Question for ASV users

[SirGaspAlot]

I just got my Dreamstation ASV today, my wife signed for it while I was at work. I have no seen any before and after examples of centrals and hypopnias on a report, id be curious to see that. Also, Ive heard it can be an extensive adjustment time getting used to these things, what are some things to expect and/or any advice you could offer? Thanks in advance.

[Rhodesie]

We switched my husband to an ASV machine in August after about 4 months on a APAP machine. We purchased the Resmed version. He loved the ASV machine as it adjusted with each breath. The first night his AHI was 1.2. His usual AHI on the APAP was around 20. He has used the ASV for 2 months and loves the machine. Most nights he is around 0.2-0.6 AHI. The hyponeas that he still has are clustered around waking so we are not concerned about them. He is set on the auto mode but we did limit the pressure support so that his ipap doesn't go too high as anything over pressure of 13 causes huge mask leaks for him.

[SirGaspAlot]

Thanks. I was wondering, will Sleepyhead ever work with it? I noticed it says its currently not compatible.

[Pugsy]

Mark was working on an updated version that was supposed to work with it but as of yet that version has not been officially released.
Now there was a snapshot version that people could get and try and you could try that if you could find it and install it.
I tried it and I couldn't get it to work but maybe I was doing something wrong.
I will see if I can still find the link in a bit or you can send prodigyplace a note as I think he was in on it.
See what he says here.
viewtopic.php?f=1&t=172912&p=1267910#p1267910

Otherwise Encore Pro from the apneaboard.

[JDS74]

I'm using a DreamStation ASV and use Encore Pro on Windows 10.
For a while, it wouldn't load onto Windows 10 but the current version with the latest updates works just fine.
Encore Pro also works on my Windows 7 system.


As to difficulties adapting to the ASV machine, the parameters that need to be set are more complex than those of either the ResMed ASV or any brand of Bi-Level machines such as the Series 60 Respironics Auto BiPap.
Does your doctor have patients using PR machines? If they usually deal in ResMed machines you're going to need a little help in setting the parameters on your machine. If that's the case, PM me with the prescription settings and I'll see if I can help translate them to PR speak.
Here are my settings:

Device Settings as of 10/12/2018
ASV - Bi-Flex
Max Pressure__________ 15 cmH2O
Min EPAP ______________8 cmH2O
Max EPAP _____________13 cmH2O
Min Pressure Support ____2 cmH2O
Max Pressure Support____7 cmH2O
Breath Rate _______________Auto
Opti-Start __________________Off
Bi-Flex Setting ________________1
Auto On ____________________On
View Optional Screens ________On
Ramp Type _________________Off

My setting are a little odd as the pressures are reduced from what is optimum for me because my doctors feel the need to protect my lungs from recurrence of a severe pneumothorax I had back in June. BTW I don't recommend one as the pain was really excruciating while it happened and while the ER docs were inserting the chest tube to get my lung re-inflated from completely collapsed.

Notice the the ASV doesn't have and Auto Off like other auto machines do. You don't want the machine to turn off during a central apnea - you want it to treat it. Similarly, Breath rate is set to Auto so the machine can account for normal variations in your sleeping breath rate and help keep from forcing you to breathe when you are just breathing slowly.

Welcome to the ASV club. Any help I can give, please don't hesitate to ask.

[SirGaspAlot]

Thanks to all. I did (after much anxiety and fidgeting) manage to get encore pro 2 up and working, seems like my hypopnias acted up a bit but the Centrals and Obstructives dropped like a rock. My average was 4.8 AHI made up mostly of hypopnias which made up 4.3 of it.
Settings:
Max Pressure: 25 cmH20
MIN EPAP: 4 cmH20
MAX EPAP: 10 cmH20
MIN PRESS SUPPORT: 4 cmH20, MAX: 6 cmH20
BREATH RATE: AUTO
OPTI START: OFF
AUTO ON: OFF
RAMP TYPE: LINEAR
RAMP TIME : 25 MINUTES
RAMP START PRESSURE 4 cmH20
MASK RESISTANCE LOCK: OFF
TUBING TYPE : OFF
TUBING TYPE LOCK: OFF
DISCONNECT ALARM: OFF
APNEA ALARM: OFF
LOW MINUTE VENT ALARM: OFF

[SirGaspAlot]

Biflex setting was 3. Missed that.

[TahoeGal]

Welcome. I’ve been on resmed asv adapt for 5 years, and got an air curve 10 this fall. I never used anything else. I didn’t have any trouble whatsoever getting used to it-save the mask search. I have never been woken up by the pressures. Only mask leaks.

[SirGaspAlot]

Perfect- thank you, works so much better than Encore. My Win-10 computer didnt even flinch. Thanks so much.

Mark was working on an updated version that was supposed to work with it but as of yet that version has not been officially released.
Now there was a snapshot version that people could get and try and you could try that if you could find it and install it.
I tried it and I couldn't get it to work but maybe I was doing something wrong.
I will see if I can still find the link in a bit or you can send prodigyplace a note as I think he was in on it.
See what he says here.
viewtopic.php?f=1&t=172912&p=1267910#p1267910

Otherwise Encore Pro from the apneaboard.

[SirGaspAlot]

So I have a question about all this, will hypopnias calm down over time? It seems like the obstructives and centrals dropped to below 1, but hypopnias are now making up most of the events, my AHI was 7.58 last night which was recorded as mostly hypopnias and some PBs. Will this level out?

[Jas_williams]

The Hypopneas are likely to be Untreated OA's or CA's without looking at the flow graphs it's difficult to know if the hypopnoeas are OA based the more EPAP pressure needed if they are CA based then more pressure support is needed. I use a resmed machine which settings are much simpler but that is the basis of settings. With graphs we can hopefully help advise

[SirGaspAlot]

OCT 13th numbers.jpg (544.94 KiB) Viewed 1174 times

[SirGaspAlot]

And PB events for those interested.

[Pugsy]

My first suspect would be PS max limit might be a suspect.
There's not much range in the PS and if it will only go to 6 and max EPAP is 10 the the most IPAP you can get is 12 (when PS is 4) or up to 18 (when PS is 12).
Second suspect would be max EPAP tying the machine's little hands so it can deal with the obstructives well.

See this document
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf

From your report...with the snores...I tend to lean towards obstructive for those hyponeas because we don't usually snore with centrals.

Did they put you on this because of centrals? PS of 6 isn't going to do much for centrals is why I asked.

[SirGaspAlot]

Yes, it was centrals and hypopnias causing problems. Most of my numbers were directed at those. Now it seems theyve resolved the centrals and obstructives but the hypopnias are up. I dont understand how the unmbers play against one another, im not savvy on all that, but i do notice i snore more and the pressure seems less than the Bipap machine was, but it had been jacked up to 6 cmH20 minimum with no ramp and now it seems its back to the original 4 cmH20.

My first suspect would be PS max limit might be a suspect.
There's not much range in the PS and if it will only go to 6 and max EPAP is 10 the the most IPAP you can get is 12 (when PS is 4) or up to 18 (when PS is 12).
Second suspect would be max EPAP tying the machine's little hands so it can deal with the obstructives well.

See this document
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf

From your report...with the snores...I tend to lean towards obstructive for those hyponeas because we don't usually snore with centrals.

Did they put you on this because of centrals? PS of 6 isn't going to do much for centrals is why I asked.