Got an ASV machine to play with. What settings should I use?

[CPAPSteve]

hey folks,

I managed to get my paws on a new aircurve 10 ASV and wanted to know what settings should I be using treat plain old obstructive apnea?

I know this machine is way overkill for my basic needs but I get to play with it so I figured why not try it out.

I use an AirSense 10 auto set for her and my max pressure is set to wide open and I use an EPR of three. Minimum pressure is 11.8.

What would the equivalent settings be for an ASV machine and are there any dangers for an otherwise healthy person to try using ASV?

Just messing with some basic settings it feels like the ASV mode is quite smooth in my exhale and inhale and I can feel it varying the pressure constantly.

[klv329]

Everyone is different, and you didn't mention where your autoset titrated to cure your obstructive apneas, you just gave a min setting.



Well if 11.8 was the autoset pressure that cured my OA and given my need for ASV I would use ASVauto settings of epap min of 11.8, ps min of 1.6 and ps max of about 12, and maybe epap max of wide open.

You could also start epap min of 2 or 3 below 11.8 and count on the PS to handle obstructive apneas, but it might be a bumpier ride the lower the epap min. Min ps could be 0, too.


You could set it to CPAP mode and use a fixed pressure.

For ASV mode your only settings are fixed epap, min ps and max ps.

Have fun I guess. I wouldn't use ASV if I didn't need it.

[squid13]

You could also set it to the default settings and sleep one night with it in Auto ASV and see what your readings are.

[klv329]

ASV auto at the default settings, wow I tried that the first time and it was a rough ride but it was fun. Go for it!

[CPAPSteve]

My bad. My osa’s were treated typically with a pressure of around 12-14.

Right now the unit is set for ASV Auto but I haven’t tweaked any settings just yet.

Well the ASV unit was too hard to pass up to try so I thought what the heck why not

[Pugsy]

On apap....minimum of 11.6 and EPR of 3 gives you on inhale..11.6 and on exhale 8.6....so in bilevel terms your would be using EPAP 8.6 and IPAP 11.6 and max IPAP is whatever you set it to.

With bilevel machines you have to add PS to EPAP to get IPAP and with apap you subtract PS (exhale relief) to get minimum EPAP.

To make the same apap comparable settings on any bilevel machine you start with Minimum EPAP 8.6 and add PS of 3 so you get IPAP of 11.6.

I have actually done what you are doing and I didn't need ASV but it was so each to breathe with it that I just really liked it and used it for a couple of years just for the fun of it.
I actually let the machine have the room to do its thing too...it won't increase anything without a good reason. If another ASV fell out of the sky and landed in my yard tomorrow...I would do it again.

Without seeing any of your apap reports...and having used the S9 Adapt which is the older big brother of your machine...here's what I suggest you start with and then see what the reports look like tomorrow.
Auto SV mode
Minimum EPAP 8.0
PS minimum 4.0
PS maximum 10.0
Max EPAP 15 or that neighborhood
Max IPAP 25

With those settings you would have starting out....12 inhale...8 exhale and PS can roam a bit if it needs to and I like 4 PS better than 3 but you could use minimum of 3 if you want...and let the machine sort it out.
Or you could rein in the PS max if you want to but if you don't have centrals it won't kick PS in.
I found it would kick in some extra PS on a rare occasion when I was falling asleep so I assume a sleep onset central but it didn't do it very much during the night.

[CPAPSteve]

Hey Pugsy,

I have the following settings available in asv auto mode

Min epap 8.6
Max epap 15
Min ps 1
Max ps 16.4

There are no IPAP settings but I am assuming with ps that if you sum the epap and ps that is your ipap value correct?

Thanks

[Pugsy]

There are no IPAP settings but I am assuming with ps that if you sum the epap and ps that is your ipap value correct?

Correct. EPAP plus PS equals IPAP and I keep forgetting that with the auto mode there is no max IPAP but instead it's inferred by EPAP plus PS.
I have used both modes....fixed EPAP with auto adjusting PS and auto adjusting EPAP with auto PS.
I actually did well with either. I haven't used the AirCurve but used the S9 Adapt model. To my understanding other than maybe a few little bells and whistles your machine isn't all that different than what I used because the basic part of the auto algorithm wasn't ever changed.

EPR is a poor man's PS...limited to 3...so it's like 3 PS. I happen to think that people should at least try a little more PS just to see if they like it or not. I like 3 PS just fine...but I love PS of 4......so much that the last machine I got a few months ago when I stumbled on a good deal was the AirCurve 10 VAuto and the AirSense 10 AutoSet for Her got delegated to back up or travel status.
Just so I could use PS of 4...that's it.

Try different things....don't go over 6 PS minimum though unless we watch things really closely.
Have some fun. You might find that you don't need quite as much pressure with this machine because part of the auto adjusting algorithm is that it responds even a little more quicker than the AutoSet responds. So when fighting the Obstructive stuff that little bit of more quicker response might end up meaning a little less minimum can be used and still be effective.

Now there will be a lot of pressure changes....so you will know real quick if they bug you or not. I was never bothered by them myself. Never knew what it was doing during the night until I saw the report the next day.
On a rare occasion I would even see 22 cm briefly....it was all PS though so I would assume a random central happened and the machine hammered it. I never knew it though. I slept through all it did during the night.

Good luck and have fun. You really can't do anything that will hurt you unless you go wild and crazy with the PS minimum.

Heck...you could even use the factory default settings for one night just to see what happens. That's what I did and then made a very slight upward increase in the minimum EPAP. Then I went to PS min of 4 just because I love how easy it is for me to breathe with 4 PS. Matches my own respiration perfectly and I barely can tell I am even using the machine.

[CPAPSteve]

Well I managed to sleep a full 8+ hours using ASV Auto and I pleased to say I would rather use an ASV machine over a standard Autoset. The therapy is smoother and to me feels more natural. I though it “puffed” me once in the middle of the night. Really neat indeed.

I also noticed that despite my settings being lower (min epap at 8.6 with a PS set to 1.0 that when I woke it level settled the min epap setting to 11.0 and was merrily chugging along at around 12-13 ipap which what my autoset 10 would typically land.

The treatment quality is likely identical but the ASV just feels better from a natural breathing standpoint.

[Pugsy]

Now you know why I used it for years just because I liked how it felt.

[squid13]

To me that is why I like it so much is that it is so easy to breath with, it feels so natural.

[Cruiser1234]

ASV really is the future. I do envisage it to be the one machine which 98% of patients are prescribed.

[klv329]

Maybe put the breathing rate chart under the mask pressure chart I think it is and see if you have respiratory rate troughs (slower breathing means a degree of awakeness) that correspond with high PS applied....for m e that is the ASV smoothing out "my stutter breathing" transitional sleep crap that hurts my sleep cycles.

A jagged trough usually means I can remember waking up, but no recollection of awakening with smooth breathing rate troughs.

I couldn't figure out my problem until I saw what the ASV was doing and when, and was then able to correlate the troughs to the local fire rescue sirens after avoiding other disturbances like acid reflux and hip nerve damage.

Never had any measured CAs that would have indicated ASV was needed, but it solved my problem.

EPRof 3 on autoset for me created a subtle form of sleep deprivation that was obvious after 2 weeks, like walking and struggling to stay awake. A high PS min(>2) is bad for me, too. I tried a VAUTO and it was like sleeping inside a running dryer, a disaster.

Beware, I say, test carefully, never drive after testing new machines and settings, you could be one of the few, you could be one of "us", the disordered stuttering transitional sleep hose head zombies. Or not.

[zonker]

Beware, I say, test carefully, never drive after testing new machines and settings, you could be one of the few, you could be one of "us", the disordered stuttering transitional sleep hose head zombies. Or not.

shockedkoala.jpg

[palerider]

ASV really is the future. I do envisage it to be the one machine which 98% of patients are prescribed.

Nah, DMEs are too cheap.