Auto BiPAP vs ASV question

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Auto BiPAP vs ASV question

Postby Steve in Cleveland » Sun Mar 24, 2013 12:31 pm

Hi, I'm recently diagnosed with extremely severe OSA, and am meeting my DME tomorrow to get setup on my machine and mask.

On my initial take-home study, my AHI was 108 and they noted breathing consistent with Cheyne-Stokes Respiration. Because of this, my in-lab titration was for ASV. The ASV study results show that there was no CSR once the obstructions were cleared up, and there were "very few machine-triggered breaths." My doctors treatment notes say " Since there was no Cheyne-Stokes Respirations, ASV is unnecessary. auto titrating BiPAP would be more appropriate with a minimum EPAP of 7 cm H2O, maximum pressure 25 cm H2O, pressure support 0-6. " Which looks to me like basically a wide-open BiPAP.

When I spoke to the DME on the phone a couple of days ago, asked what machine I was getting, and they said they doctor prescribed a Respironics ASV. (This was before I'd seen the study results.) I haven't been able to speak to the doctor directly, and the report they sent me isn't the actual prescription, I think.

I plan to ask the DME if the prescription is really for an ASV. If it is, is the ASV part of the algorithm basically just sitting dormant waiting for CSR and CA's that never occur? In other words, is an ASV basically the same as an Auto BiPAP for someone with basic (if severe) OSA? Are there downsides to starting with an ASV machine (besides the price being about 3x a BiPAP), like becoming dependent on ASV, that would make it advantageous to start with a simpler machine?

Also, is there a reason a sleep doctor would prescribe ASV without CA's or signs of CSR/periodic breathing?
Untreated AHI: 108, 02 nadir: 69%
Treated AHI: 0.4!
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Re: Auto BiPAP vs ASV question

Postby Xney » Sun Mar 24, 2013 10:04 pm

No, they're very different things. All a bipap does it change pressures based on your needs over time. It can increase pressures *over time* to reduce events. The backup timer just watches for your breathing and will kick in a pressure pulse if you need it, at the backup timer rate.

An ASV changes the pressure on every breath to match a volume of air over time. It doesn't have to wait for events and adjust afterwards. it does this by an algorithm. It'll also kick in breathing depending on the algorithm, but will pump up the air pressure until you breathe.
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Re: Auto BiPAP vs ASV question

Postby truckerdad57 » Fri Mar 29, 2013 6:22 pm

A couple of points to add....

like becoming dependent on ASV


Don't worry about dependency. One of the things about sleep apnea you need to come to terms with is that is it a chronic condition. You will most likely need to be using some kind of PAP- CPAP, APAP, Bi-PAP or ASV for the rest of your life.

Also, is there a reason a sleep doctor would prescribe ASV without CA's or signs of CSR/periodic breathing?


There is a reason they make doctors go to medical school. This is a patient support forum most of us here are patients. You've asked a pretty specific medical question you REALLY should ask your treating sleep physician. This assumes that you are being treated by a doctor board certifed in sleep medicine. From your posting you've got some complicated treatment issues. It would be a very good idea to be sure your doctor knows sleep medicine. With the CSR working with a pulmonologist might be something your sleep specialist may suggest.

If your sleep doc says you need an ASV to start go with what they say. Often you need to "fail" on CPAP and/or BiPap for insurance to cover the costs of an ASV. If your condition and sleep study results warrant an ASV to start I would suggest going with what the doctor is suggesting.

Good luck and keep us posted.
(just a truck driver with sleep apnea)
Co-coordinator Truckers for a Cause Chapter of A. W. A. K. E.
awake.truckersforacause.com
Do not substitute information from here for professional medical advise.
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