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[Equipment] Dream Station ASV - why doesn't it count BiPAP pulses?
#1
Hey everyone!

I'm back after an interesting few months. 

Some quick history.  After six years on an old, clunky brick of a CPAP machine, I talked my doctor into getting me a new sleep study that ended up with me getting an Airsense 10.  That was a much better machine and, in a lot of ways, it helped me figure a *lot* out about my apnea.  I was having tons of OA's, HA's and CA's that my old machine flatly wasn't handling and that I didn't find out about until I started reading my Sleepyhead data from my Airsense 10.  Knowing about those, and pushing back against my doctor at the time (who clearly wasn't reading detailed data), I ended up here, at Apnea Board.  The fine folks here pretty muched fixed my OA problems by suggesting pillow adjustments and, most important, a cervical collar to keep my chin from dropping and my mouth coming open.  :Smile

But I was still having problems with CA's and pressure-related blowouts of my mask seal from the Airsense 10.  So I changed doctors and, after a couple sleep studies where they tried BiPAP (which failed) and ASV (which seemed to do better), I ended up with a Dream Station BiPAP/ASV.

The ASV seems to do a much better job of addressing my apnea events while I'm fully asleep.  My AHI numbers are fabulous.

One of odd things is what happens when I'm just falling asleep or drowsing in and out of sleep. 

I've long been aware that, as I'm drifting off to sleep, my breathing slows, then stops.  I just quit breathing.  It's one of the reasons I changed docs and went in for new studies:  I was concerned about the mechanism that saw me simply quit breathing.

The Dream Station does a pretty good job of pulsing me with a BiPAP hit when that happens.  At first, it was difficult because they had the pulse set up to a fairly high pressure and it was waking me up when it fired.  Every time I'd start to drift off again, it'd fire, wake me up, and make me breathe.  Smile

They adjusted the BiPAP pulse setting so it's better now, but I'm left to question:

Why doesn't the Dream Station track/count the BiPAP pulses it hits me with?  None of the data I've seen has any tally of it, even though the Dream Station can hit me 10 or 20 times a night (depending on how long it takes me to fall asleep).  It seems to me that, either the Dream Station is being too sensitive at firing off those BiPAP pulses, or I'm having those stop-breathing moments quite a bit before I'm truly into my sleep cycles that the Dream Station is recognizing and addressing for me.

It's nice that the DS is catching all those low breathing/CA moments, but it seems like something that ought to be of interest to the tracking data.

Also, the DS is flagging a *ton* of vibratory snoring that neither I, nor my wife, are hearing.  Not sure what that's about, but it's happening a lot.

Any thoughts?
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#2
I would have rather seen you on the Aircurve10 ASV, partly because it works with Sleepyhead, and partlly because I seem to have better success coaching people to better results with it, but you have a good machine. We really need to start at your settings. Go through them and let us know settings for:
Mode
EPAP min
EPAP max
PS min
PS max
Pmax
BPM

Anything else would be fine, but that is the heart of the therapy. I will assume you're using EncorePro2 to look at data. You can post those PDF reports as attachments here so we can see what is going on in terms of events and pressure response. Your description makes me think you might be in an old ASV mode rather than AutoASV.
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#3
If you're not using Encorepro2, it installs on a PC only, it's a huge awkward program but it gives you all the details. Here is a thread with some example attachments. http://www.apneaboard.com/forums/Thread-...first-hour

You can get EncorePro2 from the Private File forum links. http://www.apneaboard.com/forums/Thread-...hines-only
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#4
The forum can help you set up the machine. Now that you have been using it for a while, perhaps you can tolerate the proper pressure to treat your central apnea. If you have a good DME, they can also help you move it back, a bit at a time. The machine doesn't give you more that you need. It is trying to follow your previous breathing.
For the snoring, OA and H, normally the minimum epap is raised until they subside.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#5
Thanks for all the quick responses.  I was unaware that there was software available that worked with the Dream Station and provided info like Sleepyhead.  So I'll be looking into that.

My DS was doctor-ordered and controlled.  I don't know if I can change the settings or if it makes sense to, given that the DME and doctor both see what my settings are. 

And really, the BiPAP pulsing I was complaining about isn't nearly as obtrusive as it was originally.  The original BiPAP pulses hit hard, with solid punch of pressure, followed by a second pulse that was about half as hard.  But the pulses (especially the first one) was too short.  It would cut off while I was still inhaling which, in turn, was more distracting.  The settings they have for it now are better.  The pulses seem more...feathered (for lack of a better term)...not hitting as abruptly and not ending as sharply.

My main question has been to try to figure out why I simply stop breathing and how often that's happening, but being covered, by the ASV stepping in to correct them.  It's obvious that the ASV is covering a lot of those events without actually recording them as events.  Of course, we won't know more until I get access to more specific data, so that's on my to-do list.

I actually caught myself snoring last night.  It's a sinus snore, coming from congestion I've been dealing with.  So that's another thing for me to check.

Thanks again!
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