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Deep tech help with Phillips ASV machine settings
#11
RE: Deep tech help with Phillips ASV machine settings
(11-18-2020, 04:20 PM)Thanks I already have that and more and repair and service manuals but so far no clue on what these setting really do and under what condictions to use them.Rich Sleeprider Wrote: Phalaronic, the titration protocol you attached was for Philips BiPAP Auto.  It's better than the ones I've been using, so thanks.  Do you have the BiPAP Auto SV from that publication?

[Image: attachment.php?aid=28197]
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#12
RE: Deep tech help with Phillips ASV machine settings
(11-18-2020, 04:43 PM)SarcasticDave94 Wrote: Oh they have stacked the decks...My first sleep study showed complex sleep apneas with lots of centrals, when I asked for a newer machine I was made to take new studies, crappy studies which they then said I only needed APAP...

I cover a lot here: http://www.apneaboard.com/forums/Thread-...-treatment

I was disquafide for the new Insight system DUE TO TOO MANY CENTRALS at the Mayo Clinic and they even followed the guild lines and said APAP...

Sleep Doctors are only good for writing the scrip, waste of space other wise.

So as I have to do in all myself for the past seven years I seek as much understanding I can get.

These seem to be the last unknown functions I do not understand.



So I self perscripe and my current doctor will write the scrip for the ASV machine...which I then hunt bargens and pay out of pocket..

Rich

If it helps any, I am on SSDI AKA Social Security Disability and PA EBT food stamps with original Medicare A, B, and D and Medicaid insurances with PA welfare/Medicaid paying my fees for Medicare D. I was able to get the ASV through Medicaid only when that was all I had in 2017 while awaiting appeals for the SSDI claim. If you'd have a doc do the medical necessity requirements, you should be able to qualify for the ASV assuming you proved medical need of course. Then insurance pays for it. Hopefully this bit of info helps.

BTW don't expect the manufacturers to offer much help on machine settings. They just make them. Most have the mindset that their customer the DME has that info so you should ask them.
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#13
RE: Deep tech help with Phillips ASV machine settings
Any success in searching Supplier #2 inventory? They have low hours ASV/SVAuto types possibly even now if a newer machine is determined to be needed by yourself.

If I come across any tidbit of setting info I will pass it on. It does seem I end up with a DreamStation SVAuto tomorrow. I don't mind passing on what I glean out of it.

BTW what settings are you using currently on your machine? If these are off any it can throw the whole therapy effectiveness out the window.
Dave

OSCAR
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#14
RE: Deep tech help with Phillips ASV machine settings
(11-18-2020, 09:33 AM)racprops Wrote: Is there anyone here that can tell me the details and uses of some obscured settings/controls of Phillips ASV machines??
 
The main one is the setting of BPM:  Phillips says, “This screen allows you to modify the Breaths Per Minute setting. The Breaths Per Minute setting is a back-up breath rate where there is a machine-triggered breath to the patient within the defined timeframe per breath. You can choose between Off, Auto, or 4 through 30. This setting only displays if PS max is greater than zero.
 
So seems fairly clear…well not really:
 
When and why should it be OFF??  What conditions are these settings for??
 
When and why should it be on auto??
 
What is the best BPM settings: 1 to 30??


Next is this setting: “Ti This screen allows you to modify the Inspiratory Time setting. You may adjust the setting from 0.5 to 3.0 seconds in 0.1 increments. This setting only displays if PS max is greater than zero and BPM is not set to Off or Auto.”
 
I would like a deeper exasperation as to these settings.
 
And Mask Type: “This setting allows you to select the appropriate Mask Type resistance setting (also known as System One Resistance Control) for your Philips Respironics mask. This feature allows the device to adjust the level of pressure compensation to match your mask. Refer to the packaging of your mask to identify the resistance setting for your mask. Note: It is important to use the appropriate “Mask Type” resistance setting to ensure proper pressure delivery to the patient.”
 
I would like a deeper exasperation as to these settings as well.
 
I have come to believe that perhaps my problems with my Sleep machine over the past seven years may have been the incorrect use of these settings.
 
Thanks.
 
Rich

Rich, I'll try some brief replies, and you can ask clarifying questions where needed.


BPM is the backup breath rate. Guidance is to set this at 2 or 3 bpm less than your normal median rate from CPAP or to set it to auto. Most  users just use the auto setting, however, there are reasons for setting this value if spontaneous respiration is very unreliable.  A typical value is 12 BPM for an individual with a spontaneous rate of 15 bpm.  We would not use a setting of off for anyone that needs the backup rate and in any SV mode.

Ti gets more complicated, but typical values are 1.2 to 2.2.  We may use a shorter time of inspiration for someone that has COPD that needs expiration time preserved due to impaired lung function.  The idea is to give sufficient time for inspiration but not let it drag on to where the patient does not have time to exhale.  If we assume 15 breaths per minute, the breath cycle is 4-seconds per breath.  A normal breath would allow for 1.5 seconds of inspiration, leaving 2.5 seconds for expiration.  If the normal breath rate is 12 bpm, then with a breath cycle of 5-seconds, Ti might be 2.0 leaving 3.0 seconds for expiration.  The idea is to create an normal breathing rate and generally a I:E ratio of less than 1.0 

Mask resistance settings are less important than this guidance suggests. Different masks  have different volumes, and setting this value correctly may help the machine to compensate for that volume in achieving flow and pressure.  Philips also says to leave it at 0 or off for non-Philips masks.  How important could it be?
Sleeprider
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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.
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#15
RE: Deep tech help with Phillips ASV machine settings
(11-18-2020, 05:05 PM)First:Machine Settings Wrote:  
Mode
ASV
Min EPAP
11.00 cmH2O
Max EPAP
18.00 cmH2O
Min IPAP
16.50 cmH2O
Max IPAP
29.00 cmH2O
PS Min
5.50 cmH2O
PS Max
11.00 cmH2O
Auto On
Off
Breath BPM
12 Breaths/min
Breath Rate
Fixed
Flex Level
3
Flex Mode
Bi-Flex
Hose Diameter
15mm
Humid. Lvl.
3
Humid. Mode
Adaptive (System One)
Humidifier Status
Connected
Mask Res. Lock
Off
Mask Resist.
1
Ramp Pressure
10.50 cmH2O
Ramp Time
5.00 Minutes
Ramp Type
Linear
Show AHI
On
Timed Insp.
1.50 Seconds
p, li { white-space: pre-wrap; }

Second:

   


SarcasticDave94Any success in searching Supplier #2 inventory? They have low hours ASV/SVAuto types possibly even now if a newer machine is determined to be needed by yourself.

If I come across any tidbit of setting info I will pass it on. It does seem I end up with a DreamStation SVAuto tomorrow. I don't mind passing on what I glean out of it.

BTW what settings are you using currently on your machine? If these are off any it can throw the whole therapy effectiveness out the window.
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#16
RE: Deep tech help with Phillips ASV machine settings
Your EPAP min is very high for ASV. That does not mean it's wrong, but it affects expiration pressure which increases flow limitation.  I don't recall how you got to these pressures, but you are on the bleeding edge of individuals using ASV.  If you want to try the Resmed ASV, Supplier #2 might be a  possibility.  Using your Philips, have you considered starting titration over and seeing what happens at lower pressures?

[Image: attachment.php?aid=12708]
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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#17
RE: Deep tech help with Phillips ASV machine settings
I Have the Titration instructions, and as per the instructions I raised the EPAP min until I can almost stop all obstructions, and the raised the Pressure support currently it is 5.5 to stop most of my Centrals and as much Hypopnea as I can.  

I have been trying lower epap min but my obstruction climbed to a 6+ AHI level.My sleep studies have reported that it takes 10 to stop my snoring and most of my obstructions.

I had pushed for all zeros and was getting them at 13.5 and 19 but it seemed to have cause some Gastritis caused by CPAP.

And there are other disorders that can be caused by CPAP, this has had been an eye opener…I NEVER in the seven years I have been on CPAP heard or read all of these.
As I was having some Digestive and gastrointestinal problems, lately so I looked into it and here is what I have found:


Digestive and gastrointestinal problems are not commonly thought of when you mention obstructive sleep apnea.


Although CPAP therapy is one of the most successful methods for treating and reducing the symptoms of sleep apnea, there are a host of CPAP side effects that may follow after constant use of sleep apnea equipment. If you wear a CPAP mask and use a CPAP machine, these issues might sound familiar to you.

Aerophagia
This is the medical term for eating or swallowing air. This generally occurs when the CPAP pressure is too high for you and can result in gas and bloating.

Discomfort:
Wearing a CPAP mask can sometimes cause discomfort when trying to sleep. The mask can feel bulky and constrictive, and the hose can get in the way of trying to sleep in positions other than your back. Exhaling can also be uncomfortable if the pressure of the sleep apnea equipment is too high.

Claustrophobia
Many people feel claustrophobic while wearing a CPAP mask because the mask fits snug around your nose. The feeling of claustrophobia can be even worse for those who wear a full-face mask that sets around your mouth and nose.

Mask Leak
If your CPAP mask does not fit properly or isn’t properly cleaned, it can cause leakage. When there is a leak, there is a high probability that your CPAP machine isn’t able to reach its set pressure.

Dry, Stuffy Nose or Nosebleeds
Having a dry or stuffy nose is a common side effect of CPAP because air from the machine is being blown into your airway. This constant flow of air can also cause nosebleeds to occur.

Skin Irritations
Because CPAP masks fit snug against your face and are worn repeatedly, your skin can become irritated. This CPAP side effect can result in skin irritations such as rash or pressure sores.

Dry Mouth
Suffering from a dry mouth is yet another common CPAP side effect for those with a full-face mask, as well as patients with a nasal mask who breathe out of their mouths.

Infections
If a CPAP machine or CPAP mask isn’t properly cleaned on a routine basis, infections, such as lung or sinus infections, can occur.

Headaches
Although headaches are not a common CPAP side effect, they can occur if the machine’s pressure is set too high or if you have a blockage in your sinuses.

Lung Discomfort
Some patients who use CPAP therapy complain of a burning sensation in the lungs. This is often a result of dry or cold air being inhaled from the CPAP mask. This CPAP side effect can possibly be reduced by using warm humidification.

Dizziness
Some complain of dizziness after wearing a CPAP mask. While the mechanism for this symptom is not clearly known, some believe that this might be due to the pressure change in the middle ear. The symptom should be short lived if due to CPAP therapy.

Shortness of Breath
While another common CPAP side effect is the complaint of shortness of breath, this feeling is usually sensorial. It is merely the sensation of not getting enough air because a functional CPAP machine never reduces the amount of air that can be inhaled.

Even though there are side effects related to using sleep apnea equipment, it’s important to be compliant with continuing to wear it. Not using your CPAP mask and machine as prescribed can cause larger, more severe health problems such as fatigue, high blood pressure, heart arrhythmias, heart failure, heart attack, or stroke.

How to help Prevent CPAP Side Effects
If you’re experiencing any of the CPAP side effects mentioned above, don’t give up on the treatment just yet. There are solutions to these common problems. Try these different strategies to reduce or completely halt your CPAP side effects.

So as you can see I am fairly well informed.

Rich










SleepriderYour EPAP min is very high for ASV. That does not mean it's wrong, but it affects expiration pressure which increases flow limitation.  I don't recall how you got to these pressures, but you are on the bleeding edge of individuals using ASV.  If you want to try the Resmed ASV, Supplier #2 might be a  possibility.  Using your Philips, have you considered starting titration over and seeing what happens at lower pressures?

[Image: attachment.php?aid=12708]
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#18
RE: Deep tech help with Phillips ASV machine settings
I'm of a mind that you might want to back down the EPAP and PS Min a little, maybe several small reductions, to see if it becomes more comfortable. Check OSCAR stats as you do this to see how it affects apnea events. Weigh events vs comfort and attempt to get a balance.

I see OSCAR stats have you at 2.x AHI but the SVAuto is giving almost all its got to get to events lingering. Subpar if I were asked.

As is according to OSCAR, these settings are not cutting apnea down to reasonable levels. Is it possible you need to go to some other treatment machine, because this doesn't look acceptable.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#19
RE: Deep tech help with Phillips ASV machine settings
Thanks for the summary of your titration progression. You already know all the basics I could possibly contribute. This is an excellent history of your progression, but unfortunately, I can't improve on your work. You have done everything right. I wish I could improve things to accomplish your objectives, but you have taken all the right steps and clearly understand the titration protocols. I was trying to address the questions you addressed in the original post, and will leave this conclusion. Zero events is an unrealistic and unnecessary goal. We often make changes in therapy settings to increase comfort, reduce events and other objectives, and have to make compromises. When therapy is within range of "efficacy", these trade offs can be very subtle. It seems you might be at that stage.
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: Deep tech help with Phillips ASV machine settings
(11-18-2020, 09:22 PM)SarcasticDave94 Wrote: I'm of a mind that you might want to back down the EPAP and PS Min a little, maybe several small reductions, to see if it becomes more comfortable. Check OSCAR stats as you do this to see how it affects apnea events. Weigh events vs comfort and attempt to get a balance.

I see OSCAR stats have you at 2.x AHI but the SVAuto is giving almost all its got to get to events lingering. Subpar if I were asked.

As is according to OSCAR, these settings are not cutting apnea down to reasonable levels. Is it possible you need to go to some other treatment machine, because this doesn't look acceptable.

 I suffer from hay fever which can cause some blockage, at least that is what I believe as I some times wake up and coff up a mess.

Now you have raised some questions:

So here is a overview:

   

And a couple of good nights with the first weeks of going for zeros not the epap and pressure support settings:


   



   

So what is wrong??

Rich
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