ASV settings

[All in Knots]

Hi,

I've been a member for awhile, but haven't been active on the board. (I'm having trouble logging in. Whenever I hit "login," the page refreshes and doesn't take me to the "enter login/password" page. This is the only site that I have trouble with. I think it might have to do with my security setttings??)

Anyways, here's my real question. I had two recent sleep study tests (within the few months) that determined that I needed an ASV machine/adapt sv machine. I received my new S9 Resmed ASV a few days ago. I was told that the settings were the "basic" settings, and the machine was set by my DME as per my sleep doc's prescription.

The machine seems to want me to breather faster than I breathe at night/when relaxed. Before I'm finished exhaling, the machine starts to whoosh in new air. In other words, I think the rate is too fast. The new air comes in about a second too quickly, and my lungs are still busy exhaling. I'm pretty confident that the machine is not adjusting for this, because I feel this as I'm going to sleep and as I'm waking up in the morning.

Is this something I can easily tweak on my own, or do I need to call my sleep doc for a new rx? (Thx to this board, I knew how to tweak some settings on my S8 apap machine, but the adapt sv seems more complicated.) And if I call my sleep doc about this, will she recommend yet another sleep study test because of this??

Thanks,
All in Knots

[Sheriff Buford]

Try the EPR mode. It is designed to make your therapy more comfortable. EPR maintains treatment for the patient during inhalation and reduces the delivered mask pressure during exhalation. You can use EPR in either CPAP or AutoSet mode. The EPR setting on the S9 can be configured on the off, 1, 2, or 3 cm H2O. Do you have the clinical manual that shows you how to adjust the settings? If you do not, PM me with your email address and I will email you a copy.

Sheriff

[All in Knots]

Hi, Sheriff!

I see that you have the S9 Autoset machine (apap). I have the ASV/adaptive servo-ventilator machine. I'm not sure if there's an EPR on that one or not (?). It's designed to treat mixed apneas, and seems extra-eager to begin shooting that air to you. I'd like it to begin shooting the air about 1 second later than it does. Does your manual explain how to do that? I have this awful feeling that I prob have to call the dr., request a settings change, wait, then have the DME RT come out and adjust...

Any ideas?

Thanks,
All in Knots

[Pugsy]

I don't believe the Adapt has EPR.
Hold on till this evening and someone with experience with your type of machine should see your post.
If you don't have the provider/clinician manual for your machine you can request it here.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

[Madalot]

I had the same problem on my Trilogy Ventilator. It sounds like the Breath Rate/RR IS a little too fast for you. In order for me to be comfortable, I had to set my Breath Rate at 7. They said that they typically set it at 10 as a mid point. Anything higher for me makes me feel exactly like you describe.

I don't know anything about your specific machine, but hopefully someone can come and help you adjust that. I'm almost positive there is a setting for it.

Edited to add: John Fisher has posted below me and said there is NOT an option on the Resmed machine. I'm sure John is right since he's much more knowledgeable than I am. Sorry about that.

[JohnBFisher]

If you provide (via PM or on a post) your email address, I can provide a copy of the clinician's manual for the S9 VPAP ASV unit.

However, the short answer is that the S9 VPAP ASV unit does not have a parameter to adjust the Respiratory Rate. The Respironics S1 ASV unit does have that as an option. The Resmed unit is based on your last three minutes as a moving average. So, if your breathing slows as your start to fall asleep, it will intervene to help sustain your rate to the average of the past three minutes.

This is one of those things that can make it difficult to become acclimated to an ASV unit.

Two suggestions. First, if this really causes you a problem, then ask if a Respironics unit would be an option. That unit allows the Respiratory Rate (RR) to be adjusted. Second, learn to start breathing slowly when you put on the mask. You will eventually adjust to the unit (in about 2 or 3 months).

[SleepingUgly]

This is a long shot, but... When you get into the clinical menu (pushing the button with the check mark and the big round button to it's right simultaneously), is the AB Filter set to "on"? It should not be set to "on" unless you're actually using an AB filter. The AB filter is not the filter you have on the back of the machine, but rather is something like this:

https://www.cpap.com/productpage/respir ... -pack.html

[Taringa542]

Hi,

I've been a member for awhile, but haven't been active on the board. (I'm having trouble logging in. Whenever I hit "login," the page refreshes and doesn't take me to the "enter login/password" page. This is the only site that I have trouble with. I think it might have to do with my security setttings??)

Anyways, here's my real question. I had two recent sleep study tests (within the few months) that determined that I needed an ASV machine/adapt sv machine. I received my new S9 Resmed ASV a few days ago. I was told that the settings were the "basic" settings, and the machine was set by my DME as per my sleep doc's prescription.

The machine seems to want me to breather faster than I breathe at night/when relaxed. Before I'm finished exhaling, the machine starts to whoosh in new air. In other words, I think the rate is too fast. The new air comes in about a second too quickly, and my lungs are still busy exhaling. I'm pretty confident that the machine is not adjusting for this, because I feel this as I'm going to sleep and as I'm waking up in the morning.

Is this something I can easily tweak on my own, or do I need to call my sleep doc for a new rx? (Thx to this board, I knew how to tweak some settings on my S8 apap machine, but the adapt sv seems more complicated.) And if I call my sleep doc about this, will she recommend yet another sleep study test because of this??

Thanks,
All in Knots

The Adapt has Pressure Support, shows as PS min & PS Max, If memory serves me correctly the default PS are 3 min & 15 max, try upping the PS min to 5

[All in Knots]

You guys & gals are the best!

I checked my machine, and the AB filter was set to "NO," so that wasn't the prob, but it was worth a try!

Checked the pressure supports. Sure enough, it was set to min. 3, max 15. I reset it to min. 5 (kept max @ 15). I briefly put on the mask, and voila! The new whoosh of air began *after* exhalation, instead of near the end of the inhalation. That feels much better!!

I have no idea why it was set to 3 to begin with? Perhaps that would be what I'd need if I were jogging with the unit on <tee hee>. Heck, it's almost a pant!

I hope this works for me. Will try this new setting tonight.

Thx again everyone,
All in Knots

[Xney]

The S9 vpap adapt doesn't let you set an EPR or BPM. What I do so it doesn't freak out is just breathe evenly yet not too quickly or slowly when it's starting to get its timing down. If you breathe really slowly, like a calm awake breathing, it seems to make the machine trigger faster breaths. But if you're just a bit slower than it likes, it seems to accept that.

Don't ask me why, just my experience.

So basically as I'm falling asleep, I breathe a little faster than I would normally, but I don't start speeding it up more than that. That seems okay until i fall asleep.

[All in Knots]

OK, so I was a little prematurely excited. Setting the PS to 5 made the air come in a little too forcefully for my taste, so I set it to 4.2. The extra pressure kind of forced me to inhale more efficiently, thereby faster, so I prob. began exhaling a little sooner than normal--but still, the new pressure was coming in. John, you mentioned that ResMed does not have a setting to adjust the breathing rate on this thing, but that the Respironics does. Why do you suppose that ResMed would not include that as a setting? Seems like a breath rate setting is pretty important! I get it, that the machine adjusts a bit to your breathing rate, but it kind of bugs me that it interferes with your exhalation (if you're a slower breather). Actually, so many disciplines try to get you to breathe slowly when relaxed (yoga, etc.), why would a machine want you to do differently?? I'm really thinking about requesting the Respironics.

All in Knots

[Bons]

John will correct me if I'm wrong, but I don't think min and max pressure support has anything to do with the speed of response from exhalation to inhalation pressures. Pressure support has nothing to do with timing of breaths.

I think he has a good suggestion is asking if you can be switched to a Phillips Respironics ASV. That machine has a rise rate, which sets the parameter for the timing of pressure changes from EP to IP, and a control for breaths per minute.

That being said, I still had a terrible time adjusting to ASV. I have a very slow awake bpm (8 bpm) and the machine setting cannot be set that low. It is now set for auto (doc originally set it for 12 ). The rise rate is set for 4, which is the slowest response rate available, and that is still too fast for my awake breathing (tech originally had that set at 1, which is the fastest switch time).

So, I did what John suggests. The machine tries to adapt to you, and at the same time your body learns to adjust to it. It is like a carefully executed dance. When I go to bed I take long, deep breaths, and breathe OVER the machine. If it switches to inhalation pressure while I am exhaling, I continue exhaling at the pace I feel comfortable with and the machine will drop back to exhalation. Same with inhaling. The machine will adjust as best it can according to the parameters that are set for it. Even though you don't FEEL in control, for the most part you are. The machine responds to your breathing, and then tries to keep you at the same pace and volume that you set, as long as the machine interprets that rate as healthy. When it determines that it is not healthy (too long a pause and it senses a central apnea) it will then try to get you back in the rhythm of the "dance".

This is not always a pleasant experience (the ASV can really shudder when you scream into a fullface mask ). Once I'm asleep, I breathe a little faster as the ASV and I compromise - I'm the only patient my doctor has who actually breathes faster when asleep than I do when I'm awake.

But in the long run, it works. Two years ago it took me an hour or more to fall asleep with the ASV. Now, it's a matter of minutes. You can still tell from the data when I'm awake during the night because my bpm drops.

[Madalot]

I'm the only patient my doctor has who actually breathes faster when asleep than I do when I'm awake.

I'm very similar. We had to set the Trilogy to 7 BPM. Any faster, I felt rushed to inhale before I fell asleep. Once asleep, my AVERAGE BPM is between 12 & 13.

During my last sleep study, when I woke up for the day, I asked the tech if he had raised my BPM because when I woke up, I felt I was being rushed to inhale. Sure enough, he had raised it to 9.

[Xney]

The good thing about the resmed ASVs is they're almost automatic, no settings.

The bad thing about the resmed ASVs is they're almost automatic, no settings.

[SleepingUgly]

Think of the ASV as a lover that has to be trained to give you what you need.

...That said, there's a limit to how trainable some lovers are.