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Breathing synchronization problems
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mergx Offline

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Posts: 5
Joined: Dec 2014

Machine: ResMed S9 VPAP Adapt Model 36037A
Mask Type: Full face mask
Mask Make & Model: Quattro FX
Humidifier: ResMed H5i
CPAP Pressure: EPAP 6, PS 3-10
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: New Mexico, USA

Post: #1
Breathing synchronization problems
I've had my first device for a week, a ResMed S9 VPAP Adapt. The technician who set it up for me told me that if the machine senses me not taking a breath every four seconds it will start pushing air at me, and that is what appears to happen. The problem I'm having is that I'm an athlete and regularly run and bike in the mountains around home, and I have a low enough respiration rate that I take fewer than 15 breaths per minute at rest. So I'll be approaching falling asleep, my rate will slow below the threshold, and the machine will start to force air into me, usually while I'm exhaling.

I was hoping that the settings controlled this four-second time, but I just watched the clinician's setup video and saw no mention of it. Is it real? Is there any way to change this? It's making the machine really unpleasant to use - I haven't been able to stay with it for more than three hours yet, and most of that time I'm awake. At this point, it's worse than the apnea and I'm on the verge of giving up on it.
12-11-2014 11:43 PM
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Ghost1958 Offline

Advisory Members

Posts: 957
Joined: Aug 2014

Machine: PRS1 Series Sixty Auto Aflex
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: PRS1 with Heated Hose
CPAP Pressure: 10.5 min 16 max
CPAP Software: SleepyHead EncoreBasic

Other Comments: Moderate to Severe SA Obstructive. Rapid O2 desat off the machine.

Sex: Male
Location: KY

Post: #2
RE: Breathing synchronization problems
No expierience with that type of machine but Welcome. Therell be folks that do know the answers around soon enough
12-11-2014 11:58 PM
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PaulaO2 Offline
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Moderators

Posts: 8,068
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #3
RE: Breathing synchronization problems
Vaughn is our resident VPAP expert. He'll have the answer.

Meanwhile, have you gotten the clinician manual for it yet? The answer may be in there. You can find it here (scroll down to Section Three):
http://www.apneaboard.com/adjust-cpap-pr...tup-manual

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


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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.
12-12-2014 12:12 AM
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mergx Offline

Members

Posts: 5
Joined: Dec 2014

Machine: ResMed S9 VPAP Adapt Model 36037A
Mask Type: Full face mask
Mask Make & Model: Quattro FX
Humidifier: ResMed H5i
CPAP Pressure: EPAP 6, PS 3-10
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: New Mexico, USA

Post: #4
RE: Breathing synchronization problems
(12-12-2014 12:12 AM)PaulaO2 Wrote:  Vaughn is our resident VPAP expert. He'll have the answer.

Meanwhile, have you gotten the clinician manual for it yet? The answer may be in there. You can find it here (scroll down to Section Three):
[link removed]

Thanks, the manual just showed up in my inbox and, looking it over, I see no mention of the four-second timeout that the technician mentioned. There's some other stuff in there that isn't clear to me that might be relevant, though. Looking forward to hearing from Vaughan.
12-12-2014 12:53 AM
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Galactus Offline

Advisory Members

Posts: 1,388
Joined: Jan 2014

Machine: Phillips Respironics System One PRS1 DS760P Auto BiPAP
Mask Type: Nasal pillows
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: System One Heated Humidifier + Climate Line
CPAP Pressure: E/I 13/20 PS 4/7 BiFlex 3
CPAP Software: SleepyHead EncoreBasic

Other Comments: Sleep can be a good thing.

Sex: Male
Location: USA

Post: #5
RE: Breathing synchronization problems
Sorry I can't help you on that machine but Vsheline can, you might want to pm him, he's a really nice guy and knows those and many other of the units inside and out. His help was invaluable to me.

If everyone thinks alike, then someone isn't thinking.
Everyone knows something, together we could know everything.
12-12-2014 01:09 AM
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DeepBreathing Offline
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Moderators

Posts: 2,296
Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Perth, Western Australia

Post: #6
RE: Breathing synchronization problems
G'day Mergx, welcome to the forum.

I have a VPAP Adapt and I really like it. I have a slow respiration (about 10 / min) and I sometimes have to override the machine when it tries to force the pace. Just blow back hard when it tries to inhale for you.

The Adapt takes its lead from your minute ventilation. Once it's established a rate based on your regular breathing, it will support your breathing at that rate. The problem can arise before you get off to sleep and haven't yet established a regular rhythm. Alternatively, if you have a very prolonged apnea it will revert to 15 bpm.

From the Resmed brochure:

Ventilation to a moving target
The ASV algorithm calculates the patient’s target ventilation based on their respiratory rate and tidal volume. The target is 90% of their recent average ventilation to ensure that the patient isn’t over-ventilated.

This target is constantly updating throughout the night (hence ‘moving target’), allowing ventilation to vary during the night in line with any changes in the
patient’s breathing.

Breath-by-breath adjustment
Throughout the night, the ASV algorithm uses the 90% target ventilation to assess whether the patient is above or below that target, and automatically provides the minimum pressure support required to ventilate the patient to the target. (That is, pressure support is decreased during periods of hyperventilation and increased during central hypopneas/apneas.) To ensure patient comfort and optimum therapy, VPAP Adapt learns the patient’s recent breathing rate. If the patient enters a central apnea, pressure support is delivered at the same respiratory rate at which the patient has been recently breathing. If the event is prolonged, the timing of the support transitions to the default backup rate of 15 bpm.


As the others have said, Vaughn has an encyclopaedic knowledge of these machines and will be able to explain this more fully and correct any errors I might have made.

DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


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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.
(This post was last modified: 12-12-2014 08:04 AM by DeepBreathing.)
12-12-2014 07:16 AM
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Peter_C Offline

Advisory Members

Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #7
RE: Breathing synchronization problems
I've got the 'other' ASV machine, and I know what you are talking about. Mine does have an 'auto' mode - where it constantly sets the rate based on my last six breaths taken. I've found that as I am falling asleep my breathing rate slows down, and my dream machine will sometimes blow at me. I've found that laying in bed for 5 minutes or so before even masking up helps with this process.

And yes, Vaughn *is* the man to talk to - he's taught me, and helped to guide me through this process (changing over to an ASV machine). Hang tough, he will arrive soon.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
12-12-2014 09:39 AM
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mergx Offline

Members

Posts: 5
Joined: Dec 2014

Machine: ResMed S9 VPAP Adapt Model 36037A
Mask Type: Full face mask
Mask Make & Model: Quattro FX
Humidifier: ResMed H5i
CPAP Pressure: EPAP 6, PS 3-10
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: New Mexico, USA

Post: #8
RE: Breathing synchronization problems
(12-12-2014 07:16 AM)DeepBreathing Wrote:  G'day Mergx, welcome to the forum.

I have a VPAP Adapt and I really like it. I have a slow respiration (about 10 / min) and I sometimes have to override the machine when it tries to force the pace. Just blow back hard when it tries to inhale for you.

The Adapt takes its lead from your minute ventilation. Once it's established a rate based on your regular breathing, it will support your breathing at that rate. The problem can arise before you get off to sleep and haven't yet established a regular rhythm. Alternatively, if you have a very prolonged apnea it will revert to 15 bpm.

From the Resmed brochure:

Ventilation to a moving target
<details removed>

Breath-by-breath adjustment
<details removed>

As the others have said, Vaughn has an encyclopaedic knowledge of these machines and will be able to explain this more fully and correct any errors I might have made.

Thanks for the info. The S9 Adapt Auto has ASV and ASV Auto modes. Do your and their explanations apply to both? Mine is set to ASV, which surprised me a little, as it seems like ASV Auto might make it easier to get used to. I also discovered that the tech had it set to nasal mask, though I'm using a full-face mask. I don't know if that will make a difference, but I corrected it and am hoping that it will.
12-13-2014 12:15 AM
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vsheline Offline

Advisory Members

Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #9
RE: Breathing synchronization problems
Hi mergx, welcome to the forum!

As we are falling asleep it is not at all unusual for our breathing to become irregular and to intermittently pause.

So it may help to use the Ramp function for perhaps 15 or 20 minutes, however much time would allow us to reach our normal sleep respiration rate before the machine finishes the Ramp period and starts therapy. (During the Ramp period, the machine does not attempt to correct for irregular breathing.)

During inhalation the machine boosts the pressure up to IPAP (the inhalation pressure). The amount of pressure boost is called Pressure Support. Whenever we suddenly pause in our breathing, ASV (and ASV Auto) machines step in and increase the Pressure Support.

For a person with normally functioning lungs, if the Max PS setting (which limits how high the PS is allowed to go) is set to 10 cm H2O or more, this would probably allow PS to adjust itself when necessary high enough to do for us all the work of breathing.

(12-13-2014 12:15 AM)mergx Wrote:  The S9 Adapt Auto has ASV and ASV Auto modes. Do your and their explanations apply to both?

Yes. As you have found, there is no way to manually control the backup respiration rate, but the machine usually will synchronize itself to our recent natural breathing rate.

The only difference between ResMed ASV therapy mode and ResMed ASV Auto therapy mode is the exhalation pressure (EPAP) auto-adjusts itself in ASV Auto mode, similar to how APAP machines like the ResMed AutoSet auto-adjusts EPAP in order to avoid obstructive events. In plain old ASV mode, EPAP is fixed, not auto-adjusting.

(12-13-2014 12:15 AM)mergx Wrote:  Mine is set to ASV, which surprised me a little, as it seems like ASV Auto might make it easier to get used to.

Use of ASV Auto mode may allow the EPAP to be lower on average, which may reduce air swallowing (aerophagia). But, on the other hand, I think some patients may have more problems with air swallowing when in ASV Auto mode if the EPAP self-adjusts very high, so maybe selection of plain old ASV mode as the initial setup was intentional. In any case, you can suggest to you doctor to have you try ASV Auto therapy mode.

(12-13-2014 12:15 AM)mergx Wrote:  I also discovered that the tech had it set to nasal mask, though I'm using a full-face mask. I don't know if that will make a difference, but I corrected it and am hoping that it will.

I think selecting the appropriate mask type will make the therapy slightly more accurate, but I think the difference might not be noticeable to the user.

By the way, sometimes shortage of time prevents me from visiting the forum for a week or longer. Feel free to Private Message or email me if I can be of assistance.

Take care,
-- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 12-13-2014 03:57 AM by vsheline.)
12-13-2014 03:37 AM
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mergx Offline

Members

Posts: 5
Joined: Dec 2014

Machine: ResMed S9 VPAP Adapt Model 36037A
Mask Type: Full face mask
Mask Make & Model: Quattro FX
Humidifier: ResMed H5i
CPAP Pressure: EPAP 6, PS 3-10
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: New Mexico, USA

Post: #10
RE: Breathing synchronization problems
Hi Vaughan, thanks for getting back to me. I adjusted three settings yesterday and managed four hours with the thing last night, though I didn't get much sleep while using it. I enabled Auto Start and lowered the ramp time from 30 to 10, though I may bump it back up again. The important change was the mask type. When the S9 delivers pressure now it seems to be a lot less than before, which makes it at least bearable to use.

(12-13-2014 03:37 AM)vsheline Wrote:  Yes. As you have found, there is no way to manually control the backup respiration rate, but the machine usually will synchronize itself to our recent natural breathing rate.

It seems to not be synchronizing. If I let my breathing just do it's own thing, then it's not long before the S9 is delivering air to me even though I'm still breathing and definitely not having an apnea (I'm awake, after all). If I try to keep breathing naturally in hopes of getting it to fall into line with me, it never does, and the increased pressure keeps me awake. I can keep it from increasing the pressure by breathing faster, trying to keep ahead of the device, and then it never delivers me extra pressure, but doing that also keeps me awake.

I had the impression that the ASV part would have the machine sync to me unless I actually stopped breathing for a while, though I don't know how long that is, but it doesn't seem to be syncing. I also seem to be swallowing enough air to keep me belching and farting and to give me cramps occasionally. Eventually I give up and take it off, which at least lets me get some sleep even though I may be having apneas.

Any thoughts you might have on its failure to sync with me would be appreciated.
12-13-2014 07:06 PM
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