ASV Mode vs ASVAuto Mode - What's the Difference?

[RayBee]

It seems that everything I have read on the ResMed ASV PAP machine assumes that ASVAuto Mode is the mode to be used. So, what is the difference between the ASV Mode and ASVAuto Mode? All I can find online is that ASV Mode drops access to define an EPAP Max setting. So I would assume ASV Mode is just a dumbed-down version of ASVAuto Mode in some way.

I don't really want to switch to ASV Mode on my machine as I think it would be a step backward in treatment technology.

Does anybody even use ASV Mode?  

[DeepBreathing]

Earlier model ASVs had a constant EPAP setting, so you got the same EPAP pressure all night. The PS was variable, and consequently so was the IPAP. This is what we now call ASV Mode.

With ASVAuto the EPAP is set to a range (min to max) and can vary as needed to manage obstructive events. In this mode the IPAP at any given moment is a combination of the EPAP and PS at that moment. It's a more complicated approach but can achieve outstanding results once properly set up.

[Gideon]

This is a 1-liner that ResMed has in their titration guide

• ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes.
   It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• ASVAuto Provides an ASV algorithm (above) plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas.
   It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

[RayBee]

Thanks for the clarification.

So no reason for me to restrict the machine's ability to adjust EPAP as its patient analysis dictates. Kind of like driving your new fancy sports car on bare rims.

[SarcasticDave94]

I’m supposing there’s some that benefit from the static EPAP of ASV, however I’m not one of those users. I’ve never tried ASV mode, and I haven’t seen the need to try it. I’ll just take my ASV Auto mode as being the right choice for me. With the 4 pressure settings found there, my AHI is as in control as it’s going to get, which means under 5 always.

[RayBee]

I’m supposing there’s some that benefit from the static EPAP of ASV, however I’m not one of those users. I’ve never tried ASV mode, and I haven’t seen the need to try it. I’ll just take my ASV Auto mode as being the right choice for me. With the 4 pressure settings found there, my AHI is as in control as it’s going to get, which means under 5 always.

Thanks Dave.

I keep a quick-and-dirty spreadsheet of basic data from OSCAR and boil it down to a 2-week running average AHI before ("before SWJ" is called Raw Data in my spreadsheet) and after discounting SWJ events. My Raw Data AHI 2-week running average varies between 5.2 and 7.8 while my Adjusted-for-SWJ 2-week running average is 2.7 to 4.6. I'd like to see the Raw data AHI go below 5.0, but I'm not really excited over it since I do feel much better during the day. What seems to be sort of a benchmark for me is if I get less than 4.5 hours on the machine, I feel a little bit tired during parts of the day. And if I get 5+ hours, then I feel pretty good the whole day. 

I'm hoping as time goes on, the "pretty good" will have a cumulate effect and I'll be able to lose some weight  with the added energy I have. I'm still just a pup   in the PAP world. Still learning and still looking for little improvements here and there. Love perusing the forum for great info. Is there any specific place here for posting "hints and tips"? Don't think I've seen anything of the sort.

[SarcasticDave94]

If you're serious about losing weight, get 75% of your stomach ripped out like I did. Now I have a banana shaped stomach and lost 110 pounds. BTW I only qualified for the insurance coverage for this because I have SA, COPD, and was obese.

[struts]

I has been put on trial on the Resmed S9 VPAP Adapt with the following setting prescribed by the sleep doctor :
PAP Mode : ASV mode, EPAP 5.0, PS 3.0-15 (cm H20), 
which solved the CSA and OSA, i.e. down to zero events.
As Resmed S9 is already obsolete , I am going to get the AirCurve 10 CS Pacewave device.

If with the S9, ASV mode can solve the CSA, will the ASVauto mode offers additional benefits?
What are the pros and cons of ASV mode and ASVauto mode?

Should I stay with the ASV mode or request the store to set the ASVAuto mode when I place the order?
If ASVAuto mode is better in my case, what setting should I use based on the setting during trial ?

Thanks.

[SarcasticDave94]

I would think ASV Auto mode would be able to tackle almost any event you throw at it. The ASV Auto mode changes a static EPAP to an EPAP range where you set a Min and Max. The good thing about this is it can increase its own EPAP while you sleep to take care of the obstructive events that crop up.

From the number settings you have now, if you activate ASV Auto mode the EPAP of 5 could be changed to Min 5, Max 10 or something like that. We'd have to see the OSCAR data to view results and then see if it's correct. ASV Auto tends to be more comfortable as well I'd think. You might be able to set the EPAP Min lower and with the range to make up for it, it would still be effective therapy. In your case, with 5 being about as low as you can get, this wouldn't apply in my opinion. If you were prescribed a higher EPAP that's when this aspect applies.

[struts]

- is AutoEPAP the only feature of the ASVAuto mode ?
- is AutoEPAP only used to deal with the obstructive SA?
 From the brochure, the device will by default stay at the min EPAP and will only increae when OSA event is detected, and when the OSA event is gone, it will return to the min EPAP. Is that how it works ?
- is the dynamic IPAP (i.e. PS) used to treat the CSA ?  

- Does AirCurve 10 ASV match the pattern in realtime based on data from each session, disregarding the previous sessions ?
 
- This is the setting for my trial on ASV device. I wonder why the doctor did not prescribe the ASVAuto mode and the AutoEPAP instead of the fixed EPAP.
 Mode : ASV
 EPAP : 5 cmH20
 Max IPAP : 20 cmH20
 PS Min : 3 cmH20
 PS Max : 15 cmH20
 Ramp : Off  
 
 From what Dave wrote, the ASVAuto should be better. What is a good EPAP range setting to start with based on the above existing prescription which already got me to 0 AHI in the 1-week trial.
 btw, is the above setting the default value of AirCurve 10 ASV device ?
 From the brochure,
 "Operating pressure range  4–20 cm H2O (CPAP mode) 
                            4–25 cm H2O (ASV and ASV Auto mode)"

 Does it mean the min EPAP can be set as low as 4 ?

- Should I have the ramp setting to be ON instead of OFF ?
 The ramp seting was set to OFF for all the devices I was put on during the trial.
 
- What other settings should I request the store to set it ?
 These are the setting of the AirCurve 10 VAuto before I was put on the Resmed S9 ASV device.
 Are those default settings ?
 
 AirCurve 10 VAuto
 Climate Control : Manual
 Humidifier Status : On
 Humidity Level : 5
 Ramp  : Off
 Smart Start : On
 Temperature : 27C
 Temperature Enable : 2

Thanks.