ASV Help Needed - See Page 3 AHI from 1-4 up to 50+

Hi all! This is my first time posting in the forums here. I am also somewhat of a newbie when it comes to sleep machines.

Last night was my second attempt at treatment for my sleep disorders.

I apparently only used the device my first night for 1.6 hours and woke up choking and unable to breathe while laying on my side. I removed the mask and turned off the machine. I honestly thought I removed the mask at least 4 hours into my sleep. My AHI for last evening was 11.4.

Under Settings I read that 90% epax was 9.0 and my Average PS was 5.3 I checked the settings and my maximum pressure is 25. The Epap min. is 8.0 and Max. is 15. The BPM is set to Auto with the PS mim at 5.0 and max at 15.

(I haven't the slightest idea what this means - nor what half of my machines numbers mean for that matter; I obviously know what AHI stands for).

I am hoping that someone can help me understand what happened last evening with my first experience and if any suggestions could be provided to assist me in benefiting greater from my machine. I do not want to fall out of compliance and I would like to get through the weekend prior to contacting my new provider if possible. I am able to edit my Bi-Flex and RAMP settings but not the others.

Has anyone else experienced what I did when they first started treatment?

Some info about my treatment to date: I originally was using a Fisher & Paykel Sleepstyle 200 (Auto-Pap) with a ResMed Swift FX Nasal Pillows System but found that the pressure was not strong enough and I was not receiving any therapeutic benefits from the machine. The provider I was working with at the time was horrible as well so I went back to my doctor and requested a new prescription and a new provider.

After two more sleep studies I was prescribed a Phillips Respironics BiPAP autoSV Advanced System One with Bi-Flex & RAMP enabled.

Welcome to the forum.

I would suggest that you edit your topic line.. add ASV help needed.
You have a very special machine and there are some members here that can explain things much, much better than I can because I have no experience with your machine.

Are you getting your reported data off the machine or do you have the software?

NJSleepless wrote:Hi all! This is my first time posting in the forums here. I am also somewhat of a newbie when it comes to sleep machines.
I apparently only used the device my first night for 1.6 hours and woke up choking and unable to breathe while laying on my side. I removed the mask and turned off the machine. I honestly thought I removed the mask at least 4 hours into my sleep. My AHI for last evening was 11.4.
Under Settings I read that 90% epax was 9.0 and my Average PS was 5.3 I checked the settings and my maximum pressure is 25. The Epap min. is 8.0 and Max. is 15. The BPM is set to Auto with the PS mim at 5.0 and max at 15.
(I haven't the slightest idea what this means - nor what half of my machines numbers mean for that matter; I obviously know what AHI stands for).
Has anyone else experienced what I did when they first started treatment?

Hi, Sleepless, and welcome to the forum. You are part of a small club, that being ASV users. Most of us have NO clue on these contraptions. You might go back in and edit your post title to include ASV so it will attract ASV users' attention; and/or post same message under the -All things ASV...- topic. Again, welcome, there's folks who are very willing to help you here at CpapTalk.

Thank you for your advice. I did change my Topic.

I am reading the data off of the machine. I do not have any software as of yet. I do have the SD card installed but it states it's 100% empty.

Thank you for your advice. I hope someone can come along and assist me as I am nervous about this evenings treatment.

I cannot recall the last time I woke up from a sleep feeling rested in the past 17 years and am desperate for relief. This machine was given to me due to the complexity of the numerous disorders I have. I hope this works and that last night was a snafu.

n0hardmask wrote:

NJSleepless wrote:Hi all! This is my first time posting in the forums here. I am also somewhat of a newbie when it comes to sleep machines.
I apparently only used the device my first night for 1.6 hours and woke up choking and unable to breathe while laying on my side. I removed the mask and turned off the machine. I honestly thought I removed the mask at least 4 hours into my sleep. My AHI for last evening was 11.4.
Under Settings I read that 90% epax was 9.0 and my Average PS was 5.3 I checked the settings and my maximum pressure is 25. The Epap min. is 8.0 and Max. is 15. The BPM is set to Auto with the PS mim at 5.0 and max at 15.
(I haven't the slightest idea what this means - nor what half of my machines numbers mean for that matter; I obviously know what AHI stands for).
Has anyone else experienced what I did when they first started treatment?

Hi, Sleepless, and welcome to the forum. You are part of a small club, that being ASV users. Most of us have NO clue on these contraptions. You might go back in and edit your post title to include ASV so it will attract ASV users' attention; and/or post same message under the -All things ASV...- topic. Again, welcome, there's folks who are very willing to help you here at CpapTalk.

I will do a repost under that Topic. I just know that folks frown upon multiple posts... I will do that now and then maybe an Admin can delete my OP here?

Eek! I'm sorry for being a pain so early on but I do not see a special forum for ASV members. I did put a post under a thread entitled ASV users: join the everything ASV thread." Is that what you were referring to?

Frankly I don't even know what ASV stands for. I feel a bit silly at the moment.

There is no need to delete your topic here. It is designed for your specific questions and the other thread is rather long.
Your needs might get swallowed up in it. It won't hurt a thing to monitor 2 threads. It's not like you have a dozen of them floating around.

Software...
SleepyHead will work with your machine.
http://sourceforge.net/projects/sleepyhead/

For the ASV you need Encore 2.5....2.4 doesn't have the new PR S1 ASV stuff.

No worry about the data card showing 100% available. There is data. It takes up such a tiny portion of the SD card that it will take several weeks for that to come off 100%.

Check your private message box in a couple of minutes and I will explain Encore Pro 2.5 in more detail.

ASV Adapto Servo Ventalation...I think..something along those lines.

I'm guessing you have been reading a bit; you had already posted your equipment as we suggest - not all newbys do that. There's a few folks on the forum with complex myriad of medical issues, so you will find more than one who can offer you good advice.
Assuming you were titrated before getting the machine, a typical occurrance with new machines is the supplier (DME) sets it up generically, with very wide ranges, rather than more tailored settings. That can on any machine make it tough on machine and user.
Bt I am out of my realm, so sit tight; know that lots of folks check in during the middays hours.. we have members from all quadrants of USA, Canada, Australia, Europe, all over. There's help out there for you. Again, welcome.

Pugsy wrote:There is no need to delete your topic here. It is designed for your specific questions and the other thread is rather long.
Your needs might get swallowed up in it. It won't hurt a thing to monitor 2 threads. It's not like you have a dozen of them floating around.

Software...
SleepyHead will work with your machine.
http://sourceforge.net/projects/sleepyhead/

For the ASV you need Encore 2.5....2.4 doesn't have the new PR S1 ASV stuff.

No worry about the data card showing 100% available. There is data. It takes up such a tiny portion of the SD card that it will take several weeks for that to come off 100%.

Check your private message box in a couple of minutes and I will explain Encore Pro 2.5 in more detail.

ASV Adapto Servo Ventalation...I think..something along those lines.

Thank you for the information. I just did a Google search and you are 100% correct to what ASV stands for. I will absolutely research the software solutions you have mentioned.

I just want to say in advance that I thank you all for your patience and assistance. I'm a 32 y/o male with serious sleep issues as well as cardiac problems and this treatment is an essential key to allowing me to live a much more healthier life.

n0hardmask wrote:I'm guessing you have been reading a bit; you had already posted your equipment as we suggest - not all newbys do that. There's a few folks on the forum with complex myriad of medical issues, so you will find more than one who can offer you good advice.
Assuming you were titrated before getting the machine, a typical occurrance with new machines is the supplier (DME) sets it up generically, with very wide ranges, rather than more tailored settings. That can on any machine make it tough on machine and user.
Bt I am out of my realm, so sit tight; know that lots of folks check in during the middays hours.. we have members from all quadrants of USA, Canada, Australia, Europe, all over. There's help out there for you. Again, welcome.

Thank you so much for your feedback as well as giving me insight into some of the terminology aka DEM. I will absolutely be checking back later today (at work right now) and will have much more time to sit and discuss with anyone willing to listen.

Warm Regards,

Nick

You should have private message by now.
While I can't help a whole lot on specifics in regards to your machine itself.. I can help with software issues.
Also someone may ask you to post one of your reports for review.
Below are instructions for adding images so they will show up like the examples here. Might give my first post a look so you will see what your reports will sort of look like. Yours will have more detail but be presented in same format.
viewtopic.php?f=1&t=64906&st=0&sk=t&sd= ... re+options

How to insert images.

Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.
Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

I sill respond in a bit with a more detailed response. It is really tough to do a detailed response on a tablet.

But let me say welcome. There are several of us, who use ASV machines. You will find that ed try to help one another.

NJSleepless wrote:Eek! I'm sorry for being a pain so early on but I do not see a special forum for ASV members. I did put a post under a thread entitled ASV users: join the everything ASV thread." Is that what you were referring to?

Frankly I don't even know what ASV stands for. I feel a bit silly at the moment.

HI NJ,

No biggie starting your own thread. Since there isn't an ASV forum, I started that thread in teh hopes of keeping things in one place, but I don't know if anyone even follows it anymore as I've seen questions going unanswered. It''s gotten quite long as well so it's difficult to read through. Since that idea didn't work, you're better off with your own thread.

I did reply over there but I'll repost it here:

Welcome, you've got one of the best machines on the market. Would you perhaps be able to post the report from your first night? There might be something there that could help in finding out what is going on.

I've never experienced the choking, so I'm not sure what it could be. My initial guess is you stopped breathing and the auto kicked in and really increased the pressure up toward the max PS and it may have caused some difficulty breathing with that kind of high pressure and woke you up.

As for your settings, those look fairly normal.

PS min= 5 is the inspiration pressure support minimum
EPAP min = 8 is the expiration pressure support minimum

The max's are the highest those can go to. Our machine follows our breathing patterns for the few minutes prior to the present and then it increases the pressures as it recogizes changes in those patterns.

Your settings are close to my prescription, my min PS was also 5 and my EPAP min was 7. I increased both because I was not getting enough support and my AHI's ran into the teens. I am now using min PS= 7 and min EPAP= 9 and since I changed to those settings, my AHI's have been 3's and 4's consistently. But it takes a little getting used to those settings.

When you say you were choking, did it happen just that one time? Did you fall asleep ok and sleep well until then? Was this the only night on this machine? I sure as heck hope you don't give up and if it happens again, try not to keep the mask off. Start it up again and use the ramp feature. The ramp lowers the pressure for aobut 20 or 30 minutes to allow you to fall asleep and then it goes up to normal pressures.

If you can post your report, that may help in knowing what is going on. Hopefully some others will chime in as well.

Greetings! Again, let me welcome you to both this forum and to the ASV club. There are several members who use and struggle with ASV therapy.

So, let me tackle a couple things first. I think it appropriate to explain a little bit about central sleep apnea. It is not clear from your post, but the primary reason you were prescribed an ASV machine would be to address central sleep apnea. You can learn a LOT more about Central Sleep Apnea, by reading through Rested Gal's Links to Central Sleep Apnea:

viewtopic.php?p=22702

Next, let me provide you with some background information about ASV therapy, which is a subset of xPAP therapy ... where xPAP stands for any "Positive Airway Pressure (PAP)" therapy. ASV therapy is used to address central sleep apnea. As you may be aware, there are several reasons why people develop central sleep apnea.

The most common reason people develop central sleep apnea is due to cardiac problems. Central sleep apnea often develops when someone has cardiac problems, such as congestive heart failure. Essentially, the disease process interferes with the chemo receptors that help measure the CO2 levels in the blood. Our bodies actually use two different techniques to determine when to breathe. The first technique we use when awake. The second (and for our discussion the more important) technique measures the acidity of the blood to determine the CO2 content. Anything that interferes with this can then cause repetitive central sleep apneas.

Essentially, as we sleep, for whatever reason, our bodies fall into an undershoot / overshoot cycle that repeats over and over again. First, the body fails to recognize the build up in CO2 as we sleep. This buildup is accompanied by a slowing of breathing, shallower breathing and even cessation of breathing. If it lasts 10 seconds or longer, than it is scored as a central sleep apnea. Remember the belts that go around your waist and chest. A central sleep apnea occurs when there is no effort - at all - to breathe. This lack of effort is the undershoot side of the cycle.

Once the undershoot situation occurs, our bodies will eventually rally and kick in and start to slightly hyperventilate. We kick over to the overshoot side of the cycle. Your respiration increases, you breathe much more deeply. And worse, you blow off too much CO2. By blowing off too much CO2, you set up the repeat of the undershoot/overshoot cycle. Your body notices the CO2 is lacking, respiration wanes and we head into the undershoot side of the cycle.

Researchers and doctors theorized that this repetitive cycle might be broken if they could provide ventilator support when the breathing started to fail. Thus, by helping ventilate the lungs, they could help reduce the CO2 build up. And their numerous tests on this proves quite conclusively that it works.

The machines we now use track the average breathing volume for the past few minutes. This is a moving average. As our breathing slows (as we head into the undershoot side of the cycle), the machines detect the lower than average volume and compensate by increasing the pressure. This increase helps sustain our breathing. We exchange CO2 for O2. Our bodies no longer are driven toward the repetitive cycle. We can keep on breathing. Thus, this xPAP device is an Adaptive Servo-Ventilator, which we call it an ASV machine. The settings are quite a bit more complex than for the average CPAP or even BiPAP device.

To continue some of the causes of central apneas ... As I noted, the most common cause is heart related issues. The next most common cause is probably opiate related. That is, people who take opiates (of various sorts) can eventually experience slowed respiration. At a high enough dosage this can result in cessation of respiration. People using opiates (generally to handle long term, chronic pain) often need an ASV device to handle the resulting central sleep apnea.

The third most common cause of central apneas is due to a negative reaction to pressure. This is known as Complex Sleep Apnea (sometimes referred to as Complex Sleep Apnea Syndrome or ComplexSAS). In essence, the increased pressure of xPAP therapy can reduce the normal respiratory drive. In this event, the ASV units have been shown to help address the resulting central apnea. However, this often takes more time to tweak than other causes.

Finally, if there is some problem with the central nervous system (CNS) or the brain stem, then due to neurological reasons people might have central sleep apnea. This is fairly rare, since it requires degeneration or damage of the brian stem or upper spinal cord. Often something that will damage that part of the brain will do much more severe damage.

You will probably want to request a copy of your sleep studies. This can help you better understand what the problem was that made your doctor feel that an ASV device was best suited to your therapy.

Hope this longer explanation helps.

And finally, I'll start the process of answering some specific questions ... not just providing the general background information.

NJSleepless wrote:... I apparently only used the device my first night for 1.6 hours and woke up choking and unable to breathe while laying on my side. I removed the mask and turned off the machine. I honestly thought I removed the mask at least 4 hours into my sleep. My AHI for last evening was 11.4. ...

First of all, 1.6 hours is close to the normal 90 minute point. I suspect you had just exited REM sleep. You probably were back into Non-REM sleep, during which your brain receives less stimulus. This tends to increase the central apneas during NREM sleep. During REM sleep the brain is more active, so tends to do better and the number of central apneas tend to decrease.

Of course, the "choking" feeling may have been a pretty normal reaction to the increased high pressure. If you had a central apnea, the machine would ramp the pressure way up to help ventilate you. Though it is supposed to do this, it is not at all normal and does take some time to adjust to it.

NJSleepless wrote:... Under Settings I read that 90% epax was 9.0 and my Average PS was 5.3 I checked the settings and my maximum pressure is 25. The Epap min. is 8.0 and Max. is 15. The BPM is set to Auto with the PS mim at 5.0 and max at 15. ... (I haven't the slightest idea what this means - nor what half of my machines numbers mean for that matter; I obviously know what AHI stands for). ...

Sigh! Both the doctors and the DMEs (Durable Medical Equipment providers) should do a better job of providing some explanatory information to help you better understand your therapy.

With an ASV machine you can control several settings.

First, you can control the Breaths Per Minute (BPM). In your case it is set to Auto. That is, it adjusts throughout the night, but normally will expect at least 10 breaths per minute.

Second, your exhalation pressure is controlled by two different pressure. The exhalation pressure is EPAP (Exhalation Positive Airway Pressure). The minimum EPAP value is 8. The maximum EPAP value is 15. That is, when you breathe the machine adjusts the EPAP value according to your apneas. If it detects an obstructive apnea, then the machine will increase the EPAP pressure upto 15cm H2O. That measurement is the amount of height (in centimeters) the air pressure will push a column of water (the H2O) up in a tube. To help support your breathing your inhalation pressure is higher than your exhalation pressure. This both makes it easier to breathe and also will support your breathing when a central apnea occurs. If you are breathing normally, then the Pressure Support (PS) for your inhalation is 5cm H2O over the current EPAP value. So, if your EPAP is 8cm H2O (the minimum value), then the inhalation pressure is EPAP plus the minimum PS ... or 13 (from 8+5). If you fail to breathe (completely), then the maximum pressure would be the current EPAP value plus a Pressure Support of the maximum, which is 15. Again, let's assume you had an EPAP value of 8, then IPAP (inhalation Positive Airway Pressure) would be 8 + 15 or 23. If you had obstructions and your EPAP value had increased to the maximum value, then your IPAP value would be 15 + 15 (or 30cm H2O). However, you have a maximum PS value of 25, so the maximum IPAP would be 25cm H2O.

As you have probably guessed, that's a LOT of pressure. It takes time to adjust to it.

NJSleepless wrote:... I am hoping that someone can help me understand what happened last evening with my first experience and if any suggestions could be provided to assist me in benefiting greater from my machine. I do not want to fall out of compliance and I would like to get through the weekend prior to contacting my new provider if possible. I am able to edit my Bi-Flex and RAMP settings but not the others. ... Has anyone else experienced what I did when they first started treatment? ...

I hope you can see that you are not alone. It takes some time to adjust to using your machine. You will need to be brave and just try to keep on using the mask. But don't be afraid to call your DME if you have questions. They make a LOT of money off these machines. You need to have a mask and setup that works well for you. If it is not, then you should get them to help.

But a note often made to newbies is quite appropriate here ... use the machine even when you are not asleep. Watch TV. Read a book. But use the machine at the same time to adjust to it. It helps you get over the initial hurdles.

Anyway, I hope all this helps.