Would ASV help ?

[Nightynite]

Been on cpap 5 yrs now.  The chart is probably a little better than usual but I think I can do better with therapy. Do you think the results would improve with ASV ?    Thanks 


   

[Sleeprider]

Try cutting EPR from 3 to 2 and see if that reduces CA events. Your therapy is not such a problem that you would qualify for an advanced therapy like ASV, and I'm not certain it would help you to sleep better, although the use of ASV generally eliminates most apnea. I think your last thread aspiring to upgrade to Vauto makes more sense. With that machine, you get trigger controls that can help with mild central periodic breathing and apnea.

[gainerfull]

I'd probably recommend you find a good pressure on bilevel (Resmed AirCurve 10 VAUTO) before transitioning to ASV as it looks like you could use more pressure support than a CPAP can offer.

From your flow rate graph it looks like you're experiencing undetected hypopneas / RERAs given messy the flow rate is even when not in REM. If you were to acquire the aforementioned bilevel I'd recommend trying these settings:

Mode: VAUTO
EPAP Min: 8
IPAP Max: 12
PS: 4
Trigger Sensitivity: High
TiMax: 3

These settings give you an additional 1cmH20 of pressure support to increase ventilation and solve more breathing events, the trigger sensitivity should help clean up your central apneas and the TiMax setting should accommodate your inspiration times and all together really clean up your breathing / flow rate. I'd be willing to bet it works pretty well for you (I'm on bilevel myself.) Once you grow accustomed to PS 4 don't be afraid to investigate 5 or 6 if you continue to see ratty flow rate like above.

The thing to keep in mind with ASV is it's like running on a treadmill because it's strict on keeping your minute vent (tidal volume / respiratory rate) on track all night so it can be tough to adjust too. Plus, in order to titrate ASV you basically give it the ability to use max pressure of 30cmH20 and it solves central apneas by jacking pressure support which can leave your chest sore the next morning.

[SarcasticDave94]

ASV? Probably would not help. Several things, low amount of CA at least in this chart, your already high leak rates will likely be worse on ASV, your low pressures now won't work well on ASV. If you have a high level of CA or the diagnosis then ASV is right.

Typical ASV settings EPAP Min between 4-8, EPAP Max up to 15, PS min between 0-5, PS Max between 5-15. Very generic, but you'll see this will almost always be lots more than you're running now. IPAP will almost always be a max of 25.

[Nightynite]

Thank you Sleeprider, gainerfull & sarcasticdave.
My intentions were always the vauto and I was second guessing myself. Thanks for clarifying.
EPR 2 tonight SR. Thanks and happy Thanksgiving!

[SarcasticDave94]

Happy Thanksgiving.

Oddly you'll find more controls to sculpt a good therapy with VAuto more than ASV. The ResMed ASV has less settings than the VAuto like trigger and cycle.

Focus on VAuto Padawan.

[MrIvanDrago]

I'd probably recommend you find a good pressure on bilevel (Resmed AirCurve 10 VAUTO) before transitioning to ASV as it looks like you could use more pressure support than a CPAP can offer.

From your flow rate graph it looks like you're experiencing undetected hypopneas / RERAs given messy the flow rate is even when not in REM. If you were to acquire the aforementioned bilevel I'd recommend trying these settings:

Mode: VAUTO
EPAP Min: 8
IPAP Max: 12
PS: 4
Trigger Sensitivity: High
TiMax: 3

These settings give you an additional 1cmH20 of pressure support to increase ventilation and solve more breathing events, the trigger sensitivity should help clean up your central apneas and the TiMax setting should accommodate your inspiration times and all together really clean up your breathing / flow rate. I'd be willing to bet it works pretty well for you (I'm on bilevel myself.) Once you grow accustomed to PS 4 don't be afraid to investigate 5 or 6 if you continue to see ratty flow rate like above.

The thing to keep in mind with ASV is it's like running on a treadmill because it's strict on keeping your minute vent (tidal volume / respiratory rate) on track all night so it can be tough to adjust too. Plus, in order to titrate ASV you basically give it the ability to use max pressure of 30cmH20 and it solves central apneas by jacking pressure support which can leave your chest sore the next morning.

Why the TiMax to 3.0? The default is 2.0 I believe, what would that help in this case? Curious to hear.

[gainerfull]

Why the TiMax to 3.0? The default is 2.0 I believe, what would that help in this case? Curious to hear.

Based upon the original poster's median and 95% inspiration time. I'm a bigger guy at 6'3" 210lbs and since I'm using a very high trigger the VAUTO is sensitive to starting inspiration pretty easily. I originally went from TiMax 2.0 to 2.4 and it helped me smooth out my flowrate SO much and get better sleep. I wasn't getting double peaks in my inspiratory flow rate any more and on a macro level my total flow rate looked much more uniform with a longer TiMax. The cool thing is you can take a breath anywhere from 0.1 to 3.0 seconds long and it works.

[MrIvanDrago]

Based upon the original poster's median and 95% inspiration time. I'm a bigger guy at 6'3" 210lbs and since I'm using a very high trigger the VAUTO is sensitive to starting inspiration pretty easily. I originally went from TiMax 2.0 to 2.4 and it helped me smooth out my flowrate SO much and get better sleep. I wasn't getting double peaks in my inspiratory flow rate any more and on a macro level my total flow rate looked much more uniform with a longer TiMax. The cool thing is you can take a breath anywhere from 0.1 to 3.0 seconds long and it works.

So why doesn't everyone set the TiMax to higher, such as 3.0? That's the max right, why would someone want it actually lower or at the default of 2.0?

[Sleeprider]

If it helps my TiMax is set at 3.0. My median tidal volume is generally over 600 mL and i have minute vent about 10 L. I rarely if ever use the maximum inspiration time, but it's there if needed so a longer, deeper breath does not go unsupported. Without the longer TiMax, the machine will sometimes cycle before inspiration ends. I don't need or want that. The only reason to shorten TiMax is if a user needs to preserve a longer expiration time. It's an important control for individuals with COPD or other "noncompliant" lung issues, but not for me or Gainerfull. YMMV