[split] Off-Label ASV and Bilevel For UARS Therapy

[Sleeprider]

In general I was successful when we encountered extreme flow limitation in using ASV, however there was a notable exception. Member plmnb had persistent flow limitations that were intermittent. They did not respond to CPAP, EPR, Vauto PS up to 7or 8 PS. We tried ASV and made some progress, and she eventually went to ST-A. Here is a sample of flow limitation persisting regardless of pressure support:

[slowriter]

Bilevel and ASV are being advocated by Dr. Barry Krakow, for treatment of UARS and sleep apnea, however he does not exclusively recommend ASV over bilevel, and uses a case by case assessment.

It's also worth noting that the research studies I've read of his never compare standard auto bilevel and ASV; only CPAP and ASV.

My hunch is if you pressed him he'd say much that same as SR's summary; that bilevel in general is better to treat UARS, and that ASV is advantageous in some situations.

The idea of using adaptive pressure support seems most appropriate to very severe cases of UARS; I have called them, "crushed cars" from the extremely flow limited inspiratory wave form. We get people showing up on the forum claiming to have UARS, that clearly have either mild cases, and they resolve flow limits using the limited pressure support of EPR with the Airsense 10 CPAPs. Others do great with 4 to 6 cm pressure support using the Vauto. When flow limitation does not resolve with up to 6 cm pressure support, or individuals  experience CA events with EPR or pressure support, we are getting into the cases that may be appropriate for ASV. I realize there are advocates of ASV for everyone, but we have seen it is absolutely not appropriate for most people that don't need it, and it can be quite disruptive to sleep quality.

Yep.

I have UARS, but my flow limitations aren't terrible. In a bilvel titration study, I was prescribed a PS of 6, which is relatively high, but I don't really get significant CAs at that setting.

I've since compared both standard auto bilevel (VAuto) and ASV, and I don't really see any objective difference in my sleep quality (in terms of metrics like sleep duration, sleep efficiency, staging, etc.) or daytime symptoms.

[SarcasticDave94]

Thanks slowriter, makes sense to me.