[Treatment] ASV settings for treatment of complex sleep apnea

[Treatment] ASV settings for treatment of complex sleep apnea - Printable Version

+- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums)
+-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area)
+--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum)
+--- Thread: [Treatment] ASV settings for treatment of complex sleep apnea (/Thread-Treatment-ASV-settings-for-treatment-of-complex-sleep-apnea)

Pages: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

RE: ASV settings for treatment of complex sleep apnea - JoeyWallaby - 03-16-2021

Yes flow limitation and UARS, tiredness, LPR, bruxism are my main symptoms.

Yes I tried bilevel but I had a lot of CAs, I don’t know why that’s not happening now. Maybe I had too high min EPAP on bilevel, considering I’m only hitting an EPAP of 5 here?

RE: ASV settings for treatment of complex sleep apnea - Sleeprider - 03-16-2021

The ASV cleans up the CA events seamlessly, but does not give you the minimum pressure support you want. That suggests you may eventually move to a Philips SV auto, or Resmed ST with a backup rate or ST-A in iVAPS mode. That covers a lot of territory, however all of those options allow for higher pressure support with a backup rate to prompt respiration through centrals. The ST would be fixed pressure and would apply the same pressure support on every breath, ST-A can use adaptive pressure support to target a respiratory volume and rate. The Philips BiPAP SV is often cited as not being as comfortable or effective as the Resmed ASV, but it does have considerably more settings for respiration rate, pressure support and others that the Resmed attempts to automatically gauge. I don't know why Resmed limits PS min to 6.0, but that continues to be the case, and I'm not aware of any means to override.

RE: ASV settings for treatment of complex sleep apnea - JoeyWallaby - 03-17-2021

BiLevel

[Image: 5gOuBWO.png]

RE: ASV settings for treatment of complex sleep apnea - SarcasticDave94 - 03-17-2021

Nope bilevel isn't even close to working. That's a trainwreck.

RE: ASV settings for treatment of complex sleep apnea - sheepless - 03-17-2021

That's vicious. how did you sleep through that?

I haven't gone back through 18 pages of posts to review your history. how did you arrive at ps 9? idk if you need it for some reason and I think you've been wrestling with ca all along, but I can imagine holding my breath against anything much over ps 6. with vauto you might do better with closer to a fixed pressure. have you tried high and very high trigger?

RE: ASV settings for treatment of complex sleep apnea - JoeyWallaby - 03-18-2021

PS 9 because that’s what breathing looked best on ASV. I was using high trigger.

RE: ASV settings for treatment of complex sleep apnea - Sleeprider - 03-18-2021

With PS that high, you will have many CA events, and require a backup rate. That might have worked on a ST, but not VPAP auto.

RE: ASV settings for treatment of complex sleep apnea - sheepless - 03-18-2021

the pattern in your 22 minute zoom is pretty evenly spaced in 30-ish second cycles. it's not picture perfect periodic limb movement but still could be. did you ever rule that out?

RE: ASV settings for treatment of complex sleep apnea - Geer1 - 03-18-2021

Ugh, you NEED to gain a better understanding of CPAP and ventilation fundamentals or stop playing with settings.

PS of 9 was ridiculous and in case it hasn't sunk in yet you induced central apneas and stressed your body by over ventilating yourself... It isn't the first time you have done this... PS of 9 is close to mechanical ventilation levels where spontaneous breathing is non existent (under general anesthesia etc), there is literally zero evidence that would support its use in your case...

When your ASV is operating at a PS of 9 it is creating rounded breaths that look nice because it is literally PUMPING YOUR LUNGS FULL OF AIR AND THEN VACUUMING IT OUT. It is an artificial breath waveform caused by significant mechanical ventilation and you are chasing unrealistic perfection... The only reason the machine is operating at PS of 9 at that moment is because in the moments prior you were not spontaneously breathing well (flow limitations, hypoventilation or probably most likely in your case fighting a central apnea), your best breathing is actually occurring when ASV is operating at minimal PS. Every time your ASV operates at higher PS your respiration rate is depressed indicating your CO2 levels are low (at least brain believes so) which is why your brain is extending time between breaths. This is contrary to every belief you have as to why you need higher PS. If you had flow limitations/UARS etc then your respiration rate would not be dropping like this. In one of your recent examples you used a min PS of 5.6 on ASV and your respiration rate was very low because again you were being over ventilated... Stop thinking that you need higher PS, nothing supports this and there are numerous signs that it is in fact screwing up your treatment.

The whole advantage of ASV is that it controls PS so you don't have to... There are very limited examples where a high min PS is helpful and your situation is not one of them. If using bilevel you have to use a slightly higher PS (then ASV min) because the machine doesn't compensate for your breathing. In your case the only breathing issue you appear to exhibit is central apneas and your best treatment for them is to try and maintain as low an EPAP and PS as possible while maintaining treatment of obstructive apnea (which seems non existent at any level of treatment) and flow limitations (which are minor to non existent).

Imo everything indicates that the ASV treats your SDB at the basic settings, EPAP of 4, min PS of 3. At these basic settings your AHI is low, your breaths look good and your ventilation and respiration numbers are good. The only thing I would potentially do is try reducing max PS as much as possible (if lowered too much it will become apparent that ASV is no longer successfully treating central apneas, if that happens increase slightly). Lower max PS will minimize your aerophagia and you will have found your best ASV settings possible.

If your sleep/health are not remedied it is because sleep disordered breathing is most likely not your problem. In the very rare situation that SDB was still an issue then the only way to determine this and to figure out how to treat it would be with polysomnogram data because it would be a complex issue not apnea or UARS. There is nothing in your data that makes me think that is the case though.

Imo your apnea is treated and you need to move on and find the real problem. If you aren't sure if bilevel or ASV is more helpful then you just need to find best settings for each and go from there. ASV as discussed is EPAP of 4, PS of 3 and as low max PS as possible. Bilevel would be EPAP of 4 and probably a PS around 4 but might have to play around a bit with PS and other timing options to figure out its ideal setting.

RE: ASV settings for treatment of complex sleep apnea - JoeyWallaby - 03-27-2021

Thanks for the honest advice geer, I went back to a more moderate setting. Is going okay, kind of tired today despite sleeping undisturbed for 10 hours.

[Image: uDBAqbw.png]