ASV users: the everything ASV thread.

[ameriken]

I have a question regarding Patient Triggered Breaths. Lately I've noticed mine have been getting better and better, without the huge dips I used to see. My AHI's have been improving also, and I haven't adjusted the pressure yet as I'm meeting with the Sleep Dr. next week. I think I remember someone saying it takes time for your body to get used to breathing with the ASV and to not fight it. So would this be the reason for the improvement in the PTB's, like the machine is teaching my body to breath on a more regular basis?

Below is a much better than average night, as I forced myself to sleep on my side most of the night, but the 99.9 was what really caught my eye.
Thanks for any insight on the PTB question.

I had a night with a PTB around 95, and I thought that maybe I was starting to get it licked and then the next night it was in the 50'. I've been on for nearly 5 months and I haven't seen any overall improvement in my PTB's and those two days are fairly recent. So I'm not saying that your PTB's arent getting better, I guess I'm just saying that they may or may not get better. At least, I think in my case whatever is causing the PTB's is still there and the machine is just helping to manage it.

Nevertheless, I do hope yours continues like that!

[pharm30]

dup post

[pharm30]

You've got to figure out those leaks and perhaps mess with the straps to get a better adjustment. I've had bad leaks with the Quattro FX in the past, but I finally got it so it leaks no more. Pad a cheek liner helps a lot as well as their anti-leak strap.

As for your pressure, the minPS seems really low. Mine was at 5 and it wasn't enough, so I bumped it to 7, and min EPAP which was at 7, I bumped to 9 and got my AHI's down to 3. I was running 7 to 20 before those increases.

But it probably makes no sense to increase your pressures until you've got the leaks under control.

After 4 phone calls, being accidentally hung up on twice, and one lady telling me I needed to call back the lady that just told me to call her, I got an appt
for a mask fit on Thursday. This particular lady actually told me I have the choice of masks after I told her the last lady basically handed me one and said looks like it fits.... any mask suggestions? I think they are respironics only.

[ameriken]

You've got to figure out those leaks and perhaps mess with the straps to get a better adjustment. I've had bad leaks with the Quattro FX in the past, but I finally got it so it leaks no more. Pad a cheek liner helps a lot as well as their anti-leak strap.

As for your pressure, the minPS seems really low. Mine was at 5 and it wasn't enough, so I bumped it to 7, and min EPAP which was at 7, I bumped to 9 and got my AHI's down to 3. I was running 7 to 20 before those increases.

But it probably makes no sense to increase your pressures until you've got the leaks under control.

After 4 phone calls, being accidentally hung up on twice, and one lady telling me I needed to call back the lady that just told me to call her, I got an appt
for a mask fit on Thursday. This particular lady actually told me I have the choice of masks after I told her the last lady basically handed me one and said looks like it fits.... any mask suggestions? I think they are respironics only.

Just respironics? I'm not sure, I'm using the Resmed Quattro FX. Just try and get something that feels really good and like it's fitting snug to your face.

[pharm30]

You've got to figure out those leaks and perhaps mess with the straps to get a better adjustment. I've had bad leaks with the Quattro FX in the past, but I finally got it so it leaks no more. Pad a cheek liner helps a lot as well as their anti-leak strap.

As for your pressure, the minPS seems really low. Mine was at 5 and it wasn't enough, so I bumped it to 7, and min EPAP which was at 7, I bumped to 9 and got my AHI's down to 3. I was running 7 to 20 before those increases.

But it probably makes no sense to increase your pressures until you've got the leaks under control.

After 4 phone calls, being accidentally hung up on twice, and one lady telling me I needed to call back the lady that just told me to call her, I got an appt
for a mask fit on Thursday. This particular lady actually told me I have the choice of masks after I told her the last lady basically handed me one and said looks like it fits.... any mask suggestions? I think they are respironics only.

Just respironics? I'm not sure, I'm using the Resmed Quattro FX. Just try and get something that feels really good and like it's fitting snug to your face.

what is the significance of flex?
is there a way to change the ramp time?
I've noticed on my graphs where I ramp and the pressure graph is flat (I assume that is why) usually some hypopneas show up in little clusters.

[JohnBFisher]

... what is the significance of flex? ...

Flex is the Respironics technique (patented, of course), that supposedly allows a more natural breathing pattern. However, some people find it actually increases their hypopneas. Essentially, when we breathe, we don't just have a single pressure that results from our inhalation and exhalation. Instead, it tends to build. It waxes and wanes.

Resmed developed another technology they call "EasyBreathe" that I find actually does make it slightly easier to breathe with a Resmed unit. (I own both a Respironics and Resmed unit, so I can compare the two).

... is there a way to change the ramp time? ...

If there is, it would be connected with the Ramp on/off settings.

... I've noticed on my graphs where I ramp and the pressure graph is flat (I assume that is why) usually some hypopneas show up in little clusters. ...

The "RAMP" feature must limit the PS value to RAMP PS, instead of IPAP Max. The difference is that the IPAP Max value is used to help sustain breathing - even when you fail to do so. I suspect the engineers thought that by allowing you to fall asleep, it would make it easier to use an ASV unit, before it switches to ventilator capability. Unfortunately, some of us have bad central apneas as we fall asleep. In that case, the RAMP feature would defeat the purpose of the unit and would not allow the machine to sustain breathing.

The "cluster" of hypopneas is probably the waning of your breathing when that would lead to a central apnea. Since you don't see any central apneas during those events, it is probably not a problem for you.

Hope that helps.

[moresleep]

I do better (lower AHI) without Flex, as do many others. There's a study somewhere--I forget where--showing that all Flex-like features are likely to make things worse and explaining why. I also do not like Ramp which, as pointed out, means you are not getting full pressure as you fall to sleep, a time when you may need it. Also, better to bite the bullet and find out if you have mask leaks at the beginning, when you are still awake to adjust the mask, rather than experience them after you have fallen to sleep.

[ameriken]

I had posed the question of Rise time vs Flex, and JohnBFisher gave me a great answer here (thanks again John):

viewtopic/p651671/viewtopic.php?f=1&t=6 ... me#p644040

I turned the flex off, and when you do that on our machine, it turns the rise time on. I've got the rise time set to 4 which is pretty comfortable for me, plus it did help my AHI's. I found the flex to be too uncomfortable.

Let me say about the ramp too, ramp has its place in our therapy when you are getting used to the machine. However once you've gotten used to using the machine, I think it's time to go without ramp. I don't use ramp any longer and just go with my regular pressure right from the get-go.

[pharm30]

maybe I need to decrease my Flex from 3?
Can someone tell me how to do it?

[ameriken]

If you press the 'silence' and 'right arrow' down simultaneously for about 3 seconds, you'll hear a beep. That brings up the settings menu. Then use the left and right arrow to scroll through all the settings. When you get to flex, use the 'heat' and 'ramp' buttons as 'up' and 'down' to set the flex to zero, which is turning the flex off. Then when the flex is off, the 'rise time' setting will show up on the menu. Set it to 3, 4, or 5 (or whatever is most comfortable). I just looked and I usually go with 4 or 5. I think you'll find rise time a hell of a lot easier and more comfortable than flex.

This is also how you would adjust your EPAP and IPAP pressures if you wanted. Just be sure you write down all the original settings in case you forget them later and want to go back to them.

[NJSleepless]

I disabled the RAMP feature on my machine as I found no theraputic value to it.

[RationalEntropy]

I noted more hypopneas when switching to ASV from Bipap. Better than all of those Clear Airway Apneas with Bipap. I changed my EPAP max to match my EPAP in Bipap therapy... I turned it up to 11 (EPAP Min remained at 9). A night later I turned my Min PS to 3, while maintaining a Max PS of 10. This seemed reasonable since my PS average was 2.5 and 90% @ 3.5 according to my data. Any minor tweaks after that did minimal help. So far the range of AHI is now 2.5 to 3.5.

Everything is, more or less, outlined here: viewtopic/t70406/ASV-Recently-Prescribe ... urned.html

Also, I turned my flex to 1, and will likely turn it off.

[jamiswolf]

Pharm30,
I've used a few Respironics masks. The easy life is very comfy but doesn't handle pressures well. And I've tried the ComfortGel FF and Nasal. The FF is harder to get a good seal with. The nasal will seal pretty good up to fairly high pressures but for me was tough on the lip.

On the rise and flex settings. Rise goes 1 to 5 and flex is only 1 to 3 if I'm not mistaken. I thought I read some different numbers earlier.

And while I'm posting, I may have a Legacy bipap ASV advanced for sale. I picked it up new from a Craigslist seller and it currently has only 50 or so hours on it. I bought it because it was a good deal but I'm finding that I probably won't need it. I just have it set up as a straight bipap right now. With humidifier, new hose and in the factory box. All manuals. PM me with questions.
Jamis

[ameriken]

I'm a little confused about the the backup "auto" function and the other BPM settings on the Respironics ASV.

On the Respironics ASV, the default backup rate is set to 'auto' which intervenes when someone stops breathing at a rate of 10 BPM.

However, you can change the backup from auto to anywhere from 4 to 30 BPM or so. It can also be turned off. When you set your own BPM, another setting appears: the "Ti" or "timed inspiration" which can be set from .5 to 2.5 seconds. OK, no problems there.

Here's my question: is there a difference in how the machine actually performs when it is on auto versus when it is set to a specific backup rate? When set to say 12 BPM and a Ti of 1.5, does the machine behave the same way as it did on auto and intervene when you stop breathing, or is it always pushing the 12 BPM regardless of your breathing pattern? Does it operate differently when set to a specific BPM?

My normal BPM is 12 to 13 BPM, and since my PTB's range 75 to 95%, it seem the 'auto'backup setting intervenes throughout the night to keep me at the minimum 10 bpm. Since my normal BPM's range 12 to 13, I'd like to increase that rate to 12 instead of 10. Last night I set it to 12 BPM, and while my AHI was 2, I noticed my PTB's dropped to 35% and I am wondering why that would be.

So other than the BPM rate, can anyone explain how the machine operates when on auto vs when set to a specific BPM? Other than the BPM rate, it does seem like there is a noticeable difference in the machines behavior and I cannot pinpoint it.

[justbreathe]

I was wondering the same thing. My PTB has been averaging about 65 to 70 with a backu RR of 12. When I looked at Encore Pro it was not clear but if you look at your data with Sleepy Head you will see that a non PTB is any time your RR is 12 or your set backup RR. My average RR is about 14 but when I hit 12 my ASV kicks in and triggers a breath with a pressure pulse.

I am still new at this but am noticing that my PTB is less the more tired I am when I go to bed. Last night I was exhausted and my PTB was only 42.

I think the auto function would set your backup RR based on your RR over the last time period and change as your RR changes as you sleep. I haven't messed with it on my AutoSV but did not like it on Resmed S9 VPAP ADAPT.

For now I like the set backup rate and find it less disturbing.