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1st Night Bi-Pap, high pressures = terrible
#11
RE: 1st Night Bi-Pap, high pressures = terrible
Just to make sure we aren't missing anything the first sleep study stated the central events were post arousal and may be physiological. Not sure if that changes anything. I'll attach it.
Brando


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#12
RE: 1st Night Bi-Pap, high pressures = terrible
We will be able to tell when you use the new settings. I was surprised to see only hypopnea events in your last Oscar chart. Since the iVAPS targets vent rate it should resolve anything you throw at it. Both studies showed CA in a pretty typical pattern for complex apnea. The problem with CA is ‘it’s consistently inconsistent’. That is the challenge in titrations with bilevel because a false efficacy is often recorded. They should have moved to ASV when CA was present after OA resolved. Pressure does not treat CA.

A tip from the ASV users is to “blow back” if you feel the machine is taking over your natural respiration rate or applying too much pressure. By that we mean take strong enough breaths and it will reset to your spontaneous rate
Sleeprider
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#13
RE: 1st Night Bi-Pap, high pressures = terrible
Help me understand your comment “ you don’t treat CA with pressure”. I assume you mean a constant pressure? The treatment for it is a breathe delivered by the machine correct? The rub, if I understand you is that the CA can occur across any pressure, so the goal is to treat the OSA at whatever pressure is needed, then when a central event pops up your machine gives you a breathe. Is that right? Sorry to take up more of your time, I really appreciate it. Hopefully when I get this figured out I can help others in a similar situation.
Brando
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#14
RE: 1st Night Bi-Pap, high pressures = terrible
(02-05-2020, 03:23 PM)Sleeprider Wrote: A tip from the ASV users is to “blow back” if you feel the machine is taking over your natural respiration rate or applying too much pressure. By that we mean take strong enough breaths and it will reset to your spontaneous rate

With a Full Face Mask it is easy.  Just blow back at the machine through your lips.  Just settles that puppy down when the pressure just ramps up out of nowhere.

John
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#15
RE: 1st Night Bi-Pap, high pressures = terrible
A BiLevel with a backup rate has a chance but an ASV is best.  

OA is treated with pressure (EPAP or Exhale pressure)
Hypopnea, Flow Limitations, RERAs, UARS, and snores are treated with IPAP or Pressure Support (PS) or on a ResMed CPAP EPR.

CA is treated by maintaining either Minute Vent or Tidal volume utilizing an ASV machine to do so via same breath increases in PS.
Some CA may also be treated with Meds or manipulation of CO2 concentration depending on the cause of the CA
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#16
RE: 1st Night Bi-Pap, high pressures = terrible
Also how does the ASV function differently? With this ST-A we set a lower and upper pressure with a backup rate. The machine adjusts the upper and lower pressure to maintain a bi-level meeting the rate and minute ventilation.  What would our settings be with the ASV? I'm trying to see how they function differently. Thanks everyone, I can hardly wait to go to sleep, lol
Thanks Brando
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#17
RE: 1st Night Bi-Pap, high pressures = terrible
The treatment for CA is pressure support (PS). PS is the difference between IPAP and EPAP and it takes 8-15 cm above EPAP to cause a breath. The problem with ST mode is PS at 5 cm is not enough to trigger a breath, and higher PS on every breath can be uncomfortable and will cause more CA as it results in hypocapnia. ASV and iVAPS use adaptive PS to target minute vent and maintain rate. Sometimes you get minimum PS and sometimes you ge more, as needed when needed.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
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How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#18
RE: 1st Night Bi-Pap, high pressures = terrible
Thanks, that makes sense. I was reading Resmed's guide for ASV and it states that the ASV breaks the hyperventilation that causes the CA. That makes perfect sense. iVAPS is more targeted for hypoventilation. Hard to know if the algorithm is similar I guess.
Brando
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#19
RE: 1st Night Bi-Pap, high pressures = terrible
Sounds like you have a perfect understanding. They work similarly but ASV is faster to move up and down PS and doesn’t have set respiratory rate and volume targets, they come from the algorithm and is based on a moving 90 second average.

The honest truth is I’d like you to be comfortable and decide if this will work. The settings you arrived with were hopeless.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#20
RE: 1st Night Bi-Pap, high pressures = terrible
Hi,
  Here is my data from last night. For some reason I took it off around 0100, thats the first time thats happened. I put it back on when I woke up around 0500 and again after I put the kids on the bus at 7. It was much more comfortable at those lower pressures. Had some hypopnea's and unclassified apnea's. Leaking problems were much better and I didn't wake up with a stomach full of air. Curious if I should just try these settings for awhile or go up a little on the epap? Still waiting to hear from my pulmonologist about the ASV. 
Thanks 
Brando


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