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New to Actually Posting - 2nd sleep study results (Need an ASV)
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vsheline Offline

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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: #21
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
(02-20-2016 07:49 PM)richb Wrote:  While your trying different settings you might want to try a night with your EPAP at 6 and IPAP at 8. Your machine will then have a lot more headroom to stimulate your breathing. These initial settings are also low enough that you will see a minimal amount of CO2 washout which triggers Central events.

Hi metsfan302,

Your PS was above 14 for at least 5% of the night. That seems high. I've read on ResMed site that normally PS of 10 is adequate to do for us all the work of breathing during what would have been a central apnea, if we have normal lung function. Do you know of any lung condition you may have, like perhaps a temporary infection or perhaps asthma or COPD?

If some of those apneas were obstructive, that would explain the high PS. Can you show us a close-up of the apneas which occurred around 0:15 or so, zoomed in until only 2 or 3 minutes fills the screen, with the Flow vertical scale zoomed-in to +/-80 Liter/minute?

However, Rich is right that there was no evidence of any obstructive events in the bilevel titration report, other than perhaps the fact that EPAP was raised. I think during bilevel titrations the technician usually is not supposed to increase EPAP unless obstructive apneas are seen, which the data says were not seen. So it seems a little strange that EPAP was raised in the absence of obstructive apneas.

Hence, I suppose, Rich's suggestion to try lower EPAP, and lower Min PS, to see if it helps or hurts.

However, in the bilevel titration a negligible amount of supine sleeping (flat on the back) occurred, and obstructive events are commonly much more prevalent when sleeping in supine position. Hence, I think it important to keep an eye on whether the apneas and hypopneas are central versus obstructive, since perhaps you might be rolling into the supine position while asleep.

If an apnea is obstructive, it may have no Flow even after PS adjusts itself high. If apneas or hypopneas are obstructive, they will tend to end abruptly with the Flow waveform showing sudden deep recovery breaths. Events which are central tend to end very smoothly as the Pressure waveform shows the PS gradually dropping lower.

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: 02-21-2016 01:10 PM by vsheline.)
02-20-2016 09:21 PM
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richb Online

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Machine: Resmed AirCurve 10 ASV
Mask Type: Nasal mask
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Post: #22
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
(02-20-2016 09:03 PM)Sleeprider Wrote:  It would be helpful to zoom in on the flow rate waveform during some of these events to really see where in the respiratory cycle the event is initiated.

This is a very important idea. We could get a much better idea of what to suggest by looking at the waveforms in question.

RichB
02-20-2016 09:43 PM
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DeepBreathing Offline
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Machine: Resmed S9 VPAP Adapt
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Post: #23
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
Quote:However, Rich is right that there was no evidence of any obstructive events in the bilevel titration report...

All those hypopneas were probably obstructive.

From the VPAP Adapt clinician manual:

Central sleep apnea detection (CSAD) is not active in ASVAuto and ASV modes. The ASV algorithm eliminates central apneas, provided the EPAP is sufficient to maintain an open airway. Therefore, any apneas reported by the device will be obstructive or indicative of a closed airway.

The OP is still getting a lot of closed airway events, which indicate to me that the EPAP is too low. By all means try reducing all pressures to see if the gentler approach works, but I think this might end up being one of those cases where it's necessary to raise pressure significantly. There are other issues going on here, I think. The elevated heart rate and high respiration rate may be caused by the apnea or may signify some underlying condition. But I think the OP's doc is probably right in trying to stabilise the apnea then look to the other conditions.

DeepBreathing
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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.
02-20-2016 10:31 PM
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richb Online

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

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Post: #24
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
(02-20-2016 10:31 PM)DeepBreathing Wrote:  
Quote:However, Rich is right that there was no evidence of any obstructive events in the bilevel titration report...

All those hypopneas were probably obstructive.

From the VPAP Adapt clinician manual:

Central sleep apnea detection (CSAD) is not active in ASVAuto and ASV modes. The ASV algorithm eliminates central apneas, provided the EPAP is sufficient to maintain an open airway. Therefore, any apneas reported by the device will be obstructive or indicative of a closed airway.

The OP is still getting a lot of closed airway events, which indicate to me that the EPAP is too low. By all means try reducing all pressures to see if the gentler approach works, but I think this might end up being one of those cases where it's necessary to raise pressure significantly. There are other issues going on here, I think. The elevated heart rate and high respiration rate may be caused by the apnea or may signify some underlying condition. But I think the OP's doc is probably right in trying to stabilise the apnea then look to the other conditions.

I think it would be valuable for the OP to try the lower settings and to post some waveforms. The OP would be doing an at home titration to find the optimal settings.

Rich
02-21-2016 07:40 AM
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metsfan302 Offline

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Machine: PR System One Auto-Cpap + Borrowing a Resmed S9 Adapt ASV
Mask Type: Nasal pillows
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CPAP Pressure: ps min 10 - max 15
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Post: #25
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
(02-20-2016 06:29 PM)DeepBreathing Wrote:  Does your machine have the ASV Auto mode? Alternatively can you give us the model number from the label on the back of the blower unit?


It is the 36007 - has no auto settings, seems pretty basic as far as whats avail for settings
02-21-2016 08:32 AM
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richb Online

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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: #26
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
(02-21-2016 08:32 AM)metsfan302 Wrote:  
(02-20-2016 06:29 PM)DeepBreathing Wrote:  Does your machine have the ASV Auto mode? Alternatively can you give us the model number from the label on the back of the blower unit?


It is the 36007 - has no auto settings, seems pretty basic as far as whats avail for settings

Your borrowed ASV machine is the one you need to try new setting on.

Rich
02-21-2016 08:43 AM
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metsfan302 Offline

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Machine: PR System One Auto-Cpap + Borrowing a Resmed S9 Adapt ASV
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10
Humidifier: yes
CPAP Pressure: ps min 10 - max 15
CPAP Software: SleepyHead

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Sex: Male
Location: Delaware

Post: #27
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
Going to Lower the settings, read prior posts and some posts that might happen today to see what I might want to/ should try adjusting it too.

As I am sure you guys are aware - Their are 3 settings on this 36007 S9 Vpap Adapt

EPAP -
Min PS -
Max PS -
Mask (can change based on what i am using)......

Also, I have a bin of diff masks I have collected over the few years even after giving alot of them away.

I use to only wear full face styles, but have taken a liking to Pillow Style masks - Airfit P10 my Fav so far.

That being said, is this an ok mask to use or are the pressures too high for this type of mask to use with this 2hand machine?

One more question, What ASV should I get? =
Once I do compleate this new study the sleep dr (said she has leeway with my DME with the brand of ASV she can order for me) .... She said she likes the Aircurve as far as bells and whistles etc but likes how to PR products report data to her - she said she does not have much exp at all with the new Dreamstation ASV if their is even one out? I do know there is a system one style of asv but isnt that pretty much outdated or dont worry about all that? I am going to be with machine for the next 5 or so years so I figure better get the best avail at this time?

Thanks so much for your time helping me out.

Should be getting scheduled for this third - ASV sleep study/tritration this week (am sure insurance will try to fight it with the dr), but she now has plenty of data she says to show its def needed.

(02-21-2016 08:43 AM)richb Wrote:  
(02-21-2016 08:32 AM)metsfan302 Wrote:  
(02-20-2016 06:29 PM)DeepBreathing Wrote:  Does your machine have the ASV Auto mode? Alternatively can you give us the model number from the label on the back of the blower unit?


It is the 36007 - has no auto settings, seems pretty basic as far as whats avail for settings

Your borrowed ASV machine is the one you need to try new setting on.

Rich

Thanks Rich, I have actually given away my ole System One auto cpap to someone in a diff group/forum that was in need. Figure it was not doing anything for me anyway
(This post was last modified: 02-21-2016 08:50 AM by metsfan302.)
02-21-2016 08:48 AM
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vsheline Offline

Advisory Members

Posts: 1,907
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: #28
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
(02-21-2016 08:48 AM)metsfan302 Wrote:  Going to Lower the settings, read prior posts and some posts that might happen today to see what I might want to/ should try adjusting it too.

Lowering EPAP is not a good idea if the apneas you are now having are obstructive.

All you need to do to find out whether the events were obstructive or central would be to zoom in and look at the Flow and Pressure waveforms. (My previous post explains what to look for.)

Since your Max Pressure Support setting has been very high (15), your ASV machine should be able to prevent all central apneas and central hypopneas unless excessive leaking was occurring at the time (which does not appear to have been happening, because the Leak waveform shows that Leaks were small).

So seems likely you are now having obstructive events, even though apparently there were no obstructive apneas during the bilevel titration (where you were sleeping only on your side).

If you are now having lots of obstructive apneas, presumably the difference is likely that you are not remaining on your side while asleep.

Quote:One more question, What ASV should I get? =
Once I do compleate this new study the sleep dr (said she has leeway with my DME with the brand of ASV she can order for me) .... She said she likes the Aircurve as far as bells and whistles etc but likes how to PR products report data to her - she said she does not have much exp at all with the new Dreamstation ASV if their is even one out? I do know there is a system one style of asv but isnt that pretty much outdated or dont worry about all that?

If settings for the 36007 cannot be found which are able to keep your AHI consistently below 5, then simply switching to the newest ResMed ASV is unlikely to be able to do any better. The main difference between the 36007 which you and I have versus the new AirCurve 10 ASV is the ASVAuto mode, which auto-adjusts EPAP to prevent obstructive events. Like manually adjusted EPAP on model 36007, ASVAuto mode on AirCurve 10 ASV does not allow EPAP to be adjusted higher than 15. Raising EPAP is the main way the machine prevents obstructve apneas. So, if it turns out that your apneas now are obstructive and an EPAP of 15 is not high enough to prevent your obstructive apneas, the AirCurve 10 ASV would not be able to prevent them either.

However, if you're now having obstructive apneas, presumably you can avoid them entirely simply by sleeping only on your side, as you did during the bilevel titration. (Unless the apneas were all incorrectly categorized during the bilevel titration, which may be possible but seems unlikely.)

The Philips Respironics ASV models are far more adjustable, allowing higher EPAP than 15 for example.

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: 02-21-2016 02:44 PM by vsheline.)
02-21-2016 02:00 PM
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metsfan302 Offline

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Posts: 27
Joined: Oct 2015

Machine: PR System One Auto-Cpap + Borrowing a Resmed S9 Adapt ASV
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10
Humidifier: yes
CPAP Pressure: ps min 10 - max 15
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Delaware

Post: #29
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
I must of misread a prior reply about someone mentioning maybe trying lower pressures etc....

Going to print this so its all infront in order etc.

I thought I had both servere obstructive and central apnea, but some are mentioning not seeing it on my reports, Ill try to look thru that again.

Again I am a noob when it comes to some of this.

So if an Auto ASV will not help what will?

Thanks again and srry for being noobish this is still really new to me
02-22-2016 06:46 AM
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metsfan302 Offline

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Posts: 27
Joined: Oct 2015

Machine: PR System One Auto-Cpap + Borrowing a Resmed S9 Adapt ASV
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10
Humidifier: yes
CPAP Pressure: ps min 10 - max 15
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Delaware

Post: #30
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
(02-20-2016 09:21 PM)vsheline Wrote:  
(02-20-2016 07:49 PM)richb Wrote:  While your trying different settings you might want to try a night with your EPAP at 6 and IPAP at 8. Your machine will then have a lot more headroom to stimulate your breathing. These initial settings are also low enough that you will see a minimal amount of CO2 washout which triggers Central events.

Do you know of any lung condition you may have, like perhaps a temporary infection or perhaps asthma or COPD?



Take care,
--- Vaughn

I do have Asthma and COPD.

I do take Proventil and Advair HFC for it.........

I have a Deviated Septum, have high blood pressure, am a shallow breather, Sleep on my side and enjoy long walks on the beach :-) srry had to insert a little humor or ill cry lol.

To keep with the openness of what might help others in helping me out with theropy/ paping.....

Due to a car accident in 03 - took alot of Opiate Pain Meds for 10 years (2 - 60mg time release morphine pills and 6 - 30mg oxycodone daily), and then added sniffing herion on top of it....... fast forward 4 years ago stopped all those by going to addiction counseling, and Methadone Liq everyday in the morning - I do take 85Mgs Methadone. I know their is a stigma about addicts and addiction but yea I just felt it was important to be open here.

My Reg family dr and my sleep dr are aware of all of the above.

MY first sleep study I was only on Herion at the time.
This sleep study regulated dosing of methadone.


I do have my orig sleep study but it does not show much but mild sleep apnea.

Hope I do not get bashed etc I know I have made mistakes in life but I am still a good guy and have pulled thru and am shining
(This post was last modified: 02-22-2016 07:00 AM by metsfan302.)
02-22-2016 06:58 AM
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