Could AutoASV machines be used for everyone?

Not everyone adjusts so quickly. It's great that you did and that you appear (based on the numbers) to have slept well. Hope it is a trend that will continue for you! ..

I feel lucky that it worked out ok. We shall see if things continue this way. Being use to the "wind tunnel" effect of my settings on previous machines helped me accept this with ease. I'm doubt that I would have liked this machine on day one of therapy at all. I know my insurance would never buy this type of machine for me. It is a luxury to find one affordable.

From looking at my Statistics Report I do feel that my previous 20/12 settings were good ones. I know my apnea is positional if it never got worse than this it appears that I could have even used 16/7. I don't think I rolled around as much as normal last night.

STL Mark wrote: I have to admit I am not the poster child for low leak rates. I worry more about comfort and remaining compliant than what is necessary to remove all leaks.

Yeah I agree that sometimes leaks have to take a back seat to how you feel in the morning (at least, during the early stages of high pressure adaptation). Sadly, I suspect, many 'leak-a-phobics' don't tend to do well on ASV if they start to get too compulsive/anxious about their software numbers. My opinion is to give the ASV machine designers and engineers some credit for dealing with reasonable leak rates - mostly because the newer machines will automatically up the baseline pressure to provide compensation. NOTE: I'm not saying to disregard major leaks, just put them into their proper perspective regarding one's OVERALL therapy. Final, final NOTE: JohnBFisher is right that there are many unique challenges to ASV. The machine might be right for everybody who needs it ... but everybody who needs it is not necessarily right for the machine. In a simplified nutshell.

PS. Several months ago, STLMark went all out to give me a killer deal on my new S9 VPAP Adapt, plus some super after-the-sale support... I can't thank him enough.

I find this discussion very interesting in light of the fact that Dr. Krakow feels that ASV machines have been very helpful for people with insomnia who also have SDB:

http://www.scitechnol.com/2325-9639/2325-9639-2-107.php

As much I greatly respect him, that never made any sense to me because of the discussions on this board about how tough it has been for people to adjust to ASV therapy. But perhaps it is the newer models that make it easier for people to adapt?

49er

Night number 2 was equally nice to have the machine. 6.8 hours sleep due to waking up early for church. 0.0 AHI on display. Feel great. The machine is a keeper.

49er wrote:... But perhaps it is the newer models that make it easier for people to adapt? ...

Nope. Though the Respironics units now have a ramp feature, it can still take upto a few months to adjust to the wild pressure swings. STL Mark is more the exception than the rule. Sleepinow is the other end of the spectrum, where just changing the pressure upward by 0.5cm H2O caused problems. Most of us land somewhere in the middle.

JohnBFisher wrote:

49er wrote:... But perhaps it is the newer models that make it easier for people to adapt? ...

Nope. Though the Respironics units now have a ramp feature, it can still take upto a few months to adjust to the wild pressure swings. STL Mark is more the exception than the rule. Sleepinow is the other end of the spectrum, where just changing the pressure upward by 0.5cm H2O caused problems. Most of us land somewhere in the middle.

Thank you so much John for responding. The issue of ASV machines/Comfort/Insomnia had been really bothering me for awhile. I know, I should have posted my concerns but you have greatly helped with this reply.

49er

I am using an ASV and I took to it like a duck to water also. I don't need it but I got a great deal on it on Craig's list. I thought it could be set to bipap when I bought it. I panicked and thought I had wasted my money when I found out it couldn't be set to bipap. Maybe it was easy for me to adjust to because I don't need it. I do feel the pressure changes. It is like my mask is giving me a facial massage doing it's little push ups on my face. I hope I never have to go back to apap. For me this is so much easier to use. I also have had my first 0.0's.

JohnBFisher wrote:STL Mark is more the exception than the rule.

I would respectfuly disagree with that, John. You have always taken an elitist and alarmist view of anyone using or considering the use of an ASV device. STL's experience with the ASV would be more the rule, than the exception. And yes STL, The auto SV or Adapt should be the standard devicee issued for anyone requiring (or not requiring, ala Dr Krakow) non-invasive respiratory intervention. The Adapt would be the gold standard, followed by the auto SV.

StillAnotherGuess wrote:... You have always taken an elitist and alarmist view of anyone using or considering the use of an ASV device. ...

Au Contraire! The fact that I reply to most of the ASV posts does tend to provide me with an insight into adjusting to the ASV. Based on posts in this forum, what I tend to observe is that folks with complex sleep apnea tend to have the hardest time. But it often takes at least several weeks to come to terms with the leaks and pressure changes. It took me several months before I no longer felt as if I was in a contest with the unit when I go to sleep. And I'm not a newbie by ANY stretch of the imagination. I had used CPAP and BiPAP therapies for more than 18 years before starting ASV therapy.

Yes. Some people do take to it like ducks (and I'll address StormyNights in my next post), but most of us take a little bit of time to adjust to the therapy.

Stormynights wrote:... I am using an ASV and I took to it like a duck to water also. I don't need it ... Maybe it was easy for me to adjust to because I don't need it. ...

Exactly. If you don't need it, you won't have quite the aggressive pressure changes that I have when I stop breathing. It's not that you can not adjust to it. What I try to do is to let people know that it will probably take a little while to adjust to it .. but patience and persistence will pay off. I don't mean to dissuade anyone from getting ASV therapy if they need it. Quite the contrary. I want people to use ASV if they need it. But realistic expectations are better than the unrealistic expectation that it won't require adjustment. Thus, if they have no problem, great. But if they encounter issues folks will know that they can and will get to a point that it won't be a problem anymore.

Hope that makes sense.

JohnBFisher wrote: Exactly. If you don't need it, you won't have quite the aggressive pressure changes that I have when I stop breathing. It's not that you can not adjust to it. What I try to do is to let people know that it will probably take a little while to adjust to it .. but patience and persistence will pay off.

John is right, If you are having Central events the pressure spikes /air volume is something you have to learn to adjust to. If you do not Centrals you'll never have this issue.
I do believe the ASV is the premire of cpap machines. If you can afford the cost it may be worth the investment in your sleep thearpy.

letsride wrote:I do believe the ASV is the premire of cpap machines. If you can afford the cost it may be worth the investment in your sleep thearpy.

First you have to convince your sleep doctor or who ever you use to give you a prescription or buy it off of craigslist which is far and few between.

I'm surprised you fell asleep so easily with the ASV machine. I've only used one once, last week for my third titration study, but I found I really hated it.

I only used a CPAP once, and that was during my first sleep study. It took 7 minutes to fall asleep, and I slept till the tech woke me up. Seems they couldn't get my AHI down below 35 with CPAP.

BIPAP took me 10 minutes to fall asleep with during the titration study, I slept better than I had for years, and I've been 100 percent compliant when I actually slept, having used it for three months, although 2 nights I didn't get the required 4 hours sleep to officially be compliant, that's because I wasn't able to go to bed long enough. I always have the machine on when I sleep.

I did my third titration last Monday using the ASV machine and although I haven't seen the results yet, It took hours to get to sleep and I woke up at least half a dozen times. I also ended up with a heck of a bruise and sore on my nose because I cranked my mask down as tight as I could pull the straps to try and get through the mask leaks. Obviously, I have a lot of centrals, thus the 3rd study, and the machine gets pretty aggressive in trying to make me breath during those centrals. I get clusters when falling asleep, and then again when I go into REM. Of course the pressure ramps way past the IPAP of 16 my bipap is set for, and makes the mask leak like mad, but generally it wakes me up prior to the big leaks.

Thanks to Furlough, I was camping when the sleep doc tried to call Friday, but I'll learn Monday if I have to try and adapt to an ASV machine or not. Having tried one once, I'm not looking forward to it, although I'm the type that will adapt, it doesn't mean I'll like it. My first impression though is that CPAP or BIPAP is the way to go if you can get results with them. They seem much easier to adapt to.

JohnBFisher wrote:STL Mark is more the exception than the rule. Sleepinow is the other end of the spectrum, where just changing the pressure upward by 0.5cm H2O caused problems. Most of us land somewhere in the middle.

I am very appreciative to have input from Mr. Fisher on this and all matters. For whatever reason I have been extremely lucky with adapting to the machines from the start. My titration pressure was 18. My history of having pressures in this range blowing in my face for three years made me appreciate this machine. If my pressure was below 10 to start with or if I had already visited the lowest pressure I could get by with on my BiPap I probably would not have noticed such a dramatic change.

StillAnotherGuess wrote:I would respectfuly disagree with that, John. You have always taken an elitist and alarmist view of anyone using or considering the use of an ASV device.

I highly appreciate the input of everyone in this thread. Mr. Fisher provided great insight as to the problems that can occur and did so without insulting others. For me it was a case of being like a curious cat, I had to see what was going on. StillAnotherGuess, your comment makes me feel uncomfortable. I would hope you have had second thoughts since that post.

SeekSleep wrote:I'm surprised you fell asleep so easily with the ASV machine. I've only used one once, last week for my third titration study, but I found I really hated it.

I only used a CPAP once, and that was during my first sleep study. It took 7 minutes to fall asleep, and I slept till the tech woke me up. Seems they couldn't get my AHI down below 35 with CPAP.

BIPAP took me 10 minutes to fall asleep with during the titration study, I slept better than I had for years, and I've been 100 percent compliant when I actually slept, having used it for three months, although 2 nights I didn't get the required 4 hours sleep to officially be compliant, that's because I wasn't able to go to bed long enough. I always have the machine on when I sleep.

I did my third titration last Monday using the ASV machine and although I haven't seen the results yet, It took hours to get to sleep and I woke up at least half a dozen times. I also ended up with a heck of a bruise and sore on my nose because I cranked my mask down as tight as I could pull the straps to try and get through the mask leaks.

I do believe that my body may adapt to changes in cpap machines better than most. Sleep techs had wake me and practically kick me out of the lab after my sleep study three years ago because I wanted to stay hooked up to the machine. It is possible that the ASVAuto mode has allowed me to accept this easier than most. It could be that your condition is better treated in ASV mode and that setting has a different learning curve.

I do think we each have a different approach to how we handle leaks. I'm not sure that I could adapt to any machine if I had my mask straps pulled as tight as I could. I have been lucky that mask leaks do not awaken me as much as some on this forum so I have taken a more relaxed approach to accepting certain amounts of leaks. I do wish you luck in finding the solutions that work best for your condition.