Lindanhotair Treatment review

[S. Manz]

Your ASV parameters are not set correctly.
Min Epap of 10 is too high and restricts the ASV to perform its full range, besides the fact that you are fighting against 10 CMH2O to exhale. (which is also what I don't quite understand when you mention that "lower EPAP pressures make you feel starved of air" because EPAP is Expiratory pressure not Inspitory. If you lower your EPAP min to machine minimum (4) you will find exhaling becomes effortless and then set your EPAP Max to high of say 15 even 20 (Dreamstation max pressure can go up to 30 so there is plenty of room .
If you don't want to feel "starved" of air, then raise your PS MIn from its current 2.5 to about 4 (maybe even 5). That should provide plenty of support for inhalation and you should not feel starved of air, then set your PS Max to a high of 20 (even 25) and set your max pressure to 30.
With ASV therapy you need to open the range from all the way down to all the way up and let the machine decide on supplying breath by breath requirements. 
FYI with my Resmed ASV I had to limit the high range because otherwise it would keep me up all night but with my DS I can leave the range wide open from the absolute minimum to maximum.
Give it a shot and see if your sleeping will improve and don't worry too much about AHI numbers for now. The point is to have a great sleep first.

[Sleeprider]

S Manz, the EPAP needs to be set at the threshold for controlling obstructive apnea and hypopnea. Higher PS can help with increased ventilation, but a lower EPAP in this case does not appear likely given the continued OA events. This is the rationale for also trying to deal with OA through use of a soft cervical collar. We have a number of members that use higher EPAP pressures and it generally works well until we get into the 14-15 cm range where the machine just doesn't have enough reserve PS to deal with the centrals and hypopnea. As far as air-starvation goes, a higher PS min can help, but if the airway is obstructing, that is when we need the higher EPAP.

In a perfect world, ASV users would be allowed to trial both Resmed and Philips machines. They are very different in their feel and approach to therapy. For many years I was convinced Resmed was better, but the fact is, the Philips has some important settings for respiratory rate, volume and rise time that the Resmed ASV has automated. I think this automation works well for most, but not for all and wish they would enable manual setting over-rides.

[LindanHotAir]

As Sleeprider states, the higher EPAP is needed to keep my airways open. With lower settings my obstructive events increase.  On an auto machine I had to use 12 and 17.5 to reduce obstructive events, and it did very little to resolve centrals.

[S. Manz]

That's exactly where ASV therapy algorithm comes into play by monitoring breath by breath requirements and adjusting its machine parameters accordingly.
If you tie down the ASV with high min EPAP pressures or any other parameter that restricts the ASV full range of servo controlled feedback, then you are not letting ASV do its job.
If you look at manufacturers clinician recommendations, that is exactly what they recommend too. Wide open range of pressures in ASV mode so it can make decisions on a breath by breath basis.

[S. Manz]

As per my response to sleeprider, this is where ASV therapy comes to play by monitoring your breath by breath requirements and adjusting its parameters accordingly. My view is that of the recommendations by manufacturers is that ASV therapy is most suited for Central Apnea patients and some complex apnea situations and they also recommend keeping the entire min/max range of parameter settings wide open so the ASV algo can do its job.

[SarcasticDave94]

S. Manz,
But are you not tying down your own ASV and SV Auto machines down by your low pressure for yourself? If the ASV or SV Auto are to be run at default, why for example does ResMed include step by step info on Titration for their ASV where EPAP Min needs turned up to address Obstructive events?

FWIW My own use of ResMed's ASV where I tried EPAP Min 8 and was just fine. EPAP Min 4 was ok but I needed more air, and there may have been a few Obstructive events. PS Min 3 or 4 both were ok for me. And yes this does signify I used ASV Auto mode or it would have just been EPAP not EPAP Min. Where my ASV failed me was no timing only.

[S. Manz]

S. Manz,
But are you not tying down your own ASV and SV Auto machines down by your low pressure for yourself?

No , I am going with titration protocol as suggested by Philips. I do NOT go with Resmed titration protocol as it does not work for me (keeps me up with wild EPAP titration levels), which is why I am back with my Dreamstation ASV at full protocol and sleeping well since I switched back.

[S. Manz]

  Phillips.pdf (Size: 56.62 KB / Downloads: 9)

[Sleeprider]

SManz I want to remind you that the way any individual sets up a machine, and even the choice of machine varies according to their needs, tolerances and response.  Your statements of how ASV or SV works has a lot of errors and misconceptions on how these machines work. The Philips Auto SV titration protocol is not much different from Resmed's, and the topic of this thread is specifically for LindanHotAir, not you.  Here is the Philips titration protocol, and the choice of higher minimum EPAP pressure is an appropriate measure for this machine, as it is for the Resmed used by Lindan.  Note the recommendation of individuals using CPAP at greater than 10 cm is to set EPAP min to 6-8 cm and to raise that pressure for obstructive apnea.  This article can help you to understand better how Resmed and Philips differ and work to resolve various respiratory problems http://www.masm.wildapricot.org/resource...Morgan.pdf  The graphic below is the simplified Philips Titration Protocol for SV.

[S. Manz]

  The graphic below is the simplified Philips Titration Protocol for SV.

I know, I had already posted the pdf file for you but maybe you missed it. Its the post just before yours.:-) Even this simplified titration protocol states to set a max EPAP of only 6-8 for severe cases of OA and much lower for other cases, whereas the OP has hers set at a minimum 10.
Also yes there is indeed a lot of misconception about how ASVs work and as a long time ASV user and the owner of not one but both models by Resmed and Philips I can tell you that most don't have a clue what they are talking about.
First of all NO ONE knows how the algorithm of either models work because no one has access to them other than their corporate engineers and the source code for both models are highly kept corporate secrets for each company, so its not like it is an open source code that some teenager can hack and tailor it to suit themselves, in their mom's basement.
Second of all there are ( as far as I have experimented with both machines,) clear differences between the functionality of each model and they certainly do not work the same way...Far from it.
What I do like about my Dreamstation Auto SV however, is the level of detail that their firmware monitors whereas Resmed looks like a stripped down bargain basement version, in comparison.
And you are right to the extent that there are no machines that can meet every individual's needs, not even at clinical levels of Ventilators, however in my opinion Philips has done a stellar job of their firmware when it comes to their ASV and even regular Auto CPAP models, in comparison to resmed (and yes, i also have the Dream station DX600 Auto CPAP and the Resmed Airsense 10 ans there's no comparison between the comfort levels that my Dreamstation provides, even in these lower models).

Thanks for your input, however I still believe that the owner of the OP here must try titrating her ASV settings, starting with manufacturer's recommended protocols and work here way up towards a better night sleep from there. It is also my opinion that it is only logical to seek a comfortable night sleep, more so than it is to fuss about bringing down arbitrary AHI levels which don't mean much especially when one's AHI maybe high but their "Total Time Spent in Apnea" is Zero (I am an example of that).