My first night on ASV

[jskinner]

What IT= time did you end up using?

Initially I tried 1.7 as you first suggested.
I then tried 60/14.5/2= 2.06 which was your second suggestion.
Finally I tried 60/12/2= 2.5 which was my calculation

Not excited to see the fall in Patient Triggered Breathing, but you do feel better?

The patient triggered breathing shot up not because I wasn't breathing but because I hadn't finished my exhale yet and the machine decided it was already time to start inhaling. I did feel better the next day but it was a rough night. I'm not sure if I felt better because of the machine or because I barely slept and thus didn't have many events. I did feel like we are headed in the right direction with Fixed BPM though

So these settings were less comfortable than what you have been using?

Very much so, I should have given up after a hour or so but I struggled for 3 hours. Eventually I sedated myself (which I don't like to do) but it was the only way that I was going to get to sleep with those settings.

Do you notice that BPM=Fixed settings right away?

Absolutely. It starts driving your breath. The problem was that my breaths where not finished and I was bumping into the machine moving on to the next one when I was still exhaling. I felt like my breaths where much more rapid which didn't make seance to me since the BPM was 2 slower than my normal average

[Snoredog]

What IT= time did you end up using?

Initially I tried 1.7 as you first suggested.
I then tried 60/14.5/2= 2.06 which was your second suggestion.
Finally I tried 60/12/2= 2.5 which was my calculation

Okay, that is good to know, so a tiny change of IT time makes a big difference.

The patient triggered breathing shot up not because I wasn't breathing but because I hadn't finished my exhale yet and the machine decided it was already time to start inhaling. I did feel better the next day but it was a rough night. I'm not sure if I felt better because of the machine or because I barely slept and thus didn't have many events. I did feel like we are headed in the right direction with Fixed BPM though

You probably want to experiment with those fixed settings during the day to get it comfortable instead of while trying to sleep. It
was probably Rise Time being set too short.

I would put BPM=Auto until you have the time to experiment with those settings.

So these settings were less comfortable than what you have been using?

Very much so, I should have given up after a hour or so but I struggled for 3 hours. Eventually I sedated myself (which I don't like to do) but it was the only way that I was going to get to sleep with those settings.

Sorry about that, next time just put the BPM=Auto so you can sleep.

Do you notice that BPM=Fixed settings right away?

Absolutely. It starts driving your breath. The problem was that my breaths where not finished and I was bumping into the machine moving on to the next one when I was still exhaling. I felt like my breaths where much more rapid which didn't make seance to me since the BPM was 2 slower than my normal average

I would put BPM=Auto until you have the time during the day to experiment with fixed timing settings to get breathing timing down better. Rise time is the time from exhale to top of inhale, Inspiration Time is how long that inspiration lasts. So you can add time to that by extending the Rise time (IT takes over after Rise Time). Slowing BPM slows breathing down, so if it seemed to fast from breath to breath that is the BPM=xx. Do the math on it to come up with the IT time. You can go up to 6 with Rise time.

Note: I would set up a 30 minute ramp with 8 cm pressure or lower if you want it lower, then it will lower EPAP for 30 minutes, might make it easier in falling asleep.

[jskinner]

Settings last night:

EPAP: 10
IPAPmin: 12
IPAPmax: 20
PBM: 11
IT: 2.7
Rise: 3

Results: http://james.istop.com/apnea/reports/AsvDec2.pdf

[-SWS]

What is happening on the "Patient Breaths Triggered" line between hours one and two reflect extreme central dysregulation. That hour, of virtually no respiratory drive being present, warrants yet additional professional involvement IMHO.

[jskinner]

I thought some might find this useful in respect to the conversation:

[jskinner]

What is happening on the "Patient Breaths Triggered" line between hours one and two reflect extreme central dysregulation. That hour, of virtually no respiratory drive being present, warrants yet additional professional involvement IMHO.

It took me roughly 1 hour to get to sleep so that happened shortly after falling sleep.

[-SWS]

I thought some might find this useful in respect to the conversation:

Two points of interest regarding BPM and IT ratio calculations:
1) The overall BPM is determined by that recurring period from the rise-time/trigger line to that same point at the beginning of the next breath, and
2) IT (or inspiratory time) is bound by the first and third dotted lines in this Respironics implementation.

We have been using the term I:E ratio, as the industry so often does. However, when you work with only BPM and IT numbers, the ratio is really better referred to as I:remainder. The above example shows a ratio of 1:1 according to approximate tape-measure used on my display: IT=5/8" and overall breath period=10/8" on my fairly approximated laptop measurements (so a "5:remainder" ratio equals 5:5 or 1:1 in the Respironics example above). Again, the overall breath-period used in BPM calculations occurs from inspiratory "trigger point" to the following inspiratory "trigger point". [on edit: had to correct for rotten initial tape measurements ]

It took me roughly 1 hour to get to sleep so that happened shortly after falling sleep.

The time period right after falling asleep (when autonomic regulation takes control) is when homeostasis does a little adjustment to maintain slightly different O2/CO2 ratios for virtually all of us. Homeostatic maladjustment seems to be a characteristic trait for CSDB patients.

[Snoredog]

I thought some might find this useful in respect to the conversation:

Two points of interest regarding BPM and IT ratio calculations:
1) The overall BPM is determined by that recurring period from the rise-time/trigger line to that same point at the beginning of the next breath, and
2) IT (or inspiratory time) is bound by the first and third dotted lines in this Respironics implementation

We have been using the term I:E ratio, exactly as the industry does. However, when you work with only BPM and IT numbers, the ratio is really better referred to as I:remainder. The above example shows a ratio of 1:1 according to approximate tape-measure used on my display: IT=5/8" and overall breath period=10/8" on my laptop (so a "5:remainder" ratio equals 5:5 or 1:1 in the Respironics example above). [on edit: had to correct for rotten initial measurements ]

Yes I agree, it is I:Remainder, I had been saying that for some time as those two values are the only values that are defined to make up the breath. I had seen that graph in the manual some time ago.

BPM Rate defines the overall length of the breath,
IT defines the duration of inspiration in addition
Rise time defines how fast that inspiration will kick in.

and NO I don't think his report is looking any better, I would like to know if the change made improved breathing against the machine any.

If he can feel the effects of these changes right away, I wonder how it feels using the fixed "minimum" settings the guide
suggests when the events seen on his report are present (now that we have everything again).

Those would be:

BPM=10
IT=1.2 (minimum)
Rise TIme=3 or 4

If there was ever a machine that Respironics made that needed a Split-Night mode it is this one. If you could run a few hours in Fixed then switch to BPM=Auto you could compare settings.



James: How do you feel after a night like that?

My guess is not good. I see in the beginning you tried to use IPAP MIn=12? then dropped back down to 11.

[jskinner]

I would like to know if the change made improved breathing against the machine any.

Yep it made a huge difference, I didn't feel like I was fighting with the machine every breath. Last night felt almost the same as being in Auto mode.

James: How do you feel after a night like that?

Strangely I actually feel quite good today. One of the better days since going on ASV actually.
I don't understand it. Clearly, as you said, CSDB is complex.

[-SWS]

James, everything besides hours 1-to-2 look clinically acceptable. Do you know if you were side sleeping, stomach sleeping, or supine sleeping during hours 1-to-2? Supposedly some CSDB patients have more problems with central dysregulation when they side sleep.

Wonder if there's a pattern of extreme central-dysregulation versus sleep position you might eventually be able to spot. Perhaps a camcorder can help with that. Alternately you might use sewn tennis balls to force a certain sleep position, looking for improvements to your CSDB.

[Snoredog]

James, everything besides hours 1-to-2 look clinically acceptable. Do you know if you were side sleeping, stomach sleeping, or supine sleeping during hours 1-to-2? Supposedly some CSDB patients have more problems with central dysregulation when they side sleep.

Wonder if there's a pattern of extreme central-dysregulation versus sleep position you might eventually be able to spot. Perhaps a camcorder can help with that. Alternately you might use sewn tennis balls to force a certain sleep position, looking for improvements to your CSDB.

Actually, between hours 1 to 2 was the only time I see he dropped down to the Fixed backup settings. BPM graph is shown at BPM=11 there.

For me, I have much more difficulty with CA when sleeping on my right side as opposed to left or supine. I'm getting
the uneasy feeling this titration guide was written by the genius that designed the M series humidifier I think
the object of the machine is to make reports look really crappy then the patient feels better

He is feeling better so we have to keep pursuing why that is.

[dsm]

James,

Agree re the comments about that early segment of sleep BUT, the machine was doing its job.

There could have been CO2 blowout causing you to drop your respiratory drive (which is what triggers centrals in someone such as yourself).

As a general comment - all the adjusting of rates etc: hasn't really altered what shows in your reports other than last nights significant
machine control of your respiration. Note too, the machine took IpapCurrent to the max during that early period (that is IpapCurrent was maxed up to IpapMax setting) so the machine was running like a conventional ventilator. That was quite a long period - BUT, if that worked & you feel ok, that helps.

I have to add though that I have now had 3 periods on my Bipap AutoSV where I was sure I was fine and the data was excellent but went into daytime drowsiness despite feeling the sleeping was v.good. Each time that started to happen I switched risetime from 3 to 2 (300 millisecs to 200 millisecs) & within 1 to 2 nights was feeling back to normal in daytime. Still trying to put a theory around why. Also I find that when things are ok I prefer to drop risetime back to 3 (until the next bout). This occurred over approx 2.5 months. The bouts got shorter as I was quicker to adjust risetime having figured out that must be a solution.

DSM

[Kiralynx]

James,

Thank you for posting this -- and for this discussion. I'm very new to CPAP, but following this with great interest since I am also on a BiPap Auto SV. I can't (yet) add anything to the discussion, but I do find it of interest. Again, thank you.

[Dunn]

hi my last 6 nights are going really badely cant go asleep with thre mask on but will keep trying. is there a certian age group that uses this syyem and is it for life

tks













]

First night went ok. Definitely felt better than usual in the morning.[/quote]

W00t, James! That sure sounds good so far!!! Hope feeling "better" continues for you.

Bet you (of all people...heheh) are really chafing at the bit to get a download off that card.[/quote]

[jskinner]

EPAP=11 (former settings were 9.0 and 10.0)
IPAP Min=13 (or where it is comfortable for him)
IPAP Max=21 (or +10 from EPAP)
BPM=Auto

Last nights results at the settings above.

http://james.istop.com/apnea/reports/AsvDec3.pdf

The numbers look pretty good. (Oddly I have a bit of a headache today) I think I will repeat at these settings tonight to see if its consitant.