Adaptive Servo-Ventilation (ASV) - How does this work?

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Adaptive Servo-Ventilation (ASV) - How does this work?

Postby sleeplessinlosangeles » Fri Mar 12, 2010 9:24 am

I clearly have complex sleep apnea, both obstructive and central however it's the central which is really kicking my hiney since my CPAP machine has no effect.

I was looking at Adaptive Servo-Ventilation (ASV) technology but I don't understand how this can possibly work.

Unless it's physically shoving the air into my lungs (very painful) how is it going to get air into my lungs when I simply am not making the effort to take the breath? If the signal to breathe is not present, how does it bypass this?

Frankly, looking at it logically I'm more than a little skeptical. The max pressure of the machine is 10cm. My CPAP machine is already set to 10cm and it does nothing for my central apnea.

So, since the machine at 10cm cannot possibly be forcing air into ones lungs how is it possible that it could get you to take the breath if you are not receiving the signal to do so? Seems a bit fishy to me.
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Re: Adaptive Servo-Ventilation (ASV) - How does this work?

Postby Daniel » Fri Mar 12, 2010 10:56 am

sleeplessinlosangeles wrote:I clearly have complex sleep apnea, both obstructive and central however it's the central which is really kicking my hiney since my CPAP machine has no effect.

I was looking at Adaptive Servo-Ventilation (ASV) technology but I don't understand how this can possibly work.

Unless it's physically shoving the air into my lungs (very painful) how is it going to get air into my lungs when I simply am not making the effort to take the breath? If the signal to breathe is not present, how does it bypass this?

Frankly, looking at it logically I'm more than a little skeptical. The max pressure of the machine is 10cm. My CPAP machine is already set to 10cm and it does nothing for my central apnea.

So, since the machine at 10cm cannot possibly be forcing air into ones lungs how is it possible that it could get you to take the breath if you are not receiving the signal to do so? Seems a bit fishy to me.


Suggest that you check out the ResMed site, to get accurate information.

Daniel.
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Postby Davebush » Fri Mar 12, 2010 9:57 pm

Sleepless, I am on a Respironics Auto SV with a min pressure of 19 and a max of 29 so I am not sure where you got the information that 10 is the highest setting. It keeps a constant pressure of 19 and if it does not feel/show signs of breathing, the it increases the pressure up to 29. Recommend you also go to the Respironics web site and review their Auto SV Advanced machine.
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Postby sleeplessinlosangeles » Sat Mar 13, 2010 4:13 am

They don't explain how the device works.

I even emailed them and got a run-around answer that made no sense at all. They simply won't answer my primary question so I'm asking you all here:

How can the machine make you take a breath if your nervous system is not sending the signal to do so?

The only way I can think of is the device works like a respirator..however filling the lungs with air in this manner is quite painful so this can't logically be the way it makes you breathe. Unless the machine is doing my breathing for me, I cannot even begin to understand how it could help me.

As for pressure, yeah I could be wrong. However I have cranked my CPAP machine up as high as it will go and it does not help...plus it makes it impossible to exhale, so I have to assume the servo machine is a type of bi-pap that assists in both breathing and exhaling? If anyone can tell me how this device works I'd appreciate it.
It is a tremendous hassle (underline tremendous about 10 times) to get SSI/Medi-Cal to pay for this and do all the tests and I'm not even going to consider it until I understand on a logical, intellectual level how it works and how it can help me.
Thanks.
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It just works

Postby forneyfrau » Sat Mar 13, 2010 6:43 pm

As the person before said, one pressure is the minimum and the constant unless a breath is not taken. When breathing halts, it pushes at an additional pressure which prompts you naturally to respond by breathing in. It's kind of like being tapped on the shoulder or something; just enough to make you mentally, go "Oh, I need to take a breath now...." I've been using the Respironics ASV for two years now. I used the ResMed ASV before that but had constant trouble with it. The technology works.
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Postby White Beard » Sun Mar 14, 2010 1:34 am

If you have been to the ResMed site and looked up there Adaptive Servo Ventilator (ASV) you would indeed find that this machine is a type of ventilator that is made specifically treat Central Apneas and Complex Sleep apnea, and Cheyne-Stokes breathing pattern, this machine has a computer in it that monitors and samples your breathing pattern and and then does whatever it takes to have your body maintain that breathing pattern through out the night. Most nights my average pressure is 12.2 but when I down load the data I find that many times during the night the pressure will go up way higher than that, to prevent me from having an apnea. It isn't unusually for it to go up to 20 or 25 or what ever for what ever length of time needed just to prevent you from having an apnea. A CPAP machine is not capable of doing that. Setting your pressure up high on a CPAP or BIPAP machine can indeed make Central Apneas worse in some people. CPAP and BiPAP machines are not the same as the ASV machine they are not ventilators. They do have special algorithms that they use to control the servo motors that run their machine and they are not about to release that information to anybody! Have you had a in lab sleep study done? and have you been told you have central apneas? That is the only way to tell if you are actually having central apneas, and the only way to get the ASV machine is to have an ASV titration study done, and have the script for it.

To put it simply these machines are a type of ventilator, and even if your brain is not telling you to breath, a ventilator can make you breath, just like when you do emergency CPR on a person, you breath into a persons mouth or nose and fill the persons lungs with air, and when the person stops blowing air into the persons lungs the lungs contract ( natural position) and the air and carbon dioxide comes out, and then the person blows air back in and fills the persons lungs, well a ventilator does the same thing, but allot better, and these ASV machines are very sensitive and monitor your breathing and give you just the right amount of air that it senses, that you need. All I can say is that it works! Read up on the machines and read up on human anatomy it all makes sense! I hope this has helped you! I do wish you luck! You are right about SSI tjhey not going to pay for one of these machines, unless it is proven that this machine is needed! These machines are very expensive! But if your having central apneas they are worth there weight in gold! I started off on CPAP and then CPAP with supplemental, Oxygen and then BiPAP with O2, in a year in a half I had 5 in lab sleep studies done, and every time they increased my pressure and all I it doing is making me worse! Well finally my sleep doctor got sick and I had to see differnt sleep doctor, I then found out that the sleep center had been recommending that I be put on the ASV machine from the very begining, but ,my old sleep doctor did not believe in the ASV machines he thought the techonology was to new and not proven, so he just kept raising the pressure and I just kept getting worse, because my central apneas kept increasing. Soon after I had my sixth sleep study, an it was an ASV titration study and I was put on the ASV machine, my night sweats disappeared and the nocturia stopped and in about 90 days the extreme fatigue and unrelenting tiredness finally was lessening its grip on me, and with in a couple of more months it was gone!

I wish you well and Good Luck to you White Beard

???? What is so painful about putting air into a persons lungs? If a person is being intubated that could be uncomfortable and painful, but just putting a mask on a person face and increasing air pressure. ??????
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Postby SleepyBobR » Sun Mar 14, 2010 9:39 am

Seems that Forneyfrau and Whitebeard have different explanations as to how the ASV actually deals with centrals. Forneyfrau says the machine gives you a prod to get you to breathe naturally using a spurt of increased air pressure. In contrast, Whitebeard says that the machine is forcing the air into your lungs, actually breathing for you. These are very different explanations. Not sure which is correct but I'm more partial to Forneyfrau's explanation at this point. I don't doubt the machine works but it's not clear how at this point.
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Postby Mrs Rip Van Winkle » Sun Mar 14, 2010 10:32 am

White Beards description is the most accurate.


From Wikipedia

Adaptive Support Ventilation (ASV)

Adaptive Support Ventilation (ASV) is a positive pressure mode of mechanical ventilation that is closed-loop controlled. In this mode, the frequency and tidal volume of breaths of a patient on the ventilator are automatically adjusted based on the patient’s requirements. The lung mechanics data are used to adjust the depth and rate of breaths to minimize the work rate of breathing. In the ASV mode, every breath is synchronized with patient effort if such an effort exists, and otherwise, full mechanical ventilation is provided to the patient.

ASV technology was originally described as one of the embodiments of US Patent No. 4986268.[5] In this invention, a modified version of an equation derived in physiology in 1950 [6] to minimize the work rate of breathing in man, was used for the first time to find the optimum frequency of mechanical ventilation. The rationale was to make the patient's breathing pattern comfortable and natural within safe limits, and thereby stimulate spontaneous breathing and reduce the weaning time. A prototype of the system was built by the inventor in late 1980s. The inventor is Dr. Fleur T. Tehrani who is a university professor in the US. Shortly after the Patent was issued in 1991, Hamilton Medical, a ventilator manufacturing company, contacted the inventor and discussed marketing the technology with her. Some years later, Hamilton Medical marketed this closed-loop technique under license of this Patent as ASV.

Since the issuance of the Patent, a number of articles have been published by the inventor and her colleagues that are related to the invention, and some of them describe further advancements of the closed-loop techniques presented in the Patent.[7]
I'm only a sufferer, not a medical pro. What I post are my thoughts as a sufferer, not that of the ASAA. As a moderator on these forums I oversee the posting rules. This is the internet, always discuss what you read with your medical team.
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Postby White Beard » Sun Mar 14, 2010 11:19 am

Bottom line is......( at least for me) is the ASV works! Whether it be ResMed or Respironics if you have Central Apneas or Complex Sleep Apnea, and CPAP or BiPAP did not work for for you, then try the ASV machines! They are specifically designed to treat this conditioin! I have no vested interest in the ASV machine, but I can say from going through a year and a half of sleep apnea H*** this machine made a difference! But like any other PAP machine you have to use it! I have been preaching this for years, you have to use your machine and mask every night all night long, to have it work and make a difference! You did not get Sleep Apnea over night and your PAP machine will not get rid of its symptoms over night either! Attitude, Determination, Patients, and Perseverance, and good dose of Humor will get you success with PAP!!. But if you know you have Sleep Apneat, you just don't QUIT! or GIVE-UP! it is just too important to do that!.....Good Luck White Beard
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Postby forneyfrau » Sun Mar 14, 2010 11:52 am

White Beard's explanation is more accurate and scientific. I was oversimplifying it probably, but this "prod" or "puff" of air is usually all I need to get back on track breathing. As for forcing air, no, I wouldn't call it force. It's a gentle help on getting back on track. If the small puff of extra pressure doesn't work, it will apply more pressure and breathe for me thru the episode. I use the Respironic machine, White Beard uses the ResMed. I have experience both and I found that they work slightly differently. I preferred the ResMed, but mine kept giving me issues mechanically and my dr. sent it back and ordered me the Respironics machine. I have found that it is more reliable, albeit not as effective at treating my apnea issue. When I'm able, I'll probably go back to ResMed. They have made some improvements since my original ASV and I hope the issues I've had are all worked out.
Good luck to you. Go see the dr. and get a true diagnosis.
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Postby Mrs Rip Van Winkle » Sun Mar 14, 2010 1:37 pm

Forneyfrau... I should have worded my statement differently...because you both are right ;-)
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Postby SleepyBobR » Sun Mar 14, 2010 1:43 pm

Given all this, I'm now partial to both explanations. :-)
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Postby Mrs Rip Van Winkle » Sun Mar 14, 2010 1:49 pm

:lol: :lol: :lol: 8-) O:)
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Postby sleeplessinlosangeles » Sun Mar 14, 2010 9:16 pm

Thanks for the explanations. The idea that it "nudges" you to breath is far more logical than the idea that it's forcing air into your lungs since doing so is quite painful and would wake you up instantly or at the very least be seriously inconvenient.

Personally, after almost 18,000 hours with this mask strapped to my face I'm sick of it and I want a cure. I have to wonder why so many people are coming down with this condition in recent years when it seems virtually unheard of in the past. Logically, since our air, food and water are literally being poisoned (you can make up your own mind as to why) this is probably what's causing it.

I abused Aspartame for many years, as it is highly addictive. It's also a Neuro Toxin and could conceivably cause a degeneration of the nerves that signal me to take a breath. I believe this, and another neuro toxin..MSG...were responsible for my having this condition. I highly suggest people avoid both. Underline highly about 10 times.

I'm going to try and cure this by using a homeopathic aspartame detox to stop the nerve degeneration (I quit aspartame a year ago but am told it is the gift that keeps on giving and must be detoxed) and also supplement with various amino acids and herbs to rebuild my nervous system. This is my only hope of being free of the machine. I'd like to go camping, hiking, etc. This stupid machine KILLS my ability to date, to have women sleep over, etc etc. Not being able to go outside for an hour after waking up (mask face) is certainly not a plus.

As for saying the only way I could tell if I had central apnea is to be tested, that's nonsense. Just like I knew I had sleep apnea when my doctor laughed at me when I asked for the test (he was not laughing when it came back) I know I have central apnea..I witness it happening just as I drift off to sleep and also the physical effects upon my health.
Most people might not be that in-tune with their bodies so I'm not saying everyone can do it.

So, wish me luck. This stupid disease destroyed my entire life, left me homeless for many years and everyone and everything I ever had is gone and I can't get it back. If I cannot cure it myself, I guess I will be a slave to the machine. However, I'm frankly sick of the western medical allopathic approach to only treating the symptoms. I want a cure!!

hugs to you all and thanks again.
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Postby White Beard » Mon Mar 15, 2010 9:59 am

I think that we would all like to have a cure for this Sleep Apnea thing! I know I sure would! I can't think of anything I hate more, that to strap that mask to my face and have a thousand mile an hour wind blowing up my nose and mouth all night long! But until they come up with a cure, I go through the hassle every night and use it all night long! As much as I hate it! It does work! For me it is is literally a must, my O2 sats go way to low ( down in the lower 60's) and they stay there! That can kill you or give you a stroke, so for me that is a pretty good incentive to continue using PAP!!!. But if they ever come up with a cure, .......welll I will be right up front in line for it!!!!. The thing that makes Central so hard to cure, is there is so many different possible causes for them! Anything from upper spinal cord injuries, to neurological diseases and or conditions, or the use of some type of pain medications, and of course the there is the just plain no reason but you have them, and believe it or not this is also legitimate. We do not know everything about the human body or how it works, so until we do, some things just have no explanation. I know it is hard to accept, but it is what it is, just the same! Hang in there and do what you can to treat it, like the rest of us we just muddle through, and cope with it the best we can, and use what we have available to us, and hope for better days..........White Beard
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