ASV help/question...

[Zzzzzzzzzzz...]

As some of you may know, I just "worked my way up" to an ASV machine (Bipap AutoSV Advanced) last week. My settings are:

Min EPAP: 5.0
Max EPAP: 15.0
Min PS: 0
Max PS: 20.0
Max Press: 25.0
Backup Rate: Auto
Flex Setting 2

I know I need to be patient, but I don't see my sleep doc for another couple weeks and my AHI hasn't been stellar. I was hoping for the magic bullet. Oddly enough, I've never had issues with hypopneas in the past on CPAP or APAP (at home anyway) but now the majority of my AHIs (which have been 13, 3.5, 5.45, 6.97 and 4.69) are Hypopneas. My CA's and everything else are down to less than 1 consistently. What could be the cause of the sudden onset of hypopneas? I've noticed some leaks, but aside from that everything's been pretty consistent. I'm trying to be patient, but wondering if there's a tweak I can make to see if my numbers go down, because frankly, the only morning I've woken up feeling good is after the 3.5 night. Which was comprised of 3.23 Hypopneas. But I was tired later in the day. As usual. Perhaps the unit is simply causing more fragmentation as well and I need to adjust more to it.
My settings seem pretty wide open, which is why I ask if there's some wiggle room in there to help correct something between now and when I see my doc. As always, thanks in advance for any advice.

Z

[flocof]

Hi there, I am not experienced but I have also recently been put on and ASV machine and at first the Hospital put me on the same machine as you and I had the same problems with hypopneas, and low other apneas....I then trialled the Resmed s9 ASV adapt and have had no problems with hypopneas, and my numbers are usually below two with some below 1. Not sure if the change of machine had anything to do with it, or I just got used to the ASV machine....
Maybe someone more experienced than me can help you?

[Zzzzzzzzzzz...]

Hi there, I am not experienced but I have also recently been put on and ASV machine and at first the Hospital put me on the same machine as you and I had the same problems with hypopneas, and low other apneas....I then trialled the Resmed s9 ASV adapt and have had no problems with hypopneas, and my numbers are usually below two with some below 1. Not sure if the change of machine had anything to do with it, or I just got used to the ASV machine....
Maybe someone more experienced than me can help you?

I'm wondering the same thing. I've been used to Resmed machines prior... and was hoping to be put on one this time as well. However, the rx parameters didn't line up exactly with the Resmed machine, so my DME didn't know how to address the issue or I would have started on one. I'll have to speak with my doctor about writing an rx close enough for me to try a Resmed if it comes down to it. They were fine with either machine if the settings were comparable. But since my lab ONLY uses Phillips machines, they were clueless. If possible, will you tell me what your settings on the PR ASV were? And then what they were on the Resmed? I know the Resmed has more fixed settings than the PR, but that may not matter if the delivery/algorithm is more conducive to my needs.

Thanks,

Z

[ozze_dollar]

Hi there, I am not experienced but I have also recently been put on and ASV machine and at first the Hospital put me on the same machine as you and I had the same problems with hypopneas, and low other apneas....I then trialled the Resmed s9 ASV adapt and have had no problems with hypopneas, and my numbers are usually below two with some below 1. Not sure if the change of machine had anything to do with it, or I just got used to the ASV machine....
Maybe someone more experienced than me can help you?

I use the same machine Flo and my AHI is mostly below 1.I think you just have to get used to it.

[JohnBFisher]

Yes. It takes a while to become accustomed to an ASV unit. However, there are some differences between the Respironics and Resmed units. The Resmed S9 unit tends to enforce a tighter control on breathing. This can be good and bad. It can tend to force better breathing (based on my own experience), but it can also make it harder to adjust, since it does not follow your own normal breathing pattern. The Respironics unit on BPM of AUTO tends to do a better job of allowing you to breathe before it intervenes. Thus, as I often describe it, if feels "looser". It is rather like the difference between a sports car and a luxury car. The luxury car transfers less of the road feel to you as you drive.

That being said, I am now using a Respironics ASV unit as my primary unit. So, I find either fairly easy to use. But I've been using it for about three years now.

One thing that can help reduce the hypopneas is to increase the lower EPAP pressure. However, I do NOT recommend at this stage of your therapy to adjust the pressure on your own. Instead, since you are scheduled to see your doctor again soon, ask if an increase in the lower EPAP pressure might decrease the hypopneas. Sometimes it also helps to slightly increase the minimum Pressure Support value.

But again, at this point, I do not recommend making those changes. You need to become acclimated to ASV therapy first. We often see people start to see their AHI numbers decrease as they become accustomed to the ASV therapy. And that just takes time.

Hope that helps.

[Zzzzzzzzzzz...]

Yes. It takes a while to become accustomed to an ASV unit. However, there are some differences between the Respironics and Resmed units. The Resmed S9 unit tends to enforce a tighter control on breathing. This can be good and bad. It can tend to force better breathing (based on my own experience), but it can also make it harder to adjust, since it does not follow your own normal breathing pattern. The Respironics unit on BPM of AUTO tends to do a better job of allowing you to breathe before it intervenes. Thus, as I often describe it, if feels "looser". It is rather like the difference between a sports car and a luxury car. The luxury car transfers less of the road feel to you as you drive.

That being said, I am now using a Respironics ASV unit as my primary unit. So, I find either fairly easy to use. But I've been using it for about three years now.

One thing that can help reduce the hypopneas is to increase the lower EPAP pressure. However, I do NOT recommend at this stage of your therapy to adjust the pressure on your own. Instead, since you are scheduled to see your doctor again soon, ask if an increase in the lower EPAP pressure might decrease the hypopneas. Sometimes it also helps to slightly increase the minimum Pressure Support value.

But again, at this point, I do not recommend making those changes. You need to become acclimated to ASV therapy first. We often see people start to see their AHI numbers decrease as they become accustomed to the ASV therapy. And that just takes time.

Hope that helps.

Well, that sounds encouraging for sure. I'll be a bit more patient and see what happens. Good to know I'm armed with some more knowledge, should I bring up making any pressure changes with my doc. I might call them tomorrow to see if they suggest upping some values beforehand. I assume the "fixed" nature of the Resmed is what makes it a "rougher ride"? I certainly have no problems adjusting to the variables as they are set on the machine now, I fall asleep just fine... and can deal with the pressure pulses, etc... it's just that my numbers aren't where I'd like them and I'm not waking up feeling very rested as a result.

Thanks as always John,

B