Bilevel and ASV Titrations: Pressure Changes for Technologists and Patients.
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- เผยแพร่เมื่อ 9 ก.พ. 2025
- If this video doesn't get your heart pumping with excitement then you are clearly dead inside. We talk about Bilevel and ASV Titrations and why the pressures are changed and titrated the way that they are. After you watch this you'll want to take a cold shower....cuz damn!!!
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Thank you!!!
Hi Jason, I am RPSGT from Czech Republik and I discovered you recently , yes, I have a certificate from US, I had the honor of cooperating with our clinic in the Czech Republic from the Mayo Clinic in Rochester, to do an internship in the sleep laboratory at this clinic and then take the exams in Rochester. I had a great teacher and you're second. I will take you as a model for learning sleep technicians in the Czech Republic, because this field is not so widespread here and I would like to work on it. Thanks for your videos and sorry for my english :-)))))
I was on Phillips dream station auto bipap and it sucked but, 50% of the time I had too many centrals. I will get my ASV machine in 2 days, I will definitely be watching the settings prescribed. A BIG THANK YOU for your help, Jason!!!
If you need help with it let me know Karen!
This was an excellent explanation.
Now, I can communicate more intelligently with the sleep doc regarding my AirCurve 10-ST.
The sleep doc says that I need to be more like a "patient" and less like a want-to-be "medical student." In other words - stop asking so many questions.
Thank you and kind regards,
T.
Phoenix, AZ USA
It's like it's Christmas every time you post 💖
mikokuijn agree
@@jamesbruzgis9476 I agree.
I've been on bi-level BiPAP for about 16 years and I never notice the changes in pressure during the night. I've had my levels changed several times though, just last year most recently. I don't ever change anything myself. If I start feeling like I'm having problems, I'll call the doc and make an appointment.
I will be getting an ASV soon. Your presentation will be very helpful with the settings. Thank you!
Im a polysomnography student and I hate watching film. BUT........This was amazing I stayed watching and wanted more. thanks for the info.
Well if you love this boring crap.....I've got news for you!!! I can bore the hell out of you in ALL of my videos!!!
Got a call from my doctor's office and he want to put me on ASV machine. I have too many apneas per hour and have central sleep apnea. I'm currently using the ResMed AirSense10 with CPAP, S and VAuto. I have my machine set to Spontaneous. Thanks for the video. Now I know a little more on what to expect.
Great explanations & analogies! I had a pair of Respironics reps try to explain ASV to me & my sleep team, & boy, they used so much technical jargon & did not explain things well at all. Thanks Lanky!!
Great video. I've been using my Resumes Vauto for almost a year. My clinic has it in auto. Max Ipap 25, min epap 12 and pressure support 4. Love the channel and watch all your videos.
I found maxing out EPAP max and PS max caused excessive aerophagia on my ASV. I have been using EPAP 5.6 -11 and PS 3-15 with an N30i mask and mouth tape, and have the best AHI (less than 1.5) and least aerophagia, since changing to these somewhat lower settings. ASV is by far the best!
I got my new ResMed AirCurve 10 ASV auto machine about 3 weeks ago. Didn't get to see the RT until last week and he setup my machine as per my sleep doctors prescription. It was on the ASV auto therapy setting. My min PS is 0 and the max PS is 15. The Epap min is 5 and the Epap max is 15. The RT said I should not change the settings. My apneas are practically gone now. I sleep better. I am using a full face or really a half face ResMed AirFit F20 mask. Sometimes when I first put on the mask I am out of breath but I think that is because I'm in Afib and am taking a new medicine that can affect my lungs and my breathing. But after a minute of taking breaths I get releaxed and then let the machine breath for me if I hold my breath to see how high the IPAP gets. There is a meter on the machine that shows the min pressure reading and the max pressure reading. I suspect that it the IPAP reading. Also on the machine it shows my min PS. It goes up when I hold my breath. After I fall asleep I get really good OSCAR reports. I want to thank Jason for helping me setup my machine and getting me on ASV before the RT set it up. The PS were 5 and 21 as Per Jason until the RT reeled the Max PS in and lowered it down to 15.
I may get into the clinical settings again and look at the settings for only plain ASV as right now I'm on ASV auto. There is a difference in the settings. I'm happy to be on the ASV auto therapy setting but am curious about the ASV settings now. Because on my ResMed AirCurve ASV auto machine I don't have a IPAP setting in the ASV auto therapy mode.
Thank you, Jason, this was very informative.
Thanks,,,and the new microphone sounds great.
8:20 This is why ASV is so useful.
Aircurve ASV, I only see 3 settings: EPAP, Min PS, and Max PS, in the Clinical Settings Menu. Am I missing something?
Hi, I just want to say that your the only one that explained what I'm looking for for the longest time. So I need your help. I am a sleep technician but I have never done ASV in the hospital setting and none so far as in lab tech. I do understand that when its on auto, the machine will able to change when needed with patient breathing but when do you make changes if needed? You helped out with the settings for Min Epap, Max Epap, Min PS, Max PS, and max pressure (ipap). The issue is that
1.) respironics or resmed protocol handbook doesn't mention which one to titrate exactly or if i have to titrate them in synchrony if issues occur?
2. What are the maximum pressures to stop at for this setting?
If you can answer that, you would be a life saver.
I was reading in the manual says medical devices do no count as carry on luggage and can be extra with no fee very interesting
Great info.
Resmed Aircurve 11 ASV. This thing attacks me like a drain plunger when I awaken during the night. Apparently wanting me to breathe at its own pace. The clinician menu is sparse. It is set to Auto ASV.
Very informative video. It would be interesting to know the criteria for graduating patients between the different cpap machines and any advice on navigating doctor's offices to advocate for the best therapy for you. For example, you do a sleep study and they find you do best on CPAP @ 10cmH20 but only monitor for 20 mins near the end of the study. Years later you've eliminated all obstructive events, minimized hypopneas and your leak rates are optimal but now the vast majority of your events are central apneas even though your overall AHI is low. Is the next step asking your doctor for a bipap titration to test therapeutic results? Does a bipap titration include asv or is that a separate titration as well?
Great useful info buddy, thank you!
Jason, if price were no object, should almost every patient be on ASV rather than Cpap or Bipap?
Fascinating.
So, for people with COPD is BiPap better? The Oscar wiki alludes to COPD'ers needing more pressure relief.
Jason thanks for this. I am on BiPap - My Max pressure is 19 Min is I think 12. I have so many mask leak issues I have just decided to try and live with them. I use Resmed Air Curve machine, which I think is a super unit. I use Resmed F20 and F30 masks, which seem to work best for me. I definitely will not play with my machine settings, but I can not help but wonder if that higher pressure could not be dropped to about 17.
I like the wood floor I had the same flooring
Since i have been using a bipap since january 2023 my heart has been elevated and causing me not to be able to sleep. i feel its the settings. Is there any help you can give me for this situation i am stuck wih i use the machine my heart goes too high when i dont use it my heart rate is good but i have sleep apnea and my 02 will drop. ANY HELP WOULD BE SO APPRECIATED
I have failed in the lab multiple times. I have a neuromuscular disease and my NMD physician said the labs and technicians are not programmed or trained to identify muscle weakness as a reason for breathing shallowly or unable to trigger a breath, and instead they misinterpret it as a hypopnea or central apnea and try to titrate away the events. He said the goal is to assist with the work of breathing, which is done by pressure support, and only touch the EPAP in the case of obstructive apneas or oxygenation problems that don't have to do with hypoventilation. All that said, how the heck do I find a place that can adequately treat me aside from just using trial and error?
Same thing happens to me, I only hypoventilate some type of nocturnal hypoventilation... Can you give your contact so we can help each other? Thanks
Good day sir. I am a sleep specialist very much interested in learning more about AVAPS and ASV titrations. May I ask what are the best reading or learning materials I can study so that I will be versed in these setups/ titrations?
Thank you very much in advance!
For AVAPS there are height and weight charts that you use as a starting point, then increase the VT as needed. ASV is basically "wide open", then increase the EPAP min if there doesn't seem to be a response to hypopneas or RERAs. Controlling for leak with both modes is critical!!!!
Is there another name for ASV? I have the Resmed Aircurve 10 and my mode selections are CPAP, S, and VAUTO.
Unless you jailbreak the device with a custom firmware (AirSense 10 can do this, voids warranty), then resmed releases ASV as a different machine, aka:
AirSense 10 AutoSet (CPAP / APAP Modes)
AirCurve 10 VAuto (CPAP / S / VAuto Modes)
AirCurve 10 ASV (CPAP / ASV Modes)
AirCurve 10 ST (CPAP / S / ST / T Modes)
AirCurve 10 ST-A (CPAP / S / ST / T / PAC / iVAPS Modes)
the DreamStation BiPAP autoSV
jason how do you get doctors to prescribe DreamStation BiPAP autoSV
Servo-ventilation system? by the way thank you sooo much for teaching about the settings. how do we contact you for specific questiosn
Why does my machine say bipap auto but gives me the settings for ASV ?
What have you observed with the Biflex setting, good or bad to use biflex? Thank you, Will
thank you!
Hey Lanky, have had complex apnea for a long time, apnea doc sent me home with a new ResMed Aircurve 10 ST
with setting of Expiration of 4 and Inspiration of 11.5, to stop centrals, am I limiting myself at 11.5 or should
I be up in the rafters at 25 to allow the machine to make the decision where to stop them. I am trying to get my AHI down from 8+ to below 5. THANKS
With that machine there isn't any "deciding" on the part of the machine. It will do what the settings are. What you are saying would be good for an ASV, but not a Bilevel ST unit. Sounds like you machine may need an adjustment, but it depends on what you are seeing (using OSCAR?) to know what adjustment to make.
Home sleep studies have you researched which ones work?
Hey Lanky. Great video as always and thanks for putting out the highly informative stuff. I have one query. Do ASV machines need titration (and a precise pressure range) like you do with Bi level machines ? Because as per this video, ASV sounds a simple way to cure all sleep disordered breathing issues and without any need for titration much.
Thanks in advance ! :)
Simple way to treat Cheyne-Stokes respiration. It's not appropriate for other forms of sleep disordered breathing. ResMed machines do need some titration. PR machines the EPAP min can be adjusted somewhat. The PR ASV is superior (in my opinion) to the ResMed for this reason.
@@Freecpapadvice So you can't use ASV for typical OSA, UARS ? I thought ASV were good for all kinds of sleep disordered breathing not just CSA but doctors didn't prescribe it because of high costs.
Hey Lefty! Thanks for the video man I enjoy the content as always. Cab I be cheeky and ask a quick question? I use a bi-level ventilator here in the UK for severe obstructive sleep apnea and one doctor tells me that low flow oxygen of 1.5 l per minute through a supplemental oxygen port into the loop will ensure my levels stay high while being treated for the OSA with the ventilator and another doctor tells me it's unnecessary given that my Sats only drop occasionally and that it could even be dangerous. I really want to go with the supplemental oxygen because I've got heart problems too. Question is in your experience (non-binding theoretical advice were not litigious for kindness in UK 🤣) could 1.5 lpm be dangerous? I've had as low as 81% on the ventilator but generally run around 91-94% SATs at night Ipap 22cm epap 10.5cm if you have the time and the kindest to answer this cheeky question then well god damnit I think you're awesome if not I'll keep loving the videos don't do anything I wouldn't do man
I think that you're fine to continue using oxygen given your circumstances that you outline. Remember that I am just a lowly sleep tech that often forgets routine aspects of his job and spends most of his day daydreaming. :^) I'm assuming it's something like CHF? Either way, 1.5 ppm is fine just considering your lowest SPO2. The baseline is also just slightly above borderline.
@@Freecpapadvice Thanks so much for answering :)! No it's Left Ventricular Hypertrophy, Diastolic Dysfunction, Hypertension, Occasional Nocturnal Bradycardia and previous Sinus Rythem pauses. I'm 31 years old in really bad health and they think that it is related to Cushing's Syndrome the damage to my heart (Too much Cortisol Hormone in the body)
I guess my main concern is that if the 81% was a one time outlier or the pulse oximetry was wrong and if my nocturnal levels go up to 100% on a pulse oximeter with the 1.5lpm can that be dangerous? Or given the fact that it's low flow o2 and my other health conditions are bad merely a good insurance policy because there's been those drops in the past?
I do worry a bit too much about thid stuff the one doctor says it will just be a safety net the other doctor says not needed. From the research I've done I think it will be ok, don't think oxygen toxicity is much of a risk at low flow rates. I don't know if the high pressure of the ipap on bi-level makes the oxygen more dangerous doubt it. I feel safer when I use the oxygen and I haven't woken up feeling more unwell than usual or had anything weird happen, I just wish I had definitive guidance from this pair of trainee narcissists 🤣 and the research is so difficult to find specifics on this online. I don't think oxygen toxicity is a risk in thid case and would like to continue adding it to the circuit but I get what you're saying even though when I've got better results 91% is still borderline so the 1.5 is warranted even if the 81% is an outlier given those conditions you still agree with the first doctor? Should be fine? Again non-binding blah blah blah blah, Also don't put yourself down then you're not a lowly sleep tech, it may be different in the US system in the UK techs are the ones that carry out the doctor's orders and have the actual hand-to-hand experience a lot of doctors don't actually deal with the equipment and generally speaking their knowledge is more broad and not as specialised and you seem like an expert to me you're passionate about your job and you put things forward in an entertaining fact your way that is approachable for people with good medical knowledge and people who don't have a clue. I'm just trying the best I can to keep myself alive until they can come up with the treatment to stop the hormones damaging my heart too much. Much Respect, Deuces.
@@abbott790What is your treated AHI? If optimal PAP therapy doesn't control your oxygen saturation while sleeping, supplemental oxygen makes sense and isn't a decision worth being fearful of unless you have a lung disease such as COPD where you may have a small risk of increasing carbon dioxide levels with the supplemental O2. The goal is to use just enough supplemental O2 to reach the goal of never going below 88-92% oxygen saturation. There is zero value in having an O2 sat of 98 or 100%.
@@matty00926 Thanks Matthew I really appreciate that I have no idea what my AHI is the ealth system doesn't provide that over here in the same way. I was aware of those high SATs of around 100 not being essential and completely understand what you're saying, I guess my question after your comment would be if SATS do go up to that level can that be harmful on such low flow rates? Is 100% dangerous? The 1.5 lpm prescribed leaves me hovering about 95%-100%. I can titrate that down to 1 per minute but do I really need to can't get guidance from the doctor it's just a case of there's a prescription get lost see you in a year for your check up I think what I'm really looking for is some reassurance that there's no huge danger if the SATs sitter 100 for a long period of time can you offer that reassurance or I don't like the whole thing's stressful I wish I had Lefty handling it 🤣
@@abbott790 Does your machine use a SD data card to record information, that you give your physician? If so, there is free software called OSCAR that you can download on your computer and upload and analyze your data from the SD card. I'm not a doctor, but if the supplemental oxygen makes you feel better when you wake up, then I would keep using it. I highly doubt such a low flow rate could really have any ill effects, and I believe some of the flow is lost when bled into the mask anyway.
Thankk youu
You're welcome Erica
I really do enjoy your videos. I started BIPAP about a month ago, and they started me at the highest levels of 25/ 21. Is this normal? Thank you.
I would say that this is outside what would be considered a normal range, but that said.....whatever works for you is all that matters.
Help.... I'm 27 up guy My doctors gave me a inhome sleep test. It was bad. So they said go get a machine. So I went and had a terrible time with it. Nobody would help me and insurance forced me to take it back. My mom bought one and I jail broke it and set it to 15. I'm I doing something wrong?
My Doc has set my home cpap unit to a 20 and having constant mask leak issues but he won’t decrease this setting. Any thoughts on this? Been unsuccessfully attempting to get minimum four hours each night.
Thomas Daly get the F30 ResMed hybrid mask
I have a Resmed ASV, Dr had it set to ASV “auto”. My AHI varied from 4-15, switched it to ASV. My AHI immediately dropped to be consistently under 2. Any thoughts why?
Because ASV works breath by breath which can eliminate potential hypopneas an central sleep apnea (CSA) events which are harder to treat with CPAP or even BiPAP. Plus, you could be on a wrong pressure earlier.
I tried to follow, but, this is over my head. I have a question, although not related to this video. Being I have been in shutoff situation with the electric company. Bipap and cpap could be the help that saves you from being shutoff.
NY made a decision recently that these machines will not be continued as a life saving device, only oxygen. The answer to my query as to why this changed, seeing it is a life saving device, is because people abused it.
Now question after background info, how does one possibly abuse this, as I have a machine with sd card, they know your usage without seeing a doctor. They will take it back if you don't use it. So, how can this be considered a machine to be misused and not eligible as life saving, unless someone alters machine, if don't think you can lie about this. I am interested to know your take on this.
Nice and concise, thanks ....
21:45 McTavish!
Come with me to a V.A. sleep lab. I'm at 17. Eaglegards...
12:30
I'm just a bad dude.
You.......are definitely a BAD dude! Caught up on your vlogs today. Hang in there!
Nobody here, watching...
.
Well thats 20 mins ill never get back
I'm offended. It was a 21 minute video. Did you skip out early?
TheLankyLefty27 its all good. Just joking.
Look....the important point here is that you suffered through the entire video. My videos are like listening to "Stairway to Heaven"....if you start it then you finish it!!! Did you violate LankyLefty27 TH-cam etiquette? :^)
TheLankyLefty27 guilty,lol. Ill have a shot of something pre-video in the future