Questions about resmed vpap enhanced ASV settings

[johnthomasmacdonald]

The clinical menu is rather confusing - this is the older model before the S9 ASV.

Are there any settings that need to be set other than EPAP and PSmin and PSmax?

A PR apap/bibpap seems to result in settings around Epap 8 and ipap 13 and my sleep doctor's initially recommendation is 8/12 or 8 and let the apap roam up to 25.

Unfortunately with these settings i tend to get about 15 to 20 points of centrals per hour, although since i only had one or two centrals on my titration study, the doctor doesn't worry about the centrals.


I was going to try the ASV machine with EPAP 8, min PS of 4 and a max PS of 16 ( empirically the highest it would allow me to set it at).

ANy ideas? Does this seem reasonable or do you think that there would be better settings for me to use.

Also is there anything else on the machine that I need to set.

Relative to the new PR and resmed machines, moving through the menus is quite complicated and confusing

I also have no clue about how to download data or what software would be required

[johnthomasmacdonald]

I'll bump on the hope of finding asv users

[-SWS]

I'm not an ASV user. But I'll try to answer some of your questions...

Are there any settings that need to be set other than EPAP and PSmin and PSmax?

Those are the only pressure settings for that model. Here are the specs & literature for that enhanced S8 model:
http://www.resmed.com/us/clinicians/tre ... clinicians
(you can see on the titration protocol that Resmed would have you address your obstructive events with EEP & PS min, reserving the PS min to PS max range for central issues--including iatrogenic centrals)

Also is there anything else on the machine that I need to set.

As I recall that model is picky about selecting the right mask type. If you're not using one of the mask types offered in the menu, then try to match up your mask's vent exhaust rate with the closest choice offered:
http://www.resmed.com/us/assets/html/ma ... c=patients


Once you select mask type, then assemble everything and run a "learn circuit" with the mask opening clear:

Learn Circuit
The Air Circuit Learn function takes approximately 20 seconds to run. It allows
the unit to 'learn' what pressure it needs to build in to its calculations, based on
the components in the system. Select LEARN CIRCUIT every time you add or
remove a component (eg, mask, humidifier) or move to a significantly different
altitude.
To run this function:
1. Set up the entire VPAP Adapt SV system (flow generator, mask, humidifier
etc) as you wish to use it.
2. Make sure that the mask is unobstructed so air can flow from the mask to
the flow generator.
3. Turn on the VPAP Adapt SV at the power switch.
4. Move through the menus until you reach LEARN CIRCUIT and select 'yes' by
pressing the Left key.
5. A message will remind you to check that the airflow from the mask is clear.
Select 'start' with the Left key.
6. A progress screen is displayed while the Air Circuit Learn function is running.

http://www.manualslib.com/manual/140504 ... ml?page=21

That machine requires a special CPAP hose with a small pressure sensing line. So don't use a standard CPAP hose with that machine. Rather, make sure you use the specialized Resmed hose for proximal pressure-sensing at the mask. Also, that model is EXTREMELY intolerant of leaks. If you have high or even moderate leaks, then event detection and therapy can become erratic.

Hopefully others can chime in. Good luck!

[RogerSC]

As I recall that model is picky about selecting the right mask type. If you're not using one of the mask types offered in the menu, then try to match up your mask's vent exhaust rate with the closest choice offered:
http://www.resmed.com/us/assets/html/ma ... c=patients

Thanks for the mask vent flow rate link, been looking for this information. I appreciate your posting it.

[johnthomasmacdonald]

Hi, thanks for your help. I've got that specialized hose and figure i better purchase a backup since i don't know how long they'll continue to make such specialized parts. I did use the learn circuit feature with a resmed mirage quattro ffm. MY leak rate was less than 0.1 and my ahi was 5.0. It was a very comfortable night - no wake ups at all in about 7 hours. I don't find it any more difficult to get used to than the apap.

[Sir NoddinOff]

Hi, thanks for your help. I've got that specialized hose and figure i better purchase a backup since i don't know how long they'll continue to make such specialized parts. I did use the learn circuit feature with a resmed mirage quattro ffm. MY leak rate was less than 0.1 and my ahi was 5.0. It was a very comfortable night - no wake ups at all in about 7 hours. I don't find it any more difficult to get used to than the apap.

Here's good thread on the Apnea Board about terms and explanations regarding ASV. Scroll down several posts and you'll get deeper into the terminology. BTW, I know you have a different machine but it's still informative. Search around once you're on the forum and you'll find lots of specialized ASV info.

http://www.apneaboard.com/forums/Thread ... cs-DS950HS

[johnthomasmacdonald]

So far, so good, each night with the ASV my ahi is lower than the night before - it was 1.8 last night and i slept great, zero wakeups over 7 hours.

This doesn't necessarily mean anything in my case since the problem for me with all the other machines has been the lack of any consistency: a week where the ahi is between 2 and 3 is followed by weekS where my ahi never drops below 15.

I didn't push the ASV machine before because I was seeing the sleep doctors and they were setting me up for overnight sleep tests. I wanted to give them the chance to solve this. However, given that they gave me pressure conditions that i know don't work and they don't believe in the results from the machines, I'll have to get my apnea under control on my own with an ASV machine

Hopefully i can get this to continue to work.

I have NO problem at all sleeping with the ASV machine, i don't find it any more intrusive than the other machine.

[sleepinow]

Well looks like I'm on the same boat. Tonight will be my first night using my own settings (default) and will see if I need to make any adjustments

I wish you luck in finding the perfect settings

[JohnBFisher]

Look .. as a general comment to anyone adjusting their ASV units ... DON'T CHANGE THE PRESSURE EVERY BLOODY NIGHT !!!!! ... And yes, I know I'm yelling. But I've seen several people bounce all over the place and then complain the therapy does not work.

Your body takes time to adjust to the ASV therapy. As you adjust to it, you will tend to find that your body will also adjust. That will gradually drag your AHI down. But it takes time for you personally and your body generally to adjust to the therapy. I can not stress that enough.

If you do feel you need to make changes, then RECORD what you are doing. Make a change and see how it works for SEVERAL NIGHTS before making any further changes. Do it scientifically.

And whenever possible, you REALLY should work with a doctor when adjusting ASV therapy pressures. Not getting it right really can screw up your sleep and breathing during the night. A titration study really is essential with ASV therapy.

Again, this is a general observation. If you are already being careful about what you are doing, great. I'm just preaching to the choir. If you bounce all over the place, please realize that my suggestion comes from living with xPAP devices for more than 20 years at this point. And I've used an ASV unit for the past four years or more at this point. So, it's not guess work. It's based on living with it for a long time.

[RogerSC]

So far, so good, each night with the ASV my ahi is lower than the night before - it was 1.8 last night and i slept great, zero wakeups over 7 hours.

This doesn't necessarily mean anything in my case since the problem for me with all the other machines has been the lack of any consistency: a week where the ahi is between 2 and 3 is followed by weekS where my ahi never drops below 15.

I didn't push the ASV machine before because I was seeing the sleep doctors and they were setting me up for overnight sleep tests. I wanted to give them the chance to solve this. However, given that they gave me pressure conditions that i know don't work and they don't believe in the results from the machines, I'll have to get my apnea under control on my own with an ASV machine

Hopefully i can get this to continue to work.

I have NO problem at all sleeping with the ASV machine, i don't find it any more intrusive than the other machine.

Congratulations on the low AHI on the ASV, I hope that it stays down for you, and that getting a good night's sleep becomes more of a habit *smile*.

[tomma]

I have to chime in an agree with JohnBFisher. What he's saying is very good, sound advise. I was one of those guys constantly changing my ASV settings, every night, every other night etc. and could not figure out why I couldn't get dialed in. After finally listening and leaving things alone for a week, even a little longer, and then reviewing my results I had much better luck. While I think I still have a little work to do I'm happy to say my AHI now ranges between around 1.5 -3.5. I wasn't getting even close to that changing things every night.

[johnthomasmacdonald]

Look .. as a general comment to anyone adjusting their ASV units ... DON'T CHANGE THE PRESSURE EVERY BLOODY NIGHT !!!!! ... And yes, I know I'm yelling. But I've seen several people bounce all over the place and then complain the therapy does not work.

Your body takes time to adjust to the ASV therapy. As you adjust to it, you will tend to find that your body will also adjust. That will gradually drag your AHI down. But it takes time for you personally and your body generally to adjust to the therapy. I can not stress that enough.

If you do feel you need to make changes, then RECORD what you are doing. Make a change and see how it works for SEVERAL NIGHTS before making any further changes. Do it scientifically.

And whenever possible, you REALLY should work with a doctor when adjusting ASV therapy pressures. Not getting it right really can screw up your sleep and breathing during the night. A titration study really is essential with ASV therapy.

Again, this is a general observation. If you are already being careful about what you are doing, great. I'm just preaching to the choir. If you bounce all over the place, please realize that my suggestion comes from living with xPAP devices for more than 20 years at this point. And I've used an ASV unit for the past four years or more at this point. So, it's not guess work. It's based on living with it for a long time.

Hi, thanks for the advice.

No, I haven't changed the settings in the week i've been using it.

I was looking for advice with whether my settings seemed reasonable as i've made them up on my own with no input from doctors or long time users - just based on what i could find based on past posts.

I'd love to work with a doctor, the problem I've had is that my apnea is extremely erratic, a week with ahi in the range of 2 followed by weeks with an ahi over 20. THis is with no change in the settings or in my lifestyle.

I've sent my waveforms over to pugsy and even she can't make sense of them.

IT's the advice to solve this that i've been looking for from this forum to solve since i came here.

THe problem is that on both nights of my sleep studies, I slept like a baby. NO centrals so my doctor does not believe that i need an asv machine.

Problem is that using the settings THEY recommend gives me an ahi in the 30s, 90% centrals, nocturia and constantly waking up.

To add insult to injury, my sleep doctor does not believe in any data unless it happens in the sleep lab.

So, at the moment until i can find a different doctor, i need to either skip cpap altogether since i actually sleep better without it, use the conditions from my sleep study --even though i feel like crap or take responsibility for my own treatment.

It seems like I made a good guess with the asv, last night was the best night of sleep i've had in a very long time. 9 hours with no awakenings, an ahi of 1.2 and i felt groggy upon waking.

if it just stays around here, I'd never change it. I was also wondering if there were more settings i should be setting. I don't know if you are familiar with my machine - I guess it is equivalent to the resmed s8 but moving around the menu is much less intuitive than the S9vpap s and PR sys one apap/bipap that i am familiar with. I was wondering if there is anything else i should be setting.