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New User Problem with BiPAP AVAPS - Part 1
#1
After some years of BiPAP therapy, my AHI's seemed to gradually be increasing to totals in the 20's, with about twice as many C's as OA's. I finally had a follow-up study and recommendations to try an AVAPS machine for complex apnea. I got a PR System One BiPAP AVAPS and have been using it now for several nights. I will include my several SleepyHead summaries that prompt this note.

My new prescription was for AVAPS, PC mode, tidal volume 800, back-up rate 12, IPAP max 25, IPAP min 7, EPAP 10. (Wondered if IPAP min & EPAP might have been transposed, as machine won’t accept IPAP less than EPAP?) I used the new AVAPS machine for the first time 4 Oct 2016. Subjectively I felt great, with comfortable breathing all night. Imagine my surprise when I ran the data and found my total AHI was 45!

[attachment=2889]

Next night Oct 5, 2016, was essentially same:

[attachment=2889]

Due to attachment size limits, I'll have to make a Part 2 to be able to send two more nights' data. Don't know if that is kosher - guess I'll find out!
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#2
New User Problem with BiPAP AVAPS - Part 2

I find the 200 newbie lock remains, so I;' just try to summarize data.

On 6 Oct 2016, I tried increasing my pressures a bit with AHI 32, OA 4,CA 9, hypopnea 19.

Last night, 7 Oct 2016, I increased the pressures to basically what they had been on my old BiPAP AUTO, with what seems to be dramatic decrease in my OA’s but still high CA’s and higher hypopneas. Total AHI 38, OA 1, CA 15, hypopnea 22.


I get basically the same results from SleepyHead and my Encore Basic.

I don’t understand why the AVAPS doesn’t work its magic and stop the CA’s, nor why now my events seem to be mostly hypopneas. Or is that an improvement? I’m afraid to play around with changing other settings (breaths/min, mode, etc.) without adult supervision.


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#3
I would like to help but I have no understanding of how AVAPS are supposed to work. Your charts do not make sense to me. Hopefully someone who has knowledge of AVAPS machines will chime in.

I am trying to get more information on AVAPS machines. Will get back to you if and when.


Best Regards,

PaytonA
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#4
jmayer, you can post unlimited images linked to images hosted elsewhere. This tutorial explains how to do it https://sleep.tnet.com/reference/tips/imgur

Also, it would help if you would include the events chart with the Flow, leak rate, snores, flow limits. This article explains how to organize the data https://sleep.tnet.com/resources/sleepyhead/shorganize

My takeaway from the information you posted is, you are having far too many CA events, and OA is also very high. In spite of this you have a remarkable tidal volume. I'd like more details on how your machine is currently setup. If you could press the ramp button and control knob at the same time, that will enter clinical settings. Rotate the control knob to settings, and press once and you will be able to scroll through the settings. I'd like you to record what you see and post that back. In addition, I'd like to know why you were setup with AVAPS (health conditions) and whether you have tried other forms of CPAP previously and if so, what your results were.
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#5
Thanks for the reply Sleeprider. I tried to post the Imgur files but got this error message:

Please correct the following errors before continuing:
• You cannot post clickable links to this forum threads and posts. Minimum post count is 4 posts. But your post count is just 3 posts.
• You are not allowed to post links in this forum.
• You are not allowed to post images in this forum.

And durned if I can find Snore or Flow Limits - seems they have disappeared from my SleepyHead chart list??

So in lieu of more charts will try to summarize.

I started with BiPAP (PR Series M machine) 7 years ago and about 4 years ago changed to System One BiPAP Auto. My pressures were always high, with 25/20 recommended "or as tolerated." I usually had to cheat a bit and dial back to c. 18-20/14-16 range. Even then I was having about half my events labelled CA's, and AHI's on a good night reached single digits. Nevertheless, I felt much better than before RX started. My sleep physician then did not think the machine could accurately distinguish CA's from OA's and recommended staying with fixed BIPAP. My AHI's gradually seemed to increase to usually well into the 20's with majority CA's and my sleepy days returned. Finally had the follow-up study and the AVAPS recommendation.

I confess, I futzed with the settings a bit, and now they are as follows: AVAPS, PC mode, Tidal Volume 750 (I am 6ft 3in and far, far in excess of my ideal weight), back up rate 14, IPAP max 25, IPAP min 18, EPAP 14. I am reluctant to do more without adult supervision. I can't get an appointment with my sleep doc until mid-November, although I did send him a note and request for interim suggestions.
Here are the screenshots. First two days at original script setting.

4 Oct 16
5 Oct 116
Then I upped the pressure a bit:
6 Oct 16
7 Oct 6
8 Oct 16

My understanding (??) was that the AVAPS was to deal with the CA's in addition to the OA's. To my knowledge I have no new health problems. I have well controlled hypertension and morbid (I prefer to say pre-morbid) obesity.
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#6
4 posts is the magic number...should work next time.

The machine is achieving the tidal volume target using pressure control (PC) mode. What we won't know until we look at details of the flow wave form, is what is going on with all these events. You should now be able to post attachments and links.

I'm not very familiar with AVAPS machines, and will rely on this titration protocol (pages 18+) in looking at ideas for you to use. https://www.sleepapnea.com/downloads/100...fGuide.pdf Really, with the number of events going on, your doctor should be in the conversation, but I think we can do some work to let you converse with your doctor and verify if the events are real. We will want to do this by zooming in on the events to see exactly what is going on.
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#7
Thanks for the link Sleeprider. I'll try to study it.

I'll see if I can post the missing data-days.

4 Oct 16
[Image: UuB0pBLl.png]
5 Oct 16
[Image: VRUPX6Dl.png]
6 Oct 16
[Image: 08GSZeUl.png]
7 Oct 16
[Image: JAqj1ill.png]
8 Oct 6
[Image: FpqRZRgl.png]
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#8
Dude! That's a mess! Good job on the graphs though. I can't figure out why you're not on a ASV machine. This is nearly all central apena. Maybe you could ask your doctor that question.

Does your machine have an AE mode?
Verify you do not have COPD, asthma or obesity hypoventilation that you are aware of?
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#9
Sleeprider,

I am not sure that I understand the charts. The respiratory rate chart looks like a normal PR pressure chart with the spikes where it is checking for better pressure, but the chart is titled respiratory rate. Flow rate chart also looks weird to me but maybe just because this is the first AVAPS chart that I have seen. Just my impression.

Best Regards,

PaytonA
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#10
The respiration rate chart looks correct and shows he varied between 14 and 19 BPM. I would guess from this that his BPM backup rate is set at 14.

The PRS1 AVAPS only provides a summarized view of the flow rate, so we don't get a breath by breath account of what happened. Unfortunately, we won't be able to use that data to see the apneas that are reported. I'm not quite sure what use that chart could be since it doesn't show the inhale and exhale phase of flow. The pressure chart shows a nearly constant EPAP pressure of 14.5-15.0 while IPAP varies widely. Again, these don't appear to be responding on a breath by breath basis which is why I asked about the AE mode which is supposed to auto-titrate. The machine is using pressure to maintain his 750 mL tidal volume with no regard to events or other problems. I think he is setup for a COPD type patient, and is not getting any treatment for complex central apnea.
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