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New on Bipap ASV, have a few questions
#31
RE: New on Bipap ASV, have a few questions
We have been trying to stay with your doctor's recommendation as much as possible. I'm going to suggest a night with a full default ASV setup as per thr ASV Titration guide that Sleeprider posted earlier.

so:
min EPAP 4
max EPAP 15
min PS 3
max PS 15

the purpose would be to do a full-on "trial" of ASV treatment.
ASV works by being allowed to use fairly high pressures WHEN NEEDED, thus the high max EPAP, and max PS.
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#32
RE: New on Bipap ASV, have a few questions
Read bonjour's comment carefully. The manufacturer intends the following uses for these machines:

ST (Spontaneous/Timed) Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions

ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)

This is important, and we can give you the documents that support this. If they try to swap you from ASV to ST, your condition(s) are not the intended use of that machine. If it was a mistake you got the right machine, then it's the best one they've made.

As far as using a full-range ASV setting trial, if you suffer from aerophagia, I think that might be too aggressive, and would argue to try resolving the positional apnea/chin-tucking first, and look at increasing pressure next.
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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#33
RE: New on Bipap ASV, have a few questions
Nothing to add says the guy on the ResMed ASV Auto with Mixed Apnea and COPD. I sincerely hope you make a way to keep this ASV.

Coffee
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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#34
RE: New on Bipap ASV, have a few questions
so I used the flatter pillow, and the eliminator under chin pillow, and the asv on full auto, and the results were disappointing.
well CA and obstructive were low (0.4) so that's good, but again Hypnoeas were out of control, this one is weird, I never had that issue on the bipap, a little but maybe a score of 3, not 15.

It seems timed breath and hypnoeas are going hand in hand is it possible the triggered breath are causing hypnoeas or causing those flags ?? 
Note: I set Backup  rate to 10, which might still be too high for me.
Also: I woke up around 2:20 with some aerophagia, but it was fairly mild, not too painful to go back to bed.

   
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#35
RE: New on Bipap ASV, have a few questions
First question is, are you reasonably comfortable with this pressure?

With your current settings with ASV variable EPAP, EPAP 5-15 and PS 3-15, you have opened up the capability of the ASV to treat events. CA and OA are not present, but hypopnea is abundant. I think we need to zoom in on these events to see what is going on. Hypopnea are incomplete apnea and represent a reduction in flow rate. Perhaps Fred has some additional ideas, but it would be helpful to take a look at how these events are happening. I suspect that the periods of hypopnea coincide with fewer breaths per minute, and it may be useful to look closer at this.

The use of a manual BPM setting might be improved with the Auto setting.
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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#36
RE: New on Bipap ASV, have a few questions
pressure was ok, didn't wake up from leaks, I did wake up bloated at 2:20, but it was not horrible.

I can send you the data file, or zoom in screenshot if you tell me what time slots you need.

and yeah might be good to set BPM to auto, the first day it was set to 0 (off) and my Hypnoea score was 1.33
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#37
RE: New on Bipap ASV, have a few questions
Agree SR, hypopneas are the issue now.
IMHO this is overall a better chart than your previous one. With the potential of losing this machine in a few days I wanted to jump on the chance to do this test.

2-3 minute zooms, drop AHI chart and Exp Time then add Minute Vent and tidal volume.
ignore everything prior to 2330 for now. randomly grab segments that include hypopneas near 0030, just after 0200, and 0430
also see where in your mask pressure you have a very thin clear spot such as around 2345 and 0040, I think, don't know, that they might be arousals so catch those too.
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#38
RE: New on Bipap ASV, have a few questions
I agree with Fred, and am glad to see him here working on this. Along with his concern for you losing this machine, I think we need to ask you if are aware of any pulmonary impairment such as COPD, Asthma, etc. Based on what we see of your respiratory volume here, it seems very unlikely, but it's a question that we have to ask.
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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#39
RE: New on Bipap ASV, have a few questions
Sounds like they d want me on the Bipap ST  :-/
---
According to your medical record, your prescription is for a BiPAP machine which does have a back up rate setting of 12. I have verified this by checking your prescription and by checking the documentation from our clinical director, Dr. <del>, who interpreted your sleep study.
The UW Medicine Sleep Center at Harborview manager, clinical director, and your sleep medicine provider have all been notified of this.
---

I'm not excited about this because when I tried those settings (6-9 with 12bpm) that was a very poor night (AHI close to 20), they want me to try that for 6 weeks ... I really don't think I can take 6 weeks of that and do my job.

>  any pulmonary impairment such as COPD, Asthma

Not that I know off, I did have asthma as a kid/teen but it was triggered by allergies (allergic to wheat dust among other things, grew up on  a farm, had bad attacks during harvest, took ventoline and even cortisone at times), however this mostly went away after puberty and while I still get congested from pollen and such I don't believe to have any pulmonary issues or asthma. I remember being noted as having a large lung capacity when I was tested, if that matters at all, but that was a very long time ago and don't remember the actual value. I play hockey regularly without problem and can run a 1/2 marathon, so I think my lung/heart feel fine (though that might not prove anything). Not taking any sort of drugs or medicines either.

> very thin clear spot such as around 2345 and 0040
Those might just have bee UI compression artifacts or such, I don't seem to see them once zoomed in, I included the screenshots anyway.

                   
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#40
RE: New on Bipap ASV, have a few questions
For reference here was the first night when t was set to 6-6 with no BPM set (0)

As you can see CA's where clearly not treated, but hypopnea where not much of an issue.


   
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