Bipap vs ASV

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Bipap vs ASV

Post by USMCVet » Mon Jan 22, 2018 6:19 pm

What's the difference? I was told either one might be in my future. I mentioned that I thought asv was for centrals and I haven't had one but was told we won't know until my titration.

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Re: Bipap vs ASV

Post by Josiah » Mon Jan 22, 2018 6:43 pm

This is a link Jay Aitchsee sent me

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629962/
Josiah

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Re: Bipap vs ASV

Post by USMCVet » Mon Jan 22, 2018 6:47 pm

Josiah wrote:This is a link Jay Aitchsee sent me

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629962/
Thank you I will check it out

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Re: Bipap vs ASV

Post by Pugsy » Mon Jan 22, 2018 6:55 pm

There are many different bilevel models that do different things.
Some with a back up rates and some without. The ones with back up rates some back up rates are manually set and some models it will auto adjust.
ASV is a back up rate capable machine that will auto adjust...
There are also bilevel machines with back up rates but they don't auto adjust the pressures as need.

It's the back up rate that is important when people are having central apneas numerous enough to be a problem....when they aren't breathing on their own. If you don't breathe because of a central the machine will force you to breathe if you drop below the back up rate that has been set.

Sometimes ASV machines might be used for targeting a specific ventilation if the person needs helps. That might be what they are looking at for you maybe...I dunno for sure. You aren't having centrals numerous enough to be I problem I don't think. They might be looking to see if targeting the volume of air moved or ventilation as a way to increase O2.

Here's the current ResMed list of bilevel models. Respironics has similar models but I don't have a link that has all the models clearly shown

https://www.resmed.com/us/en/consumer/p ... entilation

ASV is a bipap (Respironics marketing term for a bilevel machine) but not all BiPaps/bilevels are ASV capable or back up rate capable.
Some bipaps are pretty much a cpap/apap machine with greater options in pressure support (the difference between inhale and exhale) that the regular cpap/apaps don't have.

BiPap has sort of become a generic term for all bilevel machines but in reality it's a Respironics marketing term for their bilevel machines of which they have several models. ResMed doesn't use the term "bipap".

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Re: Bipap vs ASV

Post by USMCVet » Mon Jan 22, 2018 7:05 pm

Thanks pugsy! On my original sleep study I had 0 centrals, I may have had a few total according to my data since then but pretty much nothing.
I feel like I breathe shallow in general but don't think my data confirms it. I hope a Bilevel machine makes me right as rain but I don't think it will.
My back up plan is it oxygen makes me feel even 70% of normal to work hard to build up fitness to get off oxygen.
I'm just not sure why she even mentioned asv.

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Re: Bipap vs ASV

Post by Pugsy » Mon Jan 22, 2018 7:21 pm

I don't know what they were thinking about ASV either but there's probably a plan there somewhere that they might want to try and see if it helps.
Ideally they need to find out first what is really causing the O2 and then structure a plan.
You have low O2 to some extent during the day too so I would want to make every effort to make sure nothing else is going on before I try to fix it with bilevel (if it even fixes it).

There's so much potential stuff going on with you that it isn't easy to say "you just need this"...or I wouldn't be happy with that approach.
If it is just shallow breathing for some reason then targeting the amount of air moving and forcing you to breathe more deeply might just work...I dunno because at this point we don't have a clue why you are having the low O2.
If they do determine it is a hypo ventilation thing...then one of those other bilevels that can really push the air might be more suitable than the ASV.

I don't see centrals as being the problem and I don't see OAs or hyponeas being the problem either. Something else is going on I think...and I would want to rule it out before applying any bandaid long term whether it be O2 or a bilevel machine of some sort.

You need to see a real for sure good pulmonologist and start there for long term diagnosis and figuring out the why this is going on.
Then you and your doc decide which bandaid is the best bandaid long term IF you need one long term.

You aren't obese are you? I don't remember.

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Re: Bipap vs ASV

Post by USMCVet » Mon Jan 22, 2018 7:38 pm

Obese but not horrible imo. 5'11 at 230 lbs. Could definitely lose weight but so could most of America. I had lung function test done in military, you know the breathe into tube and let's give you inhaler to see if it makes a difference which it didn't so they could find those results as baseline. One thing I've noticed is that when I start doing strenuous exercise it usually gets easier after and hour or so.

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Re: Bipap vs ASV

Post by Pugsy » Mon Jan 22, 2018 7:47 pm

That's not horribly obese. I was thinking more along the lines of so obese that the lungs are squished by fat.
Not unusual to have people who are hugely obese with some sort of hypo ventilation thing because the fat limits lung function.
430 lbs...that sort of thing. You are a long way from that.
It was just a thought that went flying through my head.

Did you ever try increasing that minimum pressure from 6 just to see if it helped with the O2 levels or not?
While I have my doubts as to whether it would do anything or not...I can be wrong and actually would be very happy if I was.
It's free...you already have the pulse ox and wouldn't hurt anything to try it at least one night.

Maybe even make your current machine as close to of a bilevel as it is possible with maximum Flex setting..something to try while waiting for the other stuff to get rolling.
Like maybe minimum of 9 or 10 with Flex at 3. Just an experiment to try while waiting for the hurdles to be overcome.

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Re: Bipap vs ASV

Post by USMCVet » Mon Jan 22, 2018 7:55 pm

I have it on flex of 3 already and average pressure is 8 already so I get the full benefits of the flex without benefit. I just want to lay low until March when Dr. Death is gone lol. My RT warned me not to let her find out I changed my settings.
Hypoventilation is slow breathing right? If anything my breathing was faster then it has been which should of raised 02 correct?
Here if the night of my oximetry test

https://imgur.com/a/xdQmh

The other consistent Thing I've noticed is usually my oxygen is lower in beginning of night when I'm out, but second half I wake up a good amount and oxygen is usually better then.

Will be nice for titration study though to get more data points.

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Re: Bipap vs ASV

Post by Pugsy » Mon Jan 22, 2018 8:11 pm

Hypo can be slow or shallow or both I think. I admit that this is an area that I don't know much about.
https://en.wikipedia.org/wiki/Hypoventilation
I tend to read up on stuff that I or someone I know experience...or it just interests me and to be honest there's a whole lot about hypo ventilation that I don't understand. This is an area that I pretty much just know the bare bones basics and anytime someone has any potential lung issue going on...I don't really try to do much second guessing and instead prefer to advocate "see a pulmonologist" type of thing. Some things I just think people should go directly to the doctor...eyes, ears, lungs, heart...etc. Make sure nothing serious is going on then we can play with cpap and see what happens.

I don't see the small number of flagged events being the cause of your problem...I just don't see it.
Now I could be wrong.
Maybe in combination with something else which by itself wouldn't be that big of a deal. So maybe each separately not that big of a deal but add them together more of a problem.
The fact that your daytime O2 levels still tend to run lower than what someone your age would normally see..that bugs the crap out of me.

If you were my husband, son, family member...you would be seeing a pulmonologist sooner than later.

I understand if you don't want to play with cpap right now due to Dr Death...while I would likely just tell him to go screw himself...I can understand if you don't want to do what I would do. I am not always the best person to emulate.

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Re: Bipap vs ASV

Post by USMCVet » Mon Jan 22, 2018 8:17 pm

The VA had secret boards apparently for doctors to basically complain about patients and you don't know until they come to a decision and tell you to respond. Not to sure about that whole thing but prefer not to find out lol.

I don't think Bipap will help but hope I'm wrong. I have left over Albuterol inhaler from bronchitis or something that didn't seem to help 02 either.

Recent chest x Ray's that showed nothing. Pulmonologist will have their work cut out for them lol

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Re: Bipap vs ASV

Post by Pugsy » Mon Jan 22, 2018 8:25 pm

There's a whole lot more involved in a real lung evaluation than just an x ray and a spirometry test.
Now getting it done at the VA...I am not feeling so warm and fuzzy about that one.

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Re: Bipap vs ASV

Post by USMCVet » Mon Jan 22, 2018 8:35 pm

If I've proven anything knowledge and unrelenting annoyance gets things done lol. I'm a former smoker who hasn't smoked in 2+ years. Exposed to asbestos in military over 10 years ago. Bronchitis before I was 1 and phnemonia before I was 2. Related? Who knows. What I'm most excited to see is if my hypertension improves with oxygen. I have had hypertension since military so if it improves that would be great since I have never had it under control. Father got off meds for it when he lost weight but I had it when in ideal weight range.
Forums are great for sharing knowledge and experiences. They call it practicing medicine for a reason. They don't know everything ( heard that a lot from doctors lol) .

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Re: Bipap vs ASV

Post by USMCVet » Mon Jan 22, 2018 8:39 pm

Who knows how I'll feel on oxygen ( will know tomorrow) but when I felt lightheaded and dizzy today my 02 was higher then normal.

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Re: Bipap vs ASV

Post by ajack » Tue Jan 23, 2018 1:04 am

You won't come home with an ASV, it's not what you have. Your brain is telling yourself to breathe.
page 35 of the guide, not the page count..is what they are going to do to you to start with.
https://www.scribd.com/document/3534028 ... -Titration

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