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Weird flow graph during a 17 second CA
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Peter_C Offline

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Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #11
RE: Weird flow graph during a 17 second CA
(10-18-2014 06:36 AM)DeepBreathing Wrote:  Peter, I think what you're seeing there is the machine diagnosing the CA. It sends a series of short pressure pulses and measures the return echo to determine if the airway is open. As far as I know your machine can't teat a central but it can diagnose and record it.

That was my *guess* too. My old VPAP Auto 25 didn't even know what a CA is, which is why I took the downgrade the the CPAP when I got on Medicare - and we are now going through the process to try to get me on an ASV machine - the big question I have is why the titration shows I do better on a higher pressure than the S9 Autoset in APAP mode is giving me? As almost all of my events now are CAs, why raise the pressure?

The new script (for ASV) reads " 15/3/3 " and I have no idea what that means? Can anyone tell me?

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-18-2014 03:33 PM
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jcarerra Offline

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Posts: 284
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Machine: ResMed S9 Adapt SV
Mask Type: Full face mask
Mask Make & Model: Quattro
Humidifier: H5i
CPAP Pressure: min/max EPAP 9/15 min/max PS 4
CPAP Software: ResScan

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Sex: Male
Location: Florida

Post: #12
RE: Weird flow graph during a 17 second CA
(10-18-2014 03:33 PM)Peter_C Wrote:  .
The new script (for ASV) reads " 15/3/3 " and I have no idea what that means? Can anyone tell me?

I wish they would quit writing them like that!

It depends on what the machine is as to what the numbers will mean--and how many numbers you need to have.

If by ASV you mean an auto servo ventilator (such as a ResMed S9 Adapt SV), there still are 3 different modes in it
CPAP
ASV
auto ASV

In ASV mode, it runs with a fixed EPAP and variable Pressure Support (PS), which is specified as minPS and maxPS. So, that boils down to three numbers. 15 could be an EPAP level, but the 3/3 makes no sense for min-max PS (especially on an S9 where those have to be at least 5 apart). 3/3 as a PS spec would essentially provide a FIXED IPAP (if the machine would allow it) of EPAP+3 = 18.

Auto ASV mode would require 4 numbers, as EPAP is also allowed to auto-range between a min and max.

So I don't know what 15/3/3 means. Which makes me wonder why I wrote this.
(This post was last modified: 10-18-2014 05:51 PM by jcarerra.)
10-18-2014 03:52 PM
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Peter_C Offline

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Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #13
RE: Weird flow graph during a 17 second CA
Well, my sleep Doc is cool and knows I will learn how to adjust it - but as I am not yet sure what machine I will end up with (assuming Medicare approves it), I don't really know anything yet. The goal is to both work on my CAs, and to make sure I have a backup breathing rate.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-18-2014 04:00 PM
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PaytonA Offline
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Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Orange County,California

Post: #14
RE: Weird flow graph during a 17 second CA
(10-18-2014 03:33 PM)Peter_C Wrote:  That was my *guess* too. My old VPAP Auto 25 didn't even know what a CA is, which is why I took the downgrade the the CPAP when I got on Medicare - and we are now going through the process to try to get me on an ASV machine - the big question I have is why the titration shows I do better on a higher pressure than the S9 Autoset in APAP mode is giving me? As almost all of my events now are CAs, why raise the pressure?

The S9 Autoset probably uses a lower pressure than your new prescription because it does not respond to CAs.

With my very limited knowledge of CA treatment, it seems to me that there is a "sweet spot" of pressure that works best.

Good luck Peter and have fun with your new ASV machine. Thumbs-up-2

PayotnA
10-18-2014 04:00 PM
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Whitewabit Offline

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Posts: 158
Joined: Sep 2014

Machine: ResMed V9 VPAP Adapt S9 (36067), ASV mode
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX, AirFit P10, AirFit F10
Humidifier: ResMed H5i
CPAP Pressure: 5/4/9
CPAP Software: ResScan SleepyHead

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Sex: Undisclosed
Location: Somewhere in the midwest

Post: #15
RE: Weird flow graph during a 17 second CA
(10-18-2014 03:33 PM)Peter_C Wrote:  
(10-18-2014 06:36 AM)DeepBreathing Wrote:  Peter, I think what you're seeing there is the machine diagnosing the CA. It sends a series of short pressure pulses and measures the return echo to determine if the airway is open. As far as I know your machine can't teat a central but it can diagnose and record it.

That was my *guess* too. My old VPAP Auto 25 didn't even know what a CA is, which is why I took the downgrade the the CPAP when I got on Medicare - and we are now going through the process to try to get me on an ASV machine - the big question I have is why the titration shows I do better on a higher pressure than the S9 Autoset in APAP mode is giving me? As almost all of my events now are CAs, why raise the pressure?

The new script (for ASV) reads " 15/3/3 " and I have no idea what that means? Can anyone tell me?

I'm a new user less then a month ..

I have a Resmed VPAP Adapt running in ASV Mode and my script is written 4-3-8 ..
EPAP 4
Min PS - 3
Max Ps - 8

during my 3 sleep studies my pressure was initially set for 5-4-15 but the Max Pressure Support of 15 was too high and my AHI ended up being above 8 the first few days with it .. I was also extremely sore because of the pressure in my lungs and chest muscles .. had to stop usage for several days to recover .. so it was reduced to the present numbers and my AHI has been under 2 this week ..
10-18-2014 05:59 PM
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Peter_C Offline

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Machine: System One DS960HS
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CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #16
RE: Weird flow graph during a 17 second CA
Don't they have to add something for the backup breathing too?

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-18-2014 06:35 PM
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TyroneShoes Offline

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Post: #17
RE: Weird flow graph during a 17 second CA
It's good to know that it is the machine doing that rather than me doing that (I couldn't breathe that fast anyway).
10-19-2014 06:09 PM
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jcarerra Offline

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Machine: ResMed S9 Adapt SV
Mask Type: Full face mask
Mask Make & Model: Quattro
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CPAP Pressure: min/max EPAP 9/15 min/max PS 4
CPAP Software: ResScan

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Sex: Male
Location: Florida

Post: #18
RE: Weird flow graph during a 17 second CA
Yes. The small regular oscillations are called "Forced Oscillation Technique." The machine rapidly (4 hz) slightly increases and decreases the pressure.

If it gets flow while doing that, then your airway is open and it can "call" the non-breathing a Central Apnea.

But if there is no flow or reduced flow, it will interpret the non-breathing as an Obstructive Apnea.

The SV class machine does not do this because if it encounters non-breathing, it tries to ventilate the user rather than "diagnose."
10-19-2014 09:14 PM
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Peter_C Offline

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Posts: 1,308
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Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #19
RE: Weird flow graph during a 17 second CA
(10-19-2014 09:14 PM)jcarerra Wrote:  Yes. The small regular oscillations are called "Forced Oscillation Technique." The machine rapidly (4 hz) slightly increases and decreases the pressure.

If it gets flow while doing that, then your airway is open and it can "call" the non-breathing a Central Apnea.

But if there is no flow or reduced flow, it will interpret the non-breathing as an Obstructive Apnea.

The SV class machine does not do this because if it encounters non-breathing, it tries to ventilate the user rather than "diagnose."

Thank you for explaining that. It actually makes sense to me Smile

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-19-2014 10:29 PM
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vsheline Online

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Post: #20
RE: Weird flow graph during a 17 second CA
(10-18-2014 03:52 PM)jcarerra Wrote:  
(10-18-2014 03:33 PM)Peter_C Wrote:  The new script (for ASV) reads " 15/3/3 " and I have no idea what that means? Can anyone tell me?

I wish they would quit writing them like that!

It depends on what the machine is as to what the numbers will mean--and how many numbers you need to have.

If by ASV you mean an auto servo ventilator (such as a ResMed S9 Adapt SV), there still are 3 different modes in it
CPAP
ASV
auto ASV

In ASV mode, it runs with a fixed EPAP and variable Pressure Support (PS), which is specified as minPS and maxPS. So, that boils down to three numbers. 15 could be an EPAP level, but the 3/3 makes no sense for min-max PS (especially on an S9 where those have to be at least 5 apart). 3/3 as a PS spec would essentially provide a FIXED IPAP (if the machine would allow it) of EPAP+3 = 18.

Auto ASV mode would require 4 numbers, as EPAP is also allowed to auto-range between a min and max.

So I don't know what 15/3/3 means.

Hi Peter - it is important for you to get a copy of the full ASV Titration report, including all data. It would be helpful to post a copy of the table showing what pressures were tried, for how long, with what result. Of course, remove your true name/address/age/etc on the titration report.

What was the highest amount of PS used during the ASV titration?

The way the doctor wrote your prescription, I also think this would mean EPAP=15, Min PS=3, Max PS=3. This would make it impossible for an S9 VPAP Adapt to be used, because on the S9 VPAP Adapt the min PS and max PS must be at least 5 apart, as jcarerra wrote.

A Philips Respironics System One BiPAP autoSV Advanced could be used, because Min PS and Max PS can be the same on the PRS1 ASV machine. But a new humidifier and heated hose would also be needed, since the humidifier from your S9 AutoSet could not be used.

On your S8 VPAP Auto 25 machine you seemed to be doing okay for years with a PS of 6 to 8, right? So, I think you need to understand why your doc now wants to limit Max PS to only 3. There is no way a Max PS of 3 will be adequate if you are in the middle of a central. Is your doc concerned about the condition of your lungs not being able to use PS higher than 3?

I suggest you ask your doctor to consider prescribing EPAP=11 to 15, PS= 3 to 8, which would allow use of an S9 VPAP Adapt with reuse of your present humidifier.

I think you doctor has made a mistake, since a Max PS of 3 will not be adequate to adequately ventilate you during a central. During a central, a person with normal healthy lungs may need the machine to be allowed to adjust PS as high as 8 or 10 to keep him adequately ventilated.

But if the ASV titration used only 15/3/3, your doctor may need to initially prescribe whatever was used in the titration, planning to adjust it as needed once you actually receive the machine.

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.
(This post was last modified: 10-20-2014 04:27 AM by vsheline.)
10-20-2014 04:01 AM
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