Settings for a new Resmed ASV

kirbini · Post by **kirbini** » Tue Jul 28, 2020 4:37 pm

Hello Again,

I just received a Resmed AirCurve ASV VPAP. I have been using for the past month a Resmed S10 APAP with settings of Min 4 and Max 10.4 - low pressure to attempt to control the Centrals. I am attaching a photo of my stats from last night - fairly typical but sometimes a little lower.

The new ASV has the following settings: Min PS - 3 Max PS - 15; Min EPAP 4 Max EPAP - 15; ASV Auto Mode

Any suggestions on where I might start with the settings is appreciated.

raisedfist · Post by **raisedfist** » Tue Jul 28, 2020 8:56 pm

"The new ASV has the following settings: Min PS - 3 Max PS - 15; Min EPAP 4 Max EPAP - 15; ASV Auto Mode"

That is the starting point for titration according to ResMed, in their sleep lab titration protocols. I would just use those baseline settings and see what happens, and then adjust accordingly. Wide open is not good long-term but for a night or two it will be helpful to see what is happening and what you likely need.

Pugsy · Post by **Pugsy** » Tue Jul 28, 2020 9:16 pm

Gotta start somewhere and the factory defaults are as good a place as any.
The minimum EPAP may need a bit of tweaking but there's no way to know for sure until we see what happens with the basic default settings. The PS range is what deals with the central apneas and if it doesn't need to do much it won't do much.

There's just no good way to translate apap settings into ASV settings because of the difference in the machines and how they go about doing things.

Respiration99 · Post by **Respiration99** » Tue Jul 28, 2020 11:16 pm

I agree with the others that the default settings are a reasonable place to start, with adjustments to follow. You'll likely find that the starting EPAP and PS are too low, but let's see the data first.

I'd like to ask about that big cluster of obstructive apneas in the first sleep period on your chart. Is that something you often see? Or were you perhaps still awake / dozing during that period? Big clusters like that can occur in REM sleep (which is not likely the case here) or they could indicate positional apnea. This can occur if your chin drops down to your chest, putting strain on the windpipe. If these clusters are a common occurrence for you, you might want to consider a soft collar to support your chin.

kirbini · Post by **kirbini** » Wed Jul 29, 2020 8:48 am

I almost always have that problem at the first of the night. I have been adding supplemental oxygen for the first hour of the night to overcome the OAs. That way, my oxygen stays above 90. I am hoping with the new ASV I can eliminate that.

I screwed up last night and did not have the VPAP set to auto start and only have 4 hours of data from the beginning of the night. When I got up to pee at 1:40 I slept the rest of the night without support, but with the mask on and connected to the machine but I managed to live through the night - my oxygen looks pretty lousy for the last 3 hours but I feel pretty good today nevertheless.

Here are the readings from last night. With the settings I already mentioned: Min PS 3 Max PS 15; Min EPAP 4 Max EPAP 15; Auto ASV. I am very pleased with this result - I have not had reading this good since I started back on my therapy about 6 weeks ago. The ASV is a really nice machine as far as I can tell.

Pugsy · Post by **Pugsy** » Wed Jul 29, 2020 9:03 am

One change only (aside from turning SmartStart on

)
increase your minimum PS to 4 and lets see what happens.

I am discounting the first little bit of clustering that happened at the beginning of the night assuming you weren't asleep most likely.

UAs...pretty much OAs and likely awake breathing.

Respiration99 · Post by **Respiration99** » Sat Aug 01, 2020 4:26 am

UAs...pretty much OAs and likely awake breathing.

Resmed ASV machines report all apneas as UA (unclassified) but assume they are obstructive. So you can see the pressure jumps up after every apnea.

I'd be interested to have a closer look at that initial cluster - It goes on for over half an hour and the pressure gets up very high, so you would definitely remember it if you were awake. In Oscar, turn off the pressure graph and turn on mask pressure. Then zoom in close on that cluster so we can see what's happening and how the machine is responding.

palerider · Post by **palerider** » Sat Aug 01, 2020 8:02 am

kirbini wrote: ↑
Wed Jul 29, 2020 8:48 am
I almost always have that problem at the first of the night. I have been adding supplemental oxygen for the first hour of the night to overcome the OAs. That way, my oxygen stays above 90. I am hoping with the new ASV I can eliminate that.

All the oxygen in the world won't help you if your throat is blocked.

palerider · Post by **palerider** » Sat Aug 01, 2020 8:07 am

Respiration99 wrote: ↑
Sat Aug 01, 2020 4:26 am

UAs...pretty much OAs and likely awake breathing.
Resmed ASV machines report all apneas as UA (unclassified) but assume they are obstructive. So you can see the pressure jumps up after every apnea.

They do that because they prevent centrals, and don't wait 10 seconds before acting, so they can't differentiate between central and obstructive.

If you stop breathing, and they can't force air in, then they report an apnea.

It would make sense to set a higher MinEPAP in this case.

Pugsy · Post by **Pugsy** » Sat Aug 01, 2020 8:20 am

palerider wrote: ↑
Sat Aug 01, 2020 8:07 am
It would make sense to set a higher MinEPAP in this case.

It's being done. Actually made the jump to minimum EPAP 6 and may go to 6.6 and PS minimum to 4.4.
AHI is improved significantly (like in the 2ish range) but not as clean as I would like. There is the likelihood of some SWJ flagging though...some breaks in therapy are known.

Remember OP lives at altitude and sometimes has centrals in numbers that aren't acceptable and wasn't using EPR so can't turn it off and maybe get lucky that way and it's not a viable option at this time to do any experiments at a lower altitude.

Settings for a new Resmed ASV

Settings for a new Resmed ASV

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