Need help with ASV

[PAJerry]

Hi, all!
I've been on CPAP for about a week. I have tolerated the Mask and pressures fine...so far. CPAP has almost completely eliminated my OSA. The problem is that I have almost the same AHI because of CA's. There is a nightly increase in the number of Cheyne-Stokes and pattern breathing. The RRT called to see how I was making out with CPAP and I told about the data I was seeing. Other than being surprised that a pt could view the data, she was very helpful. She asked that I drop off the data card, said she would view the data and contact the dr. She also indicated that it would be best not to let the dr know that I was accessing the data...he may think that I was challenging him or questioning his judgement. (I don't want to quibble with fragile egos at this point in my therapy, so I'll let this pass until I can see my PCP and get another perspective.)

Anyway, she said that, if the data says what I say it say,s she would notify the dr and get a rx for a machine to take care of the problem.

My research, here as well as many other sites, indicate this is "Complex SA' and is common (up to 19% of people on CPAP for OSA will manifest it). Now I'm looking at machines. It appears that it should be a Bi-PAP with some ventilation abilities. My sleep dr likes respironics...so I am thinking PR S1 Auto SV Advanced. It is supposed to be designed for Complex SA and handle it by adjusting each individual breath on inspiration. There are also BiPAps out there with a spontaneous timed breaths. I'm not sure that having 3 timed pulses shoot into my lungs would be as comfortable as having each breath adjusted to the 4 minute average...but experience is the best teacher.

So, for anyone out there who is on a BIPAP for Complex SA or CAS, please let me know your thoughts. Do the timed pulses interrupt your sleep? What about ASV users...do they help with the CA's and Hypos? The PR S1 ASV Advanced is supposed to place the data on a web site instead of a data chip. Is that data available to the pt user?

I'm not sure how far to push for a particular machine...I'm already a PITA to them...but in fairness to them, they are doing their best to accommodate me so far.

Thanks for your input.

[Pugsy]

The PR S1 ASV Advanced is supposed to place the data on a web site instead of a data chip. Is that data available to the pt user?

We have a couple of members here with this latest machine and they have the SD card. Must have Encore Pro 2.5 though. The web data may be through a modem and some DMEs do use it but not all. The modem and web data can be used with any PR S1 machine. I think it is called Encore Anywhere. There is information about it at Respironics web site.

I am unsure if the SD card can be used in conjunction with the modem as I have never seen how the modem attaches. I know it is in the back in the area where the SD slot is.

[PAJerry]

That makes sense because there is a notation in some of the documentation that the SD card cover needs to be replaced if using a modem or other module.

So would the data on the PR S1 ASV be able to be displayed by Sleepyhead QT?
Thanks.

[Pugsy]

So would the data on the PR S1 ASV be able to be displayed by Sleepyhead QT?

I believe so. That data is one of the reasons for the recent redo. It may not be perfect yet but I do think he is working on it.
You could ask Jedimark to confirm status.

Edit.. I just opened SH 0.8.3 and PR S1 ASV machine is listed as being supported.

[PAJerry]

Edit.. I just opened SH 0.8.3 and PR S1 ASV machine is listed as being supported.

Yeah!

[Bons]

I have the older respironics ASV. Yes, they can be a PITA to get used to; hopefully you'll have a good and experienced tech doing the titration. You'll need another night in the lab 'cause there are so many settings that have to be set correctly.

The machine lets you set your own breathing pattern and tries to help you maintain it; there is a breaths per minute setting but that operates as a back-up and kicks in only if you are breathing at a slower rate than that. I breathe very slowly when awake, so mine is set at 6 bpm. There's also a rise rate that times how quickly the machine switches from inhalation pressure to exhalation pressure, and that's the bugger that drove me nuts.... I still fight with it sometimes when I'm awake. But the body learns to adjust while asleep, and once I'm asleep it doesn't wake me up.

The only time I wake up now is if too high and my mask leaks. Not all masks can tolerate the huge and quick pressure changes of an ASV.

[PAJerry]

tHANKS for the feedback with the ASV.

Not all masks can tolerate the huge and quick pressure changes of an ASV.

Is that why the ResMed only allows the Quattro FF mask?

[Bons]

You can check the signature lines on any of the longer ASV threads (use the search option to find them) and see what all masks we use. I think there are a few that don't use full face masks, but for the most part, full face works best. Some people even use the ones total face mask, like PR's fit life.

[ameriken]

tHANKS for the feedback with the ASV.

Not all masks can tolerate the huge and quick pressure changes of an ASV.

Is that why the ResMed only allows the Quattro FF mask?

I don't know if that is why Resmed only allows it, but I too have the QFX and it does tolerate the high pressure changes pretty well.

[OutaSync]

Resmed Mirage Activa, Activa LT and SoftGel all work well with and ASV. You may have to tape your mouth to keep the air from blowing out between your lips.

[moresleep]

I use the Respironics Bipap Auto SV Advanced. It works quite well with my Swift II nasal pillows mask. I don't think mask type is an issue for the Respironics ASV, old or new. While older Resmed ASVs are sensitive to mask type (although they do work with nasal masks as well as full face masks) because of the separate pressure sensor line, mask type is apparently not an issue for the new Resmed S9 ASV, which does not have a separate pressure sensor line.

Have you tried decreasing pressure a bit? That might be all it takes to stop the CAs and bring the AHI numbers down. Otherwise, you probably do need a Bipap and maybe an ASV.

The Respironics ASV is quite versatile. You can use it as a straight CPAP, as a Bipap, as an Auto Bipap, or as an ASV. So, if insurance will get you one, why not?

[wolewyck]

It does sound as though an ASV might be warranted, but I imagine the doc might (?) want you to keep trying for longer and see how things go... I may be wrong, but I think that sometimes that given sufficient time, the AHI values may drop on their own. If not, then my own experience has certainly found ASV to be an unbelievably effective tool. I have a Resmed S9 VPAP adapt and use a nasal pillows mask (Swift FX) with chinstrap. I think I can get away with this mask because my pressure settings are on the low side.

[Paper_Nanny]

The Respironics ASV is quite versatile. You can use it as a straight CPAP, as a Bipap, as an Auto Bipap, or as an ASV. So, if insurance will get you one, why not?

My DME and the Respironics Rep for our area said the Respironics ASV cannot be run as an AutoBiPAP. Are they wrong? If you know something they don't know, please share! Either post here or PM.

Thanks.
Deborah

[moresleep]

The Respironics ASV is quite versatile. You can use it as a straight CPAP, as a Bipap, as an Auto Bipap, or as an ASV. So, if insurance will get you one, why not?

My DME and the Respironics Rep for our area said the Respironics ASV cannot be run as an AutoBiPAP. Are they wrong? If you know something they don't know, please share! Either post here or PM.

Thanks.
Deborah

The earliest model Respironics Bipap Auto SV does not have Auto Bipap functionality; the two latest models do. My Respironics Bipap Auto SV Advanced (which is the middle model, timewise) can be used as a auto Bipap. It has the following pressure settings:

Max Pressure
Min EPAP
Max EPAP
Min PS (Pressure Support)
Max PS

EPAP sets the expiration pressure. EPAP+PS is the inspiration pressure. Setting PS Max > PS Min enables the ASV function.

If Min EPAP is set at, say, 8, and Max EPAP at 13, with Min PS=5 and Max PS=5, then:

ASV=off, and the Auto Bipap range is 8/13 to 13/18.

[NotMuffy]

The earliest model Respironics Bipap Auto SV does not have Auto Bipap functionality; the two latest models do.

That would not be "Auto Bipap" in the Classic Algorithic Sense, in that all obstructive events would need to be managed by EPAP; in the CAS, IPAP (or PS) plays a significant role in the management of hypopneas and flow limitation (Popt).