Can you explain Aircurve AutoASV?

joeljjk11 · Post by **joeljjk11** » Tue Mar 20, 2018 7:47 am

So I have an Aircurve 10 machine and am currently using the Auto ASV function. I was wondering if someone could explain how it works.

So it seems like with this setting my pressures end up being very high, does this mean that the machine is sensing that I am needing higher pressures and adjusting automatically? Or because of my settings is the machine just automatically going to high pressures?

I currently have 15 for the Max and 4 for the Min on each of the two settings on the machine.

Whatever I try with settings my numbers are almost always consistently terrible. Last night my AHI was 12, the night before that they were 15.7, I am wondering if because of the higher pressures that the machine is adjusting to that I am getting more central events?

Any feedback would be helpful.

Thanks,
Joel

Jas_williams · Post by **Jas_williams** » Tue Mar 20, 2018 8:05 am

The ASV is a specialist machine for treating Complex Sleep Apnea. Without graphs from sleepyhead we cannot make any suggestions.

Pugsy · Post by **Pugsy** » Tue Mar 20, 2018 8:16 am

joeljjk11 wrote: ↑
Tue Mar 20, 2018 7:47 am
does this mean that the machine is sensing that I am needing higher pressures and adjusting automatically?

yes

joeljjk11 wrote: ↑
Tue Mar 20, 2018 7:47 am
Or because of my settings is the machine just automatically going to high pressures?

no...the machine will only go to where it thinks it needs to go and if it didn't have a good reason for going higher then it wouldn't go higher.

joeljjk11 wrote: ↑
Tue Mar 20, 2018 7:47 am
I currently have 15 for the Max and 4 for the Min on each of the two settings on the machine.

There are more setting than what you mentioned and it's unclear what goes to 15 and what is 4.
You need to be more specific as to what the settings are.

joeljjk11 wrote: ↑
Tue Mar 20, 2018 7:47 am
Whatever I try with settings my numbers are almost always consistently terrible. Last night my AHI was 12, the night before that they were 15.7, I am wondering if because of the higher pressures that the machine is adjusting to that I am getting more central events?

Have no idea. Need to see some detailed software reports.
If you are having central apneas the machine will breathe for you as long as the setting parameters allow it to do its job.
So the AHI shouldn't be from centrals...might be from obstructive apneas or hyponeas though because the minimum pressure settings aren't optimal.
Need to see the detailed reports.

joeljjk11 · Post by **joeljjk11** » Tue Mar 20, 2018 4:45 pm

See attached for three days from Sleepyhead. let me know if there are any settings I should change on my machine.

Thanks,
Joel

joeljjk11 · Post by **joeljjk11** » Tue Mar 20, 2018 4:53 pm

Pugsy wrote: ↑
Tue Mar 20, 2018 8:16 am

joeljjk11 wrote: ↑
Tue Mar 20, 2018 7:47 am
does this mean that the machine is sensing that I am needing higher pressures and adjusting automatically?
yes

joeljjk11 wrote: ↑
Tue Mar 20, 2018 7:47 am
Or because of my settings is the machine just automatically going to high pressures?
no...the machine will only go to where it thinks it needs to go and if it didn't have a good reason for going higher then it wouldn't go higher.

joeljjk11 wrote: ↑
Tue Mar 20, 2018 7:47 am
I currently have 15 for the Max and 4 for the Min on each of the two settings on the machine.
There are more setting than what you mentioned and it's unclear what goes to 15 and what is 4.
You need to be more specific as to what the settings are.

joeljjk11 wrote: ↑
Tue Mar 20, 2018 7:47 am
Whatever I try with settings my numbers are almost always consistently terrible. Last night my AHI was 12, the night before that they were 15.7, I am wondering if because of the higher pressures that the machine is adjusting to that I am getting more central events?

Have no idea. Need to see some detailed software reports.
If you are having central apneas the machine will breathe for you as long as the setting parameters allow it to do its job.
So the AHI shouldn't be from centrals...might be from obstructive apneas or hyponeas though because the minimum pressure settings aren't optimal.
Need to see the detailed reports.

Also the settings were as follows:

Max PS: 15
Min PS: 4

Max EPAP: 15
Min EPAP: 4

Joel

Pugsy · Post by **Pugsy** » Tue Mar 20, 2018 4:59 pm

Can you hide the calendar and turn off the pie chart....Preferences/Appearance tab and remove the check mark for show pie chart.
That way the machine settings can be seen.
See this thread for examples.

I think you just need more minimum EPAP but I need to see the current settings better.

Pugsy · Post by **Pugsy** » Tue Mar 20, 2018 5:02 pm

Does your PS of 4 have just a minimum available or a minimum and maximum PS available as a setting choice?

What position do you usually sleep in? Spend much time on your back?
Was your OSA worse in REM by chance?

joeljjk11 · Post by **joeljjk11** » Tue Mar 20, 2018 5:05 pm

Hi the settings are:

Min PS: 4
Max PS: 15

Min EPAP: 4
Max EPAP: 15

joeljjk11 · Post by **joeljjk11** » Tue Mar 20, 2018 5:06 pm

Also sometimes I do end up on my back but most of the time I am on my side.

Pugsy · Post by **Pugsy** » Tue Mar 20, 2018 5:19 pm

There are 2 modes of operation in ASV functions on this machine
ASV mode and Auto ASV mode.
ASV mode has only the minimum PS available...auto ASV has a minimum and maximum PS available.
Looks like Auto ASV mode is being used.
I can't see the overall AHI or the category breakdown because of the pie chart and calendar and you have scrolled down so far to get the statistics.

The clustering...if you were most likely on your side then I would suspect that REM stage sleep is the culprit. You need more EPAP during the time of the clusters assuming those UAs are obstructive apneas.
Unfortunately one of the drawbacks to this machine is there is no separation into OA or Central/CA category for those UAs.
The machine just calls the apneas but usually they are obstructive because the machine will prevent the central from happening with a rapid and high pressure increase.

I can't tell how much more EPAP minimum though because it's hard to see just what you were using right before the clustering happened.

When it doubt...start conservative and see if one gets lucky.
Do you feel comfortable changing just the minimum EPAP? That's the only thing I would suggest to change...and go from minimum of 4 to 6 minimum...see what happens and then maybe 8 minimum EPAP and see what happens....then maybe 10 min.
Need to better hold the airway open in the first place instead of trying so hard to fix it after it starts trying to collapse..and that's done with more minimum EPAP.

joeljjk11 · Post by **joeljjk11** » Tue Mar 20, 2018 5:30 pm

I will adjust the min EPAP to 6. Thank you! I appreciate it!

I do not know much about what the settings on this machine mean so I am sort of winging it. My doctor is useless and always suggests lower pressures so who knows, although I haven’t seen her in a long time.

Pugsy · Post by **Pugsy** » Tue Mar 20, 2018 5:38 pm

This might help you understand the titration process...different brand but the why for doing something is the same no matter what brand.
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf

ajack · Post by **ajack** » Wed Mar 21, 2018 11:33 pm

joeljjk11 wrote: ↑
Tue Mar 20, 2018 5:30 pm
I will adjust the min EPAP to 6. Thank you! I appreciate it!

I do not know much about what the settings on this machine mean so I am sort of winging it. My doctor is useless and always suggests lower pressures so who knows, although I haven’t seen her in a long time.

start with min epap 6
page 33
https://www.scribd.com/document/3676589 ... Amer-Eng-1
The default pressure is
min epap 4
max epap 15
min ps 3
max ps 15

The titration guide would say you raise the min epap till the UA settle down. I think your UA could be positional because of the large movement in the epap pressure. I would get a $10 foam cervical collar to keep my airway open and trial it for a few nights. It's an easy way to tell if you are chin tucking etc. If this cleans up your chart, you know what the issue is, back sleeping is a possibly too.
I would really look to other possibilities. By you chart to resolve these UA with increased epap, you are looking at min epap 14, max epap 15 ( I think 15 is the max epap the aircurve asv can go to, the max PS depends on the min epap and adds to 25.)

There are several asv users on apneaboard that can help too. For some reason the sleepyhead isn't displaying your SD card ASV data properly, there is no target minute ventilation etc. I would get ResScan from apneaboard too, that will give a cross check.

ajack · Post by **ajack** » Wed Mar 21, 2018 11:39 pm

Pugsy wrote: ↑
Tue Mar 20, 2018 5:19 pm
There are 2 modes of operation in ASV functions on this machine
ASV mode and Auto ASV mode.
ASV mode has only the minimum PS available...auto ASV has a minimum and maximum PS available.
Looks like Auto ASV mode is being used.
I can't see the overall AHI or the category breakdown because of the pie chart and calendar and you have scrolled down so far to get the statistics.

The clustering...if you were most likely on your side then I would suspect that REM stage sleep is the culprit. You need more EPAP during the time of the clusters assuming those UAs are obstructive apneas.
Unfortunately one of the drawbacks to this machine is there is no separation into OA or Central/CA category for those UAs.
The machine just calls the apneas but usually they are obstructive because the machine will prevent the central from happening with a rapid and high pressure increase.

I can't tell how much more EPAP minimum though because it's hard to see just what you were using right before the clustering happened.

When it doubt...start conservative and see if one gets lucky.
Do you feel comfortable changing just the minimum EPAP? That's the only thing I would suggest to change...and go from minimum of 4 to 6 minimum...see what happens and then maybe 8 minimum EPAP and see what happens....then maybe 10 min.
Need to better hold the airway open in the first place instead of trying so hard to fix it after it starts trying to collapse..and that's done with more minimum EPAP.

Bit of a typo, the asv mode only has a single epap and min/max PS, the auto asv has min/max epap and min/max PS

Can you explain Aircurve AutoASV?

Can you explain Aircurve AutoASV?

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