Learning to breathe with ASV

Bons · Post by **Bons** » Thu Oct 14, 2010 9:55 pm

This is so weird compared to CPAP and BIPAP. The pressure starts to drop halfway through my inhalations, and every so often it will start to increase the pressure in the middle of my exhaling. It's driving me nuts!!! Can any of you ASV veterans explain what's going on? Perhaps if I understood why the heck it's doing this I could convince my body to either fight it better or grin and bear it. Should've taken an Ambien but now it's too late for tonight.

-SWS · Post by **-SWS** » Thu Oct 14, 2010 10:35 pm

Bons wrote:This is so weird compared to CPAP and BIPAP. The pressure starts to drop halfway through my inhalations, and every so often it will start to increase the pressure in the middle of my exhaling. It's driving me nuts!!! Can any of you ASV veterans explain what's going on? Perhaps if I understood why the heck it's doing this I could convince my body to either fight it better or grin and bear it. Should've taken an Ambien but now it's too late for tonight.

Bad leaks can cause a BiLevel to not cycle properly between inhale pressure and exhale pressure. So fix your leaks if you think that's a problem. Also, a machine BPM setting that is not right for your spontaneous breath rate can cause that out-of-sync problem as well.

Sometimes it's just a matter of getting used to the machine's cycling, however...

Calist · Post by **Calist** » Thu Oct 14, 2010 10:51 pm

ASV is a respironics invention designed much in the same way as bipap to use multiple pressures for inhalation/exhalation. They contend that multiple pressures is some how better and although they have run studies and produced statistics in the past to prove this they have never gained much in the way of faith from the medical community and so they have turned their efforts instead to patient marketing. Apparently it is easier to convince them that it is some how better than CPAP.

Where as BIPAP uses two individual pressures, ASV uses three pressures. That is the only TECHNICAL difference however respironics has gone the extra mile to make sure that people do not think of it as a three pressure BIPAP by adding things onto it like backup rates, pressure assist support and of course an auto-titrator. Recently Respironics has tried to push the contention that ASV can treat Complex Apnea (Even though there is a great deal of controversy surrounding the existence of Complex Apnea) the medical community at large continues to regard it- at worst "Completely useless" and at best "A three pressure BIPAP"

-SWS · Post by **-SWS** » Thu Oct 14, 2010 11:19 pm

Calist wrote:Auto Servo Ventilators are crap and cure nothing. They were designed to correct 'Complex Sleep Apnea' which is french for 'Donno howto fix patient'.

Wrong again. They were originally designed as "Heart PAPs". You will not admit to spewing incorrect information here either, of course.

Calist wrote:ASV is a respironics invention designed much in the same way as bipap to use multiple pressures for inhalation/exhalation.

ASV is a Resmed invention. Wrong yet again, Calist. By now I think most of us are not surprised at how often you authoritatively post wrong information here. Your ego is very upset with us.

Calist wrote:They contend that multiple pressures is some how better and although they have run studies and produced statistics in the past to prove this they have never gained much in the way of faith from the medical community and so they have turned their efforts instead to patient marketing. Apparently it is easier to convince them that it is some how better than CPAP.

Well, ASV is clearly better for our members who's doctors could not find suitable therapy UNTIL they migrated to ASV. But you will deny that as vehemently as you still refuse to acknowledge that the Trilogy has AVAPS capability.

Calist wrote: Where as BIPAP uses two individual pressures, ASV uses three pressures. That is the only TECHNICAL difference however respironics has gone the extra mile to make sure that people do not think of it as a three pressure BIPAP by adding things onto it like backup rates, pressure assist support and of course an auto-titrator. Recently Respironics has tried to push the contention that ASV can treat Complex Apnea (Even though there is a great deal of controversy surrounding the existence of Complex Apnea) the medical community at large continues to regard it- at worst "Completely useless" and at best "A three pressure BIPAP"

National Jewish Center for Respiratory Care, huh? Or is that a lie too?

Calist · Post by **Calist** » Thu Oct 14, 2010 11:51 pm

-SWS wrote:
Calist wrote:Auto Servo Ventilators are crap and cure nothing. They were designed to correct 'Complex Sleep Apnea' which is french for 'Donno howto fix patient'.
Wrong again. They were originally designed as "Heart PAPs". You will not admit to spewing incorrect information here either, of course.

http://www.sleepreviewmag.com/issues/ar ... -06_03.asp

ASV is a novel form of bilevel ventilation. The pressure provided during inspiration varies, increasing when the patient's tidal volume decreases, and conversely. This varying assist helps to regularize the chaotic pattern of respiration by reducing and then eliminating the alternating periods of patient over- and under-breathing. This feature operates rapidly, within two or three breaths (almost functioning like a rapidly acting adaptive PAP or A-PAP device).

Calist wrote:
ASV is a respironics invention designed much in the same way as bipap to use multiple pressures for inhalation/exhalation.
ASV is a Resmed invention. Wrong yet again, Calist. By now I think most of us are not surprised at how often you authoritatively post wrong information here. Your ego is very upset with us.

No I'm alright, thanks.

autoSV stands for automatic Servo Ventilation

http://bipapautosv.respironics.com/faq.aspx

Calist wrote:
They contend that multiple pressures is some how better and although they have run studies and produced statistics in the past to prove this they have never gained much in the way of faith from the medical community and so they have turned their efforts instead to patient marketing. Apparently it is easier to convince them that it is some how better than CPAP.
Well, ASV is clearly better for our patients who's doctors could not find suitable therapy UNTIL they migrated to ASV. But you will deny that as vehemently as you still refuse to acknowledge that the Trilogy has AVAPS capability.

I'm sick of posting links already. So I guess I'll reply with "Which med school did you go to?"

God, I can't believe I just said that, I think every med tech here just shot me an angry glare for that one. lol.

Calist wrote:
Where as BIPAP uses two individual pressures, ASV uses three pressures. That is the only TECHNICAL difference however respironics has gone the extra mile to make sure that people do not think of it as a three pressure BIPAP by adding things onto it like backup rates, pressure assist support and of course an auto-titrator. Recently Respironics has tried to push the contention that ASV can treat Complex Apnea (Even though there is a great deal of controversy surrounding the existence of Complex Apnea) the medical community at large continues to regard it- at worst "Completely useless" and at best "A three pressure BIPAP"
National Jewish Center for Respiratory Care, huh? Or is that a lie too?

[/quote]

Looking for me?

timbalionguy · Post by **timbalionguy** » Fri Oct 15, 2010 1:13 am

Bons, what are the settings on your machine?

I wonder if your doctor inadvertently set a manual backup rate, or the wrong backup rate. My doctor wanted 'auto' for me, but mistakedly put a manual rate on the prescription. I found out within 45 minutes of first using the machine that the manual backup rate was not going to work for me. Same symptoms as you describe. I set it auto and have been fine ever since.

As far as adjusting to the machine, I do not know why you were prescribed this machine. But for me, the machine has 'trained' me to sleep in the positions that result in the least ASV action (and therefore, the most 'normal' breathing). The machine has also shown me just how many sleep-stage induced centrals I am really having. Now, I just relax and let the machine do its thing.

Ignore Cailist. For many of us, ASV has made a day-and-night difference in our therapy.

Calist · Post by **Calist** » Fri Oct 15, 2010 1:41 am

Sleep stage induced centrals. Wow. Although I am a bit skeptical at the idea of a machine being able to detect a sleep stage induced central, I would like to express my delight at seeing some one on this forum actually bring up the subject as a concern.

You are the first poster I've seen to even say 'Sleep Stage induced central' or 'Transitional Central' as they are sometimes called. Out of curiosity, does it give any form of criteria as to how it distinguishes tran centrals from other events?

ozij · Post by **ozij** » Fri Oct 15, 2010 1:48 am

timbalionguy wrote:
Ignore Cailist. For many of us, ASV has made a day-and-night difference in our therapy.

Madalot · Post by **Madalot** » Fri Oct 15, 2010 7:18 am

Bons wrote:This is so weird compared to CPAP and BIPAP. The pressure starts to drop halfway through my inhalations, and every so often it will start to increase the pressure in the middle of my exhaling. It's driving me nuts!!! Can any of you ASV veterans explain what's going on? Perhaps if I understood why the heck it's doing this I could convince my body to either fight it better or grin and bear it. Should've taken an Ambien but now it's too late for tonight.

Bons, I feel your pain. My first few nights on my vent were pure torture! My RT had the tidal volume way too high and the inhale pressure was allowed as high as 30! It was awful. I called my doctor and told her that the machine tried to kill me in the middle of the night. Scared the crap out me! Now that my tidal volume is lower and my maximum pressure is 23, I am doing much better. Please stick with it and work to fine tune the therapy. I know for me, once we got the settings dialed in, it was like night and day.

Hang in there.

Bons · Post by **Bons** » Fri Oct 15, 2010 7:22 am

Calist wrote:ASV is a respironics invention designed much in the same way as bipap to use multiple pressures for inhalation/exhalation. They contend that multiple pressures is some how better and although they have run studies and produced statistics in the past to prove this they have never gained much in the way of faith from the medical community and so they have turned their efforts instead to patient marketing. Apparently it is easier to convince them that it is some how better than CPAP.

Where as BIPAP uses two individual pressures, ASV uses three pressures. That is the only TECHNICAL difference however respironics has gone the extra mile to make sure that people do not think of it as a three pressure BIPAP by adding things onto it like backup rates, pressure assist support and of course an auto-titrator. Recently Respironics has tried to push the contention that ASV can treat Complex Apnea (Even though there is a great deal of controversy surrounding the existence of Complex Apnea) the medical community at large continues to regard it- at worst "Completely useless" and at best "A three pressure BIPAP"

Cat,
I never asked for this machine and didn't know I was getting it until my DME called to tell me to come pick it up. I hated it during the sleep study when the tech swithed me to it in the middle of the night. You don't have to worry about me being stupid and gullible to PR's marketing campaign. And believe you me that even if I were gullible my health insurer is not. I spoke with them and they had approved it because neither cpap nor bipap was accomplishing anything. As for the diagnosis of complex apnea - my doctor is a bit arrogant (see my other post) but he is a prof at Penn State and a product of some of the best med schools in Lodon so I'll take his word over a lay person's.

Bons · Post by **Bons** » Fri Oct 15, 2010 7:39 am

[quote="timbalionguy"]Bons, what are the settings on your machine?

No clue until the software comes. I do know the max IPR is 15 and it looks like the Breaths per minute is set at 8. I tried to access the rise time setting to tweak with that but I can't get to it which apparently means it's not prescribed - I would think that would effect the pressure's rising while I exhale.
The only thing I can access is the ramp time, which I reduced because 45 minutes was too long.
It frustrates me that I have no way to check AHI (I'm betting that's why I have this machine, since the doc accused me of being too concerned about it).

I wonder if your doctor inadvertently set a manual backup rate, or the wrong backup rate. My doctor wanted 'auto' for me, but mistakedly put a manual rate on the prescription. I found out within 45 minutes of first using the machine that the manual backup rate was not going to work for me. Same symptoms as you describe. I set it auto and have been fine ever since.

How do I do this? I guess I'd need the software?

As far as adjusting to the machine, I do not know why you were prescribed this machine. But for me, the machine has 'trained' me to sleep in the positions that result in the least ASV action (and therefore, the most 'normal' breathing). The machine has also shown me just how many sleep-stage induced centrals I am really having. Now, I just relax and let the machine do its thing.

Again, doctor never told me I was getting it and would not go over my data with me - had a one page summary, no graphs that I know the bipap could give. It may have something to do with sleep position, like you, because he DI tell me yesterday that in my diagnostic study my OBS was over 30 on my back but less on my side. AS OBS decreases, centrals increase.

I

Bons · Post by **Bons** » Fri Oct 15, 2010 7:47 am

Calist wrote:Sleep stage induced centrals. Wow. Although I am a bit skeptical at the idea of a machine being able to detect a sleep stage induced central, I would like to express my delight at seeing some one on this forum actually bring up the subject as a concern.

You are the first poster I've seen to even say 'Sleep Stage induced central' or 'Transitional Central' as they are sometimes called. Out of curiosity, does it give any form of criteria as to how it distinguishes tran centrals from other events?

Gee, my doctor brought that up just this week. He was trying to convince me that I shouldn't be concerned about my high AHI because he thought that many of them were sleep stage induced centrals that occured in clusters as I fell asleep. Of course he didn't give me the data to prove that, but I'm sure he could have if he'd chosen to (and if he were right). I would imagine that it can be distinguished from other events because during sleep lab studies involving eegs one can correlate their occurances with what the brain is doing and what sleep stage the patient is in. Even on machines used at home, from graphs of breathing one can take a pretty accurate guess on whether or not the apneas occur at sleep onset or changes in arousal.

-SWS · Post by **-SWS** » Fri Oct 15, 2010 7:49 am

Calist wrote:
-SWS wrote:
Calist wrote:ASV is a respironics invention designed much in the same way as bipap to use multiple pressures for inhalation/exhalation.
ASV is a Resmed invention. Wrong yet again, Calist. By now I think most of us are not surprised at how often you authoritatively post wrong information here. Your ego is very upset with us.
autoSV stands for automatic Servo Ventilation
http://bipapautosv.respironics.com/faq.aspx

True to pattern, Calist, I see you conveniently chose HALF the truth this time... since this time a handy half-truth bolstered your incorrect decree better than a full truth or lie. The acronym ASV is interchangeably employed for either Resmed's or Respironic's servo ventilator . Resmed's proprietary name is Adapt SV while Respironics' is Auto SV. They are both ASV, and they are prescribed as servo-ventilator near equivalent devices. Here's a link to that original ASV that you seemed to have overlooked: http://www.resmed.com/us/clinicians/tre ... clinicians

And for those interested in further reading, the above two ASV machines are based on an earlier Proportional Assist Ventilation (PAV) design by Younes:
http://www.google.com/search?q=%22porpo ... f19b06cafa

Calist wrote:
-SWS wrote: National Jewish Center for Respiratory Care, huh? Or is that a lie too?
Looking for me?

Nope. However, if you DO work for National Jewish Center for Respiratory Care, then I won't recommend that sleep center to anybody. If you DON'T work for National Jewish Center for Respiratory Care, then I expect they would want to clear their otherwise good reputation that you drag through the mud here with your self-serving episodes of narcissistic supply and to a lesser extent narcissistic rage---against message board patients who you consistently demean. Either way, you do National Jewish Center for Respiratory Care a great public disservice IMO.

I sincerely wish all your unsuspecting patients the very best luck... They're going to need it in my opinion.

timbalionguy wrote: Ignore Cailist. For many of us, ASV has made a day-and-night difference in our therapy.

Good advice... Thanks, timbalionguy.

P.S. Good luck with your ASV therapy, Bons.

Bons · Post by **Bons** » Fri Oct 15, 2010 8:08 am

Calist wrote:
-SWS wrote: National Jewish Center for Respiratory Care, huh? Or is that a lie too?
Looking for me?

Nope. However, if you DO work for National Jewish Center for Respiratory Care, then I won't recommend that sleep center to anybody. If you DON'T work for National Jewish Center for Respiratory Care, then I expect they would want to clear their otherwise good reputation that you drag through the mud here with your self-serving episodes of narcissistic supply and to a lesser extent narcissistic rage---against message board patients who you consistently demean. Either way, you do National Jewish Center for Respiratory Care a great public disservice IMO.

I sincerely wish all your unsuspecting patients the very best luck... They're going to need it in my opinion.
[/quote]

Might be hard to become his patient since there is no such place to be found if you google it.

-SWS · Post by **-SWS** » Fri Oct 15, 2010 8:17 am

Bons wrote:Might be hard to become his patient since there is no such place to be found if you google it.

Well, you're absolutely right Bons!

Amidst Calist's fluent string of lies and patient attacks on this message board, he made up a name that is VERY similar to world renowned Denver based National Jewish Health:

Calist wrote:I thought it fitting to have a meet and greet. A quick getting to know you just for the medical professionals.

Hi, my name is James Stillwell I am an RPSGT and a REEGT. I have about 20 years experience in medicine and I work in Denver at the National Jewish Center for Respiratory Care.

viewtopic/t56427/viewtopic.php?f=1&t=56 ... sh#p528035

And in Calist's skillful deception he even chose convincing Denver for this particular lie. Yup. Yet another fluent Calist lie. Calist, did you read DSM-IV axis II yet?

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