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servo ventilation not working
#1
servo ventilation not working
Hello every one, Ive been on this forum for a while now reading up and learning a great deal about this cpap stuff. The last few years have been a struggle to say the least. To make a long story shorrt I've been on cpap for nearly 3 years now and it just plain simply does not work for me - Its almost as if it got worse since the start of Cpap. I went from a straight cpap pressure of 16 to an autoset which hangs out around the 9 to 10ish Cm02 - I went from auto set to a bilevel Vpap Auto. None of it worked for me and finally at long last my suspicions were confirmed at the last titration/study that I suffer from Central sleep apnea as well.

I just had a Vpap Adapt for about 2 and a half weeks for trial and am now on a respironics Bipap Auto Sv Advancewith about 2 weeks to go on trial. I am very dissapointed with both machines as they are doing little or nothing to improve this dibilitating fatigue I suffer day after day.

The Vpap adapt did give me one good day where I was still tired but not until later in the day and was able to fight it off until i went to bed. But 1 day out of 15 is not good enough I would say considering the cost of these machines.

The respironics machine has not given me one good day yet. (actually it gave me one decent morning)

My RX is Min EPAP 8 to max Epap 16 with MIN PS of 3 To a Max PS of 16 - BPM was left on auto in the respironics and I my self had turned the byflex completely off.

Now when I had the Adapt there was a wireless transmitter sending data back to the technition who I got the machine from - When i called in she was quite excited to tell me the machine was doing great according to the data and was thoroughly perplexed when I told her how i felt the complete opposite.

I did load the data on to my own computer using rescan. The machine had basically ran wild with Ipaps of up 20 Cm02.

Now I dont have the sofware for the respironics machine. But it seems to be a better built machine and more gentle at that. I noticed right away that I didnt have mask marks on my face due to the mask being so tight to handle the high pressures. It also has more functionality - Being able to set the exact BPM in back up rate putting it in auto or just shutting back up rate right off. Where as the resmed machine does not have those option - your simply at its mercy.But I cannot ignore the one good day I've gotten from the resmed.

Looks I am going have to choose between one of these machines and logic is saying go with the one that gave you the one good day.... maybe more will come...
on the other hand im thinking maybe there needs to be some tweaking in the settings and set properly the respironics can give me good days as well.

Does any one have any use full advise they can offer on this subject?
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#2
RE: servo ventilation not working
(08-17-2014, 01:20 PM)zoophaugus Wrote: Does any one have any use full advise they can offer on this subject?

Yes. Go tell your doctor that everything still sucks and you want your issues resolved.

It makes no difference that the tech was excited if you still fell like crap.

Terry


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#3
RE: servo ventilation not working
I did tell the doctor how I felt and he basically threw his hands up in the air and flat out told me he gives up and doesn't know what else to do. Now I am up in Canada I don't think we're quite advanced as you guys especially with these servo ventilators as our universal health does not cover one cent of them and most folks don't have 5 or 6 g's to fork out for them. This seems to be uncharted waters for these guys. The place I borrowed the respironics from had an MSRP of 10k for the machine. Ya that ludicrous I know but that's how popular these machines are and that's what some of these clowns think they can charge for the machine.
Being resourceful I've already found both machines priced just over $3k and won't be taken to the cleaners for them.
I'd like to.purchase one of them with hopes of finding some one who can help down the road with settings. Just asking for advise on which one might be better based on other people's experience.
Please and thanks.
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#4
RE: servo ventilation not working
Hi zoophaugus,
WELCOME! to the forum.!
I'm sorry you are having such a rough time with CPAP therapy.
I don't know which ASV machine would be best for you, each brand has it's pluses and minuses, as you probably know.
Just hang in there and someone will weigh in on the advantages and disadvantagesof the comperable brands, Resmed and Respironics.
Best of luck to you.
trish6hundred
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#5
RE: servo ventilation not working
Zoophaugus,

Hello, I'm using the Philips Respironics System One Bipap AutoSV Advanced just like you are now. I've been using it for less than a month. My EPAP min is 13, max is 16, PS min is 0, max is 12. max pres. is 25 with a BPM of 12. I tried setting the backup rate to auto and I had horrible residual events. I switched back. Maybe you should try setting a backup rate instead of leaving it on auto. Just a thought.

I wish I could tell you this machine has "changed my life" but I can't. I was told just because the machine is helping resolve your events, doesn't mean you're going to sleep like a baby. For some of us, there are other sleep related problems that we still need to deal with. One other thing I was told was that the ASV machines do need to "get to know you". Meaning the way you breath. How long that takes, I don't know. If you can take more time on this machine before you decide, might just as well give it a bit more time. Good luck. I hope it works out for you whichever one you decide to buy.

Snowleopard
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#6
RE: servo ventilation not working
(08-18-2014, 07:55 PM)Snowleopard28 Wrote: Zoophaugus,

Hello, I'm using the Philips Respironics System One Bipap AutoSV Advanced just like you are now. I've been using it for less than a month. My EPAP min is 13, max is 16, PS min is 0, max is 12. max pres. is 25 with a BPM of 12. I tried setting the backup rate to auto and I had horrible residual events. I switched back. Maybe you should try setting a backup rate instead of leaving it on auto. Just a thought.

I wish I could tell you this machine has "changed my life" but I can't. I was told just because the machine is helping resolve your events, doesn't mean you're going to sleep like a baby. For some of us, there are other sleep related problems that we still need to deal with. One other thing I was told was that the ASV machines do need to "get to know you". Meaning the way you breath. How long that takes, I don't know. If you can take more time on this machine before you decide, might just as well give it a bit more time. Good luck. I hope it works out for you whichever one you decide to buy.

Snowleopard

Snowleopard,
I wish to thank you as this is exactly the kind of response I am looking for. A personal experience with which I may be able to relate to or perhaps apply to my situation.
As i stated before I am not doing well these days and it feels well "hopeless" to be honest. These machines are doing some thing to me ...... some thing abnormal, as I know I did not feel this bad prior to all this cpap business. Problem is that I seemed to have developed a dependence on it. I think I may have been better off just never starting on the treatment to begin with and exploring other avenues. Its like theres a dirty little secret going on here but this is such a huge $$$$ money maker that the alternatives have been pushed aside.
Also Ive noticed theres a Cpap supply store at every mini mall or medical building now a days. Every one wants a piece of the pie.
I just want my life back.. Im not even old .. just 36 with 2 very young kids that i struggle to take to an evening movie because of this debilitating fatigue .
Again thanks for your response and I welcome more from any one else.

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#7
RE: servo ventilation not working
(08-18-2014, 07:55 PM)Snowleopard28 Wrote: Zoophaugus,

Hello, I'm using the Philips Respironics System One Bipap AutoSV Advanced just like you are now. I've been using it for less than a month. My EPAP min is 13, max is 16, PS min is 0, max is 12. max pres. is 25 with a BPM of 12. I tried setting the backup rate to auto and I had horrible residual events. I switched back. Maybe you should try setting a backup rate instead of leaving it on auto. Just a thought.

I wish I could tell you this machine has "changed my life" but I can't. I was told just because the machine is helping resolve your events, doesn't mean you're going to sleep like a baby. For some of us, there are other sleep related problems that we still need to deal with. One other thing I was told was that the ASV machines do need to "get to know you". Meaning the way you breath. How long that takes, I don't know. If you can take more time on this machine before you decide, might just as well give it a bit more time. Good luck. I hope it works out for you whichever one you decide to buy.

Snowleopard

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?

Again any kelp would be much appreciated.

Sleep well as good as you all can.
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#8
RE: servo ventilation not working
(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?

Hi zoophaugus,

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!

Take care,
--- Vaughn


The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies.  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.
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#9
RE: servo ventilation not working
I tried the System one 50 series ASV Adv. some months back and didn't sleep great for the few weeks I was trialling the machine.

Biggest issue were the arousals when the machine did its sudden pressure change, I only tried minimal changes to PS, Rise time and Biflex though as sleep doc asked me not to fiddle (I sorta did anyway!).

Getting another one soon and wish to nail down the right settings to get a good nights sleep. Will share the data here hopefully.

As for which machine to go for this is tough as you hear subjective reports of one preferring the other, but not sure I've seen anyone else who has tried the very latest model of both machines and declared one the winner (one in another forum prefers Sys 60 I think but he has the slightly older S9 adapt which is missing auto EPAP?).

Personally the rhythmic clack of the h5i helps swing me towards Philips. I know many don't care about this but I find it annoying and a bit indicative of how much Resmed cares about build quality when they apparantly make statements to the effect of 'its by design'.

Well done for trying out all the options you can, many of us can feel your frustration and share in the hope that one day there will be enough stability to allow the healing to start.
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#10
RE: servo ventilation not working
(08-29-2014, 04:42 AM)Breeze Wrote: I tried the System one 50 series ASV Adv. some months back and didn't sleep great for the few weeks I was trialling the machine.

Biggest issue were the arousals when the machine did its sudden pressure change....

Hi Breeze, welcome to the forum!

Apneaboard member goodonya tried the PRS1 BiPAP autoSV Advanced (50 series) and was unable to adapt to it. He later changed to the S9 VPAP Adapt and it worked MUCH better for him. You can search for some of his threads here on the forum. (It is not clear to me, though, how extensively goodonya may have experimented with the Rise Time and other adjustments on the PRS1 ASV machine, to see if the PRS1 ASV unit could have been adjusted to work better for him.) But others prefer the PRS1 ASV unit.

I suspect I'd probably do better on the PRS1 ASV unit than the new S9 Adapt because the max EPAP is not limited to 15 on the PRS1 ASV unit. Of course, if Max EPAP is higher than 15 this will limit how high the Pressure Support can go, since EPAP plus PS is limited to 25, but ResMed's solution is to simply never allow Max EPAP to be set higher than 15. When I don't wear a teeshirt with a tennis ball in a pocket sewn between my shoulder-blades I will roll onto my back while asleep and will need higher EPAP than 15, which the S9 Adapt cannot provide.

You mention the sudden pressure changes are a problem for you. If you mean how quickly PS is adjusted upwards during an apnea condition, the VPAP ST-A and PRS1 BiPAP AVAPS machines are more gradual in their PS adjustments, which might be better for you. But the main limitation of the VPAP ST-A and PRS1 BiPAP AVAPS machines is EPAP is fixed, not automatically adjusting. I am not sure if there are extra hoops insurance companies would make patients and doctors jump through before coverage would be granted for the "Ventilator" class machines (VPAP ST-A and PRS1 BiPAP AVAPS).

Take care,
--- Vaughn

The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies.  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.
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