(08-24-2014, 09:02 PM)zoophaugus Wrote: Again thanks for the reply snowleopard - Since the very night I received your reply I had manually adjusted the back up rate to 14 BPM. I immediately noticed feeling a lot better the next morning only- still extreme fatigue later in the day - I though okay Ill lower it a bit more down to 12 - again a bit better the next morning but some what more fatigued later in the day than previous night with rate of 14BPM. So I checked rescan with the old cpap auto data and seen an average of 16BPM and decided to set the back up rate to that setting and increased min PS to 4.5 from 3.
Wow now I am getting nearly a full have day of normal back to being human feeling again - and not nearly as fatigued later in the day ( still fatigued but much better) . My modafinil is now actually working and making me feel good .
I dared set it to 17 BPM last night with unfortunate poor results - for some reason the 90% PS auto titrated to 7cmH20 for the night and I got tired much sooner in the day today - still an improvement from when left in full auto.
Now I noticed when PS was min3 it hung around 90% 3.5-4 - as soon as I turned it up to Min 4 it auto titrated to 5 -5.5 - last night adjusting the breath rate to 17 BPM for some reason made the PS go to 7 cmH20 90% of the time with undesired results today
These are some finicky machines - this makes me think I could prolly have done fine with a Vpap auto with back up rate.
Cause this servo ventilation in full auto really just isnt doing much for me - the respironics or the Adapt - What ever is going on at night these machines are unable to out smart/adapt/treat/cope with what ever my brain or body is throwing at them. -Seems to me like I just need a plain old simple ventilator with timed breaths.
I noticed the TI adjustment would only allow 1.7 seconds max where when I stop breathing and it forces a breath into me and it gives up (cycles back to Epap)before I can finish the breath due to the fact that I started my inhale late - could use a little longer time for inhale for sure.
And yes as others have posted here there is some getting used to this machine as it does wake you or keep you from falling asleep with the back up rate.
For what ever reason as Ive noticed a long time ago the higher the pressures these machines throw at me the worse I feel the neext day - I know.. pressure induced centrals - which is why maybe I just need to tighten up the parameters on this one .
Im thinking Min/Max PS 4-5 with MIN/MAX epap 8-12 and BPM of 16-
my RX is Min/Max PS 3-16 and Min/Max epap 8-15 BPM AUTO
Any insightful thoughts on the matter that some one could share would be most welcome.
I finally got a new card reader and tried to DL all the data from last 2 weeks into sleepy head and to my dismay there has been nothing recorded to it - the sd card tab is in the up position (unlocked) and the machine is seeing the card but not writing anything to it - it tells me there is 100% space on the card - is there some kinda trick to this?
Sounds to me like you would do better with the PRS1 BiPAP autoSV Advanced than with the S9 VPAP Adapt. The S9 VPAP Adapt is a "one size fits most" type of machine, with nearly everything automatic and very few things tweak-able by the user. The extra adjustability of the PRS1 ASV unit (especially the Backup Rate) seems very helpful in your case.
I would suggest trying 15 breaths per minute.
I think you should not limit the Max Pressure Support to be less than about 10, or the machine probably will not be able to treat central apneas adequately. For a person with normal lungs a Max PS of 10 is usually adequate to allow the machine to do for us all the work of breathing when we are in the middle of a central event. If the Max PS is 5, the machine will not be able to treat centrals on its own. A Max PS of 5 might be able to help trigger our own breathing effort to restart, but I suspect it would not work out well.
Since neither machine has done all that well for you (although I think the PRS1 ASV unit has done better) I think the best machine for you may possibly be either the S9 VPAP ST-A (NOT the S9 VPAP ST) or the PRS1 BiPAP AVAPS. Both of these machines allow an absolute target for the minimum amount of air we should be breathing.
A potential problem with the ASV machines is their ventilation target is based on 90% or 95% of our recent breathing characteristics. They are designed to notice (and treat) sudden decreases in breathing, whether obstructive or central in origin. However, if our problem is that our breathing very gradually gets slower and more shallow, these machines will not notice, and their target for how much ventilation we should be getting will gradually decrease along with our recent average amount of breathing, because the machines' s target is always slowly resetting itself to 95% or 90% of our recent average amount of breathing.
In contrast, the S9 VPAP ST-A (NOT the S9 VPAP ST) and the PRS1 BiPAP AVAPS machines are given an absolute lower limit for how much ventilation we should be getting. When by our own volition we breathe more than the lower limit, that is fine and they do not interfere. But when our breathing characteristics fall below the minimum target then the machine will step in to do for us the work of breathing until we once again start breathing on our own. (That is, unless the Max PS is set artificially too low, like 5.)
When I first started ASV treatment in January 2013, I noticed that my breathing would often very gradually decrease, and the machine would do nothing to stop the descent, which would end in an arousal and large increase in my breathing (specifically, in my Minute Ventilation, which is the total volume of air breathed in or out during one minute). For me the problem appeared to be solved by raising the Min PS to 6 cm H2O, so that my breathing would always have more Pressure Support, which would tend to help keep my breathing higher all the time.
However, luckily I was using a Pulse Oximeter and discovered that my average blood oxygen level (SpO2) was spending most of the night pegged at 98% or 99%, which is too high.
A little research uncovered that an ideal range for SpO2 is considered 94% to 96%, with 90% to 94% probably being okay, also.
I am not talking about short dips, but about sustained averages. 88% and below is considered low. Less than 75% is considered severely low but not immediately dangerous, I think. I think somewhere below 50% we would start to go into a coma or something.
The point is, however, that long periods with the average SpO2 at 97% and above would be dangerous. The high levels of O2 will tend to render some medications ineffective, will cause higher levels of oxidation (free radicals) in the circulatory system, leading to atherosclerosis and inflammation and other diseases.
Now, I no longer have that problem. I have reduced my Min PS to somewhere between 4 and 5 and this has been working very well for me. My SpO2 tends to say between 94% and 96% all night.
Sorry - I don't know whether here is any trick to getting the PRS1 machine to record data on its SD card. I've never had a PRS1 machine.
You might try turning the unit off, unplugging the unit from wall power, pressing the unit's ON button as if to turn it on (it will not turn on, of course), and then waiting a minute. Make sure the CD card is fully inserted into the unit and is latched into the unit, and then plug power cord back into wall power. Good luck!