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Back On The Machine
#41
(05-05-2015, 08:06 AM)DeepBreathing Wrote: G'day Storywizard

It's a big step up from an Autoset to an ASV machine, and they have a very different "feel", but you should find that your centrals disappear pretty quickly once you get used to the machine. The biggest difference is that the ASV doesn't operate at a more-or-less constant pressure like a CPAP or Autoset, but breathes with you - every time you inhale, the machine will increase pressure, and every time you exhale it will reduce pressure. This does take some getting used to, and it can feel like the machine is trying to force your breathing. The Resmed has a patented algorithm called Pacewave which adjusts the machine's rate to match your own more closely, so that it works with you, not against you. When you start using it, just breathe slowly and regularly, and the machine will match your rate quite nicely. If it occasionally tries to rush you, just blow back quite forcefully, and it will get the message.

The difficult thing to advise is what pressures you should be using. With this type of machine, you have five settings: EPAP min, EPAP max, PS min, PS max and IPAP max. EPAP is the exhalation pressure, and should be set low enough to be comfortable but high enough to prevent obstructive apnea or hypopnea. IPAP is the inhalation pressure. On an ASV machine this can go up to 25, which you will definitely notice! PS is pressure support, which is the amount of extra pressure to get from EPAP to IPAP. Remember: EPAP + PS = IPAP.

To start out, I'd suggest the following settings: EPAP Min: 7; EPAP Max: 12; PS Min: 3; PS Max: 5; IPAP max: 20. (In fact it won't actually get to 20, but you can leave it there as a convenient ceiling for later adjustments). Try this for a week, review in SleepyHead and see how it goes.

Good luck!

Anymore opinions on DeepBreathers settings???

I need all the help I can get....

Storywizard

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#42
Stephen, I think the settings EPAP Min: 7; EPAP Max: 12; PS Min: 3; PS Max: 5; IPAP max: 20 are a reasonable start and you should see good results. You have OSA and need 7.0 to maintain your airway from what I've seen. I don't think a lower EPAP is advisable in light of the obstructive apneas at lower pressure. Take a look at your data and let us know if you you think that is true. For this part of the titration we are looking at the minimum pressure that prevents OA.

EPAP max could be anywhere from 12 to 15. In theory the machine will only move as high as required to deal with OA, so you could put this settings anywhere in that range, but 12 may be a pretty good target. Pressure support is what makes breathing comfortable. You will feel a PS of 3.0, but may find a minimium PS of 5 gives better ventilation and transition. The minimum PS is a matter of feel and comfort and getting good normal ventilation.

Where I disagree with the suggestions is the limit on maximum PS. Since you are using this as an ASV device that will ventilate you when your breathing effort fails, a higher PS max from 10 to 15 may be in order, depending on resistance to ventilation when you don't initiate the breath. The suggested PS max of 5 will remind you to breath, but it probably won't initiate inspiration without respiratory effort. That threshold is about 8.0 for most people. I recommend your set the PS range from 5.0 min to 10.0 max to start, then increase that if centrals continue to be present. The minimum is for comfort, the max is for ventilation to overcome CA.

The thing is, you're going to know pretty quickly from the data if centrals are a continuing problem. By starting at the low PS max, it is easy to increase that setting until centrals disappear. You will be better off, than with CPAP, and the lower settings might be more tolerable to start. As long as you understand the objectives of the EPAP, IPAP and PS it is something you can fine-tune and optimize within a few nights.
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#43
The S9 VPAP Adapt, the machine I am getting, does not have a min/max epap just epap. and min-max ps.

Storywizard
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#44
(05-05-2015, 07:37 PM)storywizard Wrote: The S9 VPAP Adapt, the machine I am getting, does not have a min/max epap just epap. and min-max ps.

Storywizard

It depends which mode you're in. I suspect you're looking at ASV mode, but I'd recommend ASV-Auto, which does have EPAP max and min. See P16 of the clinician manual.

In relation to the pressure support (SleepRider's post above) you could bump the PS max up a few extra points and see how it goes. I think too high a PS might wake you up until you're accustomed to the machine. The lower setting I suggested is a comfort thing - you will see on SleepyHead if the machine is trying to go higher in which case you should bump it up a bit. Just take it in small steps, depending on your own comfort levels.
DeepBreathing
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#45
(05-06-2015, 05:36 AM)DeepBreathing Wrote:
(05-05-2015, 07:37 PM)storywizard Wrote: The S9 VPAP Adapt, the machine I am getting, does not have a min/max epap just epap. and min-max ps.

Storywizard

It depends which mode you're in. I suspect you're looking at ASV mode, but I'd recommend ASV-Auto, which does have EPAP max and min. See P16 of the clinician manual.

In relation to the pressure support (SleepRider's post above) you could bump the PS max up a few extra points and see how it goes. I think too high a PS might wake you up until you're accustomed to the machine. The lower setting I suggested is a comfort thing - you will see on SleepyHead if the machine is trying to go higher in which case you should bump it up a bit. Just take it in small steps, depending on your own comfort levels.

Apparently the model I am getting the 36007, does not have Auto on it, the 36037 the model above it does have auto....:-)

Steorywizard
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#46
The lack of an EPAP max is not that important. The EPAP minimum establishes the baseline for control over OSA. The machine should automatically increase EPAP from that point and uses pressure support to provide comfortable additional pressure for patient initiated breaths, and up to 15 additional cmH2O for machine triggered breaths, depending on your minimum maximum PS settings.

DeepBreathing uses this type of machine to treat CA, so I think he is a good source to listen to. The VPAP Adapt is a remarkably intelligent machine that seems to work with patients to adjust to their needs. Your job is mainly to lay back and take the ride; then using the data, optimize the settings later. You're on the right track, and the initiative you have taken to get the treatment you need is commendable. You can count on support from all of us if and when issues arise. Regardless of whether you hit the best settings out of the box, it will be a big improvement over APAP for you, and I'm sure it will all work out fine.
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#47
Just an update while still on CPAP waiting for ASV to arrive..

No sleep aids, sleeping ok, I raised the pressure just a little, lots of Hypopneas, and still CA's of course
Looking forward to trying the ASV..

[Image: May-7-Web_zpsuwzknbbm.jpg]

Storywizard
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#48
I don't think the pressure increase will help much. We use pressure to treat obstructive apnea, and that is gone according to your data. The rest of the events are something your current CPAP can't do much about.
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#49
(05-08-2015, 02:30 PM)Sleeprider Wrote: I don't think the pressure increase will help much. We use pressure to treat obstructive apnea, and that is gone according to your data. The rest of the events are something your current CPAP can't do much about.

The increase got rid of the last 2 OA's...not sure what to do about the Hypopneas...
Still, the ASV will be interesting to use...

Storywizard

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#50
Hypopneas can be either clear airway or obstructed so if they are clear airway they will probably reduce along with the CAs when you start on the ASV.
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