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OSCAR screenshot: one night with new mask
#31
RE: OSCAR screenshot: one night with new mask
Thanks for your input.
 
I have been on the case today, ordering a new mask.

Are you saying the EPAP is too low per se, or likely because of leaks?
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#32
RE: OSCAR screenshot: one night with new mask
Increasing EPAP pressure is the accepted practice to overcome hypopneas and OAs. Philips machine are known to be slow to respond these types of events. Since you are on an advanced model, I'm not certain as to how it is supposed to react to these types of conditions.
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#33
RE: OSCAR screenshot: one night with new mask
This screenshot does what the title of the thread that I originally started says. I bit the bullet and tried a different mask,  the Wisp.

I cannot see that I feel any better but I do not feel significantly worse either. So I will persevere. 

I have been told that there was no point seeking advice until I sorted out the leaks, which this mask very much seems to have done. And I think I may improve them further with more wear time.

I would really value any input on last night's chart, posted below. What else can I do here? Do I need to change the pressures?      

This screenshot does what the title of the thread that I originally started says. I bit the bullet and tried a different mask,  the Wisp.


I cannot see that I feel any better but I do not feel significantly worse either. So I will persevere. 

I have been told that there was no point seeking advice until I sorted out the leaks, which this mask very much seems to have done. And I think I may improve them further with more wear time.

I would really value any input on last night's chart, posted below. What else can I do here? Do I need to change the pressures?      


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#34
RE: OSCAR screenshot: one night with new mask
Chalkie, I'd like you to try a change in settings. Let's move the breath rate from 8 to 10. I'd like to review what brought you to ST treatment in terms of whether there are central or obstructive apnea and what conditions cause such a low breath rate. I eally think you may need a more sophisticated machine like VPAP, iVAP or ASV, but I don't recall your history.

The rationale for increasing the breath rate is that with a breath rate at 8, that is a duty cycle of 7.5 seconds which is very close to the flagging of an apnea at 10 seconds. It is clear from your chart that spontaneous breath effort is closer to 12-13 BPM, and I think this is just set too low. You can see the variation in your respiration rate, also affects tidal volume, thus the apnea and hypopnea. The other possibility that we have hit over and over in this thread is the chin-tucking possibility. Have you ever tried a soft cervical collar?
Sleeprider
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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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#35
RE: OSCAR screenshot: one night with new mask
Hi Sleeprider

And thanks for your reply. It sounds a bit disturbing that my breath rate is so low. Does that mean the machine is actually working against me and artificially suppressing my breathing? Could you please clarify how I would increase it to 10? All I have ever changed on the settings is the pressures.

Re what brought me to ST treatment, a sleep study identified that I have complex sleep apnoea, with centrals as well as apneas and hypopneas. I have been using this machine for over 10 years now.

I have meanwhile been using an SCC for some months now, so hopefully any possible chin tucking issue is taken care of.
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#36
RE: OSCAR screenshot: one night with new mask
You will do much better with ASV. Ask your consultant to consider it. It is a far more comfortable and effective therapy for individuals with complex sleep apnea. The Resmed Aircurve 10 ASV or CS Pacewave is what you want to request. Those machine treat your obstructive apnea by maintaining an EPAP pressure that holds your airway patent against obstructive apnea. Unlike your ST, the pressure support is not constant, but "adaptive" to your needs. A comfortable low pressure support, typically 3-cm is used for comfort, and the machine can then add additional pressure support as needed to maintain your respiration rate and volume. The machine targets a consistent minute vent, by remembering targeting your natural breathing rate and volume from the last minute and a half, and targeting that. As you can see, the ST makes a mess of it because, unlike you, it simply works on a clock and makes every breath the same.

The ST by supplying the same pressure and pressure support, breath after breath actually makes complex apnea worse. This technology is actually intended for individuals with pulmonary diseases like COPD, thoracic neuromuscular disorders and obesity hypoventilation. It is frequently mistakenly used for central and complex apnea where ASV is the more appropriate therapy, and it usually fails as it has in your case. Please read the Resmed Clinical Titration Protocol https://document.resmed.com/documents/pr...er_eng.pdf This document clearly describes the intended uses for its various machines, and you need to focus on the differences between ST and ASV. Ask any questions.

Your machine does suppress your spontaneous respiration rate because it consistently flushes the CO2 from your system resulting in hypocapnea. Since a complex interaction of CO2 and blood chemistry drives your respiration, this condition results in a lack of respiratory drive. With a backup rate of 8 per minute, that is too low for you, and you need to increase the backup rate so that a breath is triggered more frequently. The ultimate solution is to move to ASV, but for now this is going to help a bit. Please discuss obtaining ASV from your NHS consultant as soon as possible. We have many cases of U.K. citizens having experienced this. This is a recent thread concerning a pediatric case of complex apnea in Ireland that we resolved. Please read it because this poor girl had the same problems you are experiencing, and ended up with an AHI less than 1 per hour with ASV using the Resmed CS Pacewave http://www.apneaboard.com/forums/Thread-...ight=apnea
Sleeprider
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____________________________________________
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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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#37
RE: OSCAR screenshot: one night with new mask
Thank you Sleeprider, that is very enlightening.

This is not the first time that I have been told I need ASV. I last attempted to obtain one nearly two years ago and turned up at the clinic fully expecting to receive it but was given the Respironics A30, which I understand is an AVAPS.

There was a Respironics rep present at the clinic and he took a long time optimising it for me, and insisted that it did the same as an ASV. I never could adapt to the machine and gave it back to the clinic in the end. That was a year ago, when of course the pandemic intervened and things have stalled. However, I have made a new appointment to see the sleep nurse, when I will be asking for an ASV machine.

I expect to get the same answer as before, i.e. that the local Health Trust does not supply them ordinarily and that a special application would have to be made. If so, I will request that. I may have to wait a bit because of the pandemic, but so be it. If the Trust really won't supply, I will have to start thinking about buying an ASV second hand, but I hope it won't come to that.

I would expect that they would want to supply a Respiromcis ASV machine if they do give me one, but if they're making special dispensation I guess there may be other options.

Concerning adjusting the Breath Rate, I can see a setting "BPM" which I am guessing means Breaths Per Minute" is set to 8. I would be grateful if someone could confirm that this is indeed the setting I should be adjusting. I want to get this right. Smile
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#38
RE: OSCAR screenshot: one night with new mask
The titration protocol I linked to describes iVAPS, which unlike your ST has adaptive pressure support, but it doesn't change quickly on a breath by breath basis. Read it's intended use, and central apnea with overlap syndrome (COPD etc) is a possibility, but ASV is still the answer. For some reason your Health Trust seems very wedded to Philips Respironics. Try to get Resmed, and try to get the right one. I gave you everything you need to know to create an argument and advocate for yourself. You need to read and learn.

The breath rate is what needs to be adjusted. It should be set to your normal breathing rate minus 2 or 3. If your breath rate is 15/minute then 12 or 13 is appropriate. Breaths per minute is abbreviated BPM
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: OSCAR screenshot: one night with new mask
Here is a screenshot of OSCAR data with a new BPM setting of 10.

I would be interested to know the impact, if any, of this.

   
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#40
RE: OSCAR screenshot: one night with new mask
No observable improvement. I think the only thing you can do other than get the right machine for your condition, is to start using a soft cervical collar and hopefully reduce the obstructive component of your apnea. You have central or complex apnea and are simply on the wrong therapy. This is according to the manufacturer:

ST and iVAPS is suitable for adults with respiratory insufficiency. Of those technologies, ST is fixed pressure and iVAPS is an intelleigent Volume Assured Pressure Support.
It is ideal for patients whose condition is likely to change and is characterized by hypoventilation (day/night hypercapnia)
Patient conditions may include:
• Neuromuscular disease and restrictive conditions – iVAPS can maintain stable ventilation when respiratory effort fluctuates1
• Obesity hypoventilation – Unlike standard Pressure Support therapy, iVAPS can compensate for changes in respiratory mechanics, such as during nocturnal changes in the patient’s body position1
• Chronic obstructive pulmonary disease – iVAPS may reduce the risk of hyperinflation associated with increased respiratory rate and can compensate for changes in a patient’s chronic airflow limitation

ASV provides demonstrated results across the spectrum of central breathing disorders including:
• Periodic breathing, both normocapnic and hypocapnic
• Other forms of central and concomitant obstructive events1 (mixed sleep apnea)
• Complex sleep apnea (CompSA)2ResMed’s ASV should also be considered for central sleep apnea (CSA) and ataxic breathing, which is sometimes seen in patients on opioids,3 and neurological patients .

Your therapy will continue to FAIL as long as you tolerate your doctor's incompetence in continuing this inappropriate therapy direction. Please do what you must to change your therapy to ASV. If you chose to move to ASV by paying out-of-pocket you would not be the first one in the U.K. NHS that made the decision to get therapy instead of wait for the system to catch up with their needs. You will never achieve acceptable results with that ST machine.
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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