NOT GETTING ENOUGH AIR

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
seajay
Posts: 36
Joined: Wed Apr 01, 2009 12:18 pm
Location: Denver, CO

NOT GETTING ENOUGH AIR

Post by seajay » Wed Jul 29, 2015 1:37 pm

I hope someone can help me. I've been on here before talking about working with a different machine. I went from a ResMed VPAP to a Respironics BIPAP Auto ASV Advanced. I don't feel I get enough air with this machine. Is it a setting or machine problem. I'm a very shallow breather and take longer breaths than the machine gives me. Sometimes I stop my breathing to see if the machine will pick it up, but it is very little pressure. I thought the ramp started out low and went high. This one does just the opposite. Do I not understand the concept? I want to go back to a ResMed Machine but the DME said they can't convert the numbers. I wonder if it's because they have a contract with Respironics??? Any one know what parameters control the pressure or is it the machine. Thank you for your help.

Seajay

JDS74
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Location: South Carolina

Re: NOT GETTING ENOUGH AIR

Post by JDS74 » Wed Jul 29, 2015 3:29 pm

Can you post your machine settings? Ramp settings do start low and increase later EXCEPT for ASV machines that can react to apnea issues and override the current ramp settings in certain situations.

Do you have software so that you can see what is going on with air flow and pressure? Shallow breathing can trigger a response as can low respiration rate.

Without the settings and the therapy data, it will be difficult to suggest a way to help you get better therapy.

_________________
Mask: Oracle HC452 Oral CPAP Mask
Humidifier: DreamStation Heated Humidifier
Additional Comments: EverFlo Q 3.0 Liters O2 PR DSX900 ASV
Oracle 452 Lessons Learned Updated
DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
Sleepyhead and Encore Pro 2.21.

JDS74
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Location: South Carolina

Re: NOT GETTING ENOUGH AIR

Post by JDS74 » Wed Jul 29, 2015 5:19 pm

Seajay:

Back in October and November, you posted about a problem getting used to the Respironics 960 BiPap ASV machine that was new to you. In order to provide help in the current situation, it will be helpful if you post your machine settings. Look at mine, and see if you can post yours.

Mine are:
Min EPAP:_______________12.0
Min Pressure Support:______7.5
Max EPAP:_______________17.0
Max Pressure Support:_____13.0
Max Pressure:____________25.0
Flex Setting:______________1
Backup Rate:_____________Auto
Humidification Mode:______System One
Humidifier Setting:_________3
Ramp_____________________Off

The parameters that seem to be the most relevant to your current post are Backup Rate and Ramp. If the Backup Rate is too high ( effectively ) then it will appear that the machine is trying to force you to breathe in before you are ready. If Ramp is set to some longish number like 30 or so, then the effective therapy will be delayed until that time has passed.
If I read your prior thread properly, the Min EPAP setting is now 7 cmH2O and this is a relatively low number. If that is still the case, then turning the Ramp to OFF most likely won't be noticeable and will eliminate a variable.

One thing to notice about the Respironics ASV machine is that the machine responds really fast to changes in your breathing. For example, if you are breathing in slowly and in the middle, you hesitate even for a second, the machine will immediately switch to inhale mode and it will seem as if it is forcing you. Setting the Backup Rate to some lower number will help in this situation but won't eliminate it entirely. The machine is keeping a running average of your breathing rate and tries to detect a central, in part, by noticing that your rate is some percentage slower than the average. Unfortunately, I don't know enough about Respironics' algorithms to describe it better than that. In the Encore reports, the average BPM is reported. On my last night's report it looks like:

Avg Breath Rate
_____16.0
Current Backup Rate
_____Auto

In SleepyHead the data looks like, for the same day,:

Channel____________Min______Med_____95%_______Max
Resp. Rate: Rate of breaths per minute (Breaths/min)
W-Avg: 15.91_______9.00_____17.00____20.00_____22.00

In your case, the SleepyHead report may be a little more helpful as it reports the minimum as well as the average (Med.)
If you want to experiment with this parameter, the knowing the minimum can provide guidance about picking a value that will keep the machine from prematurely beginning a forced inhale.

On a Respironics machine, using my numbers as an example:

Starting EPAP is 12.0 cmH2O and starting IPAP is 19.5 cmH2O.
Depending on what goes on after that, EPAP can vary from 12.0 to 17.0 cmH2O and IPAP can vary from 19.5 to 25.0 cmH2O.
Both EPAP and IPAP vary independently from each other.

As an aside, on a ResMed machine, they dance together moving up and down within the prescribed range but always keeping the distance apart the same.

Have you gotten and installed either SleepyHead or Encore so you can read your data?

EDIT: BTW, my titrations were done on ResMed systems and they had no clue as to how to translate to a Respironics machine. So the problem goes both ways.

_________________
Mask: Oracle HC452 Oral CPAP Mask
Humidifier: DreamStation Heated Humidifier
Additional Comments: EverFlo Q 3.0 Liters O2 PR DSX900 ASV
Oracle 452 Lessons Learned Updated
DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
Sleepyhead and Encore Pro 2.21.

seajay
Posts: 36
Joined: Wed Apr 01, 2009 12:18 pm
Location: Denver, CO

Re: NOT GETTING ENOUGH AIR

Post by seajay » Wed Jul 29, 2015 6:56 pm

MAX PRES-------------------------------------25.0
MIN EPAP------------------------------------- 7.0
MAX EPAP------------------------------------15.0
MIN PS------------------------------------------0.0
MAX PS-----------------------------------------15.0
BPM------------------------------------------AUTO
RAMP TIME------------------------------------0;15
RAMP START----------------------------------2.0

These are all the numbers I could find. I have tried numerous times to download Sleephead but there is always a .dll missing and it won't log. I have an HP 7, 64 bit. I hope this helps. My next move is to send the disc to the DME and then I don't know how to read it. Thanks for any help.

Seajay

|

yaconsult
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Location: "Silicon Valley", CA

Re: NOT GETTING ENOUGH AIR

Post by yaconsult » Wed Jul 29, 2015 7:53 pm

Read the note halfway down the page about how to fix the missing dll file error. Microsoft stopped including a needed library in Windows 7 so you need to install it from microsoft: http://www.sleepfiles.com/SH2/

_________________
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Pugsy
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Re: NOT GETTING ENOUGH AIR

Post by Pugsy » Wed Jul 29, 2015 7:59 pm

Try SleepyHead from here
https://sleep.tnet.com/resources/sleepyhead

When you try to open SH if you still get the missing dll file go here
http://www.microsoft.com/en-us/download ... x?id=40784
click on "download" and you will be taken to another page where you choose which file to download
choose the middle file that is 6.9 MB in size
once downloaded go to it and install it. Don't try to put it anywhere...it will go to where SH knows to look for it.
Then try opening SH again...if that doesn't work...please post the exact wording of the missing dll file message.
This will work on Win 7 64 bit computers...it works on mine.

What was your minimum PS on your ResMed machine? I doubt it was 0 but maybe it was. Can you confirm?

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JDS74
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Joined: Sun Jan 23, 2011 2:57 pm
Location: South Carolina

Re: NOT GETTING ENOUGH AIR

Post by JDS74 » Wed Jul 29, 2015 8:09 pm

Your system is set up so that, starting out, EPAP and IPAP are the same - 7 cmH2O.
That's really odd. The setting for Ramp Start appears to be incorrect. Minimum settable value is 4.0 not 2.0.
With the current parameters, the machine starts at 4.0 and doesn't get to 7.0 for fifteen minutes. If, during that time, you have a central episode, the pressure could spike up and the pressure change could be problematic.

I would suggest turning the Ramp off.

Next, as I speculated, you have BPM set to Auto. For most folks that is just fine. Do you know from your sleep studies what range you breathing rate is in? As an experiment, you might try setting BPM to 10 to see if that helps.
As always, please keep your doctor informed so you both are on the same page.

Also, you might send a PM to Pugsy and ask for a copy of Encore Basic. That is easy to install on a Win 7 system and you should be able to get your data. As an experiment, she sent me a copy for my Win 7 system and it ran just fine, although a little slow.

_________________
Mask: Oracle HC452 Oral CPAP Mask
Humidifier: DreamStation Heated Humidifier
Additional Comments: EverFlo Q 3.0 Liters O2 PR DSX900 ASV
Oracle 452 Lessons Learned Updated
DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
Sleepyhead and Encore Pro 2.21.

Sleeprider
Posts: 1562
Joined: Tue May 06, 2008 5:57 pm
Location: Murrysville, PA

Re: NOT GETTING ENOUGH AIR

Post by Sleeprider » Thu Jul 30, 2015 6:03 pm

seajay wrote:MAX PRES-------------------------------------25.0
MIN EPAP------------------------------------- 7.0
MAX EPAP------------------------------------15.0
MIN PS------------------------------------------0.0
MAX PS-----------------------------------------15.0
BPM------------------------------------------AUTO
RAMP TIME------------------------------------0;15
RAMP START----------------------------------2.0

These are all the numbers I could find. I have tried numerous times to download Sleephead but there is always a .dll missing and it won't log. I have an HP 7, 64 bit. I hope this helps. My next move is to send the disc to the DME and then I don't know how to read it. Thanks for any help.

Seajay

|
Seajay, the only change I'd make to those settings to address your "not getting enough air" problem is the Min PS. I think you'd find a minimum PS of 4.0 much more comfortable. This will increase the air on inhalation, and is the basic setting for most bilevel machines. The ASV component can greatly increase pressure when necessary for CA events. This will give you a minimum IPAP/EPAP of 11.0/7.0 rather than 7/0/7.0. Try increasing the min PS and see if that makes the machine more comfortable. I think you'll notice the difference right away.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: Sleepyhead software. Just changed from PRS1 BiPAP Auto DS760TS

PoolQ
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Re: NOT GETTING ENOUGH AIR

Post by PoolQ » Thu Jul 30, 2015 6:45 pm

FOr me I found I was quite sensitive to min pressure which had been set to 4. I tried 5, not enough, 6 too much, 5.6 seemed fine for a night and then uped to 58 which has now been fine for several days. Just like you say, feels like not getting enough air
Sleeping MUCH better now

seajay
Posts: 36
Joined: Wed Apr 01, 2009 12:18 pm
Location: Denver, CO

Re: NOT GETTING ENOUGH AIR

Post by seajay » Thu Jul 30, 2015 10:40 pm

Sir Noddingoff....Thanks for the pm just don't know how to answer a PM. Thanks

Sleeprider...I turned the ramp off and set the min PS at 4.00. I'll let you know how thi works.

Pugsy...I tried both downloads for the software but still get a Qt5Core.dll

Thanks all for your help. Seajay
Last edited by seajay on Fri Jul 31, 2015 10:28 am, edited 1 time in total.

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Pugsy
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Re: NOT GETTING ENOUGH AIR

Post by Pugsy » Thu Jul 30, 2015 11:00 pm

I am not familiar with that particular dll file. Wonder if you are trying to open SH from within the zipped folder and not the extracted/unzipped folder.
Did you unzip the SH file and then go into the unzipped folder and click on either the open GL or broken GL file that is at the bottom of the unzipped SH main folder?

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

JDS74
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Joined: Sun Jan 23, 2011 2:57 pm
Location: South Carolina

Re: NOT GETTING ENOUGH AIR

Post by JDS74 » Fri Jul 31, 2015 5:46 am

Pugsy:

Pending resolution of the SleepyHead install issues, could you send her a link to download Encore Basic which will work without issues so she can get some data?

Seajay:

Setting the Min PS to 4 has the effect of making the starting EPAP stay at 7 cmH2O while increasing the starting IPAP to 11 cmH2O. This should relieve the sensation of not getting enough air in when you inhale.

_________________
Mask: Oracle HC452 Oral CPAP Mask
Humidifier: DreamStation Heated Humidifier
Additional Comments: EverFlo Q 3.0 Liters O2 PR DSX900 ASV
Oracle 452 Lessons Learned Updated
DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
Sleepyhead and Encore Pro 2.21.

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Pugsy
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Location: Missouri, USA

Re: NOT GETTING ENOUGH AIR

Post by Pugsy » Fri Jul 31, 2015 6:02 am

JDS74 wrote:Pending resolution of the SleepyHead install issues, could you send her a link to download Encore Basic which will work without issues so she can get some data?
Sure, no problem. Consider it done.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

Sleeprider
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Location: Murrysville, PA

Re: NOT GETTING ENOUGH AIR

Post by Sleeprider » Fri Jul 31, 2015 5:51 pm

seajay wrote:Sir Noddingoff....Thanks for the pm just don't know how to answer a PM. Thanks

Sleeprider...I turned the ramp off and set the min PS at 4.00. I'll let you know how thi works.

Pugsy...I tried both downloads for the software but still get a Qt5Core.dll

Thanks all for your help. Seajay
I'm looking forward to hearing how that works out for you. Keep in touch.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: Sleepyhead software. Just changed from PRS1 BiPAP Auto DS760TS

seajay
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Joined: Wed Apr 01, 2009 12:18 pm
Location: Denver, CO

Re: NOT GETTING ENOUGH AIR

Post by seajay » Mon Aug 03, 2015 7:32 am

Sleeprider

Can't figure out how to answer you "quote" is not working for me. The settings you gave me appear to be working. I do feel the air and sleep much better. Thank you very much