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Help with awakening problem and data interpretation
#21
RE: Help with awakening problem and data interpretation
What I'm seeing is the machine cannot deliver what is asked for and expected of it. This Respironics acts overwhelmed. Go for the ResMed AirCurve 10 ST-A, the same as I'm now trying to obtain. I don't know if this failure is specific to this machine or this make/model. Again, the ResMed ST-A is different enough and more capable in my research. But I'm not the doc. You need that input.

Sleeprider and Gideon will likely know what I mean, but maybe it's a difference as simple as what drives ResMed vs Respironics on this higher level device, similar to what ASV targets. That target difference may be what makes or breaks therapy success. I think ResMed targets minute vent. Maybe this proves to be better for you. Then on top of that, iVAPS should be more comfortable as a bonus.
Dave

OSCAR
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#22
RE: Help with awakening problem and data interpretation
Dave, from the document I linked above:
iVAPS targets alveolar minute ventilation to deliver required ventilation at the alveoli, where gas exchange occurs . Unlike other volume-assurance modes, iVAPS maintains the alveolar target even when respiratory rate changes.
iVAPS may reduce the risk of hyperinflation associated with increased respiratory rate, as compared to therapy targeting tidal volum

By comparison, the Philips uses a fixed respiration rate and targets tidal volume. I mentioned previously that hyperinflation may be the reason the Philips is missing the tidal vent target. The Resmed is a far more intelligent and engineered medical device, at the design level.
Sleeprider
Apnea Board Moderator
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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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#23
RE: Help with awakening problem and data interpretation
Yep OK. I'm pretty sure that's what I was trying to refer to. Thanks for clarifying.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#24
RE: Help with awakening problem and data interpretation
Hi guys thanks for all the input

Looking back on my other sd card as Gideon said some days are better than others, I don’t quite understand why the vent copes some days but not others maybe it is sleep position as my spirometry readings are extremely low when lying down compared to sitting  . Gideon said Feb 14 was the worst day , I have found further days where the tidal volume is as low as 130ml for 40 minutes of sleep .

Sleep is a major issue for me at the minute as you can see from the readings I don’t get much sleep due to pain from the disease causing neuropathy despite medication . When I do sleep I wak even multiple times during the night .

Unfortunately having read the resmed documentation it does sound a much more advanced algorithm used In Ivaps the only problem is the hospitals non invasive ventilation department is “ sponsered” by Philips respirinics an d the chances of getting a framed device will be small 

Thanks again
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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#25
RE: Help with awakening problem and data interpretation
I've always acted by realizing that it's not going to hurt to ask. I've got the medical things I've got now to make my life better because I asked about it. ASV, spinal cord stimulator implant, hospital bed, power wheelchair. Yes there were other actions, tests to have done, etc. But it started with asking.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#26
RE: Help with awakening problem and data interpretation
Sorry for the long absence, folks.

The mask pressure chart doesn't provide useful information in this case:

It turns out that the 1130X series has the same bug that the 900X series has: it clamps the mask pressure to 127 rather than 255. As a result, the maximum mask pressure the machine will report in its data is 15.875 rather than 31.875. If you look at the actual delivered EPAP and IPAP, however, you see the correct pressures being delivered.

Almost certainly somebody accidentally used a signed integer instead of unsigned on these machines: that's appropriate for flow waveform, which can vary from -128 to +127, but it's not appropriate for mask pressure, which can only be positive. Other PRS1 machines (including the predecessor to the 900X) got this right.

Again, this simply a data reporting issue, and it's in the data reported by the machine, so official reports look just the same: mask pressure never exceeds ~16 cmH2O despite the waveform report graph having a scale of up to 30.

The only thing OSCAR isn't getting quite right as of 1.2.0 is (a) naming the machine (since we didn't have test data before) and (b) a few extraneous warnings (about values beyond ranges we had seen before). I've verified that these are all benign, and I'll shortly update the PSR1 loader to eliminate the warnings and display the machine's name.

So, ignore the mask pressure.


The low tidal volume and especially low minute ventilation, however, are accurate and are indeed concerning. That's worth bringing up with his doctor. He's not getting anywhere near his target tidal volume.

The first step will be for his doctor to adjust settings to see if this machine can provide what he needs. Maybe PC (pressure control) would be more appropriate than S/T?

If his practice is using Encore to remotely monitor patients, they're unlikely to switch to ResMed unless they've tried everything they can with the current machine.

So @Dannyj1981, do ask your doctor to review your tidal volume (TV) and minute ventilation (MV), those are way too low. Something isn't right.
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#27
RE: Help with awakening problem and data interpretation
Thank you Sawinglogz for helping us understand the mask pressure display error, and your recommendation to Dannyj1981 to have his doctor review the tidal volume and minute vent. I think your conclusion that this is something that needs professional intervention with the AVAPS is truer than my knee-jerk reaction to just change machines. I also raised the possibility of "air packing" earlier, which will prevent any ventilator from achieving tidal volume targets until the accumulated air is exhaled. That usually means reserving more expiratory time by shortening inspiratory time and slowing the breathing rate.
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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#28
RE: Help with awakening problem and data interpretation
Air packing is a great point, I hadn't thought of that.

One of OSCAR's warnings was not having encountered a backup breath rate that high, so you really could be on to something here.
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