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[Equipment] Machine with fixed EPAP/IPAP
#1
Hi there...

I am close to figuring out my restorative sleep issue. I think what is happening is that
I am reacting to the pressure spikes on the ASV machine. At present I have EPAP at 6cm, PS at 3 - 8cm. Even at that low PS I am sure I am getting arousals, hence no deep restorative sleep....

So is there a machine, probably a BiPAP that can be set with fixed PS. Or is that what Max IPAP would be??

Anyway, what I think I need is two fixed pressures...One on inhale, one on exhale

I know its out there...lol..

Storywizard
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#2
So on a regular APAP machine your exhale is figured based on a fixed amount to be reduced from your inhale. so if inhale is 10 and EPR is set to 3 your min exhale pressure is 7. your exhale pressure will track any increases in your inhale pressure.

BPAP you set a specific exhale pressure regardless of your inhale pressure and your inhale pressure is usually set to a range. You may also be able to set inhale to a fixed pressure and not use the auto range, someone tell me if I am wrong on this.

IIRC I think you can also set this on your VPAP machine. VPAP makes adjustments on a breathe by breathe basis and both the regular and BPAP make adjustments on a several breath average basis.

The users of VPAPs will chime in and help you with your machine and get it figured out
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#3
You have a lot of choices. Fixed bilevel is what is provided by the Resmed VPAP S or the PRS1 BiPAP model 660. Moving up from there is the VPAP Auto or PRS1 BiPAP Auto model 760. The Resmed works like an auto CPAP with a fixed pressure support of 4-8. EPAP and IPAP move up and down together in response to apnea precursors. The PRS1 Auto works with a pressure support range of 4-8, and the EPAP and IPAP can move independently with PS changing.

None of the above machines has an ASV function, so no spikes of PS.
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#4
(08-20-2015, 04:33 PM)Sleeprider Wrote: You have a lot of choices. Fixed bilevel is what is provided by the Resmed VPAP S or the PRS1 BiPAP model 660. Moving up from there is the VPAP Auto or PRS1 BiPAP Auto model 760. The Resmed works like an auto CPAP with a fixed pressure support of 4-8. EPAP and IPAP move up and down together in response to apnea precursors. The PRS1 Auto works with a pressure support range of 4-8, and the EPAP and IPAP can move independently with PS changing.

None of the above machines has an ASV function, so no spikes of PS.

Thanks for the info Sleeprider...I am torn these days...
I feel lousy, getting through my days on coffee, until noon, tea in the afternoon...
but really not doing well...

I am seeing another sleep tech on Saturday, will take original sleepstudy, Sleepyhead screenshots...I have no expectations of learning anything, but need to find a way out of this fatigue.

I was going over the pressure graph of my BiPAP week, it was pretty smooth, but I felt worse than the ASV...I am starting to think that xPAP may not be for me...

I will keep going a little longer...

Storywizard

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#5
It sounds like your apnea is under control, but you are just not getting quality sleep. Have you found your comfort zone with the machines other settings? If you are not comfortable then you will not get good quality sleep even though your apnea is doing fine. We spend time and money getting the right pillow, mattress, blankets... so we get good quality sleep. This is important.
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#6
(08-20-2015, 05:29 PM)PoolQ Wrote: It sounds like your apnea is under control, but you are just not getting quality sleep. Have you found your comfort zone with the machines other settings? If you are not comfortable then you will not get good quality sleep even though your apnea is doing fine. We spend time and money getting the right pillow, mattress, blankets... so we get good quality sleep. This is important.

hi there..

this my second go round with xpap...
I have the pillow, the blanket, mattress next, I have tried 3 different machines in all their configurations, 7 masks, many different sleep aids including sleep restriction...my sleep hygiene is to die for, lol...

It just maybe that I am one of the 20-30% that cannot use CPAP...I just want to try everything before I throw in the towel...

**the above stat is largely taken from dentist sites quoting studies that I could not find, so to update, : Maybe I just can't tolerate CPAP...:-)***

Storywizard
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#7
Hi storywizard.

short of throwing the towel in, you should be able to fix your inhale and exhale to a set pressure by setting EPAP to a number, and having PS range to be smaller or none (PSmin=4, PSmax=4). Then inhale pressure will always be exactly 4 above the exhale pressure you have set.

Using a recent night exa. http://i.imgur.com/gnT3Ylhl.jpg and the comparison you make to http://i.imgur.com/Hnl7k8a.jpg, it seems you should try -

EPAP of 8, IPAPmax of 14, PSmin=6, PSmax=6.

logic is:
1. Effective treatment under ASV had IPAP 95% value of 14, suggesting the low end IPAP should be more than 12 cmH2O.
2. ASV resulted in median pressure relief of (12-6) or 6 cm H2O, although settings kept it artificially high as PSmin was 5.
3. On BIPAP night, PS 95% was 3.8, and results were poor.
4. CPAP pressure of 8 cmH2O in http://i.imgur.com/e5HOOPX.jpg shows EPAP of 8 should be largely effective in stomping out obstructive apneas.

If you are willing to have some variability in a narrow band, you could also try EPAP of 8, IPAPmax of 14, PSmin=4, PSmax=6. That would result in a range of IPAP from 12 to 14 with EPAP remaining at 8.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
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#8
(08-21-2015, 07:47 AM)quiescence at last Wrote: Hi storywizard.

short of throwing the towel in, you should be able to fix your inhale and exhale to a set pressure by setting EPAP to a number, and having PS range to be smaller or none (PSmin=4, PSmax=4). Then inhale pressure will always be exactly 4 above the exhale pressure you have set.

Using a recent night exa. http://i.imgur.com/gnT3Ylhl.jpg and the comparison you make to http://i.imgur.com/Hnl7k8a.jpg, it seems you should try -

EPAP of 8, IPAPmax of 14, PSmin=6, PSmax=6.

logic is:
1. Effective treatment under ASV had IPAP 95% value of 14, suggesting the low end IPAP should be more than 12 cmH2O.
2. ASV resulted in median pressure relief of (12-6) or 6 cm H2O, although settings kept it artificially high as PSmin was 5.
3. On BIPAP night, PS 95% was 3.8, and results were poor.
4. CPAP pressure of 8 cmH2O in http://i.imgur.com/e5HOOPX.jpg shows EPAP of 8 should be largely effective in stomping out obstructive apneas.

If you are willing to have some variability in a narrow band, you could also try EPAP of 8, IPAPmax of 14, PSmin=4, PSmax=6. That would result in a range of IPAP from 12 to 14 with EPAP remaining at 8.

QAL

Hi there...

the ASV I use has to have a 5cm spread between min and max PS, with a minPS of 3cm...so that limits what I can do...

I have tried many different settings on the machine...I always feel terrible... thanks for the support, I really appreciate it...

Storywizard

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#9
I would say that I am kind of in the same boat as you, but in my case while I am in a boat-it is a different boat.

My first sleep study said I had almost all central's and was at the top end of moderate SA (29). The few hypopnea's are long gone. My sleep Doc I should ignore the centrals. Over the past 30 days I have been focusing on getting all my comfort settings correct so I tolerate APAP. My last issue has been a problem exhaling into pressure and I tried nasal pillows. My tech at the DME says that is exactly the wrong thing to do in my situation.

My numbers look good AHI last night of 0.3 and yet I feel like crap, not as bad as before but not close to decent either. I wake up and have to get up (off the machine) 3-6 times a night. I desat down to 90% but most of the time I am around 94% O2. I do periodic breathing anywhere from 4 -60 mins at a time.

I don't seem to have enough bad numbers to justify not getting better sleep. I see my cardio doc next week for the first time since they said I had SA, we will see what he thinks of my centrals and PB and 90% desat's.

I have pounded the round peg long enough that the square hole is all waller'd out now and the peg almost fits Smile
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#10
Are you in ASVAuto mode? See if your machine will let you set the following parameters:

EPAPmin=8 EPAPmax=8 PSmin=3 PSmax=8

and can you set the maximum pressure? If so, and you set maximum pressure of 14, this will limit the PSmax attainable to 6 even though it is set to 8.

That combination should give you what in bi-Level would be 11/8 until central events are sensed, and then auto adjusts as needed.

and re-read http://www.apneaboard.com/forums/Thread-...VPAP-Adapt i don't know if that helps some.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
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