ASV Legacy setup

I had been posting questions regarding my unsuccessful treatment of my sleep apnea.

To Summarize: Can't afford sleep study. Purchased Auto BiPAP. Still woke up with headaches and feeling awful after years. Suspect CSA. Which makes sense because I have now learned it is a side effect of a drug I am taking. I am applying for some emergency aid but it will take a month or more. I found a Respironics Auto SV Advanced Legacy and with a trade in I think I can afford it. This might help me in case I don't get the aid or it takes a long time.

Is it going to be impossible to setup this machine? How should I start the process. Is there a number I should start with and then what do you think I should look for and what things should be changed and, well you get the idea.

I can't afford a sleep study and have never had one done, I just can't afford it. They quoted me $2400.00

I left a lot out because I know how hard it can be reading and reading through peoples posts filled with seemingly endless details. I hope that is enough to make sure I am at least going in the right direction and that this stands a chance of working. I haven't paid for it just yet.

Thanks very much,
Russ
And special thanks to Pugsy for a lot of very helpful support. I learned more about my situation in a month then I had over the past three years.

I would recommend getting an understanding doctor or RT in the loop for your self-titration on ASV. The Respironics Auto SV Advanced Legacy has the same settings and titration protocol as the current PR1 generation Auto SV Advanced model: http://www.healthcare.philips.com/asset ... otocol.pdf

Respironics would have you start out with these settings:
EPAP Min=4cm or patient comfort
EPAP Max=15cm
PS Min=0cm or patient comfort (0cm is auto-CPAP as your base modality; otherwise auto-BiPAP as base)
PS Max=20cm
Max Pressure=25cm
Rate=Auto
BiFlex=set to patient comfort

Depending how you subjectively respond, and nightly AHI data, adjust accordingly. It's not uncommon for patients to need a higher EPAP Min. Nor is it uncommon for PS Min to require change from 0cm (auto-CPAP base modality) to say 3cm or 4cm (now auto-BiPAP base modality). Servo ventilation will adaptively fluctuate IPAP on each breath, regardless of which base modality type is used (auto-CPAP or auto-BiPAP).

Please keep us in the loop and try to keep a doctor or RT in the loop. Good luck!

uriahsky wrote: I can't afford a sleep study and have never had one done, I just can't afford it. They quoted me $2400.00

I'd suggest one last round of calling sleep labs for price quotes----especially if you haven't done so recently. I'd suggest telling them you are uninsured and broke. I'd also suggest asking them if they know ANY way a patient in your situation can get financial assistance and/or a price break toward a much needed sleep study.

uriahsky wrote: I left a lot out because I know how hard it can be reading and reading through peoples posts filled with seemingly endless details.

Here are some of your past details, should other readers wish to help/comment: viewtopic/t79752/viewtopic.php?f=1&t=78 ... 07#p717207

Does anyone know if the above Legacy ASV offers much data on the Smart Card? If so...what data?
Russ, did you ever get the DT3500 Infineer card reader? I forget if you did or not.

Pugsy wrote:Does anyone know if the above Legacy ASV offers much data on the Smart Card? If so...what data?
Russ, did you ever get the DT3500 Infineer card reader? I forget if you did or not.

Uriahsky mentioned the Advanced legacy ASV rather than the earlier non-Advanced model. BrianinTN posted plenty of data using the Advanced legacy model: viewtopic.php?f=1&t=63954&p=690239#p690108

Rhetorical questions for the helpful crowd at-large, including uruahsky: Given the complexity of health conditions indicating ASV, is it wise for a patient to pursue self-titration on an ASV? What medical and finacial recourse(s) might financially-strapped patients in uriahsky's situation have? What are the medical contraindications for ASV?

Thanks SWS, I thought it did and it does...I was too lazy to go searching and computer has been acting up.
If Russ doesn't have a DT 3500 I can help out with that little item and I think EncoreBasic will work...if not Viewer should.

-SWS brought this post to my attention. Later this evening I will try to put together a longish post to help the OP to work through this.

However, I will offer one word of caution. Any thoughts we provide are just based on our own experience. We are not doctors and do not offer medical advice. And with the ASV unit, if improperly set, can impact your medical situation. That is particularly true if you had a cardiovascular problem. If you have a known problem with your heart do NOT attempt to "self-titrate" any xPAP device. It can unintentionally increase the load on the heart, which would only make matters worse.

If you are otherwise in fairly decent health (especially your cardiovascular system), then it is possible to "self-titrate" an ASV unit. It takes time and data from the machine. I am not certain the model you have listed lists much more than compliance data.

Again, I will review this in my post later today.

This forum has been a real life saver and I really appreciate everyone's help with this.

Thank you for those starting numbers. Honestly people in this group and secondwindcpap, where I am buying the machine from know more about sleep than the doctors I work with, but I am talking to my clinic doctor today because he needs to write the script for this machine. He may not do it and then this whole plan falls through.

I called to the two places that do the sleep studies and one is a hospital and when I asked about a discount they offered me 20% off if I paid in cash. That would bring it down to $1920.00. They other place is getting back to me about discounts or programs.

I do happen to have the Infineer card reader. I had bought one for the M series. So thankfully that will help. I know this is an older machine but I think I have to be thankful they have anything at any price I can afford. They will take my Respironics Bipap Auto as a trade in so that also helps .

John,
I agree I need to be real careful. As it is right now i don't sleep more than an hour or two without waking. I was thinking of maybe setting an alarm for an hour and making sure I wake up and am feeling OK when I use the ASV. I don't have heart problems but I do have bad sinus problems and Asthma problems.

Too me the thing that I worry about is the constant CSA events and waking every hour or two with a pounding head and heart. Can I wait a month? I have to take Imitrex every night to prevent full blown headaches. I found through trial and error that if I take it right before I fall asleep I won't wake with a headache. But if I don't take it the pounding in my head turns into a headache that lasts all day. I know it can't be good to take Imitrex twice a night everyday for the past month and now maybe another month? So if I get the machine maybe that will end, but I also take a chance using the machine without a study. So I guess I take a chance either way.

So that is why I am thinking that I should get this machine even though I will spend everything I have and am taking a chance using it.

With any luck, I should maybe get the ASV this Friday.

I am looking forward to any thoughts you might have about this.

Thanks very much,
Russ

-SWS wrote:Given the complexity of health conditions indicating ASV, is it wise for a patient to pursue self-titration on an ASV?

The short answer is probably, YES.
I've self-titrated on all my ASVs.
My first night, last night, on a PR-1 auto SV Advanced yielded 0.8 AHi.

-SWS wrote:What are the medical contraindications for ASV?

The PR-1 auto SV Advanced User Manual says:
*Inability to maintain an open airway or adequately clear secretions.
*At risk for aspiration of gastric contents.
*Diagnosed with acute sinusitus or otitis media
*Allergy or hypersensitivity to the mask materials where the risk from allergic reaction outweighs the benefit of ventilatory assistance.
*Epistaxis, causing pulmonary aspiration of blood
*Hypotension

Banned,
I've self-titrated on all my ASVs.

Can you give me an idea on how you went about adjusting the settings to self-titrate?

What things did you look at and what adjustments were made. Just some general thoughts on what was done. Hopefully to save me some grief.

Thanks
Russ

JohnBFisher wrote:-SWS brought this post to my attention. Later this evening I will try to put together a longish post to help the OP to work through this.

However, I will offer one word of caution. Any thoughts we provide are just based on our own experience. We are not doctors and do not offer medical advice. And with the ASV unit, if improperly set, can impact your medical situation.

Many thanks for chiming in, John! As a side note, John and his wife are currently getting over a bug. So please rest and get well, John!

Banned wrote:

-SWS wrote:Given the complexity of health conditions indicating ASV, is it wise for a patient to pursue self-titration on an ASV?

The short answer is probably, YES.
I've self-titrated on all my ASVs.

Well, Uriahsky's unresolved health/SDB issues, and his seeming inability to attain a sleep study, take on the characteristics of a classic dilemma. I'm not sure how well or how poorly your medical situation translates to uriahsky's, Banned. Your situation is comprised of your health complications----or more importantly your LACK of health complications. Uriahsky's situation with respect to health complications are an unknown to a well-meaning & helpful message board of CPAP patients. I would also add, Banned, that you are a formally-trained engineer with an avid interest in applying machines to problems. How many different machine models and designs have you purchased and evaluated to date? You get no disrespect there, since I happen to be an engineer and so is John. But my point here is that an avid interest in solving problems with machines also stands to present selection bias and oversight when trying to help solve other peoples' health problems.

Rhetorically: Is uriahsky's health problem best solved with the application of a machine favored by this message board? Should uriahsky's problem solving focus on the difficult problem of attaining medical diagnostics and/or better access to the medical system. Uriahsky's problem presents a classic dilemma given the current state of healthcare in the U.S.

Banned wrote:

-SWS wrote:What are the medical contraindications for ASV?

The PR-1 auto SV Advanced User Manual says:
*Inability to maintain an open airway or adequately clear secretions.
*At risk for aspiration of gastric contents.
*Diagnosed with acute sinusitus or otitis media
*Allergy or hypersensitivity to the mask materials where the risk from allergic reaction outweighs the benefit of ventilatory assistance.
*Epistaxis, causing pulmonary aspiration of blood
*Hypotension

Thank you, Banned! Uriahsky, please review the list of medical contraindications with your doctor when you ask him to write the script. Good luck!

uriahsky wrote: . . . bad sinus problems and Asthma problems. . . . waking every hour or two with a pounding head and heart. . . . full blown headaches. . . . wake with a headache. . . .

Sounds to me like a significant OBSTRUCTIVE element to your problem, to this untrained patient's ears/eyes. And as I understand it, until the obstructive aspect is dealt with sufficiently to see what events remain, it would be premature to assume ASV is called for, especially based mostly on a hunch.

Home-machine labels of events are not the way to diagnose central apnea, I don't think, regardless of financial circumstances. I would tend to assume those centrals were actually obstructive apneas (perhaps with a partially open airway) or to assume they were indications of instability caused by obstructive problems related to the symptoms and conditions described, or were simply the indications of unstable sleep, if we are going on percentage chances of liklihood, if it was me doing the assuming about myself. (Not a diagnosis, mind you. Just a general observation based on my limited experiences with my situation.) And if significant central apneas occur apart from the instability caused by the obstructive events, attempting to treat those centrals without sufficiently exploring their cause, or lack thereof, would seem to me to be putting the cart before the horse. Don't hide or mask a significant symptom just for the heck of it.

Seems to me that you are describing problems related to obstructive apnea and then describing the desire to spend money on a machine that may not be needed instead of spending money on treating the problem being described, as I read it.
I would continue to work on the problem I KNEW I had before getting a special machine to treat a problem I may or may not have. But hey, that's just me. And what do I know?

jnk wrote:

uriahsky wrote: . . . bad sinus problems and Asthma problems. . . . waking every hour or two with a pounding head and heart. . . . full blown headaches. . . . wake with a headache. . . .

Sounds to me like a significant OBSTRUCTIVE element to the problem, to this untrained patient's ears/eyes. And as I understand it, until the obstructive aspect is dealt with sufficiently to see what events remain, it would be premature to assume ASV is called for, wouldn't it?

I agree there, jnk. The headaches might be based in desaturations from obstructive and/or central apneas. Alternatley they might be based in sinus problems or some other health issue(s). Judging from uriahsky's past posts, he seems to have been working on an obstructive apnea premise for years.

jnk wrote: Home-machine labels of events are not the way to diagnose central apnea, I don't think, regardless of financial circumstances.

I absolutely agree here as well. The dilema as I see it is that uriahsky can't walk into a sleep center and say, "Hi, I need medical diagnostics and a PSG, regardless of my financial circumstances." Just because that's a tough nut for ME to crack, doesn't mean that other posters here lack the knowledge to suggest how uriahsky can attain a much-needed PSG and other medical care. I honestly don't know how to crack that nut on uriahsky's behalf. Nor would I know how to crack that tough nut on my OWN behalf given identical circumstances...

jnk wrote: Poster is describing problems related to obstructive apnea...

I'm not even sure obstructive apnea is uriahsky's primary problem, given his complexities and lack of PSG to date. For instance, his obstructive and central apneas detected by his home machine might be improperly scored thanks to ataxic breathing and/or improperly-detected hypoventilation----confounded by asthma and sinus blockage. In that scenario, ASV is the wrong treatment.

I ordered the machine and it should be here tomorrow. I have to try something. I can't go on with this daily misery and pain. I guess I will find out if it helps or not in a day or three. I plan on taking it real slow and maybe using it for a short block of sleep. I guess I will be a Guinea pig for others out there whom I am sure exist. I do appreciate everyone who is open to trying and helping with what they can. I really have no where else to turn to for feedback and advise.
Thank you
Russ

-SWS wrote:Well, Uriahsky's unresolved health/SDB issues, and his seeming inability to attain a sleep study, take on the characteristics of a classic dilemma. I'm not sure how well or how poorly your medical situation translates to uriahsky's, Banned. Your situation is comprised of your health complications----or more importantly your LACK of health complications. Uriahsky's situation with respect to health complications are an unknown to a well-meaning & helpful message board of CPAP patients. I would also add, Banned, that you are a formally-trained engineer with an avid interest in applying machines to problems. How many different machine models and designs have you purchased and evaluated to date? You get no disrespect there, since I happen to be an engineer and so is John. But my point here is that an avid interest in solving problems with machines also stands to present selection bias and oversight when trying to help solve other peoples' health problems.

Rhetorically: Is uriahsky's health problem best solved with the application of a machine favored by this message board?

Well stated and thoughtfully presented, but the op is going to buy the ASV device and self-titrate, in spite of the disclaimers.

My medical complications are limited to undiagnosed sinusitis, turbinate reduction, and deviated septum surgery, which still leaves one or both nasal airways compromised at any given moment. I did ask my ENT surgeon, years ago, what he saw when he looked into my upper nasal cavity after surgery. He stated my upper nasal airway was a 'mess' and any further intervention would not be helpful.

I have purchased, self-titrated sucessfully, and used every Respironics and Rersmed ASV device (including AVAPS) with the exception being the Respironics (Legacy) BiPAP autoSV Advanced.

So, assuming that an ASV device can be far more more beneficial than merely mitigating a few central apneas and some CSA, and since the capacity to self-titrate is already built into the protocol and on-board firm-ware of the Respironics BiPAP autoSV Advanced (without using external data requiring Encore Viewer or Encore pro or Sleepyhead or any other database) including a sleep lab, why should we not explain to the op how to self-titrate?