Auto Servo Ventilation Settings. What is the correct ASV Setting?

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Proper ASV settings are discussed along with an example of improper settings and what can occur. IPAP Max, EPAP Max, EPAP min, Pressure Support, Rate....etc.

[@mariemaguire306]

Long story very short: thank you, thank you, thank you! Because of you I have set my ASV machine in a way that works for me. I’ve had several nights of good sleep and have hope for regaining wellness. Keep doing what you do - you make a difference in peoples lives. 🌷

[@joannlehrkamp5114]

Marie Maguire I wish they could get my numbers set right on ASV, I’m afraid to change them myself???

[@unclefester9113]

I am TOTALLY a fan of this web site. I very much appreciate Jason's efforts to teach new CPAP patients - what, how, why and the differences between different types of therapy. Thanks for making this stuff somewhat more understandable.

[@Freecpapadvice]

Thanks Scott! I appreciate your kind words.

[@jorisbonson386]

I spent way too much time dicking with my settings I think, and this is the video I've come to accept as the best explanation for ASV setup which no doubt applies to 99% of people. While I was going through the ASV 'honeymoon phase' and playing about, in the back of my mind I always thought I should really be just trusting what years of manufacturer experience has told them rather than my own foolish assumptions! I still get spo2 plunges (as much as 10%) at sleep onset, but they happen over a longer period now - where they used to occur in the space of less than a minute, the same single desat will occur over 10-15 mins. I think this is due to the 3 / 4 min ASV sliding window assuming my venitlation requirements are dropping (gradually lowering the target vent) but not being clever enough to know my flow rate is so shallow my spo2 is now at unhealthy levels. After that though I seem to recover and pull back up to stay around what my basal daytime spo2 normally is for the rest of the time I'm asleep - it's bizarre. While maybe not perfect, it's a lot better than when I'm without it :) This is with reported AHI of 0.0 too. As Jason rightly says, set it and forget it...

[@davidfolts5893]

Great information, Jason is the Zen Master of sleep apnea.

[@karendenney4126]

Thank you so much for the info!!! I go to my ASV sleep study in 2 days, I looking forward to better sleep in my future. I appreciate the settings. Knowledge is power, you rock Jason!

[@Freecpapadvice]

Good luck with the ASV study Karen. Nice that at least some states aren't shut down so much that people can't get medical testing done. If you ever need help, please reach out to me!

[@theJ4ZZ]

As just an extra factoid regarding how ASV determines how it changes pressure settings: ASV targets a certain minute ventilation (amt of air you breathe in a minute) over an average of 3 minutes. This is also why it takes time to let the machine learn how you breathe, and it may not fix central events instantly. When the machine senses a change in your minute ventilation due to a central event, it increases pressure support until it senses your spontaneous breathing corrects to a normal level. I also presume the machine will determine your tidal volume too (one breath) and try to match that tidal volume. Sort of like AVAPS, except ASV determines your tidal volume based on your personal breathing over that 3 minutes rather than AVAPS where you set a target tidal volume yourself.

[@cebruthius]

This only applies to the ResMed implementation of ASV

[@Moveon10001]

@@cebruthius Even ResMed has different machines. I have the ResMed AirCurve 10 ASV which has two different modes. ASV and ASV auto. And there is no max IPAP or min IPAP settings on my machine. there is a min max EPAP and a min/max PS setting but you can't set the IPAP min max. IPAP is determined by the machine.

[@tjnugent62]

Great explanation. I have only done a few titrations with the ASV, but they work so well. The first time I was able to smooth out a fellow who had been the lab for 4 titrations without avail. I turned it on and the patient instantly went into Stage 5 and spent most of the rest of the night there. I was blown away, to say the least. Fixing someone is a great feeling, but fixing someone who has an extremely difficult case is a sense of satisfaction that is rarely seen.

[@faith5802]

Very helpful and well-explained. Thank you.

[@andreaschaefer4926]

great video, clear explanation. Thank you for posting this

[@brendastarcher6294]

I'm so glad I came across your video. I'm starting on a ASV unit on April 13. I hadn't heard of this time of machine before. I know they told me that I quit breathing a lot, especially lying on my back. You answered a lot of questions for me. I can't wait to learn more. I was told my AP minimum would be 6 and the AP max 8. Is that good? I heard this from someone at the doctor's office reading it to me that didn't know what any of this meant. PS max they said was 12. Do those numbers seem good to you? This group comes highly recommended from my doctor, which will be nice since I've tried CPAPs before will no support at all.

[@ashrafc7794]

Thanks man, appreciate it.

[@spencermcdonald937]

Excellent Video, after making changes on my settings, is it possible to get a 0.0 AHI reading . Crazy after two nights on new settings have 0.0

[@pamelaruigh8185]

Could you do a video on ASV and the studies on heart failure?

[@K5MOW]

Great Video

[@Freecpapadvice]

+K5MOW Thank you.

[@tareqhasan6476]

Hello, I have a question about BiPAP pressure settings. I am on CPAP Auto (Pressure: Min: 5 MAX: 15 EPR: 1) but having trouble when I exhale and adjusting to CPAP. Doctor recommended to try BiPAP and insurance approved it. What should be ideal BiPAP setting for me. I need to know following settings for DreamStation Auto Bipap: Max IPAP: Min EPAP: PS MIN: PS MAX: OR For ResMed VPAP Auto: Max IPAP: Min EPAP: PS: Thanks a lot.

[@danyelle6525]

Ok, hi!! I’m really new to this. In fact I haven’t even received my machine yet. I do have my treatment recommendations. ASV EPAP min 4 max 20 PS min 0 max 20 max pressure 25cm H2O and heated humidity. You’ve said that the epap max is 15, I wonder why mine is 20..???

[@robert1702]

i can't find the ipap setting on my resmed aircurve 10 asv (asv auto). i only see the min EPAP and max EPAP settings. i also see the min PS and max PS setting. I'm also wondering what exactly does the PS setting do. and why do i need a min EPAP setting?

[@sciontc627]

I have a Philips Respironics system one my machine is set to when I first turn it on it says 8 and I'm told to push the button then it goes to 4 and that's what I start with and I guess the maximum it reaches is 8? Does that sound normal to you? I'm just curious they told me that I have it mild case?

[@2jamadu]

Hi, thanks for your wonderful channel! Just curious.. I have a system one sv and wondering what you suggest for the BPM setting? it is set for auto.

[@Freecpapadvice]

+2jamadu Auto is perfect.

[@Moveon10001]

Jason I just got a new ResMed AirCurve 10 ASV machine today and need to set it up right. I can't get to the doctor until the 24th of this month May. You settings in the video are different that what I see in the settings on my machine. I'm in the Clinical setting BTW. It's setup to an EPAP of 3 and a PS of 4 to 15. I don't see any EPAP max or IPAP settings at all. Only EPAP min and PS min and max settings in ASV mode. Maybe the ASV auto mode will have those settings. I'll have to look and see. I'll be going to bed in a few hours and want to use the new machine tonight and then check the SD card data using OSCAR tomorrow to see what it does. That gives me a IPAP max of only 19. I have severe sleep apnea with Central Apneas, Cheyne Stokes respirations and obstructive apneas all together.

[@ronburg3663]

I wish he would have answered this question..I'm having the exact same problem..did you ever figure it out?

[@ASpectacular3777]

They took me off my BiPap (had Mild OSA but then got Centrals) so now I’m on ASV but I get aerophagia and I think it’s damaging my lungs with high volume. So I’m on ASV (not Auto), EPAP 4, and I was on PS 3-10. I just lowered PS to 3-8. Hopefully this fixes it.

[@justintorrance3522]

is it possible to get medications along with asv to assist with centrals if all else fails? for some reason, Ambien or clonazepam reduce these events on their own at least with me. Remede system is available but extremely expensive

[@johnj28]

ok, I just got a new Dreamstation Auto BiPap as you recommended. When I look at my system one settings the Dr. had me on min Epap 8, Max Ipap 20, with PS min of 5 and PS Max of 5... Does that make any sense to you? I used it last night and got an AHI of 1.9 but my PS Min was set to 2 and my PS Max was set to 8??? My 90% Epap was 14.5 and my 90% Ipap was 16.5?? Curious if I should change PS Support settings as I still don't completely understand how they work? Thanks!

[@lorenzoishere]

Hi i just got a resmed curve 9 adapt, in de ASV mode it only has the parameters of EPAP, PSmax, PSmin. How can i programe it to reach something near like you show in the video?

[@Moveon10001]

Do different ASV machines have different settings? I'm talking about different manufactures. And my ResMed AirCurve 10 ASV machine has two different modes. One is just called ASV, and the other is called ASV auto.

[@danamullins2723]

I've been trying to use my Aircurve 10 ASV machine for a few years now, and I still have only been able to sleep with it on for a few hours max. I have severe central sleep apnea, with mixed apnea. I also have bad insomnia, which makes me extremely sensitive to the machine, and the machine usually ends up stimulating me too much and keeps me awake. On top of that, I naturally have a lower respiratory rate and take fewer breathes and breathe a little more shallow. What I find is that the machine is making me take more breathes than I need to take, and this is greatly stimulating my body and causing me to not be able to sleep when I use it. I know with older style.machines you could turn down the breathes per minute to help better adjust for this. Is there a way to help adjust for this with this type of machine?.....any help would be greatly appreciated, as my sleep doctor is worthless and just tells me not to mess with the machine. Also, I changed the settings to what you said in this video to max them out, and I'm going to try that tonight.

[@jeremyl9515]

Dana, how did it go?

[@paulkim7870]

Dana, your symptoms and experience are similar to mine. And I tried using the settings in this video and I found them to be too aggressive since my natural breathing is way more shallow than these settings. I bought the Aircurve 10 ASV yesterday and used jt last night. I found myself constantly needing to change the settings through the night until I finally did fall asleep but woke up later to a clumsy ASV not in sync with my breathing. Had to turn it off after just a few minutes of what I thought was finally a success.

[@danamullins2723]

@@jeremyl9515 it didn't work. I ended up backing the settings way down and using the mask just to get use to it. Once I got use to it I gradually increased the settings in smaller increments until my AHI was down to almost zero....now I just stick with those settings.

[@ventilator98]

In JAN of 2015 you'd done a video on the OmniLab advanced. When are ya gonna do the software operation? I know a couple years you said you'd do that.

[@Freecpapadvice]

It’s pretty much not going to happen. With HIPPA I can’t take cameras into the lab and film anymore. Totally off limits in patient areas. Sorry Peter.

[@ephraimhendrix4632]

I have a question about the water chamber in my Aircurve 10. The chamber is 380 ml and that is ridiculously small. It boils dry on a setting of 2. Do you know of any chambers that will fit the Aircuve or any way to piggy-back some? Resmed says they have only that one size. Thanks

[@Moveon10001]

What is your home's humidity level? 30% RH or less? I have that same machine and 380 ml on Auto Humidity level of about 4 is 85% RH inside the mask. My home humidity is around 55% RH Today. I turned the AC on and brough the house RH down to 50 %RH today at 75 Deg F. My Heated Air Hose is set 81 deg F right now for tonight. I was breathing at a rate of 20 BPM last night. I sleep for 9 hours and still had water in the water chamber this am. I use distilled water that is at room temperature or around 75 deg F when I pour it into my water chamber.

[@baggerjax]

So to it should read 25 IPAP and EPAP is set to 15 ,PS Max is now 8 and PS Min is 3 should i just try this for a few nights ? Setting before AHI was 9 to 13 and i was slamming coffee to make it threw the night. CA 12+ and pressure pulse was like 21 , thanks man just a dummy trying to fix what my DME jacked up.

[@Freecpapadvice]

Whoa! Wait. If that's as high as the PS max will go, then you aren't on an ASV machine. I'm sorry. I didn't read your original post closely enough. That's just a BiPAP Auto. Totally different machine than a bipap auto sv (ASV). Keep the PS support spread out as much as possible. Use SleepyHead to see if either end (IPAP or EPAP) need to be throttled back at all. Just watch the trend of leak, your pressure, and flagged events to see what is optimal. (be careful with believing all events that are flagged though)

[@Twilightsummerbreeze]

Don't they always need to be no further apart than 10cwp like in a bipap?

[@nailbomb3]

pretty wild, looked at someone's ASV data. found some missed flags! not a lot but...not zero.

[@sparks8934]

I'm trying to set my auto sv. I cannot sleep withit. I have central obstructive sleep apnea still unable to use it. Settings you explain are complicated. Help make more on this.

[@Moveon10001]

EPAP min at 5 and max EPAP at 15. PS min at Zero and PS max at 15. There you go.

[@kloozman]

I have the max pressure setting at 10, but i don't think you said what the minimum pressure support should be

[@jokerpoker2012]

Do you know what I do with a res med air curve 10 bipap. I have settings of 21-25 over min17

[@jovannehan3985]

Mine makes me breathe too deeply. I need it much lower and don’t know what to do. My APAP range was 4-8 (10 is so high I have to take the mask off) and it was perfect. Now on Bipap AutoSV, it is a nightmare; the settings are way too high. It does not adjust to my breathing at all. It’s settings are: Pres High: 25 PS High: 20 PS Low: 0 EPAP High: 15 EPAP Low: 5 BPM: Auto

[@Freecpapadvice]

Why are you on Bilevel then?

[@lauravickers1429]

Ok I have central apnea and was ordered a resmed air curve 10 with asv it is always going into asv even when I am awake. I will be reading or watching tv an this thing will start blow in air as if I am not breathing. It is crazy. In the settings it has asv and asvauto what is the difference. Either way I want it to stop giving me breaths when I am not needing it. The ramp is at 45 Epap 10 Min ps4 Max ps10 Start cpap 4.0 Climate ctrl auto Tube temp 70* Please Help

[@heytherekelilah2]

Laura Vickers I’m having this exact same problem. I’ve had mine four days and I’m completely unable to fall asleep with it. It tries to breathe over me when i don’t need it

[@heytherekelilah2]

Like it tries to give me my next breath before I’m done exhaling. Frustrating and anxiety inducing

[@johnj28]

I currently have a System One Auto BiPap machine and considering purchasing an AirCurve 10 ASV? Can you tell me if that would be a good choice?

[@Freecpapadvice]

I’d get the Dreamstation version instead.

[@johnj28]

@@Freecpapadvice I bought the Dreamstation Auto BiPap model DSX700H11. I have set it up on AutoB. The default settings are IPAP: 25 CM H2O, EPAP: 4 CM H2O, PS Min: 2, PS Max 8, Bi-Flex: On 2, SmartStart: Off, Ramp: 30 Minutes, Ramp Start Pressure: 4 CM H2O... Anything you would change especially thinking about PS Min and PS Max?

[@Epochalypse1978]

Just started on a dreamstation bipap auto ASV and were wondering if my settings are a good start? Opti start - on Max pressure - 25 Max epap - 20 Min epap - 4 Psmax - 21 Psmin - 3 Bpm - auto. When I was on APAP my results from Sleepyhead were: 90% pressure - 13.9 Ave. Epap - 8.5 Min epap - 3.4 Max epap - 18.2 My AHI on the APAP was an average of 12. My scores so far on the ASV are a bit lower at around 6 but could be better, right?

[@Freecpapadvice]

Settings look good. Scores are also fine. Remember the machine reported ahi has a massive error factor. If you look at the actual waves you could probably dismiss several tagged events.

[@Epochalypse1978]

@@Freecpapadvice great stuff, thanks. I managed an AHI of 3.6 with these settings last night and no centrals so I'm very pleased!

[@BeeBopGaming]

I have had severe sleep apnea for some time now and I got diagnosed with complex sleep apnea in Dec 2015. I've been using my asv bipap since Jan and have noticed little if any difference and my sleep scores are always over 90. How long should this take to get me to some what of a normal state?

[@Freecpapadvice]

+beebop shopbop I have a video on that. There is probably something small that you need to have tweaked to optimize your therapy.

[@CentralVirginian1]

Aircurve 10 ASV: I only see three clinical settings in the ASV mode: EPAP, Min PS, and Max PS. What are the appropriate settings here?

[@theJ4ZZ]

RPSGT here. Usually for ASV there should be an EPAPmin and max, but the PSmin and PSmax should always be 0 and however high the highest PSmax can go (unless the patient has lung damage where a big PS can harm the patient). EPAP as he said could be a bit variable, as this is the setting to resolve simple obstruction. If there's only one EPAP setting, then it should be set close to what it takes to fix obstructive apneas (in the lab I try to set it right around where it resolves full apneas since even the EPAP you need can vary based on your posture during sleep). The reason you want PSmin to be 0 is because when you're breathing normally (discussed in video), you may not necessarily need any help in breathing, so you don't need any pressure support. But if you have a central apnea or central hypopnea, you want to let the machine do whatever it needs to do to keep your breathing normalized. If you set a PSmin at, say, 5cmH2O, even when you're breathing normally, the machine will give you extra support; this is essentially now BiPAP with ASV support. This may not always be a problem depending on the patient, but having an alway-increased inhalation volume can sometimes cause central apneas, as the machine is overventilating you when you may be perfect on your own.

[@Moveon10001]

I have the very same machine. ResMed AirCurve 10 ASV Auto. I have my max EPAP set to 15 and min EPAP set to 5. My pressure support is min zero and max of 15. Most of the time it takes a few minutes for the machine to learn my breathing patten and give me enough air. Then it lets me breath on my own unless I stop breathing. When I stop breathing for more than about 5 seconds it will increase the PS from zero to up to 15. It will start out increasing the PS to around 3 or 5, then it will go up to around 10 and then finally if I keep holding my breath it will increase the PS all the way up to 15. Also, I noticed that when I get up in the morning the EPAP has increased from 5 to around 6 or 8. I suspect the machine thinks I need more air Pressure for my EPAP. I like to have a higher EPAP as it helps me breathe easier. I wish that my sleep doctor had prescribed my min EPAP as 6 or 7 or had prescribed my PS min at 5 instead of zero. That way when I first go to bed and put the mask on, I get a lot more air. I feel like with my lower settings I'm not getting enough air. I have severe heart disease and get out of breath easily so when I walk to the bedroom I'm out of breath before I even put the mask on. I use the AirFit F20 now. I was using the AirCurve F20 but the mask material tore and leaks now. Before that I used an AirCurve F10 mask for several years with a good seal. NOTE: There are no min or max IPAP settings on the AirCurve 10 ASV auto machine. But you can figure out what the IPAP settings are by taking the EPAP and adding the PS to get the IPAP. So, setting the EPAP min, max and the PS min and max takes care of the IPAP settings. I'm OK with the AirFit F20 now but if it gets dirty you can't wash it in dishwater or any water at all. It has a foam-like seal all around the mask where it touches the face. And you can't use alcohol on it either.

[@baggerjax]

At the start of the video you stated 25 IPAP, 25 i get that ,then 15 for the EPAP i use Max PS 4 and Min PS 4 Its a dream station Its set to AutoB is this the same as Auto SV? I was told to keep the the setting for Max PS and Min PS should be as close as you can get them, from one of the guys on a forum My AHI is at or around 8 and this sucks, Should i set the EPAP to a lower # like 8 and let the machine bring it up on its own? and what about MAX and MIN Pressure support should that be 6 and 4 ? any advise would help.

[@Freecpapadvice]

Having the Pressure Support Max and Min be the same number is turning your EXPENSIVE ASV machine into a shitty BiPAP Auto. It locks the IPAP and EPAP into always being 4cmH20 apart from each other. PS max should be as high as it can possibly go, and PS min should be as low as it can possibly go. EPAP Max 15, EPAP Min 4. (This will mean that PS Max will be 21 and Min will be 0....but I personally think 3 is the way to go for PS Min)

[@baggerjax]

gonna try that tonight see if i can get below 10 AHI, thanks you vids are helpful

[@jorisbonson386]

So far I've seen ASV referred to as:- Adaptive support ventilation Active servo ventilation Auto servo ventilation Adaptive servo ventilation Active support ventilation As if it wasn't confusing enough as it is :D

[@Freecpapadvice]

Thankfully with all of them you can use the Dreamwear Under the nose cushion, dreamwear gel pillows, dreamwear silicone pillows, or the Dreamwear Full Face Mask. That's assuming you don't like the DreamWisp or DreamWay masks. You could also go with the P10, P30, N30, N30i, N20, F20, F30, or F30i.....nothing confusing about it at all! 🤣

[@jorisbonson386]

@@Freecpapadvice lol I've used the PR Dreamwear FitPack and the PR FitLife. Also the F20 AirFit which I had to be careful not to confuse with the F20 AirTouch. The stress of all that alone causes more sleep loss than the apnea itself.

[@cebruthius]

You forgot Anticyclic Servo Ventilation

[@jeffjvancich2864]

Hi. I just found your channel. Great info. I had a look at my settings on my philips System one. My Auto max is at 6 and my Auto min is also at 6. Is it doing anything? This is my 2nd machine and I got my therapy provider's to input the correct settings into it when I got it. Have they made a mistake entering them in?

[@marthahintz9480]

the ps setting is at 4, and the max is at 4, so it just blows air. How do i fix this? If I change it to 5, the max also goes to 5. I tried going back to factory settings, that didn’t work either.

[@Moveon10001]

Increase your PS to around 15 but ask your sleep doctor about this. The ASV auto won't help you much if your min and max PS is the same pressure. Like Jason said, it's like putting a governor on a fast sports car.

[@seanstock4644]

I don't have an ipap setting on my air curve

[@Moveon10001]

Just add your EPAP and PS settings and figure out your IPAP setting. You can't directly set the IPAP on the ResMed AirCurve 10 ASV auto machine.

[@baggerjax]

This might be a dumb question or not ..... Is auto ASV and auto bipap the same ? if not whats the difference ?

[@Emmylouwho_]

What about those of us that don’t use Auto? I have regular AirCurve 10 ASV not Auto.

[@augustb7535]

The resmed aircurve 10 vauto doesn’t have PS min and PS max it just says PS

[@Freecpapadvice]

It’s fixed on your unit. They aren’t independently variable. An ASV is independently variable.

[@augustb7535]

TheLankyLefty27 okay, that setting can reach up to 20 with my IPAP max at 18 (currently) and EPAP min at 4 I’m not sure what the fixed setting should be for PS? This is all new to me

[@Moveon10001]

That machine is a BiLevel machine. It's not an ASV auto machine IIRC. I had the same machine you are talking about and had to send it back into the Medical Supply Company and then they gave me the ResMed AirCurve 10 ASV auto.

[@plammijr]

ASV is Adaptive Servo Ventilation.

[@Freecpapadvice]

Yes, you are correct. Many, like myself, use the Respironics tradename of Auto Servo Ventilation instead of Adaptive. I also often use the term BiPAP instead of BiLevel.

[@cebruthius]

Let's say James Bond has sleep apnea and you're a Bond villain and you just broke into James' hotel room where his CPAP gear is prepared for his return after a heavy night of womanizing. You, the Bond villain know the way to enter the pressure menu on all possible brands/models. Your goal is to screw with Mr. Bond so that he has a worse night than just sleeping in open air. Could you do it?

[@Freecpapadvice]

For sure. It would be akin to one of the unusually slow death sequences that always seem to leave too much time to escape. Bond would need a nap the next day after I'm done screwing with him.....

[@billymorgan7717]

LOL :-D

[@brendastarcher6294]

@@billymorgan7717 Lol