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first night on VPAP from CPAP (horrible)
#1
Hello all- I received my new to me S9 VPAP auto. I set it per my previous CPAP settings of 7-16 in Vauto mode, with PS of 4 (default). I set my breathing times per the chart of my breath rate, (min1 max2) and I set the trigger at LOW and the cycle at Very low, as it seemed best when I was awake, but then I realized that was in-valid because there is a leak in the humidifier.

My first 4.5 hours was totally invalid, my wife finally woke me up from the noise of the machine. I discovered that the humidifier leaks inside for some reason and chose to remove it for now. It's been humid anyways lately, I can deal with that later.

I got back to sleep for a few hours- initially things were ok, I had some time to look at the graphs on sleepytime today, I don't know what I need share here, or how but here is the issue I am seeing, by my own description.

All but 2 events were CA apneas. The CA apneas were nearly constant once I was in a deeper sleep state.
I seem to have a central issue affecting my brain signal to inhale after an exhale. I seem to just forget... I have noticed this on my own when in a semi-conscious state and these data graphs confirm it, even as a rookie with the software. My inhale time looks normal, and consistent, but my exhale time was sometimes 9 seconds or even more. During the deep part of my sleep the ratio was around 50 instead of 1 to 1.3 like I think it should be.

I imagine I can play with the trigger and cycle, but I'm hoping for some insight here, as I don't want to feel this way again tomorrow. Last thing I want to do is start messing with pressures and support levels if another setting needs correction.

Thanks everyone in advance,
Mike
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#2
I had issues when I moved from APAP to APAP with A-Flex. Essentially a bi-level machine that allows 'new' patients an easier time acclimating to xPAP therapy (would have been handy back in 2000 when I was introduced to a CPAP machine). Also, it seems I am now at a stage where I am struggling to exhale without positive pressure (while sleeping). The docs think I am crazy... but I know what I know, and the stuttering exhales I experience sure seem real to me.

Anyway -- I found I had to completely disable the FLEX therapy mode. I seem to need the pressure to stay stable as I breathe, otherwise I feel like I am not breathing right and it induces an anxiety response.

Two pillows also helps... seems I am 'healthy' enough the added girth presses on the internals sufficient to relax the reflexes.

The fact is - disabling the FLEX feature got my AHI back into a reasonable range and I am feeling a bit better for it.
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#3
Hi Mike..

I am new to ASV therapy, but it seems to me that your settings should not be the same as CPAP. ASV is a very different animal than CPAP. I hope one of the ASV veterans comes along soon to take a look...

Storywizard
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#4
Thanks for the replies. I have been reading everything I can find, but not seeing a clear explanation of this scenario anywhere. I only think I have ideas to try, but that's not cool to blindly experiment. It does seem like the adjustments to the trigger and cycle flow settings would be appropriate, but I don't want to go the wrong way.

I "think" I need the machine to recognize the end of my exhale sooner and make the switch to ipap. I "think" that this would help trian my brain, but I can't make assumptions here. Trigger, cycle, and pressure support...It's got to be within those 3 settings I would think.

Mike
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#5
What you have is not an ASV machine, it is a bi-pap machine.
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#6
Thank you, however I didn't call it an ASV, nor do I expect it to act as one. I do know that it is much more capable of dealing with CA's than my old CPAP, so I need to understand the ways to tweak these settings still.

It seems reasonable to expect that I can acheive a better AHI with this Auto Vpap than with my 7 year old S8 Cpap, doesn't it?

Mike
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#7
(05-29-2015, 03:32 PM)MaddMike Wrote: Thank you, however I didn't call it an ASV, nor do I expect it to act as one. I do know that it is much more capable of dealing with CA's than my old CPAP, so I need to understand the ways to tweak these settings still.

It seems reasonable to expect that I can acheive a better AHI with this Auto Vpap than with my 7 year old S8 Cpap, doesn't it?

Mike

have you had a sleep study ever? If not, I recommend an at home sleep study at minimum otherwise you are flying blindly and could crash and burn.

VPAP is not set up the same way as a CPAP as someone mentioned and VPAP does not treat CSA at all. It may recognize it but will not treat it. If you have CSA, then your current machine is not treating it.
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#8
Trigger, cycle, Timax, Timin, are parameters that are almost always left at default.
They are beyond the scope of most people, even RTs.

I think that's where you went wrong.
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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#9
I know the S9 vpap can react to CSA's. At minimum, it is able to continue with pressure support where as the old machine reacted to all apneas the same way and immediately deactivated the EPR.

I can understand leaving the trigger and cycle at default, and certainly can put them back, however I cannot understand why the timers would be left at default when there is clearly a table to set them at based on BPM.

I had a sleep study 7 years ago and my doctor never gave me any info i needed to continue this... I have been looking ar other aspects of my health because he didnt tell me how to even look at my AHI and had me thinking my apnea was under control.

I bought this machine because Ii found an awesome deal on it, and at minimum Ii will get better data. My S8 autoset has 20,000 hrs on it now. I could do an in home sleep study but i cannot afford any more copays this year. I cant see benefit in a prescription that i cant fill. affordable healthcare act doubled what I pay for all of this stuff if I use my insurance. I can afford insurance now because I have no choice, but I cannot afford to use my insurance.
Mike
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#10
(05-29-2015, 05:06 PM)MaddMike Wrote: I can understand leaving the trigger and cycle at default, and certainly can put them back, however I cannot understand why the timers would be left at default when there is clearly a table to set them at based on BPM.

Timax default is 2 seconds. Your breathing pattern; unless highly unusual, will terminate IPAP before 2 seconds. Timin default is 0.3 seconds. Unless you are breathing very rapidly, your normal inhalation pattern should keep the machine in IPAP for >0.3 seconds.

There is no reason to change Ti controls unless you have some highly unusual respiratory problems; and then they should be set by a professional.

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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