungs while the much lower pressure allows the lungs to deflate and provide the necessary air flow. On my machine, I make sure that this difference is never less than 10 cm H2O. My longest period in this mode was just over 3 hours during which time I didn't initiate a breath.

_________________
Mask: Oracle HC452 Oral CPAP Mask
Humidifier: DreamStation Heated Humidifier
Additional Comments: EverFlo Q 3.0 Liters O2 PR DSX900 ASV
Oracle 452 Lessons Learned Updated
DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
Sleepyhead and Encore Pro 2.21.

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archangle
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Re: My First Machine (it's an ASV), Not Feeling Very Confident

Post by archangle » Tue Dec 01, 2015 9:17 am

Apart from tweaking the settings, I think many ASV users find their brain fights the machine for days or weeks, but eventually gives up and ASV becomes comfortable.

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Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Also SleepyHead, PRS1 Auto, Respironics Auto M series, Legacy Auto, and Legacy Plus
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