BIPAP AUTO-SV SETTINGS HELP

Muffy wrote:

-SWS wrote:I honestly don't think that CSDB/CompSAS researchers are even close to closing up shop

Me neither, but I believe the focus is less on "Let's get out the Techno-Flash" and more on "Let's figure out what we're doing first."

Good focus IMO.

Muffy wrote:

-SWS wrote:"Dang! You mean all we had to do was put our patients on CPAP for 30 days? How did we ever manage to miss that?"

We didn't.

Many kudos for that.

Muffy wrote:

-SWS wrote:I think abandoning that CSDB/CompSAS research ship...

They aren't.

Didn't think so.

Muffy wrote:

-SWS wrote:1) Disordered plant gain in the above study is proven longitudinally variable rather than fixed,

How does that raise the HMS CompSAS?

Clearly if a Hyoid Myotomy Suspension procedure obviates CPAP, then these patients are happy campers. Seriously, I haven't had time to more carefully analyze. Bear in mind I can chug with physiology, having no real expertise or training...

Muffy wrote:

-SWS wrote:2) Purely obstructive patients, in which the central component becomes emergent only after the introduction of CPAP, might prove more adaptable to CPAP than other CSDB/CompSAS patients,

3) Mixed and central patients, in which the central component becomes more severe after the introduction of CPAP, might longitudinally prove more susceptible to a variety of pathogenic factors adversely affecting loop gain,

4) Purely obstructive patients, in which the central component becomes emergent only after the introduction of CPAP, still have an unknown long-term prognosis regarding any distant-future progression of disordered loop-gain,

These points are somewhat confusing to me since any definition of CompSAS requires treatment-emergent central component.

I thought treatment-emergent central SDB was the CSDB/CompSAS requirement among some prominent researchers---not that the entire central component must be treatment-emergent. Subtle distinction, but the former allows for central worsening, while the latter excludes central worsening upon treatment.

Muffy wrote: I would look very carefully at initial therapeutic approach and/or F/U on stable therapy at 1 to 3 months.

I think I already mentioned that I highly doubt you leave your patients with suboptimal therapy. Case in point.

Muffy wrote:That said, there will be some CompSAS patients that need ASV sooner rather than later, but "IMHO" it's a pretty tiny number.

You might be right. Regardless, I'd like to see longitudinal comparisons looking for any disordered loop-gain flareups between the adapted CSDB/CompSAS patients using fixed IPAP (i.e. CPAP & traditional BiLevel) and the CSDB/CompSAS patients using adaptive IPAP (ASV).

Muffy wrote:

-SWS wrote:5) More extensive longitudinal studies might actually reveal that supposedly "adapted" CSDB/CompSAS patients periodically present disordered loop-gain flareups,

The anectdotal studies are already there. Search "dial wingin'".

I think the anecdotes might actually reveal this two-fold pattern: 1) disordered loop-gain flare-ups prompting CSDB/CompSAS patients to search for better settings, and 2) that process of searching for better settings often aggravating loop-gain problems---yet occasionally managing to yield better settings. A treatment dilemma IMHO.

CROWPAT wrote:SWS- Will talk with my cardiologist about low heart rate at night when I see him about my stress test results.

So just how often are you bottoming out that graph at 50 BPM anyway, Pat?

CROWPAT wrote:The initial diagnosis of Paroxymal supraventricular arrythmia was that it was benign. He said it would not kill me, was mostly an irritant, and that we would treat it with tambacor. The alternatives to drugs were invasive and I did not want to go that route for something that was not serious. I learned to live with it and not worry about it.

One of the many, many infinite things that I don't know, is whether that might somehow place you at higher risk for hypotension during those moments when CPAP is applying its interthoracic pressure. So I'll promise to stop worrying about it if you can give us a few early morning blood-pressure measurements just as soon as you sit up in bed with the ASV machine still applying its interthoracic pressure.

CROWPAT wrote: Have carefully tried to correlate what I eat at night with AHI and how I feel, but have not observed any correlation.

That's encouraging IMHO. Still not definitive.

Muffy wrote: The anectdotal studies are already there. Search "dial wingin'".

"dial wingin"?

music to my ears.

Banned

SWS - http://www.afsashoot.com/PAT11.html shows a particularly good AHI night with the oximetry charts for that night.

CROWPAT wrote:SWS - http://www.afsashoot.com/PAT11.html shows a particularly good AHI night with the oximetry charts for that night.

Do you have any oximetry charts for your bad nights? I think it would be worth building a data picture of what your heart rate is doing on bad versus good nights. How often does it bottom-out that 50 BPM graph on the good nights? How often does it bottom-out on the bad nights? Any significant SpO2 "wander" on the bad nights? Etc.

I'll be off-line until the beginning of February with travel. When I come back, it would be nice if you had more heart-rate trending data as well as blood pressure measurements while the ASV is in the midst of applying interthoracic pressure. I think these potential points of concern should be cleared up before additional pressure-based experiments.

See you when I get back...

Go here http://www.afsashoot.com/PAT11.html to see 20 January data. BP/Pulse on waking was 114/86 pulse 62.

Bump in the night...


Wondering if any more information has become available from doctor visits.

Thanks for returning to this topic and asking. Nuclear stress test showed all was well with heart and plumbing. Blood work was normal except Vitamin D level. He put me on 50,000 units twice a week for four weeks plus 1,000 units per day. I cautiously think I feel a bit better after 3 of those 50,000 pills, but time will tell. Had two nights of the last three with 0 AI and AHI of 1 (mathematically more like .1) and no PB. No idea why. Discussed silent GERD and he put me on Famotidine 20 mg twice a day. Doc said no side effects that he had ever seen and wanted me to try it for 90 days to see if it made any difference. Snow, snow, and more snow here so I don't do the normal amount of exercise but still get out in the sun every day.

I will be change from a cpap to a BIPAP AUTO-SV, probably Wednesday. I am 61 and have been obeses for 35 years and had insomnia for 40 years. Guys, I travel between my offices in Denver, Seattle, and the killer trips (about 6 per year) to Bangkok and back. I have been so frustrated with my family practicioner of 28 years, first old doc, now his son whom I like, but their staff are simply gate keepers... with my travel and the time the referral clerk in my docs office takes to both order a study and release the study to the medical equipment people, it has taken me months to first get a cpap (the specialist wanted a follow up study because he thought I needed a bipap but needed to do more study... because I had to leave for Bangkok before I could get the additional study, he released me on a cpap with a setting of 19 (of 20?) with 1 liter of oxygen. That was July-August 2009 and I was in really bad shape. I was falling, hitting my head my arms and knees and had been for about a year. I knew I had sleep apnea from 15 years ago when it was moderate and I opted not to do the cpap thing. This past study called it severe and listed a lot of information about the things you guys are so familiar with and I am only beginning to learn. In frustration over the time it was taking to approve my follow-up study (seems like it should have been already approved as the doc said it was necessary), I want ahead and found a company that would sell me theBIPAP AUTO-SV. Two days later I recieced a call to set up the new study and of course it is February 2010. The cpap pretty much saved my life, I think, but as I have followed forums like this, it appears to me that it could not only get me a little rim sleep but maybe if the right therapy was available, I might wake up with energy again... I hope.... So I bought the BIPAP AUTO-SV (hope i am not getting conned), but now I will get the study and I have insisted on a consultatio with the doc, who is supposed to be good in this field. Insurnce didn't think it was necessary and expected him to just order something that I know nothihng about and because of cost, I assumed it would not be a BIPAP AUTO-SV. Am I correct that this is pretty much state of the art equipment? Can it be used successfull with the Auto settings, at least to start with? I go back to Bangkok after extending my trip a week so I could have a consultation with the doc, two days after the consultation. Last time it took 2 weeks to get my simple c-pap but then I was unable to even get through the airport in the shape I was in. To hell with the insureance companies, my quality of life is worth more to me than not getting good care because the insurance wont pay for what I need. What do you think?


return to guality of life?

return to quailty of life? wrote:To hell with the insurance companies, my quality of life is worth more to me than not getting good care because the insurance wont pay for what I need. What do you think?

return to guality of life?

rtqol,

Private purchase of a BiPAP Auto SV is always a good thing.

You can start using your BiPAP Auto SV with the following settings:
EPAP: 19
IPAP Min: 19
IPAP Max: 25
BPM: Auto
RT: 3

or

If you have the BiPAP Auto SV 'Advanced', your settings would be:
EPAP Min: 19
EPAP Max: 19
PS Min: 0
PS Max: 6
Max PS: 25
BPM: Auto
RT: 3

These settings will put the BiPAP Auto SV or BiPAP Auto SV Advanced in 'CPAP' mode like your original CPAP machine. However, you will have the extra pressure support for centrals (and any other issues) when you need it.

BPM 'Auto' will be fine.

Let us know how you feel at these settings.

Banned

I think you should postpone your trips, or extend them -- can't figure out which -- until your therapy is figured out properly. Make your therapy a first priority, and leave as much time as necessary in your diary to have it taken care of.

You ignored your problem 15 years ago -- and are now paying a health price for it. Don't repeat that mistake by assuming, once again, that your first priority should be your business trips.

Take time to take care of you health.

Sorry folks... just getting back to this forum and am back in Bangkok... first thing, I really wish I had read my message before I sent it... it had so many typing errors I am surprised you guys could even tell what I was saying. I think I was feeling pretty passionate and disgusted at how difficult it is to get responsive care in the US and also frustrated by the control of our insurance companies. I don't know if I had the results of, and/or mentioned that my 2nd Sleep Study recommended 25/17 settings and recommended 2 lpm of Oxygen. I am setting my bi-pap as recommended by Banned (thank you ) and I also appreciate your comments ozij... in June I will have some extended time in the Denver and will have a week there in April. I plan to meet with the doctor/specialist then and do follow-up afterwords. From Sleepstudy 2, my doctor has sent it on to the medical equipment supplier that provided my cpap and their representative tells my administrative assistant there that he doesn't know what will be ordered. I have told them upfront before the equipment was ordered that I want the Respieronics Bipap Auto-SV and was willing to pay extra if it was required, but so far we have no idea what the guy that orders the equipment has ordered. We are continuing to try to find out. As I said the first post, I have already paid for, ordered and received a Respieronics Bipap Auto-SV and while it would be good to have a second one that I could leave in the USA I am not sure what I will do if they give me something else. I am tempted to tell them to keep it if it is of lesser quality. I do have a question for any of you. Since I travel between the altitude and dryness of Denver, to the sea level cool and moist Seattle to the hot and humid sealevel Bangkok, I have assumed that the Respieronics Bipap Auto-SV would be helpful for those different climates... it seemed that when I researched it that it makes a lot of those adjustments automatically. Also, to deal with the prescribed Oxygen, I have been looking at the Respironics EverGo portable oxygen concentrator. I pay the full rental price for the one they deliverd to my home in Denver last year until the $500 deductable is reached and then an additional monthly co-pay so I think that the one there is not doing me any favors since at most it is used a toltal of 100 days a year.

Like I said previously, this is all new for me so any suggestions about any of this is very much appreciated.

Muffy wrote:

-SWS wrote:Muffy usually comes up with some very useful advice.

Well, "IMHO", this old guy can really swing an axe...

https://www.youtube.com/watch?v=z2nQZPC ... re=related

In an unrelated update, here's Marky Knopfler just havin' a good time at Wembley:

https://www.youtube.com/watch?v=DFKIqun4pkU

Wow.

25 years ago.

Muffy

return to quality of life wrote:... Since I travel between the altitude and dryness of Denver, to the sea level cool and moist Seattle to the hot and humid sealevel Bangkok, I have assumed that the Respironics Bipap Auto-SV would be helpful for those different climates... it seemed that when I researched it that it makes a lot of those adjustments automatically. ...

I assume you have a heated humidifier along with that unit. If so, then you will find that in Denver (a dryer climate) it will use more water than in Seattle. But yes. It adjusts that way. Interestingly, I did not find anything in the manuals about automatic altitude adjustment. You might need to contact Respironics directly about that. (Over the years, I found Respironics to be very responsive.) Though I suspect the answer is that it does automatically adjust the pressure based on your altitude.

You may want to register with the forum and list your equipment, so we won't keep asking the same questions of you.

Hope that helps.

return to quality of life wrote:Sorry folks... just getting back to this forum and am back in Bangkok... first thing, I really wish I had read my message before I sent it... it had so many typing errors I am surprised you guys could even tell what I was saying. I think I was feeling pretty passionate and disgusted at how difficult it is to get responsive care in the US and also frustrated by the control of our insurance companies. I don't know if I had the results of, and/or mentioned that my 2nd Sleep Study recommended 25/17 settings and recommended 2 lpm of Oxygen. I am setting my bi-pap as recommended by Banned (thank you ) and I also appreciate your comments ozij... in June I will have some extended time in the Denver and will have a week there in April. I plan to meet with the doctor/specialist then and do follow-up afterwords. From Sleepstudy 2, my doctor has sent it on to the medical equipment supplier that provided my cpap and their representative tells my administrative assistant there that he doesn't know what will be ordered. I have told them upfront before the equipment was ordered that I want the Respieronics Bipap Auto-SV and was willing to pay extra if it was required, but so far we have no idea what the guy that orders the equipment has ordered. We are continuing to try to find out. As I said the first post, I have already paid for, ordered and received a Respieronics Bipap Auto-SV and while it would be good to have a second one that I could leave in the USA I am not sure what I will do if they give me something else. I am tempted to tell them to keep it if it is of lesser quality. I do have a question for any of you. Since I travel between the altitude and dryness of Denver, to the sea level cool and moist Seattle to the hot and humid sealevel Bangkok, I have assumed that the Respieronics Bipap Auto-SV would be helpful for those different climates... it seemed that when I researched it that it makes a lot of those adjustments automatically. Also, to deal with the prescribed Oxygen, I have been looking at the Respironics EverGo portable oxygen concentrator. I pay the full rental price for the one they deliverd to my home in Denver last year until the $500 deductable is reached and then an additional monthly co-pay so I think that the one there is not doing me any favors since at most it is used a toltal of 100 days a year.

Like I said previously, this is all new for me so any suggestions about any of this is very much appreciated.

rtql

Best suggestion id to start a thread with a bullet list of your issues & a comment on what you hope to gain. That should really get the ball rolling for you. If you leave your posts in this thread they may get missed oy bypassed.

I think you have a few challenges but the 1st & best step is to lay them out here (in your own thread) and have the
resident experts, & us others, do the eval & advice.

Good luck,
DSM