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Help with awakening problem and data interpretation
#11
RE: Help with awakening problem and data interpretation
Your machine is defective. Swap it out for a Resmed Aircurve 10 ST-A with iVAPS. What's defective: Mask pressure never exceeds 15.8 cm, even though the max IPAP pressure is set to 30 cm. Your target tidal volume is 700 mL with a fixed breath rate of 15 bpm (minute vent 10.05 L/min), and this machine is not maintaining that. Between 3:40 and 4:10 you have extremely poor ventilation and the ST-AVAPS is not delivering the pressure needed to improve ventilation. This machine is not functioning properly to provide the prescribed ventilation. Return it for an exchange, and I strongly suggest you insist on the Resmed ST-A.

Note, these conclusions are based on the mask pressure and ventilation charts. It is possible Oscar is not properly reporting mask pressure, but I don't know what would cause that.

When Gidion checks in, he may ask you to send a copy of your SD card to a dropbox so the Oscar development team can QA the data. We don't see many of these ST AVAPS machines.
Sleeprider
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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.
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#12
RE: Understanding flow rate , flow limitations and machine scoring criteria
I will be watching for answers to your questions on this thread because I have been wondering about the same things. Sorry, I can't offer any help there. 

But, I have the same oximeter and have not yet been able to get it to sync with OSCAR. It does not recognize it when I use the Oximetry Wizard feature. If you have any luck getting this to work, please let me know. 

Thanks.
My get-up-and-go musta got up and went.  Cool
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#13
RE: Understanding flow rate , flow limitations and machine scoring criteria
Danny, I think the mask pressure is not giving us good information, but in this chart, we see your pressures are at 24/12 (IPAP/EPAP) through that rather serious flow restriction. That is considerably short of the 30 cm this machine should be delivering when tidal volume target of 700 mL is not met. I can only speculate on why you had this notably restricted flow, but it may be the result of what we have called positional apnea. This is a chin-tuck or position where air is restricted due to the physical obstruction resulting from a bend in the cervical spine and airway. We have described this for CPAP and ASV users in the Positional Apnea wiki http://www.apneaboard.com/wiki/index.php...onal_Apnea and shown how it is mitigated in the Soft Cervical Collar wiki http://www.apneaboard.com/wiki/index.php...cal_Collar

I linked your two threads because they really deal with the same question.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
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#14
RE: Help with awakening problem and data interpretation
Danny, you need to take these charts to your doctor that is managing your Type 2 Respiratory failure due to mitochondrial disease causing diaphragmatic weakness and Sleep related hyperventilation.  The full night of standard and advanced charts.  Zoomed views showing the decrease in both tidal and minute volume. 

On the advanced chart force the range on the mask pressure to 4 - 30  The top is getting clipped.  
Your PS is running at 17.5 median value almost constantly, this is very high.  This and the low tidal volume and minute vent are saying your therapy are not working, especially with the tidal volume set to 700.  

This therapy is not working for you.  

Please take this to your pulmonologist.  and please let us know what happens

A request if you don't mind.  I would like to add a copy of your SD card to our collection of data for the development and testing of OSCAR.  For this data we will remove any personal info and will change the SN in the data so it will never be able to be traced back to you. We do not provide this data to anyone other than our development team. Your mode and machine are not common and this info will help us developed OSCAR.

Make a zip of the entire SD card, the format is important, and put it in my drop box
Fred's DropBox Receive SD Cards
https://www.dropbox.com/request/6VeFzBXa4qZ37EgphL5b


Thanks.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#15
RE: Help with awakening problem and data interpretation
It is important to discuss these problems as soon as possible with a professional because with your conditions, the forum is out of its element and this ventilator is life-critical. The machine needs to be verified for proper function and pressure support. Something that might cause the limited respiratory volume, in addiiton to the apparent lack of pressure support, is if your lungs are packing full of air. The respiratory timing on your machine at 15 BPM and 1.3 seconds of inspiration time, is 1.3 time of inspiration and 2.7 seconds for expiration. If you are not adequately expiring your working lung volume in that time, it can result in the lungs remaining full and unable to accept the next timed inspiration. I am hopeful you will seek help from your physician because we just can't safely solve these problems remotely.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
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#16
RE: Help with awakening problem and data interpretation
Hi Guys

Firstlt thankyou for all your time and help.

i have scrolled back through older sessions although a huge chunk is missing due to a lost sd card .

The mask pressure has always read a maximum of 15.88 throughout my time of having this machine , i had used various masks also. So is this likely to be a problem with OSCARS interpretation?

I am also confused as too what i should be telling my drs , is the machine faulty ? or is the machine just not capable enough of managing my conditions?

Secondly i am going to have considerable problems getting any help from my hospital here in the uk, my NHS hospital has become COVID-19 only and is based in london and has the highest number of covid ventilated patients. My whole respiratory team has been redeployed to intensive care to manage the pandemic , my lead consultant is now clinical lead for the covid effort . Usually i attend a specialist complex neuromuscular care center at the same hospital however this unit has been shut down and has become a covid ICU , there are no face to face appointments.

I just need to clarify what exactly i am going to say to them ? My hospital uses philips encore pro to manage ventilation data , does this programme show the same detail as OSCAR?

Gideon i have put a zip of my sd card into the dropbox for you.

Thanks Danny
Type 2 Respiratory failure due to mitochondrial disease causing diaphragmatic weakness
Sleep related hypoventilation
Total heart block with implanted pacemaker
Severe OSA untreated AHI 47.6
Philips Dreamstation BiPAP AVAPS Non Invasive ventilator
Using Oscar 1.2.0

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#17
RE: Help with awakening problem and data interpretation
I suspect the issue with mask pressure is settings of the vertical axis.  If that is not the issue your machine is faulty. 

Either way it is not delivering the therapy you need for your condition.  

I'll look at your data shortly and get back to you.  

The data encore pro uses is the same data OSCAR uses.  Your team will want to look at the data with the software they are familiar with.

I assure you they will see you but you need to get their attention.

Do you have a recording oximeter? If so use it. I suspect that your O2 says are low when your breathing volumes are low. 

 More latter once I've looked at your data
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#18
RE: Help with awakening problem and data interpretation
Looking at your data,  I'm going to pass it on to our PR developer for 2 reasons/
1. we have not seen this combination of machine and mode.
2. The PS is not making sense.   The pressure graph is showing a PS of 11.45 and at the same time Mask pressure is 15.88/9.75 or ps = 6.13 @ 23:34:30 on 17 Feb  I don't understand this.

15 Feb your Tidal Vol and Minute Vent dipped low but never sustained a low. So Mixed results
14 Feb was your worst night.  
17 Feb actually looks better, in the pressure graph you see the EPAP, IPAP and PS varying over the night, not so with the mask pressure.  Bottom line on 17 Feb the therapy was working for you, it likely could be improved, but it was working.
12 Feb Another good therapy night, other than duration. (3 hrs)
As you alluded to you have a problem with sustained use of the machine, with your best nights representing just 2 hrs of use, and most of that in the ramp.  With your 20 minute ramp it means that with your 2hrs 9 minutes on the machine you lost an hour of therapy.

You are NOT having an apnea problem.

Get used to your machine, use it while watching TV, reading, playing games on your phone, just some activity that you normally enjoy.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#19
RE: Help with awakening problem and data interpretation
Thanks Gideon

Will try and use the machine more to see what happens

Danny
Type 2 Respiratory failure due to mitochondrial disease causing diaphragmatic weakness
Sleep related hypoventilation
Total heart block with implanted pacemaker
Severe OSA untreated AHI 47.6
Philips Dreamstation BiPAP AVAPS Non Invasive ventilator
Using Oscar 1.2.0

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#20
RE: Help with awakening problem and data interpretation
Ask about switching to the Resmed Aircurve 10 iVAPS. We have consistently seen a much higher level of responsiveness on Resmed vs Philips in advanced bilevel like ASV. I suspect this is also true for iVAPS. Please read pages 35 to 36 in this resource https://document.resmed.com/en-us/docume...er_eng.pdf This may be useful to discuss with your doctor.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
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