New ASV user - backup rate issue?

[jmankoff]

Hi, I was wondering if anyone had any advice with issues I've been having with an AirCurve 10 ASV. It was prescribed for treatment-emergent CA. It seems to handle both OA and CA, but I don't sleep well because the pressures go high and are timed wrong for my breathing. I suspect that my breathing falls below the "backup rate" of 15 bpm, and the machine tries to correct by taking over. I have a lot of aerophagia.

[Sleeprider]

There are only 4-settings on the Aircurve 10 ASV, so nothing to affect timing. Your settings are near minimum with EPAP 4-5 and PS 2-8, so not much room to reduce pressure. I think this is mainly a matter of adapting to the therapy. It is unusual to see such a low tidal volume and minute vent just as you start therapy, the it comes up to a median tidal volume of 600 mL and minute vent of 10.0. The machine sets its moving target based on your last 90 seconds of respiration. I usually see people mask up early and have high respiration that has to calm down. I think your EPAP range is a bit low, but since you're sensitive to the pressure there is not much I can recommend. Can't comment on respiration rate without that graph being shown. Your median of 16.4 is normal.

[jmankoff]

I understand that it can take some getting used to, but my difficulty is that the machine seems to fall into a trend of making breath to fast (fast intake, and then the next intake before my body is ready). Unless I fight it (and can't sleep), then it feels like I'm hyperventilating. While I'm not entirely sure how to interpret the graphs, maybe I am sleeping with 16bpm and I'll be able to do that longer if I stick with it? Some nights seem better than others. . . Attached are the rest of the charts, including respiration rate.

[SarcasticDave94]

If you want a change due to the high pressures you're feeling, EPAP Min and Max both need to go higher. Your range of 1 (EPAP 4-5) is very low and short. It's going to force your small PS and IPAP ranges to take up the slack. They may be wanting edited as well. You probably have a pseudo ST feel.

Yes increasing EPAP sounds counterintuitive, but please try increasing it.

I'd probably use EPAP 5 or 6 Min and about 10 to 12 EPAP Max.

As for the backup rate, unfortunately you don't get to set it. This is why I can't use ASV myself anymore. I needed less than it chose for me, along with the other time controls being missing. Inhale and exhale ratio can't be manipulated.

[jmankoff]

Thank you for the suggestion. Did you end up with an alternative to ASV that worked for you?

[Sleeprider]

jamnkoff, a lot of ASV users talk about the machine pacing them and needing to use the "blow-back technique" to get back control of the machine. This is nothing more than taking assertive breaths or blowing back against the machine. This causes the ASV to pause and begin tracking a new target.

[SarcasticDave94]

True, blowback can help when the ASV blows hard such as sleep transition phase.

As for my therapy, none at this time. I borrowed a ResMed AirCurve 10 ST-A a while ago and it has all the timing controls missing from the ASV. And it felt similar minus the EPAP being single pressure, while I was used to EPAP range of ASV Auto. I might be able to afford one myself, as all the Dr. Dolittles I dealt with aren't helpful in my complex case of Central and Obstructive Apnea and lung disease, with diagnosis interchanged between COPD and Asthma.

Good news, your therapy will not be this complex.

[stevew168]

I have been using an ASV for several months now. Breathe regularly at first, like you would like to sleep. ASV is the most comfortable treatment I have ever used, by far. The key to using it is, as Sleeprider has correctly stated, to set the backup rate in the first 90 seconds or so, like you want to as you sleep all night. Before I learned to do this, I would sometimes get the push to breathe. Since I learned this, I never get a push while falling asleep, and I sleep very well. Just relax, and train your ASV to work for you. If you have an Spo2 ring, check it and see if you are at 96-97 percent or higher starting out. You will be surprised how well it works for you. ASV is amazing!

I have added screenshots of last night, a fairly typical night with my ASV. The drops in SpO2 were lower than usual for some reason. S**t happens, sometimes. LOL!

I still felt great today.

[TBrobbs]

I’ve been using ASV for about 6 weeks now. Initially, I felt the same way you described. Blowing back helped but what worked better for me is similar to Steve’s approach. I get myself completely ready for sleep, including having the mask ready to go. Then I put the 02 ring on and wait until my pulse drops close to my resting rate, then put the mask on and the machine. It works really well for me. It’s definitely a learning curve but once you get that sorted, I think you’ll find it a lot more comfortable than your previous machine.