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Newbe with Complex Apnea - Best ASV to get?
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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: #101
RE: Newbe with Complex Apnea - Best ASV to get?
I was told by the Tech at Respironics that in the beginning of a event the machine sends out a air pulse and reads it for any back pressure or none: Back pressure is a obstruction and no back pressure is recorded as a Open, it then ramps up and pushes air to make me breath.

If I got that info correct then it could show events and their type and then show it has taken care of it..

I will call and find out.

Rich
04-21-2013 10:31 PM
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Sleepster Offline
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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: #102
RE: Newbe with Complex Apnea - Best ASV to get?
(04-21-2013 10:31 PM)racprops Wrote:  I was told by the Tech at Respironics that in the beginning of a event the machine sends out a air pulse and reads it for any back pressure or none: Back pressure is a obstruction and no back pressure is recorded as a Open, it then ramps up and pushes air to make me breath.

That's basically right. The pressure pulses are used to determine if the event is a clear-airway apnea (CA) or an obstructed-airway apnea (OA).

Quote:If I got that info correct then it could show events and their type and then show it has taken care of it.

The machine can determine to what extent your breathing was reduced, how long the reduction lasted, and whether your airway was clear or obstructed during that reduction.

If the reduction in breathing is significant and lasts for 10 seconds or more it scores it as an event.

If indeed the machine can respond and prevent the reduction in breathing from lasting ten seconds, then it will not score it as an event.

Events that score are counted up, divided by the total number of hours of use, and reported as the AHI. (Those events can even be separated as to their type and used to calculate the separate indices that are added together to get the AHI.)

You can yourself look at the graphs of flow rate versus time (sometimes called the wave forms) and see that your breathing is often reduced for less than 10 seconds, but that could be just normal breathing! It's not clinically significant. You can see when the pressure pulses were sent. You can see every breath you took while you were sleeping, and you can see the natural variations in the frequency of your breathing and the amplitude of the air flow. But you'll never know how many times you would've stopped breathing had the xPAP machine not been connected to your body.

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 10:54 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: #103
RE: Newbe with Complex Apnea - Best ASV to get?
Hi racprops,

By the way, I suspect that sleeping on your stomach might make it harder for your machine to adequately treat your central apneas, because it might be more difficult to inflate the lungs when the weight of the back is on top of the lungs. So, if you have been sleeping on your stomach, you might want to try sleeping on your side or back, to see if this reduces your CAI.


(04-21-2013 09:33 PM)Sleepster Wrote:  How does it "control" an event?

The machine used by racprops is an ASV type machine which acts like an APAP machine to prevent obstructive apneas, and, in addition, during central events, steps in during each missing breath to push air into his lungs and then let the air out of his lungs, keeping him ventilated. (A standard APAP unit would just sit there and do nothing during central apneas.)

I suppose it may be possible that whenever the machine needs to do this (whenever it needs to breathe for him) for at least 10 seconds in a row, a central apnea event is being reported. But I suspect that, instead, the reported central events are apneas which the machine was unable to adequately prevent.

I assume SleepyHead could be used to look at the plots of exhalation tidal Volume (Vte) to see how low this is falling during these central events. During central events I think the PRS1 autoSV Advanced unit tries to maintain 95% of the previous amount of Vte.

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 11:25 PM by vsheline.)
04-21-2013 11:20 PM
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Sleepster Offline
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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: #104
RE: Newbe with Complex Apnea - Best ASV to get?
(04-21-2013 11:20 PM)vsheline Wrote:  But I suspect that, instead, the reported central events are apneas which the machine was unable to adequately prevent.

I assume SleepyHead could be used to look at the plots of exhalation tidal Volume (Vte) to see how low this is falling during these central events.

I think you're right.

SleepyHead will show you the pressure pulses so you can confirm that the machine was trying to do something to prevent the event.

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.
04-22-2013 12:34 AM
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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: #105
RE: Newbe with Complex Apnea - Best ASV to get?
Thanks guys for your follow up inputs.

Something interesting has happened: I WOKE IT UP!!!

The first two nights the machine seemed to playing at it.

Tonight it is now running more like the machine used on me in the second sleep study.

I made two changes, I set the low EPAP Min. pressure to 7 and the PS min to 2.

I had found that it seemed like I was not getting enough air on 4/5 and I like 7.

BUT now when I inhale it really flows and pushes up the face mask, the mask is doing push ups with every breath..taking some getting used to that, it did not seem to do as much earlier.

Also if I skip a breath it really pumps up, I had to tighten the mask as it was causing a leak.

I had not felt the action of the machine dealing with a non breath event until now.

Comparing the first two days it was like it was in low gear, now it is in top gear.

All of this must be changing the PS min from 0 to 2 as It was running on the ramp feature from 4 up to 10 and was not reacting like this. Nor was I feeling it even when it finish the ramp up feature.

Interesting...

Rich

PS well I am going back under the mask and try to sleep all night...wish me luck.
(This post was last modified: 04-22-2013 12:55 AM by racprops.)
04-22-2013 12:45 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: #106
RE: Newbe with Complex Apnea - Best ASV to get?
(04-22-2013 12:45 AM)racprops Wrote:  I had not felt the action of the machine dealing with a non breath event until now.

Comparing the first two days it was like it was in low gear, now it is in top gear.

All of this must be changing the PS min from 0 to 2


Hi Rich,

Interesting. Seems like a software bug.

Or, maybe just a weak spot in their algorithm. The statistics you posted earlier included "Average Pressure Support 1.1 cmH2O" so the unit had been trying to treat the central events to at least a small degree.

Maybe your breathing needs some Pressure Support just to get your exhalation tidal Volume (Vte) high enough to keep you well-ventilated before your central apneas start. Unless the Vte was high enough to start with, maybe maintaining 95% of an inadequate Vte would not be adequate to adequately ventilate you.

Good Luck tonight!

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: 04-22-2013 02:43 AM by vsheline.)
04-22-2013 01:24 AM
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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: #107
RE: Newbe with Complex Apnea - Best ASV to get?
I am beginning to fear something maybe wrong.

I found I could not get to sleep with the mask doing pushups and reset the PS min to 2 back to 0.

That lowered the amount of pushups or how hard they are BUT not the seemly unprovoked pressure run up.

It seemed to just doing it with no cause, I sat and watch the readout go up and down 7, 7.5, 7, 8, 7,9, 7 and then 12...

I fear I may have damaged some of the sensors as I had a surprise coughing fit and I could not unmask in time.

I have not read anything warning not to cough with the mask on but it has been acting up every sense.

I am trying a hard reboot, I pulled the plug and will power it back up when I am ready to try again.

Drat...drat..

Well here I go again.

Good night.

Rich
04-22-2013 02:43 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: #108
RE: Newbe with Complex Apnea - Best ASV to get?
(04-22-2013 02:43 AM)racprops Wrote:  I found I could not get to sleep with the mask doing pushups and reset the PS min to 2 back to 0.

That lowered the amount of pushups or how hard they are BUT not the seemly unprovoked pressure run up.

It seemed to just doing it with no cause, I sat and watch the readout go up and down 7, 7.5, 7, 8, 7,9, 7 and then 12...

I fear I may have damaged some of the sensors as I had a surprise coughing fit and I could not unmask in time.

I think it is unlikely coughing very hard could damage the pressure or flow sensors, but maybe. The unit is under warrantee and you could ask to have it checked/exchanged.

The mask doing push-ups is normal for bi-level machines, especially with your model of mask, which has a huge surface area inside the mask. We get used to it over time. I have had pretty good results from the ResMed Quattro FX mask with either RemZzzs large full face mask liners or ResMed Gecko nasal pad (to help stop leaks near nose/eyes).

I suggest trying to get used to some amount of minimum Pressure Support (PSmin), even if only 0.5 or 1.0 cmH2O, and then working your way higher slowly, little by little each few days.

Since 90% of the time device EPAP pressure was <= 10.1 cmH2O you might want to raise EPAPmin to 9 and lower EPAPmax to 11 until you get used to the varying EPAP pressure. A higher PSmin will make it easier to tolerate a higher EPAPmin.

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: 04-22-2013 11:44 AM by vsheline.)
04-22-2013 03:39 AM
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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: #109
RE: Newbe with Complex Apnea - Best ASV to get?
Thanks I will try .5 on PS Min, and your other suggestions.

And OK This will be harder than I thought and Hoped.

Got one sleep cycle in: a hour and 1/2.

Will reset and try again.

Rich
04-22-2013 05:23 AM
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Sleepster Offline
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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: #110
RE: Newbe with Complex Apnea - Best ASV to get?
(04-22-2013 12:45 AM)racprops Wrote:  I made two changes, I set the low EPAP Min. pressure to 7 and the PS min to 2.

For what it's worth, I think it's a mistake to make these changes this early in your treatment unless you've already discussed the issues you're having with your medical providers and are getting nowhere.

In order to evaluate the effectiveness of your treatment you need several nights of data collected with the machine at the same settings. When you change the settings you interfere with the collection of that data and with your treatment.

This is especially true with new patients as your body is in a process of adapting to the therapy and it's more difficult for it to adapt to changing conditions.

Just my 2 cents worth.

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.
04-22-2013 11:51 AM
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