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[Pressure] Bipap ST to Bipap Auto sv advanced pressure settings
#1
I have a Bipap St I have been using for about 3 years now..I have known I was misdiagnosed/got a bad sleep titration for most of that...had a AHI of 24 for the study...AHI is still 20 with the Bipap....DR quack said Bipap completely cured my complex apnea for the sleep study....NP finally told me there was only 2 hours of data for my study where I registered as asleep and it was light sleep.....I will never go to that Dr again...my insurance wont pay for another sleep study for a few more years...wont cover much of it then when it finally does either..took me a year to pay off the first one..and that was with better ins so another sleep study isnt in the cards for me any time soon.

Long story short..have done research and I am sure a Bipap ASV was supposed to be my machine to begin with..so I bought one...it will arrive in a few days....Respironics System One BIPAP Auto SV Advanced DS950

..I have seen the titration page on phillips system one website so I know what it says are the basic settings to start with...

But knowing what the prescribed setting on the Bipap St was...does anyone have advice on where I should start the pressure and other settings on it based on the settings below as a starting point?....

Any help or advice will be greatly appreciated..BUT for those of who are dying to lecture me about the evils of self titration? Your not going to talk me out of trying to finally help myself after 3 years of waking up tired and with headaches....so please..if you have nothing constructive to add..please move on and help someone else instead...thanks

(13/17 with a rate of 12bpm)
I don't believe anything I hear and only half of what I see
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#2
Basically I am confused with the options of the Auto sv...any advice on what i should start out with on the options below when my present bipap setting is epap 13..ipap 17?

max pressure ?
EPAP min ?
epap max ?
Ps min ?
ps max ?

any advice will be greatly appreciated..
surely someone in here can at least help get me started in the right direction?
I don't believe anything I hear and only half of what I see
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#3
Stay tuned spdklls99 - and welcome to Apnea Board!

We have a few ASV users around here... might be a little while before they see your post here... those folks know a bit more about the proper way to set up the machines than I do, so I'm hoping they'll respond soon.

Coffee
SuperSleeper
Apnea Board Administrator
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.



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#4
Hi spdklls99,
WELCOME! to the forum.!
Hang in there, someone who knows the ins & outs of the ASV machines will be able to help you.
Edit: I wouldn't think of talking you out of self-titration because I believe, with careful study, and lots of inquiry about what you don't understand, you can do it.
Good luck to you on your self-titration and keep us posted as you go along.
trish6hundred
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#5
(06-17-2013, 11:39 PM)spdklls99 Wrote: I have a Bipap St I have been using for about 3 years now.
...
(13/17 with a rate of 12bpm)

(06-18-2013, 01:44 AM)spdklls99 Wrote: Basically I am confused with the options of the Auto sv...any advice on what i should start out with on the options below when my present bipap setting is epap 13..ipap 17?

max pressure ?
EPAP min ?
epap max ?
Ps min ?
ps max ?

Hi spdklls99, welcome to the forum!

I strongly recommend installing the latest version of SleepyHead and starting to become acquainted with the data reported by your BiPAP ST, and later with your data from the new DS950 of course. Otherwise you will be flying blind and mostly unable to see issues or optimize your treatment.

The hardest thing to control will be unintentional mask leak, because the machine will need to raise the inhale pressure as high as needed (probably somewhere in the range 20-25 cmH2O) to keep you well ventilated when Complex Sleep Apnea causes you to stop trying to breathe. The high inhale pressures (which are necessary for ASV operation) make leaks more troublesome.

What masks have you tried so far?

Suggested initial settings for the DS950:

Max Pressure: 25 (should be at least 10 higher than EPAP Max, so that the Pressure Support can go as high as at least 10 during central events, even when EPAP gets max'ed out)

EPAP Min: 10 (or perhaps as high as 13 like your BiPAP ST settings but I suggest 10 in order to lower the pressure and the machine will automatically adjust higher when needed)

EPAP Max: 15 (or perhaps as low as 13 like your BiPAP ST settings - will need to monitor data from the DS950 to see whether the EPAP is sometimes max'ing out or can be lowered)

PS Min: 4 like your BiPAP ST settings, or higher if more comfortable, or higher if data shows your Tidal Volume (volume of air breathed in or out during one breath) sometimes very slowly drifts very low without machine responding, leading to arousals. The PS is always the difference between inhale (IPAP) and exhale (EPAP). If you stop breathing the ASV machine will immediately increase PS to keep you well ventilated.

Pressure Support Max (PS Max): 15 (should be at very least 10).

Backup Rate: 12 Breaths Per Minute (or perhaps Auto, but I suggest 12 initially, as found during your BiPAP titration)

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.
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#6
(06-17-2013, 11:39 PM)spdklls99 Wrote: Any help or advice will be greatly appreciated..BUT for those of who are dying to lecture me about the evils of self titration? Your not going to talk me out of trying to finally help myself after 3 years of waking up tired and with headaches....so please..if you have nothing constructive to add..please move on and help someone else instead...thanks

I don't think anyone here is going to try talking you out of trying to help yourself. However, I will join with others in STRONGLY suggesting that you monitor your efforts in detail using either SleepyHead or EncoreViewer. SleepyHead is a free 3rd party download; EncoreViewer must be purchased from Philips-Respironics. Both display essentially the same information.

From personal experience, I can tell you that the summary information the machine gives you through its display (ie. not using software to read the telemetry) can be misleading and indicate that there is a problem when there really isn't, or that there isn't a problem when there really is.

Without looking at the detailed data, you are basically just playing Marco Polo.
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#7
thanks guys and yeah I already use encore for the bypap st cause sleepyhead doesn't work with it ....and I've already downloaded sleepyhead for when the Auto sv advance gets here ...and I've tried just about every mask out there from the hybrid to the nasal to the Quattro and I'm on the Flex Fit 431 now... it seems to work a little bit better but my goatee does make it leak some....most definitely will keep up with my data on a daily basis and start tweaking my settings maybe once a week or once every 3-4 days or so ..depending on results.....thank you so much guys for those of you who posted ...seems like I was on another forum once and mentioned adjusting my settings and I got a huge backlash of people wailing on me for suggesting something so dangerous ....lol...so it's a huge pleasure to see some people who think that you can do it do it safely
I don't believe anything I hear and only half of what I see
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#8
(06-18-2013, 04:16 PM)spdklls99 Wrote: seems like I was on another forum once and mentioned adjusting my settings and I got a huge backlash of people wailing on me for suggesting something so dangerous ....lol...so it's a huge pleasure to see some people who think that you can do it do it safely

We're very dangerous around here and we advocate patient empowerment a lot. You may not want to associate with us, as we're sometimes viewed as "CPAP outlaws". Bigwink

Read the first part of my article on this page and you'll see where I'm coming from, at least.

Coffee
SuperSleeper
Apnea Board Administrator
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.



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#9
Be sure to get the latest version of SleepyHead if that's what you use. Currently, this is 0.9.3. It's linked in my signature line. By the way, the SleepyHead page on SourceForge is a little confusing at the moment and it's difficult to find the right version.

If you adjust your own machine and don't get the right settings, you can hurt yourself. If nothing else, your apnea will come back, and you'll suffer from that.

However, the same thing happens if your doctor or DME sets it wrong, either through technical errors or just not figuring out the right pressure.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#10
(06-18-2013, 07:53 PM)archangle Wrote: Be sure to get the latest version of SleepyHead if that's what you use. Currently, this is 0.9.3. It's linked in my signature line. By the way, the SleepyHead page on SourceForge is a little confusing at the moment and it's difficult to find the right version.

If you adjust your own machine and don't get the right settings, you can hurt yourself. If nothing else, your apnea will come back, and you'll suffer from that.

However, the same thing happens if your doctor or DME sets it wrong, either through technical errors or just not figuring out the right pressure.

I logged on sleepyhead with administrator rights and it automatically upgraded to the most recent version it said..

I cant do much worse than Dr.Quack has done for the last 3 years..I have constantly complained I wasn't feeling any better after getting the $5000 Bipap st...he ALWAYS told me the data said I was doing fine...
Then when a nurse practitioner saw the data downloads a year later....her jaw dropped to the floor and said there was no way the dr could have saw the data she was looking at and say I was doing fine on the machine (but he did) and even after that..I still got no help and they wouldnt return my calls.....

so for the last 6 months I just gave up hope and kept using the bipap..my gf tells me my breathing is getting worse and worse..I stop breathing for very long periods and the machine isnt making me breath like its supposed to...why I bit the bullet and bought the pr system one I am waiting for delivery on by the end of this week.

the respironics bipap st smart card doesnt break down data into hypopneas,OA or CA's..it just lumps it all into one big number of events for the night.some nights my AHI was 40-50 by my math...

how is that if my sleep study said it was 24 originally? So I don't see how I can be any worse to myself than the care I have been getting for 3 years now from a professional health care cardiologist/sleep Dr...will be nice to have a machine that precisely breaks down all events too.

.I am sure I will asking you guys for more advice on what to tweak once the data numbers start rolling in next week.
I don't believe anything I hear and only half of what I see
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