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Influence of EPR-Level on Central Apnea
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richb Offline

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Machine: Resmed AirCurve 10 ASV
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Post: #41
RE: Influence of EPR-Level on Central Apnea
The idea is that the machine makes it easier to exhale. Many people find it hard to exhale against the full pressure of the inhalation setting. The pressure of the inhalation setting is designed to keep your airway open to prevent obstructive apnea.

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here: http://www.apneaboard.com/wiki/index.php...SleepyHead
06-22-2015 09:00 PM
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vsheline Offline

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
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Post: #42
RE: Influence of EPR-Level on Central Apnea
(06-22-2015 10:36 AM)pizza41466 Wrote:  You should show that to your doctor. It's very similar to the Cheyne-Stokes pattern.

Hi richb,

The data you posted represents a textbook example of Cheyne-Stokes Respiration. Those are real central apneas. The machine is scoring them correctly.

Congratulations. I predict that you, too, may soon be the proud owner of a top of the line ASV machine.

Or, if for some reason ASV therapy has not always been a secret desire of yours (and actually, for most people it hasn't been) then I would suggest you try turning down Pressure Support to 0.8 cmH2O or lower.

Good luck.

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: 06-23-2015 08:44 AM by vsheline.)
06-22-2015 11:30 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

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Location: California, USA

Post: #43
RE: Influence of EPR-Level on Central Apnea
(06-22-2015 04:38 PM)tedburnsIII Wrote:  Is maximum pressure support that of '4' on your BPAP machine?

Don't understand the last paragraph of your post:

(06-22-2015 03:18 PM)richb Wrote:  My machine is set to auto with min at 8 and max at 18. It has a PS pressure support level of 4. It generally is graphing between a IPAP of 8 and an EPAP of 12. The PS of 4 generally equates to a relief setting of 4.

Hi tedburnsIII,

richb meant his EPAP is usually 8 and his IPAP is usually 12.

His IPAP is always 4 higher than his EPAP.

Pressure Support (presently 4) is manually adjustable on his machine between zero and perhaps 10 (if memory serves).

His EPAP is set to automatically adjust within the range of 8 to 18, as high may be needed to prevent obstructive events.

Since his IPAP is always 4 higher than his EPAP, his IPAP can vary between 12 to 22.

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: 06-23-2015 12:30 AM by vsheline.)
06-22-2015 11:40 PM
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tedburnsIII Offline

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Other Comments: Dx moderately severe OSA. Overnight pulse oximeter-CMS50D Plus

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Post: #44
RE: Influence of EPR-Level on Central Apnea
vsheline- Thanks for your answers based on greater experience with this whole process. What didn't make sense to me is why EPAP would ever be more than IPAP. There seemed to be a contradiction in his last paragraph.

I can't imagine IPAP reaching an upper limit of 22. though, when IPAP is set for 8-18. And if maximum EPAP were at a level of 10, are you saying that maximum IPAP would then actually be at 28 (where IPAP set at 8-18cm)??
(This post was last modified: 06-23-2015 02:01 AM by tedburnsIII.)
06-23-2015 01:59 AM
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vsheline Offline

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Posts: 1,908
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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: #45
RE: Influence of EPR-Level on Central Apnea
(06-23-2015 01:59 AM)tedburnsIII Wrote:  What didn't make sense to me is why EPAP would ever be more than IPAP. There seemed to be a contradiction in his last paragraph.

... And if maximum EPAP were at a level of 10, are you saying that maximum IPAP would then actually be at 28 (where IPAP set at 8-18cm)??

You are right, EPAP will never be more than IPAP.

When richb wrote "My machine ... generally is graphing between a IPAP of 8 and an EPAP of 12" what he meant to write is "EPAP of 8 and an IPAP of 12."

I think we all sometimes say the opposite of what we mean, or at least I do from time to time.

Min EPAP was set to 8; Max EPAP was set to 18. Pressure Support was set to 4, so IPAP was always 4 higher than EPAP, making the range for IPAP be 12-22.

If the Max EPAP setting would have been 10 then the maximum to which EPAP could have gone would have been 10, and IPAP would have been 4 higher, 14, because for bi-level IPAP = EPAP + PS.

Please be patient with us, and 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: 06-23-2015 07:56 AM by vsheline.)
06-23-2015 03:13 AM
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richb Offline

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Machine: Resmed AirCurve 10 ASV
Mask Type: Nasal mask
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CPAP Software: ResScan SleepyHead

Other Comments: Idiopathic Central Apnea

Sex: Male
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Post: #46
RE: Influence of EPR-Level on Central Apnea
[
You are right, EPAP will never be more than IPAP.

When richb wrote "My machine ... generally is graphing between a IPAP of 8 and an EPAP of 12" what he meant to write is "EPAP of 8 and an IPAP of 12."

I think we all sometimes say the opposite of what we mean, or at least I do from time to time.


Please be patient with us, and take care,
--- Vaughn
[/quote]

Thank you for the correction. I did get my Es and Is mixed up.
06-23-2015 07:17 AM
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tedburnsIII Offline

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CPAP Software: Other Software

Other Comments: Dx moderately severe OSA. Overnight pulse oximeter-CMS50D Plus

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Post: #47
RE: Influence of EPR-Level on Central Apnea
As an aside, it appears that I was mistaken.

AHI apparently includes ALL apneas, and that would necessarily include central. I had thought that it did not include CAs.

I did know that RDI is the determining factor for severity of condition. It seems that many have sleep studies where AHI and RDI are the same. That would mean that no RERA's were observed.
(This post was last modified: 06-23-2015 12:03 PM by tedburnsIII.)
06-23-2015 11:20 AM
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tedburnsIII Offline

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Machine: 3B RESmart APAP
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CPAP Pressure: 10 cm CPAP
CPAP Software: Other Software

Other Comments: Dx moderately severe OSA. Overnight pulse oximeter-CMS50D Plus

Sex: Male
Location: San Diego

Post: #48
RE: Influence of EPR-Level on Central Apnea
vsheline: Could you please explain this part of your equipment details:

CPAP Pressure: 15 EPAP, PS 4-10
(This post was last modified: 06-23-2015 11:36 AM by tedburnsIII.)
06-23-2015 11:31 AM
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PaytonA Offline
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Post: #49
RE: Influence of EPR-Level on Central Apnea
(06-23-2015 03:13 AM)vsheline Wrote:  Min EPAP was set to 8; Max EPAP was set to 18. Pressure Support was set to 4, so IPAP was always 4 higher than EPAP, making the range for IPAP be 12-22.

If the Max EPAP setting would have been 10 then the maximum to which EPAP could have gone would have been 10, and IPAP would have been 4 higher, 14, because for bi-level IPAP = EPAP + PS.

Please be patient with us, and take care,
--- Vaughn

Vaughn,

I am not sure about the Aircurve 10 but with my S9 VPAP Auto there is no max EPAP setting. The range settings are min EPAP and max IPAP.

Best Regards,

PaytonA
06-23-2015 11:39 AM
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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: #50
RE: Influence of EPR-Level on Central Apnea
(06-23-2015 11:31 AM)tedburnsIII Wrote:  vsheline: Could you please explain this part of your equipment details:

CPAP Pressure: 15 EPAP, PS 4-10

I use an early S9 ASV machine which offers two therapy modes, fixed-pressure CPAP mode and plain ASV mode. It does not also offer ASVAuto mode.

In plain ASV mode EPAP is manually adjustable between 4 to 15, and Pressure Support has settings for Min PS (which can be zero to 6) and for Max PS (which must be at least 5 higher than Min PS and can be as high as 15).

I usually set Min PS around 4 or 5, and Max PS around 10.

The machine starts out with EPAP 15 and IPAP 19, but whenever my Minute Volume (the volume of air inhaled/exhaled per minute) suddenly drops lower than 90% of my recent average Minute Volume (averaged over a few minutes, I think) the machine quickly (within a few seconds) automatically increases PS as much as needed to maintain at least 90% of my recent Minute Volume. By the time the PS gets as high as 10 the machine is doing for me all the work of breathing.

So, throughout the night my EPAP is fixed at 15 and my PS varies between around 4 or 5 up to 10, as needed. This means my IPAP varies from around 19 or 20 up to 25.

Newer ResMed ASV machines have ASVAuto mode and are able to also vary EPAP within a range, if desired.

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: 06-23-2015 10:07 PM by vsheline.)
06-23-2015 03:14 PM
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