Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

[Pressure] Mysterious Sleepyhead/OSCAR periodic pressure ramps with DreamStation BiPAP ASV?
#11
RE: Mysterious Sleepyhead/OSCAR periodic pressure ramps with DreamStation BiPAP ASV?
OK let's see, I know this isn't a ResMed. Those settings just seem "off" or not right.

How about this when Sleeprider comes by again, modified ResMed titration numbers? What of this...
EPAP 9-15
PS 3-15
IPAP 12-30
Ramp I'm tempted to suggest nix it entirely.
Something like that.

Your current EPAP max and the PS min/max sounds off to me specifically.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply






Donate to Apnea Board  
#12
RE: Mysterious Sleepyhead/OSCAR periodic pressure ramps with DreamStation BiPAP ASV?
All Philips ASVs are slow to respond, and it's a great source of frustration to me as I coach their users. They consistently under-deliver on pressure support to maintain the tidal volume which the company claims is the target.  When a Philips SV user has trouble making tidal volume, it's usually the failure of the machine to provide adequate pressure support. If it happens on a Resmed, it's nearly always a problem with the settings or an obstructive event, because if the airway is clear, the Resmed will cause a breath. Let me see if I can show you the difference with a couple example charts. I know there is nothing you can do now, and we will do our best to optimize your Philips, but you need to know this for the next machine.

Example 1 is a graph similar to yours showing how a Resmed S9 (older version) can increase pressure support on a breath by breath basis to maintain a steady minute vent (Resmed's target). You can see individual spikes in the mask pressure where the machine goes from PS 3.4 to PS 15.0 in a single breath at 05:30. The results speak for themselves. That was an obstructive event and the only one of the night. Similar spikes at 00:05m 01:00 and 06:35 prevented events.

[Image: MSGS68h.png]

In this next example you can see the shape of the pressure delivered by the Resmed ASV. Compare it to the square-wave on your charts which is what Philips gives, even with Flex at 3.  Look how normal the resulting respiratory flow rate is.  Midway through this graph is an obstructive UA event (we know it's obstructive because the Resmed doesn't miss a central).  Note how quickly pressure hits the top of the PS setting when a breath is missed. It doesn't step up over 4-breaths, it comes in right away and backs off as soon as respiration is spontaneous.  The Philips lags in both directions. As a result the Resmed does not very often miss its minute vent target.


[Image: Vjh8ba9.png]
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.
Post Reply Post Reply
#13
RE: Mysterious Sleepyhead/OSCAR periodic pressure ramps with DreamStation BiPAP ASV?
That does remind me, Flex... At least drop it to 2. 3 causes disruptions from the murky oddness of Respironics. I'd really consider turning Flex off, second to that is lowering it.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#14
RE: Mysterious Sleepyhead/OSCAR periodic pressure ramps with DreamStation BiPAP ASV?
Thanks again both!

It's nearly bedtime here so I'm going to turn off ramp and flex altogether, and set the unit up as per Philips own recommendation of EPAP min 8 and PS min 4 (with unrestricted EPAP and PS max).  I'll get a set of results tonight including spo2 and post again tomorrow  Smile

Your breakdown is fantastic Sleeprider - bottom line is if this machine isn't delivering as it should be I'll have to try and make the switch.

One thing I would say is there is no such setting as target tidal volume or minute vent on the DS ASV, so I'm not sure how on Earth it knows what mine should be in a tiny 4 minute guessing window  Unsure  Perhaps one of you have some idea?  It always struck me as odd as the machine has on idea if I'm a 400lb adult or a small child  Thinking-about
Post Reply Post Reply






Donate to Apnea Board  
#15
RE: Mysterious Sleepyhead/OSCAR periodic pressure ramps with DreamStation BiPAP ASV?
I mis-spoke. The tidal volume target is what the Philips BiPAP AVAPS targets. The SVauto uses a 4-minute moving window of peak inspiratory flow. So it measures each peak and uses that flow rate as the target with pressure support. More information at page 39 of this Powerpoint link http://www.apneaboard.com/CSA-and-ASV-Up...Morgan.pdf
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.
Post Reply Post Reply
#16
RE: Mysterious Sleepyhead/OSCAR periodic pressure ramps with DreamStation BiPAP ASV?
OK look forward to seeing results on the chart. I do hope the setting edits help get this headed the right direction
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#17
RE: Mysterious Sleepyhead/OSCAR periodic pressure ramps with DreamStation BiPAP ASV?
(02-23-2021, 06:06 PM)SarcasticDave94 Wrote: OK look forward to seeing results on the chart. I do hope the setting edits help get this headed the right direction


Hi both  Shy

Thanks for pointing me to that ASV pdf - some very useful info in there!  It's fascinating to see the differences in how Philips vs ResMed titrate ASV.

Attached is my results from last night's session (OSCAR).  The settings have been adjusted to Philips' own recommendations and are 1cmH2O lower on both min EPAP and min PS (8/4 vs 9/5) than those I've found to be the best in the past in terms of basal spo2.   There is plenty of headroom for the machine to be able to bump up the EPAP and/or PS where it needs to... though as you say it never seems to push the IPAP past 16cmH2O at any point which seems a bit strange, instead it just allows my MV to hit the floor before it takes any action.

I disabled the ramp and bi-flex entirely - I'm pretty used to the machine now so this didn't present me any difficulties in getting to or remaining asleep. 

The sharp spo2 drop you see at 7:33am is a false reading, my Rad 7 alarmed at that point saying the perfusion index was low as the adhesive sensor on my finger came a little unstuck.  You'll see I disconnected for a few mins at that point to use the bathroom.  Other than that they're all correct - the drops in pat. triggered breaths correlating pretty much exactly with when I remember falling back to sleep.

Overall (albeit to my untrained eye!) the results are consistent with what I'd expect from previous sessions.  My TV/MV always nosedive then recover to a bit less than ideal ranges for the rest of the time I'm asleep.  I do wonder though, as I mentioned before, if the 'recovery' part isn't delivering enough pressure to account for my physical size given it's only working within a 4 minute moving window  Thinking-about  

If there are any particular sections of interest you'd like me to zoom in on let me know the start and end times and I'll post another image  Smile

Still v. interested to know how confident you are these particular issues would be addressed more effectively by using the ResMed which targets the MV - if it's almost certainly going to be better I'd see what I can do to try and obtain one, but for me it'd be a case of having to purchase a refurb and sell the DS I have now I think.

Once again thanks so much for your expert opinions!!

Chris


Attached Files Thumbnail(s)
   
Post Reply Post Reply






Donate to Apnea Board  
#18
RE: Mysterious Sleepyhead/OSCAR periodic pressure ramps with DreamStation BiPAP ASV?
Technically you should be able to reduce EPAP min to the point where OA begins to be observed. If 8.0 is comfortable, keep it, but it never seems to increase from there. I'd like to get a zoomed shot of the flow rate. As you know the Philips SV targets maintaining the peak inspiratory flow using pressure support, and I'd like to get a look at what that wave-form looks like. If it is very flow limited (flattened), that may explain part of the problem. Try to give us about a 3-minute view. Here is the part of the tutorial on that http://www.apneaboard.com/wiki/index.php...al_options There is a slider at the bottom of the Events tab that lets you select a zoom window, and that will hold even if you go back to Events or scroll left or right. Also note how to add a dotted line in the Wiki. It is very helpful to set the dotted line at zero for Flow Rate to see the inspiration /expiration crossover. You can also use that for things like SpO2 targets, Minute vent, etc.

Results actually look pretty good with relatively few hypopnea.
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.
Post Reply Post Reply
#19
RE: Mysterious Sleepyhead/OSCAR periodic pressure ramps with DreamStation BiPAP ASV?
Hi Sleeprider,

TBH the only reason I put it to EPAP min to 8 was Philips titration document says for users coming from CPAP over 10cmH20 that's the ideal starting setting, otherwise leave it at 4.  I'm borderline I think, as my APAP was titrating up to about 10-10.5 on occassion but not often (it never did control my desats though and my AHI remained 5-15 typically). I settled on the 8 though on the basis I had significantly better average sp02 overnight than with 4 (about 2% higher).  Maybe I should try and leave it at 6 for a while then and see how I get on  Smile

For your request I've attached 5 images - one is a 12 min window covering the significant desaturation which starts at about 8:12am.  The others are 3 min windows from 8:09am > 8:21am to give a more detailed overview of this event if needed.  All show FR at the top.  Apologies I've just realised after capturing them all I forgot to enable the dotted line!  Hopefully it's still ok?  0 is dead center.

Is that what you were looking for?  Please let me know, happy to provide more or even raw data file if it helps  Shy

Thanks again,
Chris

(remaining attachments)


Attached Files Thumbnail(s)
                   
Post Reply Post Reply
#20
RE: Mysterious Sleepyhead/OSCAR periodic pressure ramps with DreamStation BiPAP ASV?
Just as an aside in case it helps, here are a couple of typical examples of where I am spo2-wise when no PAP therapy is used... the higher readings are only when I was awake for long periods in the night, when I'm asleep it's the typical sleep apnea yo-yo!


Attached Files Thumbnail(s)
       
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  Help with Bipap settings bioshen7 16 275 8 hours ago
Last Post: bioshen7
Question Is there a way to tell if I have a BiPAP or CPAP? astraith 9 164 02-25-2021, 01:37 AM
Last Post: astraith
  periodic breathing videoman 5 253 02-17-2021, 10:42 AM
Last Post: uguu
  BiPAP on the way - help with first night? qoethe 2 122 02-16-2021, 10:13 PM
Last Post: qoethe
  [Treatment] Oscar data help bipap Moemah123 21 545 02-15-2021, 04:55 PM
Last Post: Moemah123
  BiPAP... is a resmed s10 really THAT much better an s9? CentralApneaUser909 5 207 02-02-2021, 12:45 PM
Last Post: CentralApneaUser909
  New Dreamstation Auto Bipap - lost on support settings Russ702 86 1,372 02-01-2021, 01:20 PM
Last Post: SarcasticDave94


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.