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Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
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ebitansky Offline

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Posts: 10
Joined: Apr 2015

Machine: Resmed S9 Vpap Adapt 36037
Mask Type: Full face mask
Mask Make & Model: Resmed Ultra Mirage
Humidifier: H5i
CPAP Pressure: AutoASV max EPAP 15 Min EPAP 8
CPAP Software: ResScan

Other Comments:

Sex: Male
Location:

Post: #21
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
Thank you for chiming in because there was lots of arithmetic there, and it is great to read advice from everybody.

First, a question I did not get answer for from anybody.
in the first CPAP study they didn't provide following statement:

At a pressure of 9cmH2O the AHI was 46.6 central events were at sleep onset, hypoxemia was resolved with positive airway pressure.
The positive airway pressure titration was not successfully completed due to residual obstructive events.
given these results recommended autoCPAP at a pressure of 5-18 cmH2o


The ASV study a year after doesn't say anything about central events.

Second Question is a series of few questions with your permission

My device is Confused9 VPAP ADAPT 36027
Auto ASV mode:
available options on my machine are:
Min EPAP and Max EPAP as well as Min PS and MAX PS.

I couldn't see IPAP on my device at all so I take your comment about IPAP=Max EPAP + Max PS as the fact that this value is not there but we can calculate it. on the other hand in your recommendation you said IPAP is irrelevant provided it is set above 14.

In ASV Mode:
Only options I saw are: EPAP, Min PS and Max PS
My prescription for the ASV says EPAP 6, Min PS 6 Max PS 15

Could it be that the technician was not aware of ASV Auto Mode?
Are there cases where ASV AutoMode is not advised?
What is the right way to translate this prescription to ASV Auto?









(05-22-2015 05:40 AM)DeepBreathing Wrote:  Lot of arithmetic going on here but we're probably not quite on the right wavelength for a VPAP Adapt. The available modes are CPAP, ASV and ASV Auto. To emulate an Autoset, you need to select the ASV Auto mode. The available settings in this mode are Min EPAP, Max EPAP, Min PS, Max PS and Max IPAP.

EPAP + PS = IPAP

Min PS can't be set lower than 3. So to achieve a pressure range between 8 and 14 with the equivalent of a 3 EPR you would need to set Min EPAP = 8, Max EPAP = 10, Min PS = 3, Max PS = 4. Max IPAP is irrelevant provided it's set above 14, as the machine won't go above Max EPAP + Max PS.

I don't recommend using this machine while awake to get used to it - normal pauses in breathing (which happen all the time) are sensed as incipient centrals and the machine will react in a few seconds to start pumping the pressure up. This gets quite unsettling.

I agree with the previous posters that ASV seems overkill for this patient, unless the test is seeing something that hasn't come through on the reports. The problem with an ASV if you don't need it is that the machine tries to breathe with you, which is only necessary if you have a lot of centrals. It won't necessarily do you any harm, but it does take some getting used to. When you're having problems adapting anyway you don't need this additional complication.


I copied all the notes lines but you commented only at the last two so now I made sure it is in bold (my machine is Vpap Adapt SV)
Notes:
This mask is not compatible for use with ResMed AutoSet CS™ 2 and VPAP™ Adapt SV devices.
SmartStart may not operate effectively when using this mask with some CPAP or bilevel devices that have this feature.



(05-22-2015 01:28 PM)retired_guy Wrote:  
(05-22-2015 01:05 PM)ebitansky Wrote:  I took it from airfit p10 manual page 3 section "Using your mask" at the notes:

Notes:
This mask is not compatible for use with ResMed
AutoSet CS™ 2 and VPAP™ Adapt SV devices.
SmartStart may not operate effectively when using this mask
with some CPAP or bilevel devices that have this feature.

Is airlift p10 the wrong mask ?

Oh, ok.... Smartstart and it's evil twin Smartstop may not work right. What that feature is supposed to do is automatically start the machine when you put on your mask and start breathing, and automatically stop it when you take your mask off.

That saves significant wear and tear on your index finger which otherwise has to push the start button to accomplish the same purpose.

It's a ridiculous feature, adored by some, and a real trouble maker for others.

Use your index finger. It's why God gave you two of them.
(This post was last modified: 05-22-2015 01:56 PM by ebitansky.)
05-22-2015 01:53 PM
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ebitansky Offline

Members

Posts: 10
Joined: Apr 2015

Machine: Resmed S9 Vpap Adapt 36037
Mask Type: Full face mask
Mask Make & Model: Resmed Ultra Mirage
Humidifier: H5i
CPAP Pressure: AutoASV max EPAP 15 Min EPAP 8
CPAP Software: ResScan

Other Comments:

Sex: Male
Location:

Post: #22
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
Thank you all for the replies so far.
And thank you for the one who may reply later.
I must sign offline till Monday night and probably could share few reports
Hopefully some would be more than 3 hours.
Have great weekend and Memorial Day.
05-22-2015 05:37 PM
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PaytonA Online
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Monitors

Posts: 3,013
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: #23
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
(05-22-2015 01:05 PM)ebitansky Wrote:  I took it from airfit p10 manual page 3 section "Using your mask" at the notes:

Notes:
This mask is not compatible for use with ResMed
AutoSet CS™ 2 and VPAP™ Adapt SV devices.
SmartStart may not operate effectively when using this mask
with some CPAP or bilevel devices that have this feature.

Is airlift p10 the wrong mask ?

(05-22-2015 10:41 AM)PaytonA Wrote:  
(05-21-2015 08:37 PM)ebitansky Wrote:  Thanks for the good words.
Apparently (according to the mask manual ) this mask is not compatible with VPAP adapt SV machines. ......

The only thing that I can find in the manual that might be construed to indicate that the mask is not compatible with the VPAP adapt SV machine is the following statement: "This mask should be used only with flow generators (CPAP or bilevel) recommended by your physician or respiratory therapist."

The fact of the matter is that the VPAP Adapt is a bilevel flow generator. I do not think that statement was meant to rule out ASV machines.

Best Regards,

PaytonA

Sorry Ebit, I guess that I was confused. I was looking at the user guide for your Ultra Mirage mask.

Best Regards,

PaytonA
05-22-2015 07:08 PM
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trailrider Offline

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Posts: 304
Joined: Feb 2015

Machine: A10 Autoset for Her
Mask Type: Nasal mask
Mask Make & Model: Eson or P10
Humidifier: autoset
CPAP Pressure: 6-12 DME, 7-13 me
CPAP Software: SleepyHead

Other Comments: engineer. EPR at 3, unheated hose, humidity at 2. Routine hose entanglement.

Sex: Female
Location: Ontario

Post: #24
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
Thanks for the clarification DB! I admit to not understanding ASVs well at all.

Ebit, wrt the first study, it was an observation only study. They watched you and counted events and tallied up numbers. The recommendations was "yep, looks like typical apnea, comeback for a titration." That's when they fit you up with a mask and machine they control. As you go into events during the night, they will actively increase the pressure (called titrating) and observe the results. So only after your second study would there be a note about pressure; not before.

In the third study it looks like they were chasing centrals.

However to ease your mind, your initial study numbers were not that much different than mine. I was 236 events, and AHI of 36.7. My O2 didn't drop as much as yours though.

Anyways, you will get through this rough patch.
05-22-2015 10:23 PM
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DeepBreathing Offline
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Posts: 2,295
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: #25
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
(05-22-2015 01:53 PM)ebitansky Wrote:  First, a question I did not get answer for from anybody.
in the first CPAP study they didn't provide following statement:

At a pressure of 9cmH2O the AHI was 46.6 central events were at sleep onset, hypoxemia was resolved with positive airway pressure.
The positive airway pressure titration was not successfully completed due to residual obstructive events.
given these results recommended autoCPAP at a pressure of 5-18 cmH2o


The ASV study a year after doesn't say anything about central events.

Yeah, the wording on these things is often unclear. Central apneas at sleep onset and awakening are (I think) not uncommon and generally no cause for concern provided there is a limited number and a limited period. And I'm not really sure where you'd draw the line, but remember that your machine doesn't know if you're asleep or awake so most of these centrals could be false positives.

Quote:Second Question is a series of few questions with your permission

My device is Confused9 VPAP ADAPT 36027
Auto ASV mode:
available options on my machine are:
Min EPAP and Max EPAP as well as Min PS and MAX PS.

I couldn't see IPAP on my device at all so I take your comment about IPAP=Max EPAP + Max PS as the fact that this value is not there but we can calculate it. on the other hand in your recommendation you said IPAP is irrelevant provided it is set above 14.

My mistake - I must have had a different machine in mind. You're right, there is no IPAP max setting on the VPAP Adapt. Because you don't have a way to set the upper limit, just be aware that if you get a high pressure support occurrence at a time when your EPAP is close to maximum you IP will be really high and could wake you. (IPAP = EPAP + PS). If that does happen you might need to reduce PS Max.

Quote:My prescription for the ASV says EPAP 6, Min PS 6 Max PS 15

Could it be that the technician was not aware of ASV Auto Mode?
Are there cases where ASV AutoMode is not advised?
What is the right way to translate this prescription to ASV Auto?

I don't really know why you'd want a straight ASV mode though I guess there could be clinical reasons. I think the older models only had ASV and not ASVAuto, so it's possibly a hangover from that time (which might also explain why you were prescribed a constant EPAP). The ASV Auto allows the machine to vary EPAP as required to suppress obstructive apneas and keeps the pressure low until an event or precursor is detected.

Given that the central apnea result looks like an anomaly, I was going to suggest you discuss this with your Dr, but I see from your first post s/he thinks you're just non-compliant. So I think you should treat your machine like an APAP and see how it goes. As a start, try Min EPAP = 8, Max EPAP = 10, Min PS = 3, Max PS = 4. You'll need to monitor your results using SleepyHead or ResScan software and see what happens. Once you have a week's data, post it back here and let us give you some further advice.

Quote:This mask is not compatible for use with ResMed AutoSet CS™ 2 and VPAP™ Adapt SV devices.
SmartStart may not operate effectively when using this mask with some CPAP or bilevel devices that have this feature.

I checked this with Resmed in Australia some time ago - the P10 is fine to use except for two provisos - 1) Smart start / smart stop may not work properly (in my experience they don't work properly anyway) 2) at high pressures the lack of a proper headgear on this mask means that it will not maintain a seal. At the pressures you're using I don't think that would be a problem.

DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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.
05-23-2015 09:12 PM
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vsheline Offline

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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: #26
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
(05-23-2015 09:12 PM)DeepBreathing Wrote:  
(05-22-2015 01:53 PM)ebitansky Wrote:  First, a question I did not get answer for from anybody.
in the first CPAP study they didn't provide following statement:

At a pressure of 9cmH2O the AHI was 46.6 central events were at sleep onset, hypoxemia was resolved with positive airway pressure.
The positive airway pressure titration was not successfully completed due to residual obstructive events.
given these results recommended autoCPAP at a pressure of 5-18 cmH2o


The ASV study a year after doesn't say anything about central events.

Yeah, the wording on these things is often unclear. Central apneas at sleep onset and awakening are (I think) not uncommon and generally no cause for concern provided there is a limited number and a limited period. And I'm not really sure where you'd draw the line, but remember that your machine doesn't know if you're asleep or awake so most of these centrals could be false positives.

Hi ebitansky,

Sounds to me like the centrals were occurring only at sleep onset and were not significant in the overall AHI.

US federal law (HIPPA) gives you the right to a copy of your personal health records, and this includes the "full" sleep study reports, including data. Doctors or companies which ignore requests for copies of your own records can be subject to large fines

I suggest you should obtain copies of the full reports from the diagnostic study and also for each titration. From the table or plots of when events happened in time you/we would be able to see what was actually happening.

(05-22-2015 01:53 PM)ebitansky Wrote:  Second Question is a series of few questions with your permission

My device is: S9 VPAP ADAPT 36027
Auto ASV mode:
available options on my machine are:
Min EPAP and Max EPAP as well as Min PS and MAX PS.

I think 36027 must be a typo. REF# 36037 was the earliest ResMed blower unit offering ASVAuto therapy mode.

Unfortunately, as on all ResMed ASV machines, in ASV modes the Max PS setting must be at least 5 higher than the Min PS setting.


(05-22-2015 01:53 PM)ebitansky Wrote:  My prescription for the ASV says EPAP 6, Min PS 6 Max PS 15

Could it be that the technician was not aware of ASV Auto Mode?
Are there cases where ASV AutoMode is not advised?
What is the right way to translate this prescription to ASV Auto?

The tech and/or doctor may not have been familiar with ASVAuto mode. But the main question or issue seems to be why was Adaptive Servo Ventilator therapy prescribed instead of standard APAP or standard bi-level PAP therapy?

I suspect a standard bi-level Auto machine (I think the PRS1 BiPAP Auto with Heated Tube is the best in this category of machine) would likely have been the optimal choice in your case.

If someone is having painful problems from swallowing too much air (or from any of the other problems which very high IPAP can cause or make worse), "ASV" therapy mode might be preferable to "ASVAuto" therapy mode for an individual which needs ASV therapy (which I suspect you do not need).

Normally, an ASV machine is not authorized by insurance companies unless central apneas are predominate over obstructive apneas (while being treated by standard CPAP, APAP or bi-level therapy). I suspect this normal requirement was overlooked or ignored in your case. I suspect this because it seems from the your sleep reports that centrals were not a significant contributor to your overall AHI or RDI.

Since your main problem seems to have been obstructive events, ASVAuto may be a better therapy type to use than straight ASV, but as DB has pointed out, the max IPAP pressure can get quite high when both EPAP and PS can auto-adjust.


(05-23-2015 09:12 PM)DeepBreathing Wrote:  I don't really know why you'd want a straight ASV mode though I guess there could be clinical reasons. I think the older models only had ASV and not ASVAuto, so it's possibly a hangover from that time (which might also explain why you were prescribed a constant EPAP). The ASV Auto allows the machine to vary EPAP as required to suppress obstructive apneas and keeps the pressure low until an event or precursor is detected.

Given that the central apnea result looks like an anomaly, I was going to suggest you discuss this with your Dr, but I see from your first post s/he thinks you're just non-compliant. So I think you should treat your machine like an APAP and see how it goes. As a start, try Min EPAP = 8, Max EPAP = 10, Min PS = 3, Max PS = 4. You'll need to monitor your results using SleepyHead or ResScan software and see what happens. Once you have a week's data, post it back here and let us give you some further advice.

Unfortunately, because the Pressure Support (which is a form of exhalation pressure relief) cannot be set to a fixed number, a ResMed ASV machine cannot be adjusted to behave like an APAP or an Auto bi-level machine, because in ResMed ASV or ASVAuto therapy modes the Max PS must be at least 5 higher than the Min PS.

- - - - - - - - - - -

ebitansky, in order to set your machine to work kinda sorta like an Auto bi-level machine with a crazy aggressive attitude (which I think is the best you can do with the machine you have), I would suggest the following settings:

Therapy Mode: ASVAuto (so that the machine will be free to adjust EPAP in order to treat/prevent obstructive events, allowing you to see what EPAP the machine is deciding is needed). In brief, on standard APAP and Auto BiPAP machines it is mainly EPAP which is adjusted to minimize obstructive apneas and hypopneas.

EPAP Min: I would suggest at least 8 cmH2O (because your obstructive events will need at least this much, and because it is not good to have the Min EPAP way too low, because ResMed machines use the Min EPAP as a target EPAP level which they are always slowly trying to get back to).

EPAP Max: At least 10 cmH2O. (The maximum allowed by ResMed ASV machines is only 15.)

Min PS: At least 0.2 cmH2O (so in the machine's data you will be able to easily see the time periods which the machine considers to be inhalation versus exhalation). But actually, in your case I suggest at least 1 or 2 or 3, not only because having some reduction in pressure during exhalation is usually more comfortable but also because I think a higher Min PS would tend help keep your Respiration Rate from falling too low.

Max PS: Use the minimum allowable amount (to minimize the ASV aspect of the machine's behavior, so that IPAP is not raised unnecessarily high). The minimum will be 5 higher than whatever the Min PS is set to.

- - - - - - - - - - -

But here's something important, here's what may even be the most important thing for success in treatment of your Obstructive Sleep Apnea: OSA is usually highly positional.

If (as I suspect may be the case) the machine will be unable by itself to lower your AHI adequately when you have rolled onto your back and are dreaming, you can help it tremendously by taking precautions that will ensure you will not ever be sleeping flat on your back, which is usually the worst position for OSA.

Try using the machine while sleeping in a LaZBoy type of comfortable lounge chair which leans back and can be used for sleeping. Or use bricks or boards to raise the head of your bed a foot or so, or wear a teeshirt with a tennis ball in a pocket or two sewn on the shirt along the spine between the shoulder blades, or wear a light knapsack with something light but bulky in it, or a combination of these different approaches, to make sure you will not ever be sleeping flat on your back.

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: 05-24-2015 02:31 AM by vsheline.)
05-23-2015 11:59 PM
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ebitansky Offline

Members

Posts: 10
Joined: Apr 2015

Machine: Resmed S9 Vpap Adapt 36037
Mask Type: Full face mask
Mask Make & Model: Resmed Ultra Mirage
Humidifier: H5i
CPAP Pressure: AutoASV max EPAP 15 Min EPAP 8
CPAP Software: ResScan

Other Comments:

Sex: Male
Location:

Post: #27
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
Thanks for all the information.
I am attaching the past week results. seems like breath rate is quite low.
last night I used the new ASVAuto Mode while the previous night I used the regular ASV mode.
none of the night was more than one hour but I made sure I put the mast few minutes before falling a sleep.
previous month (file too big to attach here, had 2 and 3 hours of night sleep)

Thanks
EBITA

.zip  sleepyhead_username_details_2015-05-19_2015-05-26.zip (Size: 23.16 KB / Downloads: 39)
(05-23-2015 11:59 PM)vsheline Wrote:  
(05-23-2015 09:12 PM)DeepBreathing Wrote:  
(05-22-2015 01:53 PM)ebitansky Wrote:  First, a question I did not get answer for from anybody.
in the first CPAP study they didn't provide following statement:

At a pressure of 9cmH2O the AHI was 46.6 central events were at sleep onset, hypoxemia was resolved with positive airway pressure.
The positive airway pressure titration was not successfully completed due to residual obstructive events.
given these results recommended autoCPAP at a pressure of 5-18 cmH2o


The ASV study a year after doesn't say anything about central events.

Yeah, the wording on these things is often unclear. Central apneas at sleep onset and awakening are (I think) not uncommon and generally no cause for concern provided there is a limited number and a limited period. And I'm not really sure where you'd draw the line, but remember that your machine doesn't know if you're asleep or awake so most of these centrals could be false positives.

Hi ebitansky,

Sounds to me like the centrals were occurring only at sleep onset and were not significant in the overall AHI.

US federal law (HIPPA) gives you the right to a copy of your personal health records, and this includes the "full" sleep study reports, including data. Doctors or companies which ignore requests for copies of your own records can be subject to large fines

I suggest you should obtain copies of the full reports from the diagnostic study and also for each titration. From the table or plots of when events happened in time you/we would be able to see what was actually happening.

(05-22-2015 01:53 PM)ebitansky Wrote:  Second Question is a series of few questions with your permission

My device is: S9 VPAP ADAPT 36027
Auto ASV mode:
available options on my machine are:
Min EPAP and Max EPAP as well as Min PS and MAX PS.

I think 36027 must be a typo. REF# 36037 was the earliest ResMed blower unit offering ASVAuto therapy mode.

Unfortunately, as on all ResMed ASV machines, in ASV modes the Max PS setting must be at least 5 higher than the Min PS setting.


(05-22-2015 01:53 PM)ebitansky Wrote:  My prescription for the ASV says EPAP 6, Min PS 6 Max PS 15

Could it be that the technician was not aware of ASV Auto Mode?
Are there cases where ASV AutoMode is not advised?
What is the right way to translate this prescription to ASV Auto?

The tech and/or doctor may not have been familiar with ASVAuto mode. But the main question or issue seems to be why was Adaptive Servo Ventilator therapy prescribed instead of standard APAP or standard bi-level PAP therapy?

I suspect a standard bi-level Auto machine (I think the PRS1 BiPAP Auto with Heated Tube is the best in this category of machine) would likely have been the optimal choice in your case.

If someone is having painful problems from swallowing too much air (or from any of the other problems which very high IPAP can cause or make worse), "ASV" therapy mode might be preferable to "ASVAuto" therapy mode for an individual which needs ASV therapy (which I suspect you do not need).

Normally, an ASV machine is not authorized by insurance companies unless central apneas are predominate over obstructive apneas (while being treated by standard CPAP, APAP or bi-level therapy). I suspect this normal requirement was overlooked or ignored in your case. I suspect this because it seems from the your sleep reports that centrals were not a significant contributor to your overall AHI or RDI.

Since your main problem seems to have been obstructive events, ASVAuto may be a better therapy type to use than straight ASV, but as DB has pointed out, the max IPAP pressure can get quite high when both EPAP and PS can auto-adjust.


(05-23-2015 09:12 PM)DeepBreathing Wrote:  I don't really know why you'd want a straight ASV mode though I guess there could be clinical reasons. I think the older models only had ASV and not ASVAuto, so it's possibly a hangover from that time (which might also explain why you were prescribed a constant EPAP). The ASV Auto allows the machine to vary EPAP as required to suppress obstructive apneas and keeps the pressure low until an event or precursor is detected.

Given that the central apnea result looks like an anomaly, I was going to suggest you discuss this with your Dr, but I see from your first post s/he thinks you're just non-compliant. So I think you should treat your machine like an APAP and see how it goes. As a start, try Min EPAP = 8, Max EPAP = 10, Min PS = 3, Max PS = 4. You'll need to monitor your results using SleepyHead or ResScan software and see what happens. Once you have a week's data, post it back here and let us give you some further advice.

Unfortunately, because the Pressure Support (which is a form of exhalation pressure relief) cannot be set to a fixed number, a ResMed ASV machine cannot be adjusted to behave like an APAP or an Auto bi-level machine, because in ResMed ASV or ASVAuto therapy modes the Max PS must be at least 5 higher than the Min PS.

- - - - - - - - - - -

ebitansky, in order to set your machine to work kinda sorta like an Auto bi-level machine with a crazy aggressive attitude (which I think is the best you can do with the machine you have), I would suggest the following settings:

Therapy Mode: ASVAuto (so that the machine will be free to adjust EPAP in order to treat/prevent obstructive events, allowing you to see what EPAP the machine is deciding is needed). In brief, on standard APAP and Auto BiPAP machines it is mainly EPAP which is adjusted to minimize obstructive apneas and hypopneas.

EPAP Min: I would suggest at least 8 cmH2O (because your obstructive events will need at least this much, and because it is not good to have the Min EPAP way too low, because ResMed machines use the Min EPAP as a target EPAP level which they are always slowly trying to get back to).

EPAP Max: At least 10 cmH2O. (The maximum allowed by ResMed ASV machines is only 15.)

Min PS: At least 0.2 cmH2O (so in the machine's data you will be able to easily see the time periods which the machine considers to be inhalation versus exhalation). But actually, in your case I suggest at least 1 or 2 or 3, not only because having some reduction in pressure during exhalation is usually more comfortable but also because I think a higher Min PS would tend help keep your Respiration Rate from falling too low.

Max PS: Use the minimum allowable amount (to minimize the ASV aspect of the machine's behavior, so that IPAP is not raised unnecessarily high). The minimum will be 5 higher than whatever the Min PS is set to.

- - - - - - - - - - -

But here's something important, here's what may even be the most important thing for success in treatment of your Obstructive Sleep Apnea: OSA is usually highly positional.

If (as I suspect may be the case) the machine will be unable by itself to lower your AHI adequately when you have rolled onto your back and are dreaming, you can help it tremendously by taking precautions that will ensure you will not ever be sleeping flat on your back, which is usually the worst position for OSA.

Try using the machine while sleeping in a LaZBoy type of comfortable lounge chair which leans back and can be used for sleeping. Or use bricks or boards to raise the head of your bed a foot or so, or wear a teeshirt with a tennis ball in a pocket or two sewn on the shirt along the spine between the shoulder blades, or wear a light knapsack with something light but bulky in it, or a combination of these different approaches, to make sure you will not ever be sleeping flat on your back.

Take care,
--- Vaughn
05-27-2015 08:23 AM
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Machine: REMstar System One with Autoflex
Mask Type: Full face mask
Mask Make & Model: Quattro AirFit F10
Humidifier: yes typical setting = 4
CPAP Pressure: 5-13 Autotritrating CPAP
CPAP Software: SleepyHead EncoreBasic

Other Comments: CMS-50F Plus oximeter /w SPO2 Assistant software. Avowed mouth-breather switching to nose-breathing

Sex: Male
Location: US

Post: #28
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
so your data shows 19 hypopneas and 1 apnea for the whole week, average hypopnea of 27 seconds, only one was extra long of 125 seconds. The apnea was 15 seconds long. not bad.

05/19 IPAP avg 17.4 EPAP avg 8.7
05/20 IPAP avg 17.3 EPAP avg 9.3 Hyp=7
05/21 IPAP avg 16.4 EPAP avg 6.0 Hyp=1
05/22 IPAP avg 16.3 EPAP avg 6.0 Hyp=2
05/23 IPAP avg 13.5 EPAP avg 6.0
05/24 IPAP avg 15.6 EPAP avg 6.0 Hyp=3
05/25 IPAP avg 16.5 EPAP avg 6.0
05/26 IPAP avg 16.2 EPAP avg 6.0 Hyp=2 Ap=1
05/27 IPAP avg 12.9 EPAP avg 8.8 Hyp=4

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.
05-28-2015 12:06 AM
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ebitansky Offline

Members

Posts: 10
Joined: Apr 2015

Machine: Resmed S9 Vpap Adapt 36037
Mask Type: Full face mask
Mask Make & Model: Resmed Ultra Mirage
Humidifier: H5i
CPAP Pressure: AutoASV max EPAP 15 Min EPAP 8
CPAP Software: ResScan

Other Comments:

Sex: Male
Location:

Post: #29
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
Hello all and thanks for the help so far.
Update:

Although I still wear the mask only for one hour of sleep with about 20 additional minutes to fall asleep, the number of events looks much better with below 2 AHI
All events were hypopneas according to rescan some of 60 seconds

Current Settings:
Mode is ASVAuto (switched away from the regular ASV)
EPAP MIN 6
EPAP MAX 10 (Min allowed)
PS MIN 5
PS MAX 10 (difference between PS Min and PS Max needs to be min of 5)
Climateline heated set to auto with 82F
Sleeping on the side to reduce obstructive events.

I do have some questions and comments I would like to get feedback for please:

1. My RR still goes to 4-5 at times, and at other times at 20. Which of the device parameters controls that?
2. I feel bloated while awake and believe it causing me taking off the mask, is this normal in ASVAuto mode? Anything I can do to change that?
3. It takes me long time to fall asleep, machine while awake is pushing very high pressure, which is why some of you said it is not recommended, to have the mask on with the air pressure while still awake. Is the ramp feature going to work with ASVAuto? (It can be set up but would it mean the machine will not try to correct the behavior?)
4. Being with the mask without the air gets me light headed.
5. If I still find it hard to go to sleep, is it still not recommended to get Xanax or Lunesta until building the tolerance?


Thanks
EBIT
05-29-2015 10:01 AM
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DeepBreathing Offline
Wiki Editor
Moderators

Posts: 2,295
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: #30
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
Hi EBIT, I'll try to answer your questions, but hopefully Vaughan will chip in with his greater expertise.

1 - I don't think there is any way to change the respiratory rate on the Adapt. The machine uses the Pacewave algorithm which adjusts various parameters automatically based on a moving average of your breathing rate and depth. There used to be a good description on Resmed's site but since it was overhauled I can't find it any more. I just checked my own rate which varies between about 5 and 17 so a similar sort of range. The slowest rates seem to be associated with flow limitations and snoring, at which point the machine will jack the pressure up.

2 - Fortunately (for me) I've never had this problem, so I can't really advise you. I'm not aware of ASV machines being any worse in this regard, though the higher pressures they use may be a factor.

3 - By all means use the ramp if you are having trouble falling asleep. The machine won't respond to events during the ramp period, so don't set it for too long - just enough to make sure you're asleep. If you find the machine is trying to force your breathing or applies too high a pressure while you're still awake, just blow back forcefully, and it will reduce pressure.

4 - I think that's to be expected - although the mask is vented it's not the same as normal breathing. I'm not familiar with your specific mask - does it have a swivel elbow which can be removed to allow easier breathing? This should help acclimatise yourself to the mask but without the hose attached.

5 - There's no point lying awake for hours. If you can't get off to sleep and your sleep hygiene is otherwise OK, then I think a mild sleeping aid is in order. As always, check with your health professional.

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.
05-30-2015 05:39 AM
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