Smargie’s Therapy Thread...in Need of ASV Advice

Pugsy wrote: ↑

Tue May 28, 2019 11:37 am

Someone once compared them to 2 automobiles....one a sports car (ResMed) and the other a nice Cadillac (Respironics) and both will get you to where you want to go. Some like fast and forget it and some like slower with more things to fiddle with to get you there.

HAH, I'd say the Respironics is more like a chevy chevette... it'll get you up to highway speeds.. (eventually) but it'll take a while, and you're holding up traffic and being passed by annoyed people, and it makes a lot more rattling noise getting there.

Sorry for the slow response... I've been sick, but am much better now.

Thanks for the links, Pugsy. Respironics sure doesn't give much information or do a hard sell. I poked around on their website before officially being prescribed the ASV and was pretty surprised by how little there was. The ResMed site is so much more descriptive. I don't know if this is common, but the examine rooms in the sleep clinic I go to double as the rooms you sleep in when you do a study. It's strange to have a doctor's appointment in what looks like a cheap motel room. Anyway, there was a very thick manual from ResMed meant for the doctor which I took some time studying...it was nice to have access to that.

Do doctors have their own preferences? Are they heavily influenced by sales people from the 2 companies? Obviously not all doctors think alike, but I'm curious if they get any benefits by prescribing one brand over the other. I saw the prescription for my first machine and all it specified was APAP with a nasal mask, so I suppose that means that the Respiratory Therapist at the DME chose the machine. And I believe people on here have said something like the DME gets paid the same amount no matter which machine they give you? Is that correct? I don't really follow how that works, to be honest.

I haven't been contacted by the DME yet, but the last time I went in they said "Here you go, and here's how to use it." I would prefer the ResMed AirCurve 10 ASV. What do I if they bring out the Respironics Bipap ASV?

Palerider, I loved your chevy chevette analogy!

Some doctors have preferences in the machines they prescribe. The sleep clinic we use prescribes ResMed machines, only. My prescription called for a MesMed bilevel machine.

Smargie wrote: ... so I suppose that means that the Respiratory Therapist at the DME chose the machine. And I believe people on here have said something like the DME gets paid the same amount no matter which machine they give you? Is that correct? I don't really follow how that works, to be honest.

I haven't been contacted by the DME yet, but the last time I went in they said "Here you go, and here's how to use it." I would prefer the ResMed AirCurve 10 ASV. What do I if they bring out the Respironics Bipap ASV?

Hi, Smargie. Just checking in during my travels and saw your post. Insurance companies usually pay by the type of machine rather than brand, so sometimes DME will try to provide the cheapest (to them) brand that will satisfy the prescription.
I suggest you ask the Doctor to write the prescription for the type of machine you want. That way, the DME will have to give you that machine to fill the prescription

I finally got my ASV yesterday! The DME I was working with before was dragging their feet so my doctor's office sent me to a different one and it seems to be much, much better. I requested the ResMed AirCurve 10 and they gave it to me without hassle or question. I didn't use it last night because I wasn't feeling well and didn't have the energy to look at the manual, but I'm about to take it out and set it up.

During the sleep study (my second) the ASV portion felt very uncomfortable. The bursts of air were really intense and it felt like I was being given more air than my lungs could accommodate. I'm pretty nervous about tonight...I'm worried it will keep me awake. I say this because I didn't feel like I slept at all during the study. Of course the report says otherwise--I spent 97% of the time in N 2, with 40 arousals and 4 awakenings, and zero REM the entire night. My AHI was 53 with 46 CAs, 0 OAs, and 59 hypops.

Does anyone have experience they can share regarding getting used to ASV?

Play with it while awake and under no pressure to fall asleep.
Watch TV or read a book or meditate or something....take your time with it.
The more you use it the more quickly the body/brain will adjust to it and not want to fight it so much.

Good luck.

I’ve tried it for 45 minutes and it’s just way too aggressive. I just can’t breathe as deeply as the amount of air it’s pushing in. I now have a heated hose and experienced rain out for the first time—large drops of water on my nose. I feel nauseous now and have a headache. I’m going to call the respiratory therapist at the DME tomorrow and see if she will adjust it. I guess according to my sleep study this setting gave me the lowest AHI, but I couldn’t tolerate it then and I can’t now. I’m not going to use it tonight because I doubt I’d get any sleep. Boo!

So exactly what settings did they set it at?
Go into the set up menu area and right down what all the settings say.

Include the humidity settings as well...and your ambient house temperature.

I can’t tell how to get into the set up menu. I’ve played around with all the options and didn’t find that one. Is this something I’d need the clinical manual to do? Humidity is on auto and the house temp is about 77 degrees. When I switched the humidity to manual it said it was on 4.

Yes, you should probably get the clinical/provider manual. You have to go into the clinical setup area to see all the various settings.
Request it from here...go ahead and get it and read it later.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

Short version is the same as with the AirSense 10 models.
https://www.apneaboard.com/resmed-airse ... setup-info

Plug the machine in. The "dial" can be turned or pushed. The button below the screen with the house icon is called the "home" button. To access the clinician menu, press the dial and the home buttons simultaneously for 3 seconds. The clinician menu will appear.

Setting of 4 isn't all that much but maybe the heated hose temp was lower and your house temp is cool because of air conditioner.
Need all the settings...hose air temp as well as house thermostat temp.
Really odd to get condensation so quickly but it might be a combination of cooler ambient temps and moisture in your own breath adding to the incoming humidified air and tipping the scales so that the air cools off too much and releases the moisture.
Warmer air will hold more water than cooler air...so we have to warm up that air in the mask somehow.

Mode: ASVAuto

Min EPAP 10

Max EPAP. 15

Min PS. 6

Max PS. 15

Tube temp 81

Our thermostat is set for 76, but it’s a little warmer upstairs where we sleep (and where I used it today), probably 78 degrees.

Also, I do have a runny nose, which got a lot worse after using the machine. And I’m right on the cusp of small and medium for the nose mask. I tried both and got rainout both times. With the medium it feels like some air is leaking from the top. Last time I used the “pillows” but this time I’m not. I guess I could try the pillows again if that would make any difference.

Did you by chance happen to wash your hose or mask recently....and maybe a little bit of moisture stuck to the insides of the hose or mask pillows.
I am using higher humidity with colder room air and lower hose air temps and I get no condensation at all.
At your settings I wouldn't think there would be condensation happening.

Min EPAP 10

Max EPAP. 15

Min PS. 6

and on your previous machine EPAP was just 7 for inhale and exhale.

No wonder you are having trouble....right now you are getting 16 on inhale and 10 on exhale.
That's a huge jump.

How about a change in minimum PS just to see if you can better tolerate the pressures and see what happens.
Change minimum PS to 3 and see if that is easier to deal with....leave everything else the same.
If it is still too much to handle...change that minimum of 10 EPAP to 8 and see how it feels.
Maybe we can work you up in small increments to your prescribed settings. It's doing you zero good right now if you can't use it.

Thanks Pugsy! I'll give that a try tomorrow if I'm feeling better. My runny nose has gotten worse since I last posted and that sinus headache was intense. I'm so glad to know that there is a reason it feels so different. I was worried that maybe my lung muscles have become weak and tight. I find that I often don't breathe during the day and then have to take big breaths or even yawn to correct it.

Hope the rainout corrects itself. I don't know what I'll do if it doesn't, since it's not JUST annoying.