No Answers Yet For Problems With ASV

rested gal wrote:

dsm wrote:Re your main chart, I notice again a lowish Av Tidal Volume.

If Deborah's is low (440 for that night), mine is too -- and I don't have any health problems (other than mild OSA and mild PLMD.)
For over a week on an S8 VPAP Auto 25, my 95th% tidal volume was: 400, 340, 340, 380, 340, 380, 340, 340, 360, etc. The mean was almost always 300, occasionally 320, and as low as 260 one night.

Of course, tidal volumes that seems to do ok for me aren't necessarily right for Deborah or someone else.
But anyway... "To each their own" -- tidal volume, among other things.

(DSM) ## Yes, good point (PS: I did go back over Deborah's past charts - a high that I found was 570 - low as best I recall was around this current number - so correlation ?).

dsm wrote: The CA's are obviously needing professional interpreting as they seem excessive.

Well, ummm, that is one of the many things NotMuffy is looking into ... and will be looking into further when Deborah is able to get the NPSG raw data he requested.

##(DSM) Yes again & NM was the professional here I was thinking of.

NotMuffy wrote:there is also the preaforementioned issue of the breathing irregularity of phasic REM. And I think that as the REM-suppressant medication effect wears off in the latter part of the night, you have a pile of it (that might be an interesting thing to look for in your raw NPSG data).

You probably want to leave the variability of phasic REM alone (including centrals that are in there. They are generally considered to be normal phenomenon.)

##(DSM) Thanks.

DSM

NotMuffy wrote:BTW, I am not a big "Auto" breath rate fan.

I could turn it off and then post those graphs, if anyone wants to see that.

I am not sure what settings I should actually have my machine on at this point, since I did the BAD THING and got a machine that can't run as a nonASV BiPAP. Can't set the machine as a BiPAP; can't follow MSD's orders.

I ran it as an ASV the one night to see what was going on all those nights when I had low PTB%. Is there a reason to run it like that additional nights?

Ran it as a CPAP last night, but I just guessed on the pressure. Should I do something else with the pressure? Should I try reconfiguring the entire set up and get it to run as a toaster? Or a chain saw? Oh, a television! I don't have one of those. It might be nice to have an ASV TV. Hugest screen available. That would be the icing on the cat's meow, indeed!!

Deborah

Paper_Nanny wrote:That would be the icing on the cat's meow, indeed!!

Indeed it would be! The Real McDog's pajamas, even!

NotMuffy wrote:BTW, I am not a big "Auto" breath rate fan. When it first came out, it defaulted to a rate of about 9. That didn't work out very well.

The new multi-layered algorithm relies heavily upon exhalation time. While it can work well in treating what it was designed to treat (chain centrals), once one starts using this thing for stuff other than it was designed for (especially relatively normal breathing), I believe short exhalation times will make the algorithm "pushy".

Ditto about the Auto Breath Rate! That is, if you are referring to leaving it in auto breath rate as opposed to setting a minimum breath rate. I've mentioned this several times to various users if they felt the machine was hitting them with breaths they did not want. I did not know the underlying cause but, the default is quite intrusive and if its variable also, well, bleh! I lay down and timed my 'about to fall asleep' breathing rate and asked my respiratory therapist to change it to below that. All the other middle of the night wake ups went away. I jumped from being able to sleep 4.5 hours a night to 6.5+ hours a night because the auto backup rate was effectively disabled by setting a safe rate that was below rather than above my comfort zone.

@DSM. My RT and I were discussing tidal volume and I was asking how one decided what to give a person on a ventilator who was lets say, ginormous. I was wondering how one delivered enough oxygen for metabolism. He said its the minute volume that is the effectively critical factor. And, he said the lung is only so big so that if a person was too large then they added oxygen rather than increasing BPM or trying to "increase" tidal volume.

Paper_Nanny wrote: I could turn it off and then post those graphs, if anyone wants to see that.

Up to you.

Paper_Nanny wrote:I did the BAD THING and got a machine that can't run as a nonASV BiPAP. Can't set the machine as a BiPAP; can't follow MSD's orders.

Couldn't have happened to a nicer gyrl..

Paper_Nanny wrote:I ran it as an ASV the one night to see what was going on all those nights when I had low PTB%. Is there a reason to run it like that additional nights?

Not really. ASV will probably never be too kind to you.. And you still have not told anyone if the Iousy PTB on ASV feels better or worse than 100% PTB on CPAP. But that maybe your closely guarded "secret".

Paper_Nanny wrote:Ran it as a CPAP last night, but I just guessed on the pressure. Should I do something else with the pressure?

You should try a page out of Brian's hymnal and set EPAP Min 7. Leave all other settings the same.

StillAnotherGuess wrote:And you still have not told anyone if the Iousy PTB on ASV feels better or worse than 100% PTB on CPAP. But that maybe your closely guarded "secret".

Not a secret. In fact, I wrote a fairly lengthy post in reply to your earlier question about how I feel today and I have no idea what happened to it. I don't know if it vanished, as several of my other posts have. I don't know if it was part of a different post and I cut it, meaning to then paste it into a new post and never pasted it. I don't know.

As for your wondering if I felt better on ASV or on CPAP, that is a difficult question to answer in that form. The question confuses me. Sometimes everything confuses me. Wasn't I only on CPAP for one night? Hasn't ASV been fairly well eliminated as a long term option?

How do I feel? I'm tired. I feel like my Window of Functional Time has narrowed considerably ever since my AHI's started going up. Somewhere around the beginning of this thread... WFT being the amount of time during the day in which I actually feel functional. Like I can get things that require more than the minimal amount of energy and effort.

My AHI was sort of stable. And then it became unstable. And I haven't felt the same since. I am confused. I don't know what I am doing anymore. I have lost track of myself. Maybe most of all, that is the secret. I am feeling a bit hopeless. I don't know WTF (not to be confused with WFT) I am doing anymore. And possibly never did. I am tired. And I am crying.

I know I need to have a sharp pharmacist go over my medication list with me. I know I have to get raw data and a shiny DVD from the sleep lab. I know I need to get an order for a MIF MEF NIF. (GNIP GNOP, anyone?)

And right now, I am hungry. And my dinner is ready. Complete with rhubarb pie.

Deborah

Paper_Nanny wrote: My AHI was sort of stable. And then it became unstable. And I haven't felt the same since.

I'm happy to see you experimenting with bland, vanilla, CPAP.
Tonight, see if EPAP Min 7 can further reduce the CA: 8.4 score that you got using EPAP Min 8.

Are you going to have someone look your machine over to see why you cannot access bi-level mode?

StillAnotherGuess wrote:I'm happy to see you experimenting with bland, vanilla,

Vanilla?? Who said anything about vanilla? I said I was having rhubarb pie for dessert. How did you get vanilla out of that?? No vanilla in a rhubarb pie. I know, cuz I made it outta butter, flour, salt, rhubarb, and sugar. Nothing more, nothing less. And certainly no vanilla!!

StillAnotherGuess wrote:Are you going to have someone look your machine over to see why you cannot access bi-level mode?

No. The problem isn't with accessing bi-level mode. I don't even understand what you mean by "bi-level mode". Bi-level ala mode?? Yech. I would much rather have vanilla.

Seriously, though, there isn't something called bi-level mode to access. There is a way to set up the machine so it is running like a BiPAP, with one pressure for inhale and one pressure for exhale. It is the set up I am having trouble with. So-- Big deep exhale, big inhale, exhale, breathe as you normally would. And I will now explain this again and hope that if there is a fatal flaw in my reasoning, someone will point it out to me so I can fix it.

In order for me to run the machine as a non-ASV BiPAP set at 8/12, I set EPAPmin at 8. I set EPAPmax and MaxPressure at 12. And, since I need those numbers not to change, I set PSmin and PSmax to 4. I could do that on my old machine.

[oh, ick. this is even worse the bi-level ala mode on rhubarb pie. it was the hokey pokey song faintly planing in my head just now. "i set the epap min, i set the epap max. i set the epap min, then i change it all around." yes, my mind can be a scary place sometimes. a very scary place.]

On my new machine, I cannot set PSmin to 4 if I have EPAPmax = Max Pressure. That is not a problem with my machine. That is not a problem with me. That is how it is. To paraphrase from the provder instruction manual: PSmin may be adjusted from 0 cm H20 to the difference between the Maxiumum Pressure setting minus the EPAPmax setting. In my case, MaxPressure = EPAPmax, so MaxPressure- EPAPmax= 0. So I can set mine from 0 to 0. So, I cannot lock in the numbers and consequently, I cannot set this machine up as a BiPAP with no ASV.

Deborah

Why are you setting EPAP max to equal 12? It's the IPAPmax that should equal 12.
BIPAP 12/8 means IPAP -12 and EPAP =8.
By setting " EPAPmax and MaxPressure at 12" you are telling the machine it can function with a pressure support (or pressure separation) of 0. So it stands to reason you can't budge the PS Min under those conditions.

IPAP = inhale positive air pressure
EPAP = exhale positive air pressure.

And PS is is the separation between the two.

Paper_Nanny wrote: In order for me to run the machine as a non-ASV BiPAP set at 8/12, I set EPAPmin at 8. I set EPAPmax and MaxPressure at 12. And, since I need those numbers not to change, I set PSmin and PSmax to 4. I could do that on my old machine.

On my new machine, I cannot set PSmin to 4 if I have EPAPmax = Max Pressure. That is not a problem with my machine. That is not a problem with me. That is how it is. To paraphrase from the provder instruction manual: PSmin may be adjusted from 0 cm H20 to the difference between the Maxiumum Pressure setting minus the EPAPmax setting. In my case, MaxPressure = EPAPmax, so MaxPressure- EPAPmax= 0. So I can set mine from 0 to 0.

Ok, lets assume the machine is fine and everything you are doing is pilot error. Since I have never seen or played with the advanced machine in any version, try the following:

EPAP Min 8
EPAP Max 12
PS Min 4
PS Max 4
Max Pressure 25

Does it fly?

Note: If want to run as a straight BiPAP and you do not want EPAP to float between 8 and 12 (which you probably don't) try this:

EPAP Min 8
EPAP Max 8
PS Min 4
PS Max 4
Max Pressure 25

NotMuffy wrote:BTW, I am not a big "Auto" breath rate fan. When it first came out, it defaulted to a rate of about 9. That didn't work out very well.

The new multi-layered algorithm relies heavily upon exhalation time. While it can work well in treating what it was designed to treat (chain centrals), once one starts using this thing for stuff other than it was designed for (especially relatively normal breathing), I believe short exhalation times will make the algorithm "pushy".

Little gems like this is why I keep slogging through these long posts. NM, thank you for explaining this.

I do use auto and have no problem with it. Though as I've noted, I actually prefer my Resmed VPAP Adapt SV Enhanced unit. As DSM and I have noted it is a bit more of a "task master" on breathing than the Respironics. Since not breathing for longish periods (I had apneas that lasted in excess of a minute) were part of my issue, I find it comforting to have this level of regimented breathing.

Again, thanks for taking the time to share your experience. It helps all of us.

ozij wrote:
Why are you setting EPAP max to equal 12? It's the IPAPmax that should equal 12.
BIPAP 12/8 means IPAP -12 and EPAP =8.
By setting " EPAPmax and MaxPressure at 12" you are telling the machine it can function with a pressure support (or pressure separation) of 0. So it stands to reason you can't budge the PS Min under those conditions.

IPAP = inhale positive air pressure
EPAP = exhale positive air pressure.

And PS is is the separation between the two.

My best guess as to why I did it that way is: I did it that way because I am confused and I am having difficulty transferring information about one machine to another machine. It seems like all the information I need is right here. But I can't fit the pieces together to come out right.

I have every reason to believe this is a very clear example of how the ms has trashed my brain. I used to be able to do these things. In the past, problems like this didn't reduce me to a puddle of pathetic goo, In fact, I liked them! Now, I feel hopelessly frustrated and cannot think my way through to an answer. I wish I could explain the deep to the core anguish I feel about that and I wish I could it explain how very difficult it is for me to admit that I cannot figure this out.

But enough of that, and on with the information--

No, no no!!! This is incorrect!! These are not!! the settings BrianinTN gave me for this!!! Error!! Error!! See later post for correction!!

When the question of how to set my old machine as a BiPAP came up, BrianinTN came up with the following settings. BPM to Auto; PresMax to 25; EPAPmax to 15; EPAPMin to 8; PSmax to 15; PSmin to 0.
*********************************************************************************
This is correct:

On Thu Jun 16, 2011 at 3:57 pm

BrianinTN wrote:You can make your ASV act (pretty much) just like a standard BiPAP. You'd set your min PS and your max PS to the same value, set your max pressure to your desired IPAP pressure, and turn your backup rate off. (If you wanted it to behave like a BiPAP S/T rather than a standard BiPAP, you'd set a backup rate.)

And on Fri Jun 17, 2011 at 6:05 pm

BrianinTN wrote:It's a little confusing, but on our ASVs, when you raise your min PS, you actually are raising min IPAP. On our ASVs, min IPAP is just a variable rather than a constant number. Expressed as an equation, Min IPAP = min EPAP + min PS.

Using the above infomration, can someone tell me how to set my machine for 8/12?

I got the first one okay. BPM- Off.

Deborah

edit for truth in advertising

Deborah, please don't feel bad. I have been reading this stuff for 4-8 hours a day for nearly 4 years and I still can't figure out what any of it means. I'm not stupid, or at least, I didn't used to be, but I just can't wrap my brain around how any of this ASV /BiPap stuff works. I can't even blame it on MS! I think I've had OSA way too long and some of the brain damage is irreversible and it seems to have something to do with the math part of my brain. I need step by step instructions. I can't think past two things at a time.

You are doing very well to be able to keep your sense of humor throughout. Keep up the good work. I'll keep trying to follow along.

Bev

Paper_Nanny wrote:Using the above infomration, can someone tell me how to set my machine for 8/12?

Ok, since you did not like using..

StillAnotherGuess wrote:Note: If want to run as a straight BiPAP and you do not want EPAP to float between 8 and 12 (which you probably don't) try this:

EPAP Min 8
EPAP Max 8
PS Min 4
PS Max 4
Max Pressure 25

Then try the same settings with EPAP Max 0.