Is ASV ok if you don't know what kind of sleep apnea you have?

[vilnius]

I wrote this post once and it magically disappeared after I pressed Ctrl + Enter so apologies if I'm double posting.

I got diagnosed with mild sleep apnea in August (~8 AHIs on my side(s), ~12 on my back). Got a F&P APAP which made me feel much better after day 1 but my AHI's were still 2-5 and it was not OSCAR-compatible so I got rid of it and got a ResMed AirCurve 10 ASV. This one is great on paper: 0.0-0.1 AHIs every night. And I think I feel a bit better every day. However, I don't get the same feeling I got after the first day on the APAP. Also, I often wake up after ~5 hours on the machine because the pressure feels too high and the mask starts to leak. But, when I look at the data on OSCAR it seems that everything is fine. Is this part of the adjustment process (it's only been one month on this machine) and I'm being a little hypochondriacal or should I consider switching my settings or the machine? I have a ResMed S9 APAP on standby which I haven't gotten around to cleaning yet (I bought it used).

My main concern is that I read ASVs are best for people with CSA and I don't know if I have it. Also, I went to a nurse in July and she told me I have arrythmia. Another nurse said my heart is fine. I never went to get more testing because that is expensive. My eart rate is very high usually (80-100bpm) and ~70bpm when I'm rested or not anxious which does not happen very often (I have CPTSD). I read that ASV is not recommended for some people with chronic heart failure. I did feel some chronic tightness in my chest before being on CPAP but now my heart feels so much better because of the CPAP. But I'm not sure if it's the placebo effect or not.

The way ASV 'dictates' your breathing pattern feels kinda weird to me (I'm not sure if that's how it works). I read in a book ("Breathe" by James Nestor) that the ideal breathing rate for most people is 5.5s inhale, 5.5s exhale. The respiration data on OSCAR shows that my respiration rate is faster than that. If I train myself to breath 5.5s in 5.5s out, will the ASV learn to keep up as well?

Screenshots below. Note that my sleep schedule is messed up and the data is cut off at 12PM so I posted data from two days so you can see what my typical 'night' looks like.

Mask: ResMed Swift FX. No liners.
Accessories: Heated tube + ResMed tube wrap + Mouth Taping
Settings: PAP Mode: ASVAuto
Min EPAP 4.0 Max IPAP 22.0 PS 3.0-14.2 (cmH2O)











Edit: messed up the pictures the first time. also the second day got 0.12 ahis (hypopneas) but couldn't post due to 10 URLs limit per post

[GrumpyHere]

Pugsy answered your question as to whether your AC10 ASV can be used for plain OSA when you asked about buying it for $200.

https://www.cpaptalk.com/viewtopic.php? ... 8#p1395353

The warning put out by ResMed about chronic heart failure was CYA. It was based on a flawed study.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990958/

If you felt better using your F&P APAP than after using your AC10, then try your back up S9. You won't know which one is better for you until you try it. Acclimating to either machine is going to take time regardless the choice.

Keep in mind, you will need to optimize the settings for the S9 whereas the ASV yields pretty AHI numbers from the get go. But then pretty AHI numbers is not the end goal.

So long as your resultant AHI is below 2, the machine that gets you feeling more rested is the one you should use.

BTW AC10 ASV does not dictate your breathing pattern, it synchs to your breathing pattern.

The AirCurve 10 ASV device uses breath phase mapping to provide a timed backup rate that is synchronized with the patient’s own breathing. When the patient deviates from the ventilatory target, the ASV device aims to stabilize the patient by adjusting Pressure Support. If necessary, it will adjust the timed backup rate from one that matches the patient’s own recent rate towards the built-in default 15 BPM backup rate.

You can force AC10ASV to recalibrate to match your breathing pattern by blowing hard against the pressure. It samples your breathing pattern for the next 3 minutes or so. Breath slow and sturdy while recalibrating.

Good luck.

[Pugsy]

Next time you post images of your reports can you look here for guidelines?
viewtopic/t158560/How-to-post-images-for-review.html
You have made a lot of extra work for yourself and included stuff that isn't needed.
You can get everything needed on one screenshot.

ASV won't hurt you but the way it goes about doing its job/algorithm can sure be difficult to learn to adjust to and if you are having trouble falling asleep then it confuses the machine sometimes.
I don't have a problem with too many central apneas and I have used an ASV machine just because I rather liked the way it did things but then I wasn't new to bilevel therapy or cpap when I got to try one and I knew how to "fool" the machine into not going so wild with its pressure changes. Hint...when you first start the machine each night you have to breathe slowly and deliberately and calmly for about 5 minutes so that the machine thinks this is your normal breathing and sets up the auto adjusting back up rate nice and low and it won't be so quick to give you the big bursts of pressure which can sure be disturbing.

I don't know that I agree with the idea that the "ideal" breathis 5.5 seconds inhale and then 5.5 seconds exhale. That sure makes for a long breath and not very many of them during a minute. I don't think most normal people can breathe comfortably that slowly. I know I sure couldn't.

The ASV machine is overkill for your situation but it can be used for plain jane vanilla OSA but it maybe could stand a little tweaking so that it doesn't do the things that it normally does for central apneas that while needed for centrals...not real helpful when you don't need it and can be a bit unnerving for sleep in general.

How about we make a little change and limit a setting that could be affecting your sleep quality and see if that helps you feel those nice low numbers???

Your PS...pressure support...that's what deals with central apneas and I am betting that while awake you are restless and having trouble sleeping and probably holding your breath a bit (and not realize you are doing it) but the machine is thinking those pauses in breathing are central apneas and the machine senses the pauses and thinks "OMG...a central apnea...I need to go to work" and when it goes to work it gives a rapid quick burst of PS to force you to breathe. Works great when asleep and you don't know it but not so great when awake and you get hit with that big burst.

Change your PS max to 5 if it will let you do it. So minimum PS 3 and maximum PS of 5.
When you turn on the machine each night pay special attention to your breathing. Don't try the 5.5.second thing...just breathe nice and calmly and slowly and don't move around much in bed. Breathe normally for YOU.
Do this for about 5 minutes. You will have to do this every time you turn the machine on because it doesn't remember anything once the machine is turned off. The machine will learn a little bit about your breathing but it can't remember anything it learns once it gets turned off.

The stuff you read about ASV maybe being bad for people with congestive heart failure....that was a flawed study that scared the bejesus out of people and is slowly being debunked or looked at differently. They took some REALLY sick people who admittedly didn't use their ASV machines all night every night and when they died at a slightly higher rate than other people who also used ASV they blamed ASV....no one seemed to consider that maybe the fact that these people already were REALLY sick and had one foot at death's door and then they often didn't use their machines even 4 hours a night...and wondered why they died. Duh??? Maybe if they had used the machine all night and every night they wouldn't have died...or maybe they were so sick they would have died anyway.?????

[GrumpyHere]

Change your PS max to 5 if it will let you do it. So minimum PS 3 and maximum PS of 5.

Unfortunately, ResMed ASV limits the min diff in PS to 5.

So if Min PS = 3, the lowest allowed Max PS is 8.
If you want to limit max PS to 5, then min PS needs to be 0.

[Pugsy]

Unfortunately, ResMed ASV limits the min diff in PS to 5.

Well crap. I was afraid of that which is why I said "if it will let you do it".
What I wanted was to reduce PS and not have it with such a big difference.
Maybe if he did the 5 minutes of extremely calm breathing at the beginning of the night the machine won't want to do the big bursts so much.

Once someone actually gets used to ASV it's not all that disruptive but it's a lot to ask of someone brand new to cpap therapy.

[Miss Emerita]

A normal ratio of inspiratory to expiratory breathing times is 1:2, give or take. (Pauses between breaths count as part of the expiratory time, I believe.)

The normal number of breaths per minute during sleep is somewhere between 12 and 20.

So that 5.5/5.5 business is way off.

[vilnius]

Pugsy answered your question as to whether your AC10 ASV can be used for plain OSA when you asked about buying it for $200.

https://www.cpaptalk.com/viewtopic.php? ... 8#p1395353

Yes I remember that but just wanted to see if I could get more responses.

The warning put out by ResMed about chronic heart failure was CYA. It was based on a flawed study.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990958/

Interesting! What is CYA?

You can force AC10ASV to recalibrate to match your breathing pattern by blowing hard against the pressure. It samples your breathing pattern for the next 3 minutes or so. Breath slow and sturdy while recalibrating.

Good luck.

I'll try this out. Thank you.

Next time you post images of your reports can you look here for guidelines?
viewtopic/t158560/How-to-post-images-for-review.html
You have made a lot of extra work for yourself and included stuff that isn't needed.
You can get everything needed on one screenshot.

Yes, sorry.

I don't know that I agree with the idea that the "ideal" breathis 5.5 seconds inhale and then 5.5 seconds exhale. That sure makes for a long breath and not very many of them during a minute. I don't think most normal people can breathe comfortably that slowly. I know I sure couldn't.

The guy's idea is that most people are over-breathing and thus are left with a surplus of CO2. Getting to a 5.5 inhale/ 5.5 exhale respiration rate takes a lot of practice and it's hard, but when you train yourself to do it, you feel much better (according to the author).

Do this for about 5 minutes. You will have to do this every time you turn the machine on because it doesn't remember anything once the machine is turned off. The machine will learn a little bit about your breathing but it can't remember anything it learns once it gets turned off.

Does it go strictly by the data of the first 5 minutes or so? Asking because sometimes I like to watch/read stuff in bed and I put the mask on and I might not be paying attention to my breath for the entire time but I could do it for 5 minutes before I nod off.

A normal ratio of inspiratory to expiratory breathing times is 1:2, give or take. (Pauses between breaths count as part of the expiratory time, I believe.)

The normal number of breaths per minute during sleep is somewhere between 12 and 20.

So that 5.5/5.5 business is way off.

Interesting. That book by James Nestor (and his interview on JRE) seemed pretty well-sourced and credible. I'll have to look more into it. Where are you getting your numbers from?

[Pugsy]

What is CYA?

Cover Your Ass.

Does it go strictly by the data of the first 5 minutes or so? Asking because sometimes I like to watch/read stuff in bed and I put the mask on and I might not be paying attention to my breath for the entire time but I could do it for 5 minutes before I nod off.

Actually it's 3 minutes and not 5 minutes but I couldn't remember exact amount of time...and it's from the time the machine is turned on. So if you read for 15 minutes....the averaging is already done by the time you decide to stop reading and want to not off. You would need to restart the machine if you want a new more accurate calculation.

As far as the author of that book...believe what you want to believe but I certainly don't agree with it....and I am not the only one. 5.5/5.5 means about 6 breaths a minute....not comfortably doable IMHO. Plus I have no idea what that restrictive of a breath might do to oxygen levels. It's NOT normal.
People write, read and believe all sorts of crap.....doesn't make it a good idea.
But do whatever you wish and believe what you want. We get to disagree with it as well.

[GrumpyHere]

What is CYA?

Cover Your Ass.

aka The lawyers made us say it

aka Nah Ni Nah Ni, you can't sue us anymore... we really, really, really hope

Does it go strictly by the data of the first 5 minutes or so? Asking because sometimes I like to watch/read stuff in bed and I put the mask on and I might not be paying attention to my breath for the entire time but I could do it for 5 minutes before I nod off.

Actually it's 3 minutes and not 5 minutes but I couldn't remember exact amount of time...and it's from the time the machine is turned on. So if you read for 15 minutes....the averaging is already done by the time you decide to stop reading and want to not off. You would need to restart the machine if you want a new more accurate calculation.

The algo uses 3-minute moving average according to the marketing material.
So a rolling window of the last 3 minutes determines the parameters throughout the sleep session.

https://www.resmed.co.uk/healthcare-pro ... thm-works/

Minute Ventilation

As of July 2019, PaceWave is the only adaptive servo-ventilation device to target the patient’s own recent minute ventilation.

• PaceWave algorithm calculates respiratory parameters (frequency, shape of the breathing wave, tidal volume) at a split-second resolution on a 3-minute moving average, in order to calculate the patient’s own minute ventilation.

• The target is automatically set to 90% of the patient’s average recent minute ventilation to prevent over-ventilation.

• PaceWave compares the patient’s current minute ventilation with the target minute ventilation and responds rapidly and precisely to changes in minute ventilation.

• Pressure support is increased when minute ventilation falls below target and is reduced to the minimum level set by the physician when minute ventilation exceeds the target.

Breathing phase mapping

PaceWave analyses 13 points per breath and accurately monitors and adjusts its response to deliver a comfortable experience for the patient.

• With its high-resolution breath phase mapping algorithm (13 points per breath), PaceWave accurately monitors variations in minute ventilation, which depends on respiratory rate and breathing pattern.

• The PaceWave algorithm adapts precisely and rapidly in response to the patient’s needs.

• Effective synchronisation with patient’s own respiratory patterns participate to therapy comfort.

• PaceWave continuously learns from each patient’s unique respiratory pattern.

• The Easy-Breathe wave form mimics the shape of natural breathing and pressure support is synchronised with the patient’s spontaneous breathing.

• Pressure support is synchronised with the patient’s spontaneous breathing and adapted to the minute ventilation, in order to achieve the target pressure. This provides comfort that supports the patient’s acceptance of the therapy.

[Miss Emerita]

I to E ratio, from one of various trusted sites:

"The I:E ratio denotes the proportions of each breath cycle devoted to the inspiratory and expiratory phases. The duration of each phase will depend on this ratio in conjunction with the overall respiratory rate. The total time of a respiratory cycle is determined by dividing 60 seconds by the respiratory rate. Inspiratory time and expiratory time are then determined by portioning the respiratory cycle based on the set ratio. For instance, a patient with a respiratory rate of 10 breaths per minute will have a breath cycle lasting 6 seconds. A typical I:E ratio for most situations would be 1:2, if we apply this ratio to the patient above, the 6-second breath cycle will break down to 2 seconds of inspiration and 4 seconds of expiration."

https://www.ncbi.nlm.nih.gov/books/NBK535395/

Respiration rate, again from one of various trusted sites:

Adults

The normal respiratory rate of an adult at rest3 is 12 to 20 times per minute. In one study, the average sleep respiratory rate rate for people without sleep apnea was 15 to 16 times a minute.

Adults Over 60

Our respiratory rate at rest changes as we grow older4. A range of 12 to 28 breaths per minute is normal for adults between 65 and 80 years old, while a range of 10 to 30 is normal in those over 80 years old.

https://www.sleepfoundation.org/sleep-a ... atory-rate

[palerider]

I don't know that I agree with the idea that the "ideal" breathis 5.5 seconds inhale and then 5.5 seconds exhale. That sure makes for a long breath and not very many of them during a minute. I don't think most normal people can breathe comfortably that slowly. I know I sure couldn't.

The guy's idea is that most people are over-breathing and thus are left with a surplus of CO2. Getting to a 5.5 inhale/ 5.5 exhale respiration rate takes a lot of practice and it's hard, but when you train yourself to do it, you feel much better (according to the author).

The guy is a crackpot.

Also, "over breathing" would be INCREASED respiration, and that would REDUCE PaCO2

a state of coherence: Coherence is the measurement of the harmony of two signals. Whenever two signals increase and decrease in phase, they are in coherence, a state of peak efficiency. Much more about coherence and the benefits of breathing 5.5 times a minute with 5.5-second inhales and exhales can be found

Well, you can try to do whatever you want while you're awake, your body won't give a crap and will do whatever it wants to do while you're asleep.

Do this for about 5 minutes. You will have to do this every time you turn the machine on because it doesn't remember anything once the machine is turned off. The machine will learn a little bit about your breathing but it can't remember anything it learns once it gets turned off.

Does it go strictly by the data of the first 5 minutes or so? Asking because sometimes I like to watch/read stuff in bed and I put the mask on and I might not be paying attention to my breath for the entire time but I could do it for 5 minutes before I nod off.

The machine uses a rolling average, it won't matter what you try do before you go to sleep. The ASV adjusts continually throughout the night as your needs change.

A normal ratio of inspiratory to expiratory breathing times is 1:2, give or take. (Pauses between breaths count as part of the expiratory time, I believe.)

The normal number of breaths per minute during sleep is somewhere between 12 and 20.

So that 5.5/5.5 business is way off.

Interesting. That book by James Nestor (and his interview on JRE) seemed pretty well-sourced and credible. I'll have to look more into it. Where are you getting your numbers from?

Medical science:
https://www.ncbi.nlm.nih.gov/books/NBK535395/
https://derangedphysiology.com/main/cic ... -ratio-and
https://www.medscape.com/answers/810126 ... entilation
https://www.scottishintensivecare.org.u ... i-e-ratio/

But your "popular journalist" is really out there:

They discovered that the optimum amount of air we should take in at rest per minute is 5.5 liters. The optimum breathing rate is about 5.5 breaths per minute. That's 5.5-second inhales and 5.5-second exhales. This is the perfect breath.

So, apparently, everyone in the world is breathing wrong, who'da thunkit?

[vilnius]

Thanks all for the replies!