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Newbe with Complex Apnea - Best ASV to get?
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JJJ Offline

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Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Most recent: Wisp, Pilairo, Mirage Vista
Humidifier: ResMed S9 Autoset
CPAP Pressure: 17-20
CPAP Software: SleepyHead

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Sex: Male
Location: USA 97217

Post: #91
RE: Newbe with Complex Apnea - Best ASV to get?
(04-20-2013 12:11 PM)racprops Wrote:  OK I have my first report:
I had a reading of:
AHI 18.92
I take it a fair beginning??

It's a beginning. The good part is that you managed to use the machine for over six hours. That itself is a major accomplishment, so congratulations!

But the AHI is too high. You want to get it under 5. Don't kick yourself, though. It usually takes beginners several weeks of tweaking before they get things under control. In your case I wouldn't change any settings yet. Keep using it the way it is for at least a week or so - remember every night is unique. After a week or two you can see the trends.and then make a better decision what kinds of changes to make.

More importantly, how do you feel?
04-20-2013 02:09 PM
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racprops Offline

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Posts: 260
Joined: Mar 2013

Machine: Respironics DS960HS
Mask Type: Full face mask
Mask Make & Model: Respironics FitLife FFM
Humidifier: Respironics
CPAP Pressure: ????
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Phoenix AZ

Post: #92
RE: Newbe with Complex Apnea - Best ASV to get?
Fair...

I understand I need to get used to the machine...

Rich
04-20-2013 02:28 PM
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racprops Offline

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Posts: 260
Joined: Mar 2013

Machine: Respironics DS960HS
Mask Type: Full face mask
Mask Make & Model: Respironics FitLife FFM
Humidifier: Respironics
CPAP Pressure: ????
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Phoenix AZ

Post: #93
RE: Newbe with Complex Apnea - Best ASV to get?
Well I think I will have to override the Docs settings…

Using the ramp feature I am fine. In fact I have already reset it for a higher start pressure.

But once it reaches the Doctor’s prescribed 10cm full pressure I have many problems…first at times I seem to have trouble breathing, specially exhaling, I think the 10 cm is too high for me. I noted that I had a lot of clear air apneas the first night and as I have centrals DUE to CPAP, think the too high pressure is causing them.

Second at 10cm my mask keeps pulsing and leaking and waking me.

The ramp up feather is great and I can see how each pressure affects me.

At around 8cm I start having breathing problems, so I am thinking I will go with 7cm.

Last night was not as good as the first, I have some coughing and had to take the mask off a few times, and around 1.30 I fell asleep without it and lost a couple of hours without help.

Feedback?


Rich
04-21-2013 11:21 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: #94
RE: Newbe with Complex Apnea - Best ASV to get?
(04-21-2013 11:21 AM)racprops Wrote:  But once it reaches the Doctor’s prescribed 10cm full pressure I have many problems…first at times I seem to have trouble breathing, specially exhaling, I think the 10 cm is too high for me. I noted that I had a lot of clear air apneas the first night and as I have centrals DUE to CPAP, think the too high pressure is causing them.

Second at 10cm my mask keeps pulsing and leaking and waking me.

Hi racprops,

You have an adaptive servo ventilator machine (PRS1 BiPAP autoSV Advanced).

What were your machine's original settings for the min/max range of Exhalation Positive Airway Pressure (EPAPmin, EPAPmax), for the min/max range of Pressure Support (PSmin, PSmax), and for maximum Inhalation Positive Airway Pressure (IPAPmax).

With your new changes, what are your machine's new settings for the EPAPmin, EPAPmax, PSmin, PSmax and IPAPmax?

The EPAPmin is the EPAP pressure your machine ramps up to if no obstructive events are occurring. (I take it you have lowered EPAPmin to 7.)

I think the EPAPmax needs to be high enough to prevent all obstructive events, but not higher than 25 minus PSmax.
The PSmin helps you to inhale, and I think it should be high enough to make it comfortable to exhale.
I think the PSmax should be at least 10 cmH2O above EPAPmax, to allow the machine to adequately treat central apnea events.
I think IPAPmax should be at least EPAPmax plus PSmax.

Your machine should be preventing any central apnea events from occurring. I wonder if the central events which it is reporting include the times when central apneas would have occured except they were prevented from occuring?

If the central apnea events reported were actually all adequately treated/prevented by your machine, I think you can ignore them.

I think you will be able to see whether these central apnea events were adequately treated by looking closely at the Flow waveform during these events. I would zoom in until one or two minutes of the flow waveform fills the screen, so I can see every breath clearly. If SleepyHead does not give a plot of Flow then I would look at the plot of Exhaled Tidal Volume (Vte), if there is one.

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: 04-21-2013 05:51 PM by vsheline.)
04-21-2013 04:51 PM
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racprops Offline

Preferred Members-2

Posts: 260
Joined: Mar 2013

Machine: Respironics DS960HS
Mask Type: Full face mask
Mask Make & Model: Respironics FitLife FFM
Humidifier: Respironics
CPAP Pressure: ????
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Phoenix AZ

Post: #95
RE: Newbe with Complex Apnea - Best ASV to get?
Well:

Therapy Data Summary - All Data
Compliance Summary
4/18/2013 - 4/19/2013 (2 days)
Days with Device Usage 2 days
Days without Device Usage 0 days
Percent Days with Device Usage 100.0%
Cumulative Usage 9 hrs. 14 mins. 14 secs.
Maximum Usage (1 Day) 9 hrs. 13 mins. 17 secs.
Average Usage (All Days) 4 hrs. 37 mins. 7 secs.
Average Usage (Days Used) 4 hrs. 37 mins. 7 secs.
Minimum Usage (1 Day) 57 secs.
Percent of Days with Usage >= 4 Hours 50.0%
Percent of Days with Usage < 4 Hours 50.0%
Date Range
Total Blower Time 9 hrs. 14 mins. 14 secs.
BiPAP autoSV Advanced Summary
90% of the time device EPAP pressure was <= 10.1 cmH2O
Average Percent of Night in Periodic Breathing 11.7%
Average Time in Large Leak Per Day 30 secs.
Average Breath Rate 18.1 bpm
Average Minute Vent 8.6
Average AHI 21.6
Average Percent Night in Large Leak 0.2%
90% of the time device Pressure Support was <= 2.2 cmH2O
Average Pressure Support 1.1 cmH2O
Average EPAP 8.1 cmH2O
Settings
Min EPAP: 10.0
Max EPAP: 15.0
Min Pressure Support: 0.0
Max Pressure Support: 15.0
Max Pressure: 25.0
Flex Setting: 2
Backup Rate: Auto

Patient ID: 130420092833 Coyle, Richard

As I understand it this system: Machine: Respironics DS950HS

Mask Type: Full face mask
Mask Make & Model: Respironics FitLife FFM
Humidifier: Respironics
CPAP Pressure: none yet
CPAP Software: SleepyHead

Does report events even when it has handled them…

But I am looking for understanding the readouts.

Rich


PS I have not change anything
(This post was last modified: 04-21-2013 05:54 PM by racprops.)
04-21-2013 05:51 PM
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vsheline Offline

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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: #96
RE: Newbe with Complex Apnea - Best ASV to get?
(04-21-2013 05:51 PM)racprops Wrote:  4/18/2013 - 4/19/2013 (2 days)
...
90% of the time device EPAP pressure was <= 10.1 cmH2O
Average Percent of Night in Periodic Breathing 11.7%
Average Time in Large Leak Per Day 30 secs.
Average Breath Rate 18.1 bpm
Average Minute Vent 8.6
Average AHI 21.6
Average Percent Night in Large Leak 0.2%
90% of the time device Pressure Support was <= 2.2 cmH2O
Average Pressure Support 1.1 cmH2O
Average EPAP 8.1 cmH2O
Settings
Min EPAP: 10.0
Max EPAP: 15.0
Min Pressure Support: 0.0
Max Pressure Support: 15.0
Max Pressure: 25.0
Flex Setting: 2
Backup Rate: Auto
...

Does report events even when it has handled them…

But I am looking for understanding the readouts.

Hi Rich,

It would be very interesting if the PRS1 BiPAP autoSV Advanced does indeed report events even when it has adequately handled them. But how do we know this is the case?

From the statistics you have posted I don't see anything which would definitely contradict this, but it does not make sense to me because an apnea is defined as not breathing (or very shallow breathing) for at least 10 seconds, so if ventilation is being adequately maintained then I do not understand why Philips Respironics would be reporting these events.

For example, the ResMed S9 VPAP Adapt does not report any event which it has adequately handled/prevented, so my machine usually reports an AHI of zero.

I would look closely at the time plots of the breathing, and only if the Flow or expiration tidal Volume (Vte) is being adequately maintained during these central events would I conclude the machine is indeed adequately treating these central events even though it is also reporting them.

Regarding the statistics you posted:

If 90% of the time device EPAP pressure was <= 10.1 cmH2O then your EPAP pressure was pegged near the bottom at least 90% of the time, so I think 10 cmH2O is higher than needed. It would make sense to me to lower it to 7.

But I think your primary problem is your minimum Pressure Support is zero.

I think you would find it much easier to breathe out if your PSmin were raised to at least 2.

And, as you get used to having Pressure Support, you may find you prefer it to be 3 or higher. I have read that most people prefer PSmin somewhere between 2 and 6.

Because you have an adaptive servo ventilation machine, I think there should be no problem if you raise the PSmin to a more comfortable level.

I don't know if your machine limits how high PSmin can be set. As far as I know, it does not. But the ResMed S9 VPAP Adapt only allows the PSmin to be set between 0-6, so there may be medical reasons for not going too high.

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: 04-21-2013 06:55 PM by vsheline.)
04-21-2013 06:51 PM
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Sleepster Offline
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Machine: ResMed AirCurve10 VAuto
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Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #97
RE: Newbe with Complex Apnea - Best ASV to get?
(04-21-2013 06:51 PM)vsheline Wrote:  It would be very interesting if the PRS1 BiPAP autoSV Advanced does indeed report events even when it has adequately handled them. But how do we know this is the case?

No machine can report an event that hasn't occurred. The purpose of xPAP therapy is to prevent events!

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.
04-21-2013 08:34 PM
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racprops Offline

Preferred Members-2

Posts: 260
Joined: Mar 2013

Machine: Respironics DS960HS
Mask Type: Full face mask
Mask Make & Model: Respironics FitLife FFM
Humidifier: Respironics
CPAP Pressure: ????
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Phoenix AZ

Post: #98
RE: Newbe with Complex Apnea - Best ASV to get?
I was thinking that it would report the events and that it had controlled them.

That way you can see what is happening and how good it is working.

BUT As IT reports a high AHI I am not sure…

I will be calling Respironics tomorrow.

Rich

Thanks vhseline I have made that change.

Rich
(This post was last modified: 04-21-2013 09:08 PM by racprops.)
04-21-2013 09:07 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

Sex: Male
Location: California, USA

Post: #99
RE: Newbe with Complex Apnea - Best ASV to get?
(04-21-2013 04:51 PM)vsheline Wrote:  The PSmin helps you to inhale, and I think it should be high enough to make it comfortable to exhale.

In bi-level machines, Pressure Support (PS) is the difference between the low exhalation pressure (EPAP) and the high inhalation pressure (IPAP). The bigger this difference is, the easier it is to inhale and exhale.

EPAP + PS = IPAP

During inhalation PS boosts the pressure, helping us to breathe in.

During exhalation PS drops back to zero, reducing the pressure, and the lower pressure makes it more comfortable to exhale.

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: 04-21-2013 09:23 PM by vsheline.)
04-21-2013 09:10 PM
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Sleepster Offline
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Moderators

Posts: 4,995
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #100
RE: Newbe with Complex Apnea - Best ASV to get?
(04-21-2013 09:07 PM)racprops Wrote:  I was thinking that it would report the events and that it had controlled them.

How does it "control" an event? In the case of an obstructive apnea or a hypopnea it supplies enough pressure to open a collapsed, or partially collapsed, airway so that you can breathe. The machine has a flow rate sensor so it knows by how much you're breathing. If you're not breathing enough it scores an event, if you are it doesn't.

In the case of a central apnea all the machine knows is that you're not breathing enough AND your airway is not collapsed.

Again, it doesn't know any more than that, so it either scores an event or it doesn't. If it prevents an event, then by definition that means the event didn't occur and it can't score it.

An xPAP machine is just a fan blowing air into a hose. Yes, there are bells and whistles that can make it a very sophisticated machine blowing air into a hose, but when it comes down to it, that's really all it is.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.
04-21-2013 09:33 PM
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