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

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Smargie
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Re: Smargie’s Therapy Thread...in Need of ASV Advice

Post by Smargie » Wed Jun 26, 2019 6:23 pm

Hi Pugsy!

Regarding the mask, no, I haven't washed it recently.

I did another 40 minute trial this evening. I changed the PS down to 3 and it helped a little but was still pretty aggressive, so I turned the EPAP down to 8. Can I turn it down to 6? :lol: The machine wants me to breathe more quickly and deeply. I found that if I inhaled before waiting for it it was much gentler. If I let the machine go first the amount of air it gives is still too much and I have to start exhaling before it's done giving me a breath. I never let 10 seconds go by between breaths and I shudder to think what it will do when I have a central.

I can't think of what it's called (aerophagia or something like that), but I definitely feel like I swallowed air. Also, both my throat and nasal passages got pretty dry and there was a small bit of rainout again, but not nearly as bad as yesterday. And I didn't get the sinus headache or runny nose either, so that's progress. Should I try turning the humidity up to combat the throat and nose dryness or is auto the best way to go?

I was lying in bed watching TV when I used it. My head was propped up against the pillow, so the position of my neck was kind of like when you're standing and you touch your chin to your chest. Could that have anything to do with why it's so uncomfortable? I was also wondering if the fact that I start to exhale before the machine is finished giving me air could have something to do with the rainout.

The respiratory therapist at the DME is very nice and treats everyone like a patient. She said she sometimes downloads info to check on her apnea clients. I hope she doesn't decide to check on me! I was supposed to call her if I was having any problems and she would make adjustments with the doc's permission. But I'm more comfortable with the gang here. 8) Oh, and she also said that I HAD to use it for 30 days straight. She seemed very knowledgeable but I hope she's wrong about that. Could that be because I started with the CPAP back in March?

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Jas_williams
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Re: Smargie’s Therapy Thread...in Need of ASV Advice

Post by Jas_williams » Thu Jun 27, 2019 12:01 am

Smargie wrote:
Wed Jun 26, 2019 6:23 pm
Hi Pugsy!

Regarding the mask, no, I haven't washed it recently.

I did another 40 minute trial this evening. I changed the PS down to 3 and it helped a little but was still pretty aggressive, so I turned the EPAP down to 8. Can I turn it down to 6? :lol: The machine wants me to breathe more quickly and deeply. I found that if I inhaled before waiting for it it was much gentler. If I let the machine go first the amount of air it gives is still too much and I have to start exhaling before it's done giving me a breath. I never let 10 seconds go by between breaths and I shudder to think what it will do when I have a central.
If you feel the machine trying to breath for you and your still awake blow back at it hard it will reset the algorithm and it will back off for 3 minutes.


Our awake breathing is very irregular this will cause the ASV to blow to provide more air. You and the machine will become one over time. You need to learn to start breathing evenly and slowly when first attaching the mask more like your asleep breathing.the ASV will then follow that lead as you progress to sleep

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

Post by Smargie » Thu Jun 27, 2019 1:54 pm

Thanks for your response, Jas. I wore it last night for 4+ hours and I did find that if I blew back at it it calmed down. Why for only 3 minutes, though?

Unfortunately I never did progress to sleep last night. I almost drifted off towards the beginning of the night, but then the aggressive blowing would start again. It's hard to believe that the ASV and I will become one over time, since currently we seemed to be locked in near constant battle. :lol: I think I may have also been having trouble with my mask because I found that if the machine was blowing super hard that if I adjusted the mask it would calm down again.

I didn't get any rainout last night (yay!), but I did still swallow at lot of air and am very bloated today. And for some reason OSCAR did not register my hours from last night (which I posted about on the OSCAR bugs thread). The machine shows the hours, but the myAir app, which is supposed to provide a breakdown of the night, keeps saying the data is not available yet. At the DME they said that if the ASV detects a poor mask fit it will not count the hours. I ran the test fit function 3 times last night since I had to keep adjusting the mask, and each time it said the fit was good. But then for the night's summary, which only provides hours used and mask fit unless you download the app, it said the mask fit was poor. I'm really confused and don't know what I'm doing wrong.

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Jas_williams
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Re: Smargie’s Therapy Thread...in Need of ASV Advice

Post by Jas_williams » Thu Jun 27, 2019 2:05 pm

The reason the machine only backs off for 3 minutes is it uses the last 3 minute average to target when to give its puffs (Blasts) of air. You could try ramp but with ASV it’s better getting treated straight away

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

Post by Smargie » Thu Jun 27, 2019 3:05 pm

I suppose you're right... but I may have to use the ramp for a bit if I can't get to sleep at all.

How are you doing with your treatment? How long did it take you to get used to the ASV? Did you switch from regular CPAP to the ASV, or is that how you started out?

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Pugsy
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Re: Smargie’s Therapy Thread...in Need of ASV Advice

Post by Pugsy » Thu Jun 27, 2019 4:01 pm

Smargie wrote:
Wed Jun 26, 2019 6:23 pm
she also said that I HAD to use it for 30 days straight. She seemed very knowledgeable but I hope she's wrong about that. Could that be because I started with the CPAP back in March?
She's just trying to put the fear of God in you...
Refresh my memory....who is your insurance with?
I don't have time to go back and look.

I knew you would have to meet compliance again with the new machine but no one requires 100% usage for first 30 days straight.
Most of the time it is 70 % of 30 consecutive nights you have to use it 4 hours or more...so 21 out of 30.
And if you have Medicare you have 90 days to get that done.
When in doubt....always call up your insurance company and just ask them.
I remember 1 DME telling a person they had to use it every night for 3 months...and she called up her insurance and her insurance didn't have any compliance requirements at all. Talk about being lied to.

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

Post by Smargie » Thu Jun 27, 2019 4:26 pm

I have Medicare so she definitely gave me the wrong information.

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Pugsy
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Re: Smargie’s Therapy Thread...in Need of ASV Advice

Post by Pugsy » Thu Jun 27, 2019 4:46 pm

Medicare compliance.....

You have 90 days to use the machine for 21 days out of 30 consecutive days for 4 hours of more.
You do have to have a face to face with the doctor prior to the 91st day.

I think DMEs put the fear of God in people thinking it will help keep them motivated but I think all it does is foster a defeatist attitude.
Especially with ASV....not only are you having to learn how to deal with bilevel pressures...you have a machine that's pretty aggressive when it thinks you aren't breathing like you should.
All she did was make you worry more and cause more stress.....the last thing you need right now.
She's not near as nice as you thought. :lol:

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

Post by Smargie » Fri Jun 28, 2019 9:25 am

I actually slept last night! It was for 4.25 hours broken into 2 chunks. I switched the nasal cushion over to the one with pillows, and I don't know if that did the trick, but I only had one period of large leak and crazy pressure. It was toward the end and I couldn't get it to stop so I took the mask off. AHI 2.51, all hypops, no centrals! And I actually think some of those hypops weren't real since they happened almost entirely during ramp up time and when the mask wasn't fitting.

Thank you all for your help. I would have given up without it.

I don't have a grasp on how ASV works like I did with the CPAP, so it's hard to understand most of the settings and some of the data. I've already done an internet search and came up with nothing helpful. Can anyone point me toward something like an ASV for Dummies? :lol:

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

Post by Pugsy » Fri Jun 28, 2019 10:59 am

This is the titration guide for ASV from Respironics...it has a simplified section in it.
See if it helps.
The basics are the same for a ResMed as to how and why ASV machines do what they. Sorry, but I can't find the link to the ResMed version at this time and I don't have time to look for it.
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf

Short version....EPAP is needed to take care of the obstructive stuff...very similar to EPAP on the APAP needing to be high enough to hold the airway open. Minimum EPAP is just as important as minimum pressure on the APAP....and again it has to be high enough to get to where it needs to be to prevent the obstructive stuff. EPAP will auto adjust as needed but the minimum is a critical setting.
While the response is faster than with APAP it's still not a blink of an eye 4 cm to 12 cm EPAP kind of thing. If you need more EPAP to hold the airway open you still have to give it a good head start.

PS is what helps you out when you have a central apnea...you get a rather big puff of air flow above EPAP to help you jump start your own breathing again. It doesn't last long but it can be really big or seem really big until you get used to it. Ideally you are asleep when it happens but sometimes your awake breathing irregularities makes the machine think you are having centrals and it will dispense that big puff of PS.

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

Post by palerider » Fri Jun 28, 2019 11:05 am


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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

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

Post by zonker » Fri Jun 28, 2019 11:36 am

palerider wrote:
Fri Jun 28, 2019 11:05 am
Here's one:
https://www.resmed.com/us/dam/documents ... er_eng.pdf
at first i thought that said DAMN documents.
:roll:
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Smargie
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Re: Smargie’s Therapy Thread...in Need of ASV Advice

Post by Smargie » Fri Jun 28, 2019 1:17 pm

Thanks Pugsy, Palerider and Zonker. You’ve all been super helpful. 8)

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

Post by ajack » Sat Jun 29, 2019 6:13 am

Smargie wrote:
Tue Jun 25, 2019 8:02 pm
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.
You had a titration for these numbers? The pressure will be a shock.
PS reduces the breathing effort. It was also determined that you needed min ps6. The default setting is min ps3. I wouldn't change this without putting it past your doctor. It was obviously determined in the lab that you needed it
10 would have been needed to clear obstructive events.
both epap and PS max are at the default settings.

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

Post by Jas_williams » Sat Jun 29, 2019 9:46 am

ajack wrote:
Sat Jun 29, 2019 6:13 am
Smargie wrote:
Tue Jun 25, 2019 8:02 pm
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.
You had a titration for these numbers? The pressure will be a shock.
PS reduces the breathing effort. It was also determined that you needed min ps6. The default setting is min ps3. I wouldn't change this without putting it past your doctor. It was obviously determined in the lab that you needed it
10 would have been needed to clear obstructive events.
both epap and PS max are at the default settings.

Min EPAP 10 with Min PS of 6 makes your IPAP minimum pretty high.


You Min pressure on the APAP was only 6 any your max pressure ever hit on a typical night was 16 how on earth did the come up with these ASV settings I would be suggestions setting back to close to the defaults and try that for a few nights. Many DR’s have no experience of the ASV’s and how they work. We may find we need to increase the EPAP after a few nights


Min EPAP 6
Max EPAP 15
Min PS 3
MAX PS 15

Mode AUTO ASV


Below is one of your horrible nights on APAP

Image

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