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

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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)

Actually, on your machine I think EPAP Max can be as low as EPAP Min, if desired.

PS MIN 5
PS MAX 10 (difference between PS Min and PS Max needs to be min of 5)

True, in ResMed ASV mode or ResMed ASVAuto mode the difference between PS Min and PS Max needs to at least 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?

The times when your Respiration Rate goes to 20 may be normal (if the RR is steady) or may indicate arousals (if the RR of 20 is much higher than your usual RR and lasts for only a short time, such as immediately after an apnea or hypopnea).

I think an RR of 8 or 9 is perhaps okay but low and should be brought to the attention of your doctor (if feasible). I think an RR of less than 8 is of special concern.

As you can look up in the setup manual (Clinician Guide) for your machine, the ResMed S9 VPAP Adapt (like other ResMed ASV models) has no setting for Backup Respiration Rate. When you are making no effort to breathe for yourself it automatically starts breathing for you at your recent natural RR. However, I think that if you stop breathing and your recent RR has been below 15 breaths per minute, when the Adapt starts breathing for you I think the machine will gradually increase the RR toward a target of 15 breaths per minute.

When your RR drops very low, perhaps you are having obstructive apneas which are too strong for the machine to treat. To avoid obstructive apneas and hypopneas, sometimes we may need to take measures to make sure we are never sleeping on our back, and we may need to raise the head of our bed, and we may need to increase the EPAP pressure setting or the Min and Max EPAP pressure settings.


An important thing you can do: To see what is happening while the RR is so low, using ResScan or SleepyHead I recommend you zoom in during times when the RR is near 5 or 6 or 7 (zoom in until 1 or 2 minutes fills the screen horizontally) to see what is happening at those times, looking at the Flow and the High Rate Pressure waveforms.

If Pressure Support is cycling the pressure back and forth between EPAP and IPAP but the Flow remains at zero or near zero, then an obstructive apnea must be occurring.

In ResScan or SH, what does the Flow waveform and the High Rate Pressure waveform look like when the RR is 7 or lower?

I think there is some possibility you may already be benefiting from a Min PS setting of 4 or higher. (I am of the opinion that my PS setting of 4 or 5 helps my RR stay higher and not drift too low). In future, if you lower the Min PS, do keep an eye on your average RR and how often it is dropping too low, to see whether lowering the Min PS setting has improved or made worse or had no effect on your RR.

If you are having centrals throughout the night and need ASV therapy, you may need an ASV machine like the PRS1 BiPAP autoSV Advanced which *can* provide a fixed backup RR for use when you stop breathing on your own.

Or, you may need an "ST" therapy mode machine. A machine with ST therapy mode provides a manually-adjusted EPAP plus a manually-adjusted Pressure Support synchronized to your own breathing while you are breathing on your own, but when you stop breathing the machine automatically steps in and cycles between EPAP and IPAP at a manually-adjusted "Backup Rate".

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?

Because ASV machines tend to raise the PS to high levels (like 10), yes, I think people on ASV therapy tend to experience higher pressures and more air-swallowing than most CPAP or bi-level patients do.

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?)

I looked it up in the setup-manual for your machine. Yes, the Ramp works in all three modes. During the Ramp the machine does not respond to events. If you use the Ramp I suggest setting the Start EPAP for the Ramp only 1 or 2 cmH2O lower than your EPAP or Min EPAP setting.

4. Being with the mask without the air gets me light headed.

If you are wearing the mask to accustomize yourself to wearing it, I suggest removing the hose from the mask (some masks have a quick connect/disconnect mechanism so the hose can be easily disconnected and reconnected) or have the machine running.

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?

I don't know. Have you googled these medications to find out all their side effects?

[quote]Thanks
EBIT