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advise please Dreamstation SV Auto
#1
advise please Dreamstation SV Auto
    DreamStation ASV
Pres 25.. Epap 4 - 8  PS 8-19 Flex 2 Ramp 4 15min




Hi guys, I have been up and down the past few months after pretty much being left to it. My sleep Doc is very busy and up until recently had not seen him for 3months. I was diagnosed with Complex SA but predominately Centrals. My ahi was 75 but rose to 84 on Cpap. After a long time, I finally got a brand new Dreamstation asv and now can keep track of my nightly ahi range. which is approx. 23-9min. One night I scored a 6 with only hypopneas.  So I finally see my sleep Doc and he says that as my apps are mainly hypopneas to raise my epap max first. So it went from 6 to 8. He also said he thought my pressure was abit too high and if need be we could perhaps lower this. I don't have my appointment till end of this month so was wondering if anyone had any suggestions?  I have Oscar but must be honest cannot make head nor tail of the graphs or what they really mean. I will try attaching a couple of graphs as I know this can help. Thank you.


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#2
RE: advise please..
Addysnan, we have a new beta version of OSCAR that will correct the problems we see in your graphs. Please send a personal message to bonjour who is the project manager, and ask for access to version 1.1.0 Beta 2. This will allow us to properly see your settings and the machine response to events.

You report your settings are Epap 4 - 8 PS 8-19 Flex 2 Ramp 4 15min The graph is such a mess it's hard to trust these numbers, so I'm reluctant to make recommendations until you update OSCAR to the beta, however, I think we might want to explore using lower PS min. The high pressure support on every breath is going to really trigger central apnea, The machine corrects much of this to hypopnea, but such a high pressure support is not normally used with ASV. A key problem appears to be leaks. What mask are you using, and have you always had a high leak rate with it? Does air escape from your mouth, or is this a mask seal issue? Finally, your events are highly clustered, and we may have a positional apnea issue to deal with using a soft cervical collar. Please read this wiki. http://www.apneaboard.com/wiki/index.php...cal_Collar A soft cervical collar can help with both leaks and obstruction that pressure cannot resolve.

I modified your thread title to flag this as an ASV thread and bring in the appropriate forum expertise.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#3
Idea 
RE: advise please..
Hi thank you for your reply, very much appreciated. yes I wondered why the settings on the graphs were different. my pressure is 25 Epap min 4 to 8 max ps 8 - 19. I will do as you say and upload with right version. its getting late and I have my last day at work tom, so will come back tom night ok. have a good nite and thanks again... great page x
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#4
RE: advise please Dreamstation SV Auto
Hi addysnan, welcome to Apnea Board.

(Sleeprider and other setting gurus) Does it make sense to have settings and pressures similar to how I've ran my ASV? I started by finding my minimum air stent, AKA what is needed as a base to hold the throat open with air. This is my EPAP Min. of 8.

I plugged in a range of EPAP that was comfortable and had low apnea events via trial/error, signified by my EPAP of 8-13.

I found PS somewhat like EPAP except it seemed to me the PS range dealt with CA events mostly, and I dialed for best comfort to event ratio and came up with PS 4-13.

I'm not saying addysnan needs these same numbers, but isn't this basically titration? It took me about a month of trial and error to get these ranges. I went by the method of a bump up or down depending on what particular event or feeling I was dealing with. Example: EPAP Min, I knew 4 was not acceptable. I think I tried 6, saw a few events and felt a need of more air. I bumped EPAP Min up 1 to get 7. Still not enough air and events were down some, so I bumped to 8. OK the result was events were down and I felt air starvation was gone. I did try 9 but it lessened comfort a bit with no impact to events, so I went back down to 8.

Bumps in settings can be done by way of whole steps of 1 at a time or a more focused fine adjustment of fractional steps. I found fractional is useful in places where an example of 8 EPAP min is not enough but 9 seems too much.
Dave

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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.
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#5
RE: advise please Dreamstation SV Auto
EPAP of 4 is not necessarily too low on a BiLevel, ASV included. It is typically too low of a Pressure (IPAP) on a CPAP which lowers to the EPAP via EPR.

Dave your titration is sound.  I might of set PS Max to 15+ to maximize room to work though getting that high is not common
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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#6
RE: advise please Dreamstation SV Auto
For me, EPAP of 8 was mostly for getting enough air. It did have some impact on events indirectly, meaning I'd eventually get more events with lower pressure after a few hours sleep. With that Min. EPAP of 8, events more or less never showed up. Again, these settings are specifically mine, not suggesting same settings/results will be good for others. Just a little of my how/why of setting an ASV.

And note that not even I regularly hit my IPAP Max 26, maybe 24-25 at times. But it can't hurt to have it open to hit that high; if you never hit it, it won't even matter on a person's how-do-I-feel factor. However, it can go that high if it's ever needed.

PS: I found it easiest to focus on EPAP settings first, beginning at EPAP Min, then Max, then working on PS. In other words, working on my base pressure then working on higher numbers later. I just got better results from building the base and building on it.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
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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.
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#7
RE: advise please Dreamstation SV Auto
Hi Guys Thank you for your much needed advice. SleepRider I have downloaded the version you suggested ans have uploader the last 2 nights plus one from last week. I have a Dreamstation ASV I use a humidifier setting 4 because I suffer very dry mouth. I use the pillow masks phillips dream ware, gel pillow, and the resmead nasal pillows which I alternate due to alleviating pressure sores on my nasal area. I have been a mouth breather most of my life and have had to work hard at breathing thru my nose. I mostly use tape and a thin chin strap which usually get s me a 100% mask fit most nights. Most of my attempts at trying to get the right settings have been a slow and uneducated guess. So any help is greatly appreciated. I also have tried to understand the graphs in Oscar but Im finding that hard. Well here is my updated graphs with correct settings. Thank you all.
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#8
RE: advise please Dreamstation SV Auto
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#9
RE: advise please Dreamstation SV Auto
Classic case of needing a cervical collar to control chin tucking.  See my signature for the link on collars.

Scratch that.

Why are you attaching charts from December that are 4 months old.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#10
RE: advise please Dreamstation SV Auto
oops no so sorry and disgregard my latest attachments wrong ones... I will return shortly. Sorry
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