Central Sleep Apnea Treatment: Adaptive Servo Ventilation

Sleep apnea

If you suffer from sleep apnea, there are a variety of methods you can try to reduce your symptoms and live a happier and healthier life. One central sleep apnea treatment you and your doctor may want to consider is adaptive servo ventilation. This new sleep apnea device is showing positive results for patients with central sleep apnea and other sleeping disorders. Gain a better understanding of adaptive servo ventilation and how it works, so that you can decide whether it’s the right sleep apnea treatment for you.

What is Adaptive Servo Ventilation?

Created in 1998, Adaptive Servo Ventilation (ASV) is a non-invasive method for treating central sleep apnea and other conditions such as complex sleep apnea, mixed sleep apnea, and Cheyne-Stokes. Adaptive servo ventilation is a relatively new central sleep apnea treatment that continuously monitors the breathing status of patients. Considered to be a form of positive airway pressure therapy (PAP), adaptive servo ventilation adjusts pressure delivery based on the detection of pauses, or apneas, in breathing during sleep.

How Does Adaptive Servo Ventilation Work?

The sleep apnea device used with adaptive servo ventilation works by using a pressure window and computer algorithms. This pressure window is set to respond to feedback from the user which allows it to change and adjust throughout the night. Adaptive servo ventilation continuously adjusts pressure to prompt breathing when needed (based on the patient’s breathing patterns). This sleep apnea device resembles CPAP machines and uses the same masks, hoses, and attachments.

This central sleep apnea treatment is distinctive because of its ability to rapidly stabilize breathing patterns and arterial blood gases, as well as minimize discomfort and arousals often associated with bilevel treatment. All of these positive outcomes are made possible by the method in which adaptive servo ventilation personalizes pressure ventilation.

Differences Between Adaptive Servo Ventilation and Other Treatments

Along with adaptive servo ventilation, there are two other widely used treatments for sleep apnea. CPAP and BiPAP therapy are the most popular therapies that doctors recommend for patients suffering from different forms of sleep apnea. While CPAP and BiPAP are similar to adaptive servo ventilation, this central sleep apnea treatment is unique and should only be prescribed to certain patients.

Number of Pressures

The most obvious difference between adaptive servo ventilation and CPAP and BiPAP is pressure related. While CPAP provides one continuous pressure and BiPAP provides two pressures (on inhale and exhale), adaptive servo ventilation adjusts the pressure based on an algorithm. Because of this adjustment setting, there is no consistent number of pressures applied to this central sleep apnea treatment. It changes amongst each user and their breathing patterns.

Doctor Recommendations

In addition to pressure differences, you should also be aware of the typical doctor recommendations that come with using adaptive servo ventilation. While a visit to your doctor is the only way to know for sure which treatment is best for you, it has been found that adaptive servo ventilation is usually considered a last resort option for sleep apnea patients. 

CPAP and BiPAP therapy are well-known treatments for sleep apnea and many people try these methods to start. CPAP is normally tried first, then BiPAP, and adaptive servo ventilation may come next. One of the main reasons for this consequential process is the patient’s comfort level with each therapy’s pressure method. CPAP’s pressure is continuous, BiPAP’s pressure involves two pressures (inhaling and exhaling), and adaptive servo ventilation consists of adjusted pressures. Trying each type of therapy is the only way to discover which is the most successful and comfortable for you.

The modern technology used with adaptive servo ventilation is quite extraordinary and opens the door for improved sleep apnea treatment. If you suffer from any form of sleep apnea, consult with your doctor to get a proper diagnosis and from there, consider the different forms of sleep apnea therapy that may work best for you.

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27 thoughts on “Central Sleep Apnea Treatment: Adaptive Servo Ventilation

  1. John W Reply

    Are there any dental devices that will work with both Central and OSA conditions? I am currently on a CPAP which has been effective but have issues with the full and partial masks affecting my skin around the masks themselves. I am an open mouth sleeper so I do not believe pillows will be affective.

  2. wmba dams Reply

    Resmed makes me breath TOO FAST with its default of 15 for RR.
    Should have had a Phillips. At least the claim is NOW that you can set the default rate to what matches you. Earlier I did not see that as an option and my insurance forced a used Resmed on me anyway with no choice or say in the matter.

    Tried Resmed. TOTAL FAIL.
    Not worth fighting with insurance again.
    May or may not try to buy a used Philips and set the rate myself, assuming that such a setting is available to the user and not just the seller.

    What Philips should do is default to my rate when it restarts not some setting. And Resmed , possibly Philips TBD, should ramp up the force not start with max when it thinks (in my case erroneously) that I had stopped breathing.

    My natural sleep inhalation is low and slow. Maybe because my VO2 was at the level of a trained athlete and I appear to have occasional idiopathic CSA.

  3. Holly G Reply

    My son has a VP shunt, due to meningitis, and was recently diagnosed with mild central sleep apnea. He has used a CPAP machine in the past but could not tolerate the masks & I fear the mask straps may interfere with the functioning of the shunt. He has not been fitted yet for this most recent diagnosis but I am trying to do some research on what would be the best method to deliver the ASV without compromising the shunt. Does anyone have any experience with this or any suggestions?

    • Bethany Notter Reply

      I also have a VP shunt and my straps DO NOT interfere with the functioning of my shunt. if it presses on the valve you can take a foam paint brush apart and use the foam piece as a cushion for the confort of you and your son, I have done this and then found a headgear that does not interfere with my shunt at all.

  4. Susie Reply

    if you are born with heart defects that are both electrical and mechanical as they tell me I am. I diagnosed with central sleep apnea. They say I have had it since birth. Now they told me I have to have ASV therapy. What does ASV therapy mean? They say it might help with shortness of breath during day. Will I always have central sleep apnea?

  5. anonymous Reply

    I read online that ASV shouldn’t be used if you have heart failure, because of an increased cardiovascular risk. Do you know why it is harmful in these cases, i.e. the mechanism of action of the increased risk?

  6. Shumon Reply

    I have learn several excellent stuff here. Definitely price bookmarking for revisiting. I surprise how so much effort you place to make this kind of fantastic informative site.

  7. hilbert tooley Reply

    I have had a stroke and CHF with stints in my heart all in the past two years. I have been diagnosed with CSA, would you recommend ASV or oxygen for treatment?

    • Philip Reply

      Major studies were released warning against ASV in CHF patients. Guidelines were readjusted. Consult your doctor.

  8. vegus 168 Reply

    I’m amazed why your blog is writing so well, I’m curious to see what Adaptive Servo Ventilation is.

  9. ปั้มไลค์ Reply

    Like!! I blog quite often and I genuinely thank you for your information. The article has truly peaked my interest.

  10. Elisa Reply

    Nice blog here! Also your website loads up very fast! What host are you using? Can I get your affiliate link to your host? I wish my site loaded up as fast as yours lol|

  11. Stephen Reply

    I have Central sleep apnea in addition to general apnea, and have been on CPAP therapy for over 15 years. I have been told that I stop breathing when I sleep on my back. So of course have been told to sleep on my side. I try to sleep on my side and even wedge a pillow under one side of my back to keep from laying flat. However I always wake up lying on my back. Is there a device that can compensate for the lack of breathing when I’m in the prone position?

    • Peg C. RPSGT Reply

      The old tennis ball trick works great. Fill a sock with 3 tennis balls and pin or stitch it to the back of your night shirt.

  12. Rick Reply

    I have complex/mixed/cpap-bipap emergent central sleep apnea without signs of heart failure, I have had two ASV machines, one ResMed and now a Phillips Respironics. I have used the Phillips with excellent results for nine months, average use 7.5 hours AHI 1.5 with excursions to 3.5 and 0.5 respectively. I find the Phillips machine much ‘softer’ in the pressure changes making it easier to fall and stay asleep.

      • Peg C. RPSGT Reply

        AHI is the apnea-hypopnea index. An apnea is a period without a breath when the airway is blocked and while there is an effort to breath, there is no airflow. A hypopnea is similar to an apnea, except there is a small amount of air movement, but not enough to maintain the oxygen level. The AHI is the number of desaturations divided by the number of hours slept.

  13. Jim Larson Reply

    I have been diagnosed with CSA. I did not tolerate CPAP and now I use a BiPAP. I actually can wear the mask all night. The problem I am having is a inconsistent # or apnea’s throughout the night. When I have less than 5 apnea’s per hour I feel like a million bucks. The next night I could have over 20 apneas per hour and I wake up groggy. I wonder if I will ever experience a consistent # of apneas?

    Secondly, what I noticed is that I stay in the exhale way too long even during the day. So I would prefer we call this condition central apnea as it affects me during the waking hours as well. I am active as I’m a cyclist and I play tennis. I have to consciously inhale and breath in order to not get lightheaded throughout the day. Does anyone else in this forum experience the same.? Thank you.

    • Albert alt Reply

      Yes indeed. I’ve observed exactly the same phenomenon, eliminated, of course, when exercising or breathing consciously. I had great results last night on my first try at ASV and need to keep my head in the game whilst awake.

    • Peg C. RPSGT Reply

      Having been diagnosed with CSA, I urge you to see a pulmonologist. In Central Sleep Apnea the patient is not immediately stimulated to take a breath. This differs from OSA(Obstructive Sleep Apnea) in which the airway is temporarily blocked. The treatments are often different for OSA and CSA.

  14. Brad Crouch Reply

    Could somebody make a recommendation for an ASV machine that would be good for both Obstructive and Central Sleep Apnea? I was looking at the ResMed AirCurve 10 ASV until I came to page 15 of the owner’s manual, which said that that machine was unable to detect Central Apnea’s. Are there any machines that actually treat both?


  15. Dawn Capewell Reply

    My friend has been diagnosed with severe sleep apnea. She was not able to use the CPAP until she had developed a buildup of CO2, and was rushed to the hospital. They wanted to put her on BiPap, but the machine was so big and invasive that she would not tolerate it. Now I read that the BiPap uses the same masks and supplies as CPAP. Can you tell me why the hospital BiPap was so much different than the CPAP? Does ASV use the same masks and supplies as CPAP? How does she know if she needs ASV?

    • rick gerken Reply

      Don’t know if anyone answered you yet but I can tell you the hospital BIPAP (at last the model that would be used in a “critical” situation) is usually the “Cadillac” of BIPAPS. Home PAP units only need to be set and then forgot, with a re-evaluation every couple of years, the hospital units need to be able to cover a wide variety of modes (CPAP, BIPAP, AVS, AVAPS, etc.) and accommodate a variety of masks and tubings. The feel of the therapy should be the same, 10 cm/h20 is 10 cm/h20 whether it is being delivered by a large machine or small. I would guess that when your friend was brought in, the ER staff probably set the machine up higher settings because she was in an acute attack, and that probably made it hard to tolerate, also they probably didn’t use a mask that she was familiar with, and lastly your friend was probably quite anxious to start with and the emergent setting would have made her more anxious (like a viscous circle). As for your friend’s need of ASV, they would be able to ascertain her need from a formal, in house sleep study. ASV seems to be geared towards the sleep apnea patient with a “central” apnea, which is more rare than the more common obstructive apnea. I hope this helped.

      Rick, therapist x 30 years at a mid-sized, regional hospital.

      • Paul M Reply

        Rick, just as an FYI, I have both obstructive and central sleep apnea. I’ve been using a BiPAP machine quite successfully for several years now.

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