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servo ventilation not working
#11
Hi vsheline, thanks for the warm welcome.

It's too late! Have the 960 on its way to me now.

A few other things have changed since then too, like my methods to get a nasal mask working effectively and I will be a bit more bold with settings experimentation. Of course I would not fight against futility if the machine was that bad, but hopefully I'll 'adapt' Wink

Looking back through some of goodonya's experiences, it also seems the Respironics algorithm doesn't really suit his disposition. Not sure if my arousals were just more sudden PS related which might be an issue on Resmed too. My memory of the period isn't too sharp so will have to get back to basics.

Might just leave settings wide open for a bit and see what the machine thinks, I know setting the EPAP near my 95% the last time isn't necessarily a golden ticket as the 95% is just that pressure or below on Resmed I think, so could spend a lot of the night below that.
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#12
Hey guys/gals ..thank you so much for the replies as they are a fountain of info to be absorbed and applied for all who read and their individual situations.

I did go ahead with the purchase of the Philips Respironics System One BiPap AUTO SV ADVANCE machine - as stated before it had more functionality or fine adjustments than the Resmed VPAP Adapt . Its ability the set a minimum Back up rate proved indispensable to me.

I will admit I am not "cured" but rather I appear to be stabilized from the downward spiral I was in.

As stated before i did tighten and continue to tweak the parameters of the machine.

My RX is Min/Max Epap 8-16 - Min/Max PS 3-15 - Backup rate Auto

I now have the machine set to epap = 8-12 And PS 4.5-10 with BR 16

I did notice some thing very interesting - leaving the epap at 8-12 and leaving the PS wide open I have the lowest AHI (below 1 average)

Leaving epap 8-12 and dropping PS 4.5-10 my AHI goes to around 3.

Leaving alone epap and further dropping PS to 4.5 - 7 or 8 my AHI goes to around 5ish or just a little over .

I actually feel better when the AHI rises a bit - having it too low means the machine is going ape sh*t trying to "fix" me causing more severe fatigue the next day - most likely disrupting slow wave sleep with the higher pressures.

I have a few more experiments I would like to try with the machine in the near future.
I think I may also be suffering from hypercapnia as well (high C02 levels in the blood stream) which explain the horrible way I feel a lot of times in the morning and trough out the day on top of the tiredness. I will try and set up the machine more as a basic ventilator with hopes of possibly blowing off more C02 during the inhale and exhale process - I am going to raise the PS to 8-10 and lower the Back up rate to 14 and increase the TI (inspiratory time) to allow for the larger breaths with hopes that it may make me feel better.

As Vsheline sated previously perhaps I may just need straight ventilation with minimum target ventilation.
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#13
(08-29-2014, 08:24 PM)zoophaugus Wrote: I am going to raise the PS to 8-10 and lower the Back up rate to 14 and increase the TI (inspiratory time) to allow for the larger breaths with hopes that it may make me feel better.

Hi zoophaugus,

A minimum PS of 8 would be very high.

I would recommend buying a Pulse Oximeter to verify your average SpO2 (not counting the occasional dips during apnea events) will not be higher than around 96%. If using at least 8 for PS all the time, your average SpO2 might be dangerously high most of the night.

Until you are monitoring your SpO2, I suggest leaving Min PS at 5 or lower.

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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#14
(08-29-2014, 08:44 PM)vsheline Wrote:
(08-29-2014, 08:24 PM)zoophaugus Wrote: I am going to raise the PS to 8-10 and lower the Back up rate to 14 and increase the TI (inspiratory time) to allow for the larger breaths with hopes that it may make me feel better.

Hi zoophaugus,

A minimum PS of 8 would be very high.

I would recommend buying a Pulse Oximeter to verify your average SpO2 (not counting the occasional dips during apnea events) will not be higher than around 96%. If using at least 8 for PS all the time, your average SpO2 might be dangerously high most of the night.

Until you are monitoring your SpO2, I suggest leaving Min PS at 5 or lower.

Take care,
--- Vaughn

You are right, caution is advisable and i will head your advise. I will leave things as they are a dig up my pulse oximeter before going ahead - I have a CMS50E.
Resmed makes a device that attaches inside of you full face mask and actually gives you and approximate reading of how much C02 is being exhaled. My "GUY" is
looking into it for me.
Accordinng to the machine data last night's average PS was 5.6 .
Min/max was 4.5 - 10.
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#15
(08-29-2014, 08:44 PM)vsheline Wrote:
(08-29-2014, 08:24 PM)zoophaugus Wrote: I am going to raise the PS to 8-10 and lower the Back up rate to 14 and increase the TI (inspiratory time) to allow for the larger breaths with hopes that it may make me feel better.

Hi zoophaugus,

A minimum PS of 8 would be very high.

I would recommend buying a Pulse Oximeter to verify your average SpO2 (not counting the occasional dips during apnea events) will not be higher than around 96%. If using at least 8 for PS all the time, your average SpO2 might be dangerously high most of the night.

Until you are monitoring your SpO2, I suggest leaving Min PS at 5 or lower.

Take care,
--- Vaughn

Vsheline,

Im not sure what exactly happened but I seemed to have found a "sweet" spot with the machine - I Feel 10 times better than before - All I did was increase the PS from 4.5-10 to 4.5 to 11 - .
I stil get tired but have not used my modafonil for 2 whole days now.

I am some what confused as the "BiPAP Auto SV Advanced summary"
is stating
My AVERAGE PS is 6cmH20
90% of the time device PS was 9.1cmH20

If the average PS is 6, then how can 90% of time be 9.1 ?

I am almost certain that the higher pressure support is the direct cause of me feeling better.

I have yet to sleep with the pulse oximeter and check saturation levels.



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#16
(09-04-2014, 09:11 PM)zoophaugus Wrote: I Feel 10 times better than before - All I did was increase the PS from 4.5-10 to 4.5 to 11 - .
I stil get tired but have not used my modafonil for 2 whole days now.

I am some what confused as the "BiPAP Auto SV Advanced summary"
is stating
My AVERAGE PS is 6cmH20
90% of the time device PS was 9.1cmH20

If the average PS is 6, then how can 90% of time be 9.1 ?

I am almost certain that the higher pressure support is the direct cause of me feeling better.

You are also adapting to the therapy, and changing PS back to 4.5 to 10 might not make a lot of difference now. If swallowing too much air is a problem for you, lowering the Max PS might actually help, but I would recommend against lowering Max PS any lower than around 10 unless you are have problems (pain) from swallowing too much air.

The summary is reporting that the median Pressure Support is 6, which means that AT LEAST 50% of the time PS was 6 OR LOWER, and AT LEAST 50% of the time PS was 6 OR HIGHER.

The "90%" value is the 90 percentile value. It means PS was 9.1 OR LOWER at least 90% of the time. This also means PS was 9.1 OR HIGHER at least 10% of the time.

As an extreme example of medians and 90 percentiles, if PS was exactly 6 for 51% of the night and was exactly 9.1 for 49% of the night, the median PS would have been 6 (even though the average would have been higher than 6) and the 90% PS would have been 9.1 (even though PS would have been 9.1 longer than 10% of the time).

And if PS was exactly 6 for 49% of the night and was exactly 9.1 for 51% of the night, the median PS and the 90% PS would both have been 9.1.

Very glad things are going well for you.

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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