Using a Bipap Auto SV and using a Vpap Adapt SV

Banned,

Last night's use of the AdaptSV was so comfortable I'll be using it again.

Also, went to doc today who agreed with my diagnosis re doubling my dose of Pariet to 1 20mg tab am & one more prior to dinner. He did a lot of checking of any alts but in the end said 40mg of Pariet per day was going to be the way to go.

Since adjusting GERD meds the data from even the BipapSV is yet more consistent again. Certainly the data & numbers from both machines are surprisingly close.

Last night I nose breathed with the Adapt SV which worked fine & in the early hours I did some mouth breathing & the machine was fine with both.

I did lower the PS back to 3.6 from 4.6 & tonight will drop PS to 3.2.

So to get the high level of comfort & consistency from both machines, 1st needed me to deal with the silent GERD symptoms, then get the pressures right & am confident I have that now.

The Bipap SV records very low AHI data now - typically 1 or 2 hypops for the entire night & often 2 to 8 AIs for an entire night. If numbers can be believed & the numbers have meaning then the machines are doing an outstanding job all round.

DSM

PS I'll now stay with the Vpap SV for as long as it feels good and so I can get a good history of nightly data.

dsm wrote: PS I'll now stay with the Vpap SV for as long as it feels good and so I can get a good history of nightly data.

It's interesting that you can become pretty adept at dial wingin' with these SV machines.

Banned

Banned wrote:

dsm wrote: PS I'll now stay with the Vpap SV for as long as it feels good and so I can get a good history of nightly data.

It's interesting that you can become pretty adept at dial wingin' with these SV machines.

Banned

Banned,

I did do one simple mod to my Adapt SV set up. I added a 1ft tube at the mask end which shifts the pressure sampling away by that 1 foot & I believe is a workable way to soften the responses of the machine just a little. Is working fine thus far - passes learn circuit ok.

Will be interesting to see if there is any significant change to the data. I'll also do a nights SpO2 collection (but using Ohmeda rather than the Resmed xPod attachment which I still need to modify the plug on).

DSM

Question,

Can the Respironics USB SmartCard Reader be used to read (download) a ResMed SmartCard?

Banned

[quote="Banned"]Question,

Can the Respironics USB SmartCard Reader be used to read (download) a ResMed SmartCard?

Banned

This is only indirectly related to the topic here. The machines you have give you information on variable breathing. Does it give you specifics of the duty cycle of the breathing, that is, the ratio of the INS to EXP?

Does this ratio vary as the breathing frequency changes? Does this ratio vary over time for the same breathing frequency? In any case, what are the typical range of this ratio?

I am trying to refine my 'Here is how to measure your exact intentional leak rate SLPM'
viewtopic.php?t=32896&highlight=

Thank you for any info or further research references.

BTW, I am also interested in the details of the CFLEX algorithm used in the Respironis M-series Auto Aflex machines. How much does it reduce the pressure during the EXP cycle, w/ the 1,2,3 settings? I suppose there would be a patent on this somewhere??

[quote="feeling_better"]This is only indirectly related to the topic here. The machines you have give you information on variable breathing. Does it give you specifics of the duty cycle of the breathing, that is, the ratio of the INS to EXP?

Does this ratio vary as the breathing frequency changes? Does this ratio vary over time for the same breathing frequency? In any case, what are the typical range of this ratio?

I am trying to refine my 'Here is how to measure your exact intentional leak rate SLPM'
viewtopic.php?t=32896&highlight=

Thank you for any info or further research references.

BTW, I am also interested in the details of the CFLEX algorithm used in the Respironis M-series Auto Aflex machines. How much does it reduce the pressure during the EXP cycle, w/ the 1,2,3 settings? I suppose there would be a patent on this somewhere??

An observation re the BipapSV machine and one outstanding side effect of its pressure support system (The SV feature that tracks to a target Peak Flow).

These two charts from the past 2 nights show massive leak. I am still trying to find out why - at one point air was escaping from the point where the H/H plugs into the machine (I may revert ti the trusted HC150).

But in combination with extended GERD medication the data shown, despite the massive leaks, shows rock bottom AHI numbers & consistent minute ventilation & flow.

So, if there was one outstanding side effect of the PS mechanism it is that this machine can keep delivering near perfect therapy whilst battling large leaks. In terms of therapy, this is a substantial plus.

http://www.internetage.com/cpapdata/dsm ... d_leak.pdf

http://www.internetage.com/cpapdata/dsm ... d_leak.pdf

In particular look at the bottom & see the black bars over the leak data & then count the total AI & HI events noted allowing for that leak data.

DSM

feeling_better wrote:BTW, I am also interested in the details of the CFLEX algorithm used in the Respironis M-series Auto Aflex machines. How much does it reduce the pressure during the EXP cycle, w/ the 1,2,3 settings?

As far as I know, when C-flex (instead of A-flex) is turned on in the Respironics M series Auto with A-flex machine, C-flex works in that machine exactly like it does in any Respironics machine with C-flex.

C-flex does not drop the pressure by an exact number of cms. The C-flex settings of 1, 2, and 3 give (respectively) "some drop in pressure", "more drop in pressure", and "most drop in pressure" when you start to exhale. The amount of drop when you start to exhale with any of those settings, however, is dependent on how forceful the start of your exhalaion is.

If the beginning of your exhalation is light or weak, the pressure won't drop much, even at the setting of 3. If you start an exhalation rather forcefully, like with a big "huff" to breathe out, the pressure drops considerably more...at any of the 3 settings.

Likewise, the length of time C-flex keeps the exhalation pressure down is dependent on how long you breathe out with the same force as the way your exhalation started. At the first sign of your exhalation starting to dwindle or lessen, C-flex stops holding the pressure down and lets the "regular" pressure come back in. The "regular" pressure coming back in happens before your exhalation is completely finished, and might even happen very early while you're breathing out. It all depends on how steady the force of your normal exhalation is.

Of course, the "regular" cpap pressure coming in at you can have an effect on how forcefully you can get an exhalation started in the first place. If a person normally exhales rather lightly or softly and has a lot of trouble breathing out against, say a pressure of 16, C-flex even at 3 might not make much of a dent in it. Or might just make a blip of a drop for a split second at the very start of the exhale and let the pressure of 16 back in almost immediately...long before the exhalation is finished.

C-flex is designed to let the regular pressure back in before the exhalation is completely finished. That's to insure that the throat will not have collapsed with the less pressure it receives during C-flex, and will be open sufficiently (assuming the "regular" pressure is right) by the end of exhalation, for inhaling again.

That feeling of pressure coming back in while you're still exhaling can be unnoticeable or can feel like a bump...again depending on several things all playing together -- how strong your normal exhalation is, what C-flex setting you chose, and how high the "continuous" pressure is that you are trying to breathe out against.

Some people are so aware of C-flex letting the regular pressure back in, they start trying (deliberately or without meaning to) to match their breathing to what C-flex is doing. They start trying to breathe in when they feel the regular pressure come back in, before they've finished their exhalation. You have to ignore what C-flex is doing and breathe in your own natural way. If you can't ignore it and find you keep breathing faster and faster trying to get in sync with it (impossible...C-flex will always let the regular pressure back in before an exhalation is finished) you need to use a lower C-flex setting, or turn C-flex off.

The first night or two I used C-flex for the first time, I thought the machine might be broken. I mistakenly thought that C-flex would keep the pressure down throughout the entire exhalation -- much like a bipap does. I kept feeling the pressure go back up before I had finished exhaling. But if I tried to match my breathing with what C-flex did, it was like a dog chasing it's tail...never could "catch" C-flex.

After it was explained to me (thanks, "-SWS") that C-flex was supposed to do that (let the pressure back in before exhaling is finished) I quickly learned to ignore what C-flex was doing and simply enjoy the ease of getting each exhalation started. C-flex was comfortable for me.

All that said... I found A-flex to be much more comfortable than C-flex. Exhaling with A-flex does feel almost exactly like exhaling with a bipap machine. For me, exhaling with either type of machine (Auto with A-flex turned on, or BiPAP with Bi-Flex turned on) feels almost like breathing out into an empty hose.

A-flex gives the same vague but definite drop C-flex does for exhaling, but A-Flex also rounds out the transitions much like Bi-Flex does in a BiPAP when the Bi-Flex feature is enabled. A-Flex Feels more like smooth natural breathing than just C-flex, imho.

rested gal,

Thank you very much for that nice lengthy detail. I had some general idea of it, but not as precisely as you have described.

BTW, I have never used a bi-pap (at least knowingly, I do not what they had for the titration study). In my case I have no problem with cflex, I do not feel that 'pressure returning early' at all. So I am rather surprised that is what it is supposed to do. These days my setting is 1, but I do not remember any problem with 2 or 3 either, which I had tried earlier during my start of cpap about 2 months ago.

However, I cannot tolerate a-flex at all. That was how I started. Aflex has, IMO, an anticipation of exhale algorithm, which really comes on too early for me, and do not allow any type of deep breathing which I normally do occasionally. I had exactly the same problem you described of breathing faster and faster trying to keep up with aflex, and really unsatisfactory results!! So, I am bit perplexed, but I guess we are all different.

BTW, when I asked my questions about cflex algorithm, what I am trying to do is figure out or estimate what the average pressure would be (for a given pressure say 10) and the cflex setting of say, 1. As you said, this now depends on the user too, but I looking for is ball parks now: such as it reduces about 10-20% average pressure in setting 1 when using pressure 1. So pressure of 10 would effectively be pressure of 8-9 average.

Ok last night was horrid. Every time I started to doze off I would have a central and the machine would Alarm, I would reset the alarm start to doze off and same thing. This has me really worried. I feel like $#!& today. Even if I had the alarm off not breathing woke me up anyway. I know it was not the obsructions. I did not snore at all. It was just that I keep holding my breath. Is there anything that can cause centrals to be worse. I put a call into my Doc and RT waiting to hear back from them. I am very sick to my stomach today from it and just feel horrid.

wlo2008 wrote:Ok last night was horrid. Every time I started to doze off I would have a central and the machine would Alarm, I would reset the alarm start to doze off and same thing. This has me really worried. I feel like $#!& today. Even if I had the alarm off not breathing woke me up anyway. I know it was not the obsructions. I did not snore at all. It was just that I keep holding my breath. Is there anything that can cause centrals to be worse. I put a call into my Doc and RT waiting to hear back from them. I am very sick to my stomach today from it and just feel horrid.

I think you need assist from RT to get to the cause of this. Changing settings may not aide without understanding what is happening.

Good luck

DSM

I just got off the phone with my RT. She asked what was diff that I have done, Medication, Drinking anything. The only think diff was that I have finals this week for my classes and I have been under a lot of stress. She said stress can make my centrals worse. She want's to see how I do in the next couple days and also change my mask. I think I am having to many leaks.

She said if I continue down this path that I will have to make an appointment with my Neurologist Sleep doc to see what else might be going on. I have an appointment in Aug anyway to see if there is any improvement. But she said if I am getting worse that they need to do something about it.

wlo2008 wrote:Ok last night was horrid. Every time I started to doze off I would have a central and the machine would Alarm, I would reset the alarm start to doze off and same thing. This has me really worried. I feel like $#!& today. Even if I had the alarm off not breathing woke me up anyway. I know it was not the obsructions. I did not snore at all. It was just that I keep holding my breath. Is there anything that can cause centrals to be worse. I put a call into my Doc and RT waiting to hear back from them. I am very sick to my stomach today from it and just feel horrid.

If the quality of your RT is like mine (not very knowledgeable), I would suggest you go see the doctor right away. My RT only knows how to set up a machine to match the doc's rx, even that with difficulty.

Don't know why I had trouble finding this thread again. But Banned & DSM I got the software up and running that you sent me. I downloaded my data

DSM here is what my data is from the smart card

My current setting are Ipap max of 14, Ipap Min of 8 and Epap of 5, Rise time at 3

My Average Peak of Ipap pressure is 11.2cm
My Average Breath rate is 19.5 BPM
Average triggered breaths is 99%
Average Tidal volume is 349.2 ml
Average Peak Flow 25 lpm
Average Apnea Index 3.5
Average Hypopnes Index 0.5
Average AHI 4
Average Leak 28.6