Need Advice on Setting up New Machine

Good morning!

I am getting a new machine, it is a Philips Respironics System One ds 960 hs ASV. I have obtained the clinical instruction manual from the apnea board (and I noticed, on the front cover is a "caution" telling the clinician to remove the manual before giving the machine to the patient!).

Currently I am using a Resmed S8 VPAP ST. I believe I was prescribed the ST due to central apneas during my titration study. I have read here on this group that an ASV is another way to address this issue, possibly a better way, and so I have decided to give that a try. BUT, I am in need of input on how to set the new machine up when it gets here.

My current settings on the S8 VPAP ST:

VT 280-480
MV 4.0-6.1
Trigger: Med
Cycle: Med
Mode: ST
IPAP: 14.0
EPAP 11.4
Resp Rate: 8 bpm
Rise Time: 300 ms
Ti Max: 3.0 S
Ti Min: .3 S (or that could be 03 S? I don't think so, but I am looking at a handwritten sheet that I keep with the machine in case I need to reset it)

Thank you so much!

This might help you understand the various settings you are going to see on the new machine.

http://www.isetonline.org/yahoo_site_ad ... 190318.pdf

I am thinking EPAP minimum around 10
PS minimum of 3 with max to 15
EPAP max around 14
IPAP max of 25

Respiration set to Auto for time being.

So to be clear...your original diagnosis was Obstructive sleep apnea and the centrals showed up during the titration process....???
If you didn't have much obstructive stuff going on you might do well with an even lower EPAP.

You know I am going to have to arrest you and take you to jail!

Sheriff

Pugsy wrote: So to be clear...your original diagnosis was Obstructive sleep apnea and the centrals showed up during the titration process....???
If you didn't have much obstructive stuff going on you might do well with an even lower EPAP.

Thank you, Pugsy! Here are excerpts from my first (diagnostic) sleep study:

" MONITORING:
Sleep was monitored with four leads of EEG, two leads of
EOG, and chin EMG. Respirations were monitored with chest
and abdominal strain gauges, nasal and oral thermistry, finger oximetry, a nasal pressure air flow transducer, and a snore microphone. EKG rhythm was monitored in a single lead. Bilateral anterior tibialis EMG was monitored and body position was monitored. CPAP pressures were also monitored.
FINDINGS: This was a diagnostic study. Much of her abnormality was seen in the last 2 hours of the night, including turning supine for the only portion of the night during this time, but also for some reason her difficulty on her left side was worse late in the night than it was early in the night.

Cardiac rhythm was normal sinus rhythm. Periodic leg movements were minimal, averaging 8.7 per hour.

Total sleep time was 6.5 hours with a sleep efficiency of
87%. Regarding sleep stage distribution and percent of total sleep time, Stage Nl sleep was 7%, Stage N2 was 65%, Stage
N3 was 9%, and Stage R was 18% of total sleep time.

Regarding respiratory events there was 1 obstructive apnea,
33 central apneas that occurred mostly "post-arousal."
There were 184 hypopneas and 60 additional respiratory effort-related arousals. This gave an apnea-hypopnea index of 33.3 events per hour, and a respiratory disturbance index
of 42.4 apneas, hypopneas, or respiratory effort- related arousals per hour. 4% 02 desaturation was required for definition of hypopnea.

Her difficulty was worse in REM sleep compared with non- REM. Apnea-hypopnea index in REM sleep was 60 per hour, compared with 27 per hour in non-REM sleep. It was also worse supine compared with non-supine. Supine apnea-hypopnea index was 106.5 events per hour during the 1.25 hours she was supine.
During the 4.5 hours she was on her left side apnea­ hypopnea index was 15 per hour. During the 1 hour she was on her right side apnea-hypopnea index was 20 per hour.

ASSESSMENT: Severe obstructive apnea-hypopnea syndrome with an apnea-hypopnea index of 33.3 events per hour, and a respiratory disturbance index of 42.4 events per hour. Lowest oxygen saturation of 74 %. Most of the desaturations below 80% occurred in the last 2 hours of the night during which time she was mostly supine."

I do not have my titration study on my jump drive here at work, I need to pull it from my file and scan it still. During the titration study, after I had been asleep a short time, the tech woke me up and said, "you are not even trying to breathe," and she told me briefly what central apneas were and switched something, perhaps to Bi-level. In that write up it notes that I improved when switched from CPAP to Bi-level, and that is why I got a Bi-level machine with ST.

Sheriff Buford wrote:You know I am going to have to arrest you and take you to jail!

Sheriff

Oh.....so YOU are the Apnea Police.....!!!! Guilty as charged!

Sounds like the centrals were problematic with the addition of cpap pressure but the original diagnostic study is primarily obstructive in nature.
The centrals mentioned in the diagnostic study were documented as post arousal so not as critical.

You may have to do some experimenting finding the right EPAP pressure to take care of the obstructive stuff but shouldn't be too difficult.
What we do is have EPAP prevent the OAs...and have PS be able to go high if needed for the centrals and have your maximum IPAP so the PS jump can work its magic.

I think a good starting point would be what I suggested above...it's close to what you start out the night at now and will allow the machine to address the centrals when they occur.
Minimum EPAP is going to be likely where we need to fiddle around a little bit as its primary job is to hold the airway open well enough so that it doesn't collapse. Very similar to minimum pressure setting in apap mode.

Thank you so much, Pugsy, both for the settings you suggested and the document link!

I will report back once I have received the machine and used it for the first time.

Your assistance is truly appreciated.

Jill