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Ubderstanding the settings on a Respironics DS950HS
#1
Question for today.

I would really like to fully understand all the settings on my Respironics DS950HS and what the function and actions changing these settings will do.

IE: I was told that the Pressure Support Min when set to "0" made the machine work more like a plan old CPAP and kind of stopped it from being its automatic multi-level self. (Which if correct, means I was using a costly machine inplace of a cheaper one…and that my Doctor messed up…)

Rich
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#2
I don,t use bilevel machine but presume you,re correct
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#3
(04-27-2013, 11:32 PM)racprops Wrote: Question for today.

I would really like to fully understand all the settings on my Respironics DS950HS and what the function and actions changing these settings will do.

IE: I was told that the Pressure Support Min when set to "0" made the machine work more like a plan old CPAP and kind of stopped it from being its automatic multi-level self. (Which if correct, means I was using a costly machine inplace of a cheaper one…and that my Doctor messed up…)

Rich

Hi Rich,

It is great that you have set yourself the task to understand what the different settings really mean. This is important in order to fully understanding what your SleepyHead reports are showing.

Your doctor did not mess up.

The Pressure Support Min (PSmin) merely sets the bottom end of the range that the machine can use (if needed) to boost your inhale pressure above your exhale pressure to make you breath during what would otherwise have become central apneas.

Your autoSV machine will automatically adjust the PS between PSmin to PSmax as may be needed, unless it it limited by the "Max Pressure" setting.

Your machine would act like a plain old CPAP machine if both EPAPmin and EPAPmax were set to the same two pressures (such as 10 and 10 cmH2O) and both PSmin and PSmax were set to zero. Your pressure would always be 10.

Your machine would act like a standard APAP machine if EPAPmin and EPAPmax were set to a range (such as 10 and 15 cmH2O) and both PSmin and PSmax were set to zero. Your pressure would automatically adjust from 10 to 15 as needed to prevent obstructive apneas.

Your machine would act like a standard BiPAP machine if EPAPmin and EPAPmax were set to the same pressure (such as 10 and 10 cmH2O) and both PSmin and PSmax were set to the same non-zero number (such as 4 and 4 cmH2O). Your pressure would always be 14 during inhale and 10 during exhale.

Your machine would act like a BiPAP Auto machine if EPAPmin and EPAPmax were set to a range (such as 10 and 15 cmH2O) and both PSmin and PSmax were set to the same non-zero number (such as 4 and 4 cmH2O). Your exhale pressure would automatically adjust from 10 to 15 as needed to prevent obstructive apneas, and your inhale would always be 4 higher than your exhale.

In your ASV machine the EPAPmin and EPAPmax can be set to a range (such as 10 to 15 cmH2O) and the PSmin and PSmax can be set to a range (such as 0 and 10 cmH2O). Your exhale pressure would automatically adjust from 10 to 15 as needed to prevent obstructive apneas, and your inhale would automatically adjust higher than your exhale as much as allowed by the PSmax and Max Pressure settings, to make you breath during what would otherwise have become central apneas.

Common Terms:
PAP: Positive Airway Pressure
EPAP: Exhalation PAP, the pressure during exhalation (always same or lower than inhalation pressure)
IPAP: Inhalation PAP, the pressure during inhalation (always same or higher than exhalation pressure)
Max Pressure: Max allowed inhalation pressure (also called IPAPmax)
CPAP machine: Constant PAP machine, same pressure for both inhale and exhale. Some CPAP machines can reduce exhale pressure as much as 3 cmH2O, if desired.
APAP machine: Automatic PAP machine, automatically adjusts EPAP as needed, between EPAPmin to EPAPmax. Some APAP machines can reduce exhale pressure as much as 3 cmH2O, if desired.
BiPAP or VPAP machine: Bi-level or Variable PAP machine, boosts IPAP up to 10 cmH2 above EPAP. The amount of boost is called Pressure Support.
BiPAP Auto or VPAP Auto machine: Automatically adjusts EPAP as needed between EPAPmin and EPAPmax. IPAP can be set to a fixed amount of pressure higher than EPAP.
BiPAP autoSV: Bi-level machine which can independently adjust both EPAP and the amount of Pressure Support.

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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#4
Thanks..

I seem to have way more Clear Way apneas and as I get the complex apneas from having pressure, which is WHY I have to pay for a second sleep study and had to buy a ASV machine, so I believe I want my basic all the time pressure low and only jump for inhaling and of course events…

My OA are under 5 per night where my OA are running from a onetime low of 8.38 to 39.64.

And I get a lot of Hypopnea as well running from 3.78 to 15.79.

Ad of course one setting helps one problem and raises another…

I really need to know more about this machine…

Rich
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#5
(04-28-2013, 01:29 PM)racprops Wrote: Thanks..

I seem to have way more Clear Way apneas and as I get the complex apneas from having pressure, which is WHY I have to pay for a second sleep study and had to buy a ASV machine, so I believe I want my basic all the time pressure low and only jump for inhaling and of course events…

My OA are under 5 per night where my OA are running from a onetime low of 8.38 to 39.64.

And I get a lot of Hypopnea as well running from 3.78 to 15.79.

Ad of course one setting helps one problem and raises another…

I really need to know more about this machine…

Rich


Hi Rich,

I hope you will be able to achieve use of the settings prescribed by your doctor. Judging from the SleepyHead plots you posted on your other thread, your doctors's prescribed settings are very appropriate.

(May help to have PSmin higher than zero, though. I think PSmin is usually considered a comfort setting, similar to EPR on ResMed machines or Flex on Philips Respironics machines. I think doctors usually go with whatever the patient finds most comfortable.)

I can understand that, if the mask leaks are waking you up when the pressure gets close to 20 cmH2O, you may feel you must limit the Max Pressure so that the bothersome leaks do not happen, but I suggest the solution will be fixing the mask leaks, not lowering the max pressure, which has limited your machine's ability to treat your central apneas and hypopneas.

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
Here is the thing:

I had to get the ASV as I have Complex Central Apneas..BROUGHT ON BY THE PRESSURE OF A NORMAL CPAP machine.


In fact it seems I was reacting to around 5 to 10CM, as the first sleep study said I stopped shoring at 5cm, I would believe my airway was opened at that pressure as snoring is part of OAs right??

So setting my machine at a start and running pressure of 10CM seem to CAUSE my Centrals...

And for the first 6 days the only time I got good numbers and lower Centrals was the two days I have set for 7 and 6.5 EPAP.

Although the last couple of days I cannot still say that.

Also my OA are almost not happening.

Rich



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#7
Hi Rich,

I see your point.

On the other hand, I think snore is often resolved earlier than apneas and hypopneas. During titrations, the pressure is started at a low level and is increased only little by little whenever obstructive events are observed. The doctor would not have prescribed a minimum EPAP pressure of 10 unless the titration results showed evidence that at least that much pressure was needed to avoid obstructive events.

Also, the SleepyHead plots you posted show the EPAP adjusted itself up to 13 in response to your obstructive events. This was for just a few collective hours of use, so certainly it makes sense to have the max EPAP pressure set a little above 13, if feasible. So the doctor's prescription of 10-15 range for EPAP looks very appriopriate.

I think the biggest problems now are the leaks that are waking you up, plus the issue that the Max Pressure has been adjusted lower than the sum of EPAPmax + 10. As discussed in earlier posts, to allow effective treatment of centrals even when the EPAP gets close to the top end of its range, the Max Pressure should be set at least 10 higher than EPAPmax.

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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#8
Well things are changing.

Last night talking things over with Jackie, my wife, she said as all my efforts was not getting anywhere, I might as well try the Doctor’s settings, so I did after trying my last settings, lower pressure which did not work.

So around three I reset to 10cm EPAP. ETC.

I got for the first time a low readout of all problems.

It looks like if I had ran these settings I would have had even better readings as most of the apneas happened in the first part of the night.

The graphs are unlike any I have recorded…during the last part of the night.

Also when I woke up I first thought the machine had shut down..there was so little pressure/air.

AND I took my blood pressure: normally waking gives me the highest readings this morning I got 118/over 78…Great.

It was slow waking..

Here is the readout:

[Image: 28Report_zps1bb0a2e2.jpg]

Note the graphs from just before 5 am.

Those patterns have not happened before, there has been a couple of hints…

Tonight will be interesting.

Rich
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#9
Your leaks are off the chart. Getting the leaks under control will help your therapy.

I also note SleepyHead does the same thing to you as it does to me. You went to bed at 10:08 pm and got up at 7:34 am, which should be 9:26 hours of sleep. But SleepyHead thinks you slept for only 5:58 hours. And if you do the math manually you will discover that SleepyHead calculates your AHI based on what it thinks the total is (the 5:58), resulting in an AHI far higher than it really is.

Not only does my SleepyHead have trouble telling time (although mine adds extra time), it also can't add. For example, last night it said I had nine hypopneas, but it displayed only five on the graph and there were only five listed in Events. Yet SleepyHead used 9 to calculate my AHI, increasing it more than it really was.

I love SleepyHead, but you have to keep an eye on it.
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#10
But does this not show low leaks??

[Image: 28BReport_zps732eb1e4.jpg]
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