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Fast pressure rises/and at max
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regbeach Offline

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Posts: 21
Joined: Oct 2015

Machine: Philips BiPAP Auto SV Advanced
Mask Type: Full face mask
Mask Make & Model: Amara View or F10
Humidifier: Philips System One
CPAP Pressure: 9-18 IPAP, 6-12 EPAP
CPAP Software: SleepyHead

Other Comments:

Sex: Female
Location:

Post: #1
Fast pressure rises/and at max
I read this in the Beginner's Guide to Sleepyhead.
"On the one hand, the maximum pressure setting needs to be high enough to effectively prop the airway open during the times when the airway is most likely to collapse. If the maximum pressure is not high enough, the airway will continue to be prone to collapsing off and on throughout the night.

On the other hand, the minimum pressure needs to be high enough where the machine does not need to increase the pressure by a significant amount during the first cluster of events. Sharp rapid increases of 5-8 cm of pressure in 10 minutes might not allow the airway enough time to stabilize and settle down. And unstable breathing can cause further events, which leads to more pressure increases and more unstable breathing."

My mom's Auto Bi-PAP is set for min. of 9 and max of 18 (IPAP). Sometimes when I put the mask on her, I watch the pressure steadily rise from min to max within less than a minute. Most of the night it stays at/near the max. even if she wakes up. The mask is not leaking and it happens with different masks. After about 2 hrs. of use, there are times when the EPAP is at max. and IPAP is at max or above and it wakes her. At these times, her AHI is also very high (40-50). I turn off machine, let air out of mask, turn machine back on and it's good for the next 2 hrs (but again the pressures typically increase fairly quickly- sometimes she is in a sleepy state, sometimes awake).

She just had a second sleep study and the tech told me that her AHI was below 10 at an IPAP of 14 but she did not have any REM sleep during the study. If that is true, why does the machine just keep going up to the max?
And, is the quoted text correct, that a quick rise like what occurs creates unstable breathing?
Thank you.
10-11-2015 04:34 PM
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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: #2
RE: Fast pressure rises/and at max
(10-11-2015 04:34 PM)regbeach Wrote:  My mom's Auto Bi-PAP is set for min. of 9 and max of 18 (IPAP).

Hi regbeach,

Your mom does not have an Auto BiPAP machine. She has an ASV machine, a different animal altogether.

When we are falling asleep it is not uncommon for us to have some central apneas and generally for our breathing to be somewhat unstable during the transition into sleep.

ASV machines will very quickly raise Pressure Support (PS is the pressure boost which occurs during inhalation) whenever the machine sees a sudden decrease in breathing, unless the Ramp is on. (Maybe it would help to use the Ramp?)

Also, Obstructive Sleep Apnea is usually very strongly influenced by sleep position, with sleeping flat on our back usually being the worst position. If your mom can totally avoid sleeping on her back, this may help a very great deal. Some are able to sleep only on a comfortable reclining chair or hospital bed with head and chest elevated.

Can you post a link to a pdf of your mom's most recent titration report, including all data, except with name and address, etc, eliminated? (You may need to post a few more times first, to get your post count up to 8 posts, in order to be able to post links.)

Your mom has a right to full copies of all her sleep reports and titrations, for her own medical records.

Do you have the setup manual (Provider Manual) for the machine? It should be requested by email.

http://www.apneaboard.com/adjust-cpap-pr...tup-manual

The Philips Respironics System One BiPAP autoSV Advanced is highly adjustable, and perhaps we could suggest adjustments to the settings which may make it behave better for your mom, for you and her doctor to consider, but more information is needed.

For example, what is the full wording on her prescription (you should have a copy of her prescription, too, for her personal medical records), and in which therapy mode is her machine set in, and what precisely are all of the machine's present settings?

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: 10-12-2015 02:33 AM by vsheline.)
10-12-2015 12:58 AM
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regbeach Offline

Preferred Members

Posts: 21
Joined: Oct 2015

Machine: Philips BiPAP Auto SV Advanced
Mask Type: Full face mask
Mask Make & Model: Amara View or F10
Humidifier: Philips System One
CPAP Pressure: 9-18 IPAP, 6-12 EPAP
CPAP Software: SleepyHead

Other Comments:

Sex: Female
Location:

Post: #3
RE: Fast pressure rises/and at max
Right, she has an AutoSV machine.
She sleeps on her back but elevated on a wedge pillow with a flat regular pillow under her head. She cannot sleep on her side. (I propped her on side for a home sleep study and though I never got exact results, it did not "solve" her apnea issues. It wasn't comfortable for her, so we don't experiment with side-sleeping and using machine.)

I put the mask on her after she falls asleep. During the night, if she takes it/wants it off, I sometimes use the ramp as a way to get her to put it right back on (we call it "low").

Lab is mailing me the report (thanks for telling me to get it). I would like to post some Sleepyhead data and am close to having that privilege.

Her current settings are:
BiFlex 3
30 min ramp that starts at 4
Min pressure- 9, max 18
Min EPAP 6, max EPAP 12
BPM 8
PS min 3
PS max 12

I am SO looking forward to your input once I can get some detailed data posted.

At the sleep lab, she used the Amara View with new headgear set differently then what we had at home. I tried that exact mask/headgear at home the next night and had the same issue with just 2 hrs. of sleep and high AHI. My mom was so annoyed. We switched back to F10 mask which sometimes goes for a couple more hrs. before waking her/us.
Thank you.
10-12-2015 05:43 PM
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regbeach Offline

Preferred Members

Posts: 21
Joined: Oct 2015

Machine: Philips BiPAP Auto SV Advanced
Mask Type: Full face mask
Mask Make & Model: Amara View or F10
Humidifier: Philips System One
CPAP Pressure: 9-18 IPAP, 6-12 EPAP
CPAP Software: SleepyHead

Other Comments:

Sex: Female
Location:

Post: #4
RE: Fast pressure rises/and at max
My first attempt at posting a screenshot from Imgur. All directions say to choose thumbnail but I don't see an option to change size.

This shows a typical night where my mom either wakes up and wants mask off, or we both wake up because we hear the high pressure or some mask noise after about 2 hrs. This is with Amara View FFM. Some nights this mask allows for a lower AHI (around 10) if you want to compare. If I can post another image- I will post last nights use with F10 mask separately.

Amara View-
[Image: PvH62Oy.png?1]



Thank you for any comments.
10-12-2015 10:13 PM
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regbeach Offline

Preferred Members

Posts: 21
Joined: Oct 2015

Machine: Philips BiPAP Auto SV Advanced
Mask Type: Full face mask
Mask Make & Model: Amara View or F10
Humidifier: Philips System One
CPAP Pressure: 9-18 IPAP, 6-12 EPAP
CPAP Software: SleepyHead

Other Comments:

Sex: Female
Location:

Post: #5
RE: Fast pressure rises/and at max
Here is data from Oct. 11 with a different mask- F10 FFM. I thought she was able to wear this one for longer periods but this graph does not show it. Unfortunately, the data for the other 2 nights we used it since I downloaded this software did not save to the SD card.
[Image: lRLH5VM.png?1]
10-12-2015 10:34 PM
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PaytonA Offline
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Monitors

Posts: 3,014
Joined: Dec 2013

Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Orange County,California

Post: #6
RE: Fast pressure rises/and at max
I am not any kind of expert on ASVs or CAs but what looks obvious to me from these charts is that your mother sleeps better and has fewer events when the PS is high. Her PS setting currently appears to be 3.9-12.1. My thought would be to increase the minimum PS slowly until it is about 10.1 or maybe even 11.1. I would watch closely as it is increased to make sure that nothing is getting worse and, of course, that her sleep is not getting worse. As always the decision is yours and you might want to check with the doctor before making any adjustments.

Best Regards,

PaytonA
10-13-2015 12:34 PM
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regbeach Offline

Preferred Members

Posts: 21
Joined: Oct 2015

Machine: Philips BiPAP Auto SV Advanced
Mask Type: Full face mask
Mask Make & Model: Amara View or F10
Humidifier: Philips System One
CPAP Pressure: 9-18 IPAP, 6-12 EPAP
CPAP Software: SleepyHead

Other Comments:

Sex: Female
Location:

Post: #7
RE: Fast pressure rises/and at max
How do you read the PS (pressure support) in the graphs? Also, in the Pressure graph what is the difference between Max. IPAP, IPAP and Min. IPAP. It is obviously not just the min/max setting on her machine because then the min/max lines would not move.
(This post was last modified: 10-13-2015 01:18 PM by regbeach.)
10-13-2015 12:48 PM
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PaytonA Offline
Wiki Editor
Monitors

Posts: 3,014
Joined: Dec 2013

Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Orange County,California

Post: #8
RE: Fast pressure rises/and at max
The PS Min and Max settings are listed on the left hand pane under the AHI for the session and under the description of the machine and mode. I do not see a line for the min and max on the chart. If you get a Mask Pressure chart on Sleepyhead with the ASV, that might tell us some more of the story.

I was under the impression that for Auto ASV machines one set the range for the EPAP and the IPAP was the result of the EPAP plus the PS in effect at the time. So what I would expect to see is a Min and Max EPAP setting but what I see is a Min EPAP and Max IPAP setting similar to my Bilevel auto machine.

Anyway, if I am reading the chart right, it looks to me like your mother does better with a larger Pressure Support.

Best Regards,

PaytonA
10-13-2015 07:10 PM
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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: Fast pressure rises/and at max
(10-13-2015 12:34 PM)PaytonA Wrote:  I am not any kind of expert on ASVs or CAs but what looks obvious to me from these charts is that your mother sleeps better and has fewer events when the PS is high.

Not yet sure if she is sleeping when the PS is so high.

Quote:My thought would be to increase the minimum PS slowly until it is about 10.1 or maybe even 11.1. I would watch closely as it is increased to make sure that nothing is getting worse and, of course, that her sleep is not getting worse. As always the decision is yours and you might want to check with the doctor before making any adjustments.

Slowly and cautiously is good.

I wouldn't suggest a Min PS greater than around 6. If the Min PS is too high I think it will be constantly annoying, and also may cause her O2 levels to be too high. Also, if the Min PS were to be as high as 11 the low setting for Max IPAP would leave almost no room for EPAP to be raised above its Min EPAP level when an increase in EPAP is needed to prevent obstructive apneas.

The main problem looks to me like many obstructive events are occurring, probably because the EPAP is too low, probably because IPAP is maxing out (because Max IPAP is set low) preventing EPAP from being able to adjust higher.

The EPAP cannot adjust itself higher when IPAP is already maxed out.

I would like to see the titration study before making any suggestions. I wonder why Max IPAP is low, and I wonder why the backup rate is so very low. Perhaps the ASV titration may show why.

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: 10-14-2015 02:50 PM by vsheline.)
10-14-2015 02:21 AM
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regbeach Offline

Preferred Members

Posts: 21
Joined: Oct 2015

Machine: Philips BiPAP Auto SV Advanced
Mask Type: Full face mask
Mask Make & Model: Amara View or F10
Humidifier: Philips System One
CPAP Pressure: 9-18 IPAP, 6-12 EPAP
CPAP Software: SleepyHead

Other Comments:

Sex: Female
Location:

Post: #10
RE: Fast pressure rises/and at max
Quote:Not yet sure if she is sleeping when the PS is so high.

I was thinking the same thing last night in reading other posts. I read about flow in the "Beginnner's Guide" but need some help.
Here is a zoomed flow pattern from the Oct 6 data I posted.

[Image: 85qgB5i.png?1]


1. Is she awake during part of this? I think I see repeated sleep flow pattern like at 35 and 34:30.

Quote:I would like to see the titration study before making any suggestions. I wonder why Max IPAP is low, and I wonder why the backup rate is so very low. Perhaps the ASV titration may show why.

2. The lab is mailing it to me. Will post.

3. Is the back-up rate breaths per minute or something else?

4. What are the 3 IPAP lines in the pressure graph? Min IPAP, IPAP and Max. IPAP. They don't seem to correlate with the EPAP up and down movements so the min./max don't seem to be EPAP + PS min/max.

Thank you so much.
10-14-2015 09:13 AM
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