Adapting to ASV technology

[jerrydaw]

I just had a sleep test using an ASV machine. It was not a ResMed, however I don't know the make. It was a miserable night. Probably the worse in many months. I slept fitfully. I don't know whether it was the machine, or the strange bed, or the miles of wire that hooked me up. I have been pushing my doctor for an ASV machine because I have been averaging central apneas in the 23 per hour range. After last night, I am wondering if I shouldn't drop the push.

Whatever the ASV machine was, I could immediately tell a big difference in the ease of the inhale vs my ResMed AirCurve10 VAuto. Could this non-ResMed machine also be less efficient in the ease of handling central apneas than the ResMed?

I guess what I am really wondering is whether the ASV machine woke me constantly when it was increasing pressure to handle the central apnea? If so, is this something you eventually get used to, and if so, how long does it take. I guess I was crazy in thinking I would come away loving the new ASV machine technology on my first meeting.

Should I drop the push, or should I dive in and confront my problem with the ASV machine???

[DeepBreathing]

G'day Jerry.

An ASV machine does have a totally different feel from an ordinary CPAP and takes a bit of getting used to. The good news is that they are incredibly successful in treating central apnea.

AFAIK the only ASVs on the market are the Resmed and Philips Respironics. I've tried both and really didn't like the Philips - the Resmed was a lot more comfortable for me. The Philips does have a number of manual settings to fine tune your experience, so these may need attention. On the other hand the Resmed uses sophisticated software to adjust all the parameters.

A lot of people prefer the Philips while others prefer the Resmed. If you do get a Philips you need to make sure the trigger, cycle and other settings are all adjusted to optimise your comfort. If possible try both and see which suits you best.

[jerrydaw]

DeepBreathing

Did it take you a while to get used to your ASV? Did the pressure increases cause you to wake during the night?

I am inclined to stick with my initial decision to go with the ASV since it is my only way to treat my high number of centrals. Perhaps I can do some tinkering with the settings if I have trouble adjusting to the machine.

jerry

[bons]

I doubt that anyone really likes the ASV for the first few weeks of usage. They can be a pain in the butt to get used to. I always compare it to learning to dance when both dance partners want to take the lead. In reality, both you and the ASV have some control, but you have to get used to it.

Your current machine changes pressures in reaction to your breathing. The ASV tries to take the lead, in that it anticipates your breathing and tries to maintain a specific breathing pattern - that's what eliminates the centrals. The expiration pressure controls the obstructive apneas by keeping your airway open; the increase in pressure is to remind you to take a breath. That's the feature that drives most of us crazy - the machine can set a perfectly timed pattern but most of us don't- we pause to flip a pillow or transition between sleep stages or roll over (or get lost in thought as we are still awake) and the machine doesn't know what we are doing. It senses that we aren't taking that perfectly timed breath and it intervenes by upping the pressure to say, hey, take a breath. Once you are asleep and the brain transitions to automatic breathing, it usually follows the lead of the ASV; until then, as you are consciously breathing, you may be fighting to take the lead.

Eventually you learn to dance with it. Mostly by breathing over it and making it do what you want to do while awake (if you continue to exhale when it wants you to inhale or inhaling while it drops the pressure thinking its time to exhale, it will take its cue from you and respond. Screaming with frustration into a full face mask makes the machine stutter like crazy.

I had an older Respironics machine that could not adapt to my very slow breathing and the fact that I often take less than 8 breaths per minute. We had to play around a lot with the breath per minute setting and the rise rate (how fast it switches from inhale to exhale pressures). The newer model is much more adaptable. I almost never have to breathe over it. My doctor does not ever prescribe ResMed machines because the sleep lab titrates on Respironics ASVs, and the settings are different since Respironics has more exact settings and the ResMed machine can be more flexible.

Perhaps your doc can prescribe the ResMed ASV and work with you to adapt the settings as needed?

I know from this and other boards that people have preferences for one over the other, but some prefer ResMed and some prefer Respironics.

Which ever you choose, stick with it. It can take a few weeks of frustration, but it is well worth it.

[DeepBreathing]

I think Bons has the perfect analogy there. I found the Philips was more aggressive in wanting to take the lead (and at that time I didn't know about all the secondary settings). The Resmed was far more accommodating.

Also as Bons said, it's worse when you're still transitioning into sleep and the machine is trying to work out what's going on. I have found that once I got used to the thing I was able to get off to sleep almost instantly. High pressures during the night can still be disturbing, but only occasionally.

[trish6hundred]

Hi jerrydaw,
WELCOME! to the forum.! Much success to you with getting used to your ASV machine.
Hang in there for more responses to your post.