(05-12-2013 11:11 PM)Nord Wrote: I am having an average treated AHI 5.45 (AHI ranging from 2.3 - 16.8 per night), Min pressure 5, max pressure 12 at EPR3. (Resmed S9 Autoset with FX Mirage Nasal mask)
(05-14-2013 06:50 PM)Nord Wrote: From what I have heard from friends with Apnea, it is unlikely that the New Zealand public health system will fund a APAP or similar device for patients with consistent AHI levels below 16 (not what my treated trial test results show), so there is no point in waiting for that reason alone.
No way to know if your untreated AHI is worse than 15 except to have the sleep study. One would expect that your AHI when untreated is worse than your AHI when treated, and if a sleep study shows that your untreated AHI is worse than 15 then you would not need to buy a CPAP/APAP machine your own. Right?
I suppose that if the untreated AHI must be 16 before the New Zealand public health system will fund any sort of machine, then there may be a similar threshold for funding an ASV machine, meaning the CAI when under treatment with a CPAP/APAP machine may need to be 16 or higher before the New Zealand public health system would fund an ASV machine.
(05-24-2013 01:20 AM)Nord Wrote: Unfortunately all the gently used S9 Autoset from #2 have sold out by now.
may get some in again, in a few days or weeks.
(05-24-2013 01:20 AM)Nord Wrote: I found that even now I am still having quite a lot CSA events. Most nights about 25 events with a number of them quite long lasting (above 30 seconds). Is this still in the range of normal?
Sounds like your CAI after 4 weeks of treatment is nearly 3, only a little less than during your first 2 weeks of treatment.
I hope you have tried reducing or turning off EPR. If you haven't yet tried this, doing this might largely solve the problem.
Regarding the 30 second central apneas, if they are starting after having hyperventilated then I would expect that your O2 saturation may have been dropping into the mid 80% range or lower, which is at least a little too low. 89% or higher is considered adequate. 94% or higher is considered optimal.
But if 30 second central apneas have been starting during periods of hypopnea (or during periods of less than average ventilation), then (1) I would not expect reducing EPR would improve the situation but increasing EPR might help, and (2) I would expect that your O2 saturation may have been dropping into the mid 70% range or lower.
I suggest you consider getting one of the wrist-mounted Pulse Oximeters which are available from Supplier #19
, so you can find out exactly how low your O2 levels are dropping.
(05-24-2013 01:20 AM)Nord Wrote: Could I do anything wrong in buying a Resmed ASV device and use it in ASV Auto mode? Maybe this would solve the CSA events?
The way ASV machines would treat your centrals is by automatically raising the Inhale pressure up to 10 or more cmH20 higher than the Exhale pressure, which causes air to enter and exit the lungs even though your central nervous system is failing to make any effort to breathe. The machine notices when you stop breathing and steps in to breath for you. The exhale pressure may need to be the same as what an APAP or Bi-level machine would need to treat obstructive events (i.e., up to 12 cmH2O in your case). That means that, when CSA events are happening, your Inhale pressure would be above 20, approaching 25. That is a lot of pressure and leaks can be very hard to control. For example, the Exhale pressure I need to eliminate obstructive events is about 14, so my ASV machine is often raising my Inhale pressure 10 or more higher than that, to 24 or 25, and I am constantly working hard to try to control leaks without over-tightening the mask, but I have not quite arrived at how to accomplish that yet. As my face gets sore from one or another of my masks, I alternate between three masks: 2 different ResMed Full Face masks plus one Respironics FitLife Total Face Mask, and I use RemZzzs mask liners or a ResMed Gecko gel nose pad to help protect my nose and to help control leaks.
I think it is likely that an S9 ASV device would largely eliminate your central events. It has lowered my CAI from occasionally being above 5 (when I was using S9 AutoSet and/or S9 VPAP Auto) to now being always zero. That means no apnea lasts longer than 10 seconds, and that means no detectable (sudden) hypopneas occur. However, occasionally my breathing will very gradually become more and more shallow, and the machine does not notice. Eventually I will have an arousal and sudden big increase in breathing. I think if my machine were more adjustable I could fix this (1) by setting the Minimum Respiration Rate to somewhere around 10 or 12 breaths per minute, and (2) by setting my Minimum Pressure Support (Pressure Support is the difference between the high Inhale pressure versus the low Exhale pressure) to something higher than 6 cmH2O, and (3) by setting a minimum target for Tidal Volume (which is the amount of air in one breath) and (4) by setting a minimum for the Target Minute Volume (Minute Volume is the volume of air breathed in one minute, and the Target Minute Volume is a target for how much Minute Volume the machine should try to maintain while it is breathing for you). The relatively unadjustable S9 VPAP Adapt does not allow these things to be done. The Philips Respironics System One BiPAP autoSV Advanced allows the first two to be done. Perhaps a future generation ASV machine will allow all four.
The S9 VPAP Adapt is a simpler "one size fits most" ASV machine, by which I mean it has few adjustable parameters and automatically adapts itself to your needs. Pretty much, one could simply (1) set the EPAP (exhale pressure) range to the same range one has found to be optimal when using a standard CPAP or APAP machine and (2) set a wide open range like zero to 15 for Pressure Support (PS is the difference between the low Exhale pressure versus the high Inhale pressure) and in most cases the result would be that the machine would automatically adjust the pressures to eliminate both obstructive and central events. In general, the Max PS needs to be at least 10 and at least 5 higher than the Min PS. In my opinion the Max Pressure (also called Max IPAP) should be the sum of the Max EPAP plus the Max PS, so that EPAP and PS can both be max at the same time, if needed. By looking at the Detailed Data downloaded from the machine, one could optimize the settings by applying common sense adjustments. In my case I found I need the setting for the Min PS to be fairly high (to reduce how often I have the problem of my breathing gradually becoming too shallow).
If you do decide to get a ResMed ASV device, I would suggest verifying before buying that it would be S9 VPAP Adapt model 36037 (manufactured starting November 2012) rather than S9 VPAP Adapt model 36007 (still widely sold as "the ResMed S9 VPAP Adapt" without without making it clear that this is not the most recent model). ResMed changed the model NUMBER (and capabilities) but not the model NAME.
The slightly less expensive Philips Respironics System One BiPAP autoSV Advanced is more adjustable and customizable, but at the same time that makes it more complex to get adjusted. Nonetheless, knowing what I have learned since purchasing my S9 VPAP Adapt in January, if I could do it all over I would get the PRS1 BiPAP autoSV Advanced, for two reasons. I think I would do better with a minimum Respiration Rate around 10 or 12 breaths per minute and I think I would do better if my Min PS could be adjusted to 7 or 8. On the PRS1 ASV unit I could have done these things, but on the S9 VPAP Adapt I cannot.
But if one were wanting to attempt self titration on an ASV machine, I think the S9 VPAP Adapt would be easier to work with. Also, that one would have the option of using ResScan to monitor one's progress is a very attractive feature of ResMed machines, in my view.