Auto SV User Needs Help

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
q49q49
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Joined: Tue Feb 09, 2016 9:37 am

Auto SV User Needs Help

Post by q49q49 » Tue Feb 09, 2016 1:39 pm

Hi All,
There is so much useful info here, my head is spinning.

My husband started using a Philips Respironics BiPap AutoSV Advanced System One (950P) 2.5 years ago. It's made an amazing difference, but it is torture for him to fall asleep using it. He has to stay up until he's totally exhausted at night. If he needs to use the restroom at night, it takes forever to fall back to sleep. If it is close to dawn, he just has to get up to start his day because he can't get back to sleep. But he's still infinitely better rested then before the BiPap.

Other than the yearly 15 minute appointment to pull the data off the SD card to verify compliance for insurance company, the sleep doctor hasn't been much help. The doctor considers treatment a success because DH's API is below 2. The doctor did suggest trying a nasal only mask, but the nasal was harder to tolerate than the full mask. The only thing that has been changed from his initial prescription was to turn on the ramp option. There will be no further study to check or adjust the settings until he has lost a significant amount weight or some other big change.

Regarding the ramp, every time they check the SD they reset the ramp to the initial setting of off and then it is really impossible for DH to fall asleep. So I make a return trip 2-5 days later to have it set back to 15 minutes. Four months ago, DH asked them to set it to 30 minutes and that is making it worse. He's convinced they didn't set the ramp to what he asked for. I can tell by watching the numbers that is it doing something, but don't understand the algorithms well enough to make it easy to measure the ramp time. I found this site while searching the internet for how to measure the ramp. I did see the thread that discussed raising min EPAP vs using a ramp.

We've spent a lot of time online looking answers and found one sheet on the internet from Philips explaining their suggested titration protocol. (AND I just noticed that his settings are the same as default initial settings). I don't know if anything other than Bi-flex and humidity are changeable by the user. Because I'm not the one using the BiPap, I don't know the right questions to ask DH to understand what he is actually experiencing.

It this enough info for anyone to point us in the right direction?
Thank you in advance.

_________________
Machine: ResMed AirCurve 10 ASV Machine with Heated Humidifier
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Additional Comments: DreamStation autoSV EPAP(4,15) PS(2,15) Mx-30 BPM AUTO
Last edited by q49q49 on Tue Feb 09, 2016 2:28 pm, edited 1 time in total.
8/21 - Resmed AirCurve 10 ASV EPAP(4,10) PS(2,7) Mx-25
2/19 DreamStation autoSV EPAP(4,15) PS(2,20) Mx-30 BPM AUTO 3/20 PSmax 15
11/18 Resmed AirCurve 10 ASV
7/13 PR AutoSV Adv System One EPAP(4,15) PS(2,20) Mx-25 Rate-Auto BPM Biflex-3

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ChicagoGranny
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Re: Difficult to fall asleep or go back to sleep

Post by ChicagoGranny » Tue Feb 09, 2016 1:56 pm

q49q49 wrote:Philips Respironics BiPap AutoSV Advanced System One (950P)
Please edit your original post and change the subject to "Auto SV User Needs Help". This will help get the attention of some other Auto SV users who can help. There are not too many of them on the forum, but you should still get the help needed.

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ChicagoGranny
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Re: Difficult to fall asleep or go back to sleep

Post by ChicagoGranny » Tue Feb 09, 2016 1:59 pm

q49q49 wrote: He has to stay up until he's totally exhausted at night. If he needs to use the restroom at night, it takes forever to fall back to sleep. If it is close to dawn, he just has to get up to start his day because he can't get back to sleep.
Here is a checklist of some basics for every CPAP user:
- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps.
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Optimize emotional stress in your life
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems.

CG

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Bons
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Re: Auto SV User Needs Help

Post by Bons » Tue Feb 09, 2016 3:19 pm

ChicagoGranny,
I think you missed her point. He stays up until exhausted because sometimes that's the only way to fall asleep with an ASV. They can be annoying things to deal with while falling asleep because every night you have to "dance" with the thing until you get into matching rhythms. If you are exhausted enough, you pass out during the struggle, which is the quicker way to get to sleep.

q49q49:
I found that its best not to use the ramp, but to start out right away at the set pressures. Othewise I'd just wake up when the full pressure started. It's best (for me anyway) to just battle with the thing. Even after 6 years we fight several times a week. When it tries to make him inhale while he's still exhaling, it will adjust if he forcefully exhales to let it know that he's still exhaling. Same with inhalation: if it drops to trigger exhalation, just keep on inhaling and the machine gets the message. My issue with it is that I normally breathe only 8 or so times per minute while awake, which the machine doesn't tolerate. We have the BPM set to default. When I fall asleep, my breath rate actually increases to work with the machine (the only patient my doc has who breathes more often when asleep than when awake).

The machine can be unlocked and then set by the user. I've adjusted mine, because my respiratory tech left it unlocked for me.

Do a search on this site and you may learn how, or someone might come along and tell you how.

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LSAT
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Re: Auto SV User Needs Help

Post by LSAT » Tue Feb 09, 2016 4:08 pm

Compliance should not be an issue if he has been using this machine for 2.5 years. Normally the insurance company wants to make sure he is using it for the first 60-90 days. There is no reason for going to the doctor if he is not helping him.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: Fisher & Paykel Vitera Full Face Mask with Headgear (S, M, or L Cushion)
Additional Comments: Back up is S9 Autoset...... Buckwheat hull pillow

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M'ohms
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Re: Auto SV User Needs Help

Post by M'ohms » Tue Feb 09, 2016 4:18 pm

I have been on ASV for a year and a half and have had similar issues when turning the machine on. What works for me is to turn off the Flex altogether. Instead, I have set the Rise Time to 2 which more closely matches my breathing timing. I no longer have any issues at all.

_________________
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: Supplemental oxygen at 2.5 lpm
AutoSV 960 with heated hose. Settings: EPAP Min-12, EPAP Max-17, PS Min-5.5, PS Max-13, Max Pressure-25, Rate-Auto, Rise Time 1. Use Sleepyhead and Encore Pro.

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palerider
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Re: Auto SV User Needs Help

Post by palerider » Tue Feb 09, 2016 4:20 pm

q49q49 wrote:My husband started using a Philips Respironics BiPap AutoSV Advanced System One (950P) 2.5 years ago.
It this enough info for anyone to point us in the right direction?
Thank you in advance.
start off by getting the 'secret' clinical manual for your machine here: http://www.apneaboard.com/adjust-cpap-p ... tup-manual scroll down to section 3 for instructions, and request this by email: " Respironics PR System One BiPAP AutoSV Advanced" then you'll know how to go in and verify the settings.

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Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

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ChicagoGranny
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Re: Auto SV User Needs Help

Post by ChicagoGranny » Tue Feb 09, 2016 5:35 pm

q49q49 wrote: Philips Respironics BiPap AutoSV Advanced System One (950P)
If this exact machine is not in the equipment drop down, you can go to User Control Panel/Profile/Edit Signature and paste it in there. This may save the trouble of mentioning it on future posts.

JDS74
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Re: Auto SV User Needs Help

Post by JDS74 » Tue Feb 09, 2016 6:07 pm

q49q49:

Let's get back to basics and get some information that will be useful in helping in this situation.
1) Get a copy of all sleep study reports and especially the one where the sleep titration occurred. This last study will have the pressure parameters are discussed and will give you the setting information needed to set your current machine to match. If your parameters are indeed the same as the Philips titration guide states, then your machine was delivered to you set to factory numbers. That's a bad choice and needs to be corrected.

2) Get a copy of SleepyHead or Encore Pro software so you two can look at your actual data and see what is going on. Make a separate post asking for a download of SleepyHead software and / or Encore software and someone on this forum will reply with a PM pointing you in the right direction. BTW, these programs run on Windows so if you are a Mac user, state that in your post. I believe that SleepyHead is available for the Mac platform and that there is a way to run the Windows Encore program within the Mac environment but I'm not expert in that arena.

3) Get the clinician manual as suggested above and begin by checking and writing down all the current parameters before you change anything.

4) Unlike 'ordinary' cpap machines, ASV machine will override Ramp settings during the Ramp period if a central event is detected. That may be why there seems to be a feeling that the RT didn't set the ramp time properly. One of the things that happens during that short period when we are transitioning from being awake to being asleep is that "false" centrals can occur and the machine reacts. What happens is that the bodies breath control mechanism is switching between being controlled by blood oxygen and blood carbon dioxide. (I forget which way the switch occurs.) If, like most folks, those two control points don't closely correspond, then the body waits for a little bit before ordering a new breath. That's a false central and only matters if you are hooked up to an ASV machine which notices and reacts. With a good attitude and a learning period, he can learn to "not notice" the machine doing that and continue to drift off to sleep.

5) As suggested above, pay particular attention to sleep hygiene. This means going to bed at about the same time each night and only then if your husband is sleepy. Tired and sleepy are different states. if, after 15 to 20 minutes, he is not asleep, then he should get up and go to another room and do something really boring and not exciting at all until the feeling of sleepiness returns. The idea is to retrain the brain with the habit of "I'm in bed, I'm going to sleep, I'm not going to just lie here and struggle." In this case bed is for sleeping - no TV, no lying there struggling to go to sleep. When this new habit is created, this whole struggle will get better. It may take a while but it will happen.

Hang in there and keep asking any questions about the ASV and how it works. There are several of us out here using similar equipment.

_________________
Mask: Oracle HC452 Oral CPAP Mask
Humidifier: DreamStation Heated Humidifier
Additional Comments: EverFlo Q 3.0 Liters O2 PR DSX900 ASV
Last edited by JDS74 on Tue Feb 09, 2016 6:51 pm, edited 1 time in total.
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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ChicagoGranny
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Re: Auto SV User Needs Help

Post by ChicagoGranny » Tue Feb 09, 2016 6:22 pm

palerider wrote:start off ...
JDS74 wrote:q49q49:

Let's get back to ...
Nice posts. I knew you ASV types would show up quickly.

q49q49
Posts: 12
Joined: Tue Feb 09, 2016 9:37 am

Re: Auto SV User Needs Help

Post by q49q49 » Wed Feb 10, 2016 1:50 pm

Thank you everyone for all your quick feedback.

Just knowing that what he's experiencing is common to others and even to long time users, is strangely encouraging. Bons' description of needing to "dance" with the machine and JDS74's explanation that ASV machines can override the ramp setting helps make sense of what my husband is describing.

palerider - We have requested the 'secret' manual apneaboard. I'll try restrain myself from attempting to enter Clinician mode until we've had time to look the manual. Who knows, it might even have been unlocked this whole time. Hopefully the manual will help me to understand everyone's suggestions. Like M'ohms " .turn off the Flex altogether...set the Rise Time to 2"

JDS74 - We have copies both of his sleep study reports (one diagnostic and one therapeutic). He barely slept during either. I wonder if that is why they 'titrated to' the default settings.

I'll try to install SleepyHead tonight. Any trick for using with Windows 10?

Thanks again


ChicagoGranny - Is there a link explaining how to properly format responses? Above is my attempt to respond everyone in one post.

_________________
Machine: ResMed AirCurve 10 ASV Machine with Heated Humidifier
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Additional Comments: DreamStation autoSV EPAP(4,15) PS(2,15) Mx-30 BPM AUTO
8/21 - Resmed AirCurve 10 ASV EPAP(4,10) PS(2,7) Mx-25
2/19 DreamStation autoSV EPAP(4,15) PS(2,20) Mx-30 BPM AUTO 3/20 PSmax 15
11/18 Resmed AirCurve 10 ASV
7/13 PR AutoSV Adv System One EPAP(4,15) PS(2,20) Mx-25 Rate-Auto BPM Biflex-3

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palerider
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Re: Auto SV User Needs Help

Post by palerider » Wed Feb 10, 2016 3:54 pm

q49q49 wrote:palerider - We have requested the 'secret' manual apneaboard. I'll try restrain myself from attempting to enter Clinician mode until we've had time to look the manual. Who knows, it might even have been unlocked this whole time. Hopefully the manual will help me to understand everyone's suggestions. Like M'ohms " .turn off the Flex altogether...set the Rise Time to 2"
clinical mode always takes some combination of button pushes, knob turns something... on every cpap I've ever seen, they (the DMEs, some doctors) don't want people stumbling onto it by accident. which is a good idea, one should know what one is doing before changing the settings. there's nothing illegal (no matter what your dme/doctor/RT may say) or even wrong about changing the settings yourself, but you should do it knowledgeably, not randomly.

no tricks for SleepyHead on windows 10, it works fine as is, though do pay attention to the install instructions, if there are any missing bits, it may require another download from microsoft... this is documented on the web pages.

as to making replies... hit the quote button when replying to a single person.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

JDS74
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Re: Auto SV User Needs Help

Post by JDS74 » Wed Feb 10, 2016 4:43 pm

Take a look in the titration study and see if there is any comment on the pressures that they tried.
What you will be looking for is reference to:
Min EPAP
Min Pressure Support
Max Pressure Support

Max pressure should be set to 25 cmH2O

It might be helpful if your husband could have the system up and running while he is just sitting there to help him become adjusted to the way the machine is working. It is very different from a "plain vanilla" BiPap.

Send me a PM if you cannot get the Clinician Manual for his machine. If you have correctly posted that it is a ASV 950, then it is one generation back.

_________________
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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ChicagoGranny
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Re: Auto SV User Needs Help

Post by ChicagoGranny » Wed Feb 10, 2016 9:21 pm

q49q49 wrote:ChicagoGranny - Is there a link explaining how to properly format responses? Above is my attempt to respond everyone in one post.
You did fine, but if you want to use the forum's full functionality to reply to multiple posts:

1. Click "Post Reply" icon near the bottom of the thread.

2. Scroll down to find the post you are replying to.

3. Within that post, highlight the sentence you want to reply to. Then click on "Quote" icon in that person's post. That is what I did above to reply to part of what you wrote.

4. Then you can type your message below the other person's quote.

5. If you are replying to multiple members' posts, then repeat the process. If you are only replying to one post, then skip to 6.

6. Finally, click "Preview", and if you are happy with the results, click "Submit".

That sounds complicated, but after you have done it for a few times, it gets easy and you appreciate the functionality.

q49q49
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Re: Auto SV User Needs Help

Post by q49q49 » Wed Feb 10, 2016 9:30 pm

JDS74 wrote:Take a look in the titration study and see if there is any comment on the pressures that they tried.
The study report does include a spreadsheet that shows the response to various combinations of EPAP level, IPAP level, and Pressure Support level. Response recorded appears to be Periods (# of), Total time, Sleep time, % Sleep, %REM, %nonREM, # of CA, OA, MA, Hypop, andA+H, AHI/h, #RERA and RDI/h. He never got to REM sleep. No notes anywhere indicating if any of the combinations was better than any other. It really looks like they punted and just prescribed the factory numbers. Is there a previous post that you would recommend as a crash course into what the data means and how to they relate to one another?
JDS74 wrote: It might be helpful if your husband could have the system up and running while he is just sitting there to help him become adjusted to the way the machine is working. It is very different from a "plain vanilla" BiPap.
Can you point me to any tutorials to help me understand how this all should work? I think I understand basic CPAP. I don't understand how "plain vanilla" BiPap works well enough to explain it to my husband. The Auto SV seems like fuzzy logic. I'm looking forward to getting Sleepyhead installed and to start looking at data. I'm an ex-engineer and my husband is a technical person too. If I can explain to him what the machine is trying to do, it will go a long way to help him adjust to it.

_________________
Machine: ResMed AirCurve 10 ASV Machine with Heated Humidifier
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Additional Comments: DreamStation autoSV EPAP(4,15) PS(2,15) Mx-30 BPM AUTO