been on new PR ASV machne a week ahi going up

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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OSAHell
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Re: been on new PR ASV machne a week ahi going up

Post by OSAHell » Wed Jun 17, 2015 1:59 pm

Hi,

I can't really tell you why your machine won't go up to 10 but if I look at my numbers in SleepyHead my max pressure (max IPAP) will alway top at 15 at least one time during the night but the 95% will always be around 13.8.
Is your aerophagia problem new? Did it came with the new machine or before? Because you seems to had a really good period of good AHI from nov 2, 2014 to mar 13, 2015 on the Adapt from your statistics. Did you have good hours (7-8hrs) of sleep during that time? You also tried several nights with a fixed pressure (no ASV mode) with good AHI results, was your sleep good during that time? You might be better with a fixe pressure. The one cool thing about the AutoSV vs the Adapt is that it will record CA and CSR, so you might try fixe pressure (CPAP) for a week and see how it goes with the OA, CA and CSR.

Setting AutoSV for fixe pressure (CPAP) of 5
Max pressure: 5
EPAP min: 5
EPAP max: 5
PS min: 5
PS max: 5

Or something with a little pressure support to start and work your way up:
Max pressure: 10
EPAP min: 5
EPAP max: 5
PS min: 0
PS max: 5
and add +1 to Max pressure and +1 to PS max after a few days with no aerophagia repeat that until you get to PS max to around 10. The point of this is to get use to the pressure, don't be to concern with your AHI during that time

Also don't try to get the same "numbers" (AHI) with the autoSV that you got with the Adapt. Because, in my case anyway, (and limited time using AutoSV) AutoSV is flagging more hypopneas that the Adapt so that my average AHI is alway +1 or +2 with the AutoSV compare to the Adapt.

Also someone with aerophagia problem might be of better help than me with your problem. The worst problem I had with high pressure is when the pressure was going over 17 (it woke me up) with an APAP or an ASV. Lucky for me at my current setting the max pressure the machine can go is 15 with an average AHI just under 2.

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wilsonintexas
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Re: been on new PR ASV machne a week ahi going up

Post by wilsonintexas » Wed Jun 17, 2015 6:29 pm

The problem with aerophagia started about a year ago. I had a pituitary tumr removed, and since then I have had problems with nausea. It was traced to several things:

1) the eye nerved were damaged by the tumor and the followup radiation. This led to a disconnect between the eyes and the ears.
2) I had some meniers and balance problems
3) The combination of the above have been diagnosed as central nausea. It starts as soon as start moving. I take meds almost daily for it.

BUT, I also noticed a year ago that I was getting gas in the morning... This is when I started lowering my pressures. On the RESMED, I lowered it as low as it would go, so I tried to go lower as you see by gong to straight CPAP, and even at 4, my ahi was not bad at all. (at least on the RESMED detection method)

The aerophagia go a lot better when I got the pressures down some, but it is still a problem.

I was up for a new machine, so I went for the PR System, because it looked like I could lower the pressures more than on the RESMED. For a while, I thought I might be able to get off the CPAP. When my ahi was low on straight cpap of 4, I had hope. (I have lost some weight, and was hoping). BUT, even with a low ahi on the PR my s patient trigger breaths would drop during my REM cycles. The RESED does not give this information.

It has been several years since my sleep study. On the RESMED my AHI had been 0 almost since I got the ASV machine.

I started the PR system on March 31. The AHI has been going up since then. The other day it got up to 13 for the night, and during my REM it peaked at 45.

I guess I will try and increase the max Pressure and mas PS to give it some more room to work.

I increased my eap from 4 to 5, and am willing to take it higher.

AT this point, I do not want to play with to many things. I am not sure if I need to increase the max pressure or the minimum eap pressure.

Since I have the max pressure at 10, and it is not getting up that high, I guess it would be better to raise the min pressure a little more first.

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palerider
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Re: been on new PR ASV machne a week ahi going up

Post by palerider » Wed Jun 17, 2015 6:34 pm

I'd go back to the resmed, maybe the respironics just isn't for you.

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OSAHell
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Re: been on new PR ASV machne a week ahi going up

Post by OSAHell » Wed Jun 17, 2015 9:36 pm

Palerider might have a valid point here. In my case, I see a big difference between the 2 when I'm awake and trying to fall asleep. But to be honest I did not use the AutoSV very much or played to much with the other settings like Rise time or Bi-Flex to find something "confortable". Also, newer Adapt can have there PS min set to 0 that might be easer on you.

As for which setting to change in your case, since you had so good results (from your stats screenshot) with a fixe EPAP at 4 on the Adapt, I personally would not go higher that 5 for the EPAP at first and concentrate on your PS to find the sweet spot for confort (aerophagia) and AHI.

If I understand your last post correctly you said that you tried in CPAP mode with a fixe pressure of 4 and still had aerophagia? If that's the case, I don't know what more I can add... That's way over my head.

If you did not see your sleep doc since last year when all you "new" problems start, now would probably be a good time! Your others Dr, that treat your other problems, might come handy also since all that coincide with tutor removal, it might be some side effect of meds.

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wilsonintexas
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Re: been on new PR ASV machne a week ahi going up

Post by wilsonintexas » Thu Jun 18, 2015 1:19 pm

Thanks for the comments. I was back at the sleep dr, I needed to see him toget the new script. He did not have any other recommendations for the aegro, other than the lowest pressure that will control the apnea.

The aegro did improve at the lower pressures, which is why I was looking to see how low I could go.

I do find it strange that things were clear on straight cpap, with me lowering the pressure to see how low I could get it, but on the ASV, they were never as good as on straight cpap.

It could be that the RESMED does not classify as many events.

Since the new RESMED can go to a 0 PS (which my current model can not, it only goes down to 3) I will probably switch back to the resmed. I bumped the min eap up last night, and the ahi was improved from the 13 to about 4.6.

I understand it is not abut the number as much as how I feel, and I am not sleeping nearly as well, and am waking up more during the REM stages.

AT least I am renting it for now. I guess it will be a call tomorrow to the DME and see about switching me to the new RESMED ASV.

Thanks for all of the support. I will let you know how it goes.

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OSAHell
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Re: been on new PR ASV machne a week ahi going up

Post by OSAHell » Fri Jun 19, 2015 12:52 pm

Hi, I'm glade if I've been of any support and I wish you good luck with your next steps.

Here one more comment on one of your observation (see quote). But remimber that I'm NO Doctor and those are just thoughts for you and you should probably investigate with your Sleep Dr if you think it make any sense. There is surely many things I'm not aware in your case and my thinking is based only on what i've read in this particular thread.
wilsonintexas wrote:...
I do find it strange that things were clear on straight cpap, with me lowering the pressure to see how low I could get it, but on the ASV, they were never as good as on straight cpap.
...
It "might" be related to your pituitary tumor removal. Here how I came to that possibility:

The fact that you've been put on ASV means for me that you probably have been diagnosed with something like: Complex sleep apnea or central sleep apnea or periodic breathing. And those sort of things are, from my understanding, central in nature and can be caused, but not necessarily, by neurological problem.

A little search on google on "pituitary tumor" lead me on the Pituitary gland wikipedia page. "That gland is a protrusion off the bottom of the hypothalamus at the base of the brain"...

Maybe, just maybe, the tumor removal had a positive impact on the "central" side of your sleep apnea problem and that might explain why you seems to do well under CPAP now.

This is highly speculative and should be discuss with qualified health professionals before making any real conclusion.

But even if I'm way off with this, I would talk to your sleep Doc about the simple fact that you now seems to do good on CPAP and see what he think.

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wilsonintexas
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Re: been on new PR ASV machne a week ahi going up

Post by wilsonintexas » Sun Jun 21, 2015 11:02 am

I appreciate your comments. I agree that several things may be going on since the surgery. I know that my balance is worse, and the neuro says that the area that processes balance is close, and it may have been agrivated during the surgery, swelling after, or the radiation treatment. It has been a year since the radiation, and things should have settled down to a steady state by now. (I hope)

You are correct in that I had complex apnea, including a high portion of centrals which is what led me to the ASV a few years ago. On straight CPAP I had no centrals and very low AHI, at least that the RESMED recorded. I was also feeling better.

The first few nights of the PR were also central free. Here is the progression

Code: Select all

date June              1          3           6          8         10          15      17            19
EAP                    4,12       4,10       4,10       4,10       4,10       5,10    6,11.5       6,11.5
PS                     00-8       0-6        0-6         0-6       0-6        1-5     0.2-5.7      0.9-5.5
AHI total              1.61       1.97       2.26       4.03       6.0        13.11    4.38         2.36
cheyney strokes        0          .16        .31        .58        1.34       4.44     1.63          .25
clear airway           0          .12        .23        .92        .92        3.99     .13           .13
obstructive            0          0           0          0         0           .13      0             0
hypo                  1.61        1.85       2.4        3.11      4.96         9.66     4.25       2.23
Flo limit             0.88       .99        .91         .23       .92          .13       0           .26
timed breath          10.08     16.64        11.66      29.25      48.60       41.47    19.57       17.28
trying, to fix spacing..... first attempt at using the code button...... about 30 previews later, beter.
Sorry about the table format, it is the best I could do.
AS I look at this, it looks like as my body adjusted to the PR system, things got worse. The overall AHI, the CSS and centrals, and the timed breaths. It is getting better over the past few days. I will increase both the min eap and max pressure again tonight and see what happens.
It could be that my brain had adjusted to the RESMED and needs time to adjust to the PR algorithm.

I am going to increase the min eap, ax pressure and PS range some moretonight and see what happens. It is getting better since going from 4 to 6. so far the trapped gas is not to bad, so we will see.

I am renting the machine for the first three months, so I can switch it out if I want to. The main reason I went for this machine, is that it could be a backup for my wife's bipap if needed, and I could go back to the RESMED. But I am not sure that think that I may be able to play with the pressures on the RESMED like I can on the PR and make it a bipap if needed.

I have a post out there asking if anyone has tried the new RESMED ASV, and how it compares to the ST ASV. I hope to get a reply today, and I will probably call the DR on Monday and ask for a new script for the RESMED.

Thanks again for the comments.
Last edited by wilsonintexas on Sun Jun 21, 2015 11:48 am, edited 1 time in total.

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palerider
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Re: been on new PR ASV machne a week ahi going up

Post by palerider » Sun Jun 21, 2015 11:14 am

wilsonintexas wrote: The first few nights of the PR were also central free. Here is the progression

Code: Select all

date June      1        3      6     8     10    15     17      19
EAP            4,12   4,10   4,10  4,10   4,10   5,10  6,11.5   6,11.5
PS            00-8    0-6    0-6   0-6     0-6   1-5   0.2-5.7 0.9-5.5
AHI total     1.61    1.97   2.26  4.03    6.0   13.11  4.38    2.36
csr           0       .16     .31   .58   1.34   4.44   1.63     .25
central       0       .12     .23   .92    .92   3.99    .13     .13
obstructive   0       0      0     0      0       .13   0        0
hypo          1.61   1.85    2.4   3.11   4.96   9.66   4.25    2.23
Flo limit     0.88    .99    .91    .23    .92    .13   0        .26
timed breath 10.08  16.64  11.66  29.25  48.60  41.47  19.57   17.2
Sorry about the table format, it is the best I could do.
adjust your spacing in an editor with a fixed spacing font, then use the 'code' button in the edit window here. it's not perfect, but it's better than the default of having all the spaces squashed out.

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OSAHell
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Re: been on new PR ASV machne a week ahi going up

Post by OSAHell » Sun Jun 21, 2015 1:38 pm

Good to see that your AHI stopped going up and your trapped gas are not to bad with the new pressure.

Yes, it was my understanding that you where renting the machine and the reason why you went with the AutoSV. I can't speak for the new Resmed Aircurve 10 ASV but for my Resmed S9 VPAP Adapt (36037) you wouldn't be able to use it as a straith Bi-level machine. One of the reason is that you can't set the PS max the same as PS min. "PS max" would not got lower than "PS min + 5", I thinks it's the same on your older Adapt. The big change for Pressure Support between your Adapt and mine is that it can now be set with a minimum "PS min" of 0, but PS max wont go lower than 5.

I would suggest that you find the clinical manual for the Resmed Aircurve 10 ASV, if available, and see what you can do with the settings.

PS Thanks to Palerider for the "table" tips!
PS2 And Thanks wilson for making the change in your original post!

I hope things will settle down for you

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wilsonintexas
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Re: been on new PR ASV machne a week ahi going up

Post by wilsonintexas » Tue Jun 23, 2015 12:28 pm

I bumped the min eap up twice, and I a not sleeping any better. My ahi did dtro to 2.3 for a day, but was back to 3.6. It is not the ahi as mch as the fact that I do nto feel as rested as I did no the RESMED. I am also starting to get more gass problems. My nausea is kicking back up in the mornings, to the point that I am taking the nausea medication the past two days to make it through the morning.

I have given it 23 days, and since I am having to up the pressure on the PR, I will call he DR and see if I can get a new script for the RESMED AIRCURVE 10 ASV. It will be interesting to see what happens with the DME. I did call them last week, and they said all I needed was a new script.

I will update this when things change.

Thanks again for the support.

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palerider
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Re: been on new PR ASV machne a week ahi going up

Post by palerider » Tue Jun 23, 2015 4:22 pm

wilsonintexas wrote: trying, to fix spacing..... first attempt at using the code button...... about 30 previews later, beter.
if you have to do it again, what I'd suggest is getting it looking good in another editor, maybe wordpad, set to fixed spacing... not proportional, and then paste that into a code block here... it's a lot easier than trying to make it look good here hitting the preview button over and over.

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OSAHell
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Re: been on new PR ASV machne a week ahi going up

Post by OSAHell » Tue Jun 23, 2015 5:32 pm

wilsonintexas wrote: Thanks again for the support.
Your welcome! And I think the switch back to Resmed might be a good thing in your case.

Good luck

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wilsonintexas
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Re: been on new PR ASV machne a week ahi going up

Post by wilsonintexas » Tue Jun 23, 2015 10:09 pm

Thanks for the advice on notepad. I will try it next time.

I called today and asked for a new script, I will let you know.

wilsonintexas
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Re: been on new PR ASV machne a week ahi going up

Post by wilsonintexas » Tue Jun 30, 2015 4:34 pm

got script.... dme sent in for reauthorization....... on phone now to insurance, reauth not needed, since they approved a code not a model and the new machine is the same code...

insurance is calling dme and setting them straight......


jusy fyi....

for 23 days my ahi was creaping up. I raised min eap and all I got was worse gas....

so I dropped it back down and the ahi is going down..... last night was 0.1........

maybe I am getting use to new machine..... just as the switchback to resmed is aqbout lined up......

oh well, more updates later

wilsonintexas
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Re: been on new PR ASV machne a week ahi going up

Post by wilsonintexas » Thu Jul 09, 2015 9:48 am

The DME has had the new script since the 25th of last month. After many c, it turns out that my account was in "suspense" because the insurance compny had asked foe some documents and he DME had not sent them in. they were in the file.

The local branch manger sent 2 emails and nothing happened.

I was directed to the billing department after a 45 minute hold, they drop the call, in the middle of verifying my details..... after another 45 minute hold, I find out that there is a separate billing department just for my insurance..... ...... and after half an hour with them, here is a suspense deThey happen partment that has to get involved.... why I was not sent there fist I will never figure out. i I finally get my account un suspended...... The local branch manager finally gets the word that it is cleared up.....

wait for it......

HE IS HAVING PROBLEMS SETTING UP THE MACHINE and has CALL INTO REESMED Technical support for help.

I reviewed the past month on the PR ASV. the machine is very gentile, to put it mildly. I can see clusters where my ahi is ramping up to as high as 30 or 45 and the machine still has not hit the maximum limits after an hour. Even when I increased the min eap to give it a head start it did not solve it. I tend to get these around 3-5 and then 6:30 until I get up. It is usually worse as I transition out of sleep in the morning.


I look forward to getting back on the RESMED. At least for me it was better. I have not been this tired since I finally got on the ASV 3 years ago.

thanks for letting me rant.... again.

Hopefully I get the new machine today, if not, I am going to camp out at the office tomorrow until I get it.