Fired My Sleep Doctor

[Paper_Nanny]

Oh my, your machine is definitely due for replacement (but do keep the old one for a back-up). Most insce. co's replace at 5 yrs, and you should talk to yours about that.

I will give the DME place a call tomorrow.

[palerider]

This is the graph from last night. Settings are: Max pres= 25; EPAP min= 7; EPAP max= 15; PS min= 3; PS max= 18. The PS min had been at 1. AHI of 14.27 was slightly better than 22.27 the night before. Still not good, though. And I am still so exhausted.

I'd really love to see you with a resmed ASV, if you're looking for a new machine in the near future.

in the meantime, try setting the backup rate at 8, and the PS min to 4. let's see if that makes a difference.... but it's like your machine just isn't responding most of the time, could just be the difference in algorithms

[Paper_Nanny]

I'd really love to see you with a resmed ASV, if you're looking for a new machine in the near future.

Why is that?

[palerider]

I'd really love to see you with a resmed ASV, if you're looking for a new machine in the near future.

Why is that?

most of my experience is with resmed ASVs, which have a more aggressive algorithm which causes them to ignore fewer events, and respond faster when there's uneven breathing, so my feeling is that they would eliminate the centrals, as well as support you better through the hypopnea episodes, where your machine seems to be pretty much doing nothing.

in fact, resmed asvs don't even score central apneas, because they immediately force a breath without waiting to see what kind of an apnea you're having.

[raisedfist]

This is the graph from last night. Settings are: Max pres= 25; EPAP min= 7; EPAP max= 15; PS min= 3; PS max= 18. The PS min had been at 1. AHI of 14.27 was slightly better than 22.27 the night before. Still not good, though. And I am still so exhausted.

I'd really love to see you with a resmed ASV, if you're looking for a new machine in the near future.

in the meantime, try setting the backup rate at 8, and the PS min to 4. let's see if that makes a difference.... but it's like your machine just isn't responding most of the time, could just be the difference in algorithms

ResMed has a more appealing/easy to use interface as well, along with more therapy options that you can customize and take control of.

A manual backup rate is a good idea as well, it sounds like the OP was experiencing dyssynchrony in their breaths as their patient triggered breaths took a dive. I believe on the Respironics ASV the default backup rate on "Auto mode" is 15bpm, and it goes down to as low as 10bpm depending on the minute volume calculations (which I believe are breath by breath).

[palerider]

more therapy options that you can customize and take control of.

A manual backup rate is a good idea as well, it sounds like the OP was experiencing dyssynchrony in their breaths as their patient triggered breaths took a dive. I believe on the Respironics ASV the default backup rate on "Auto mode" is 15bpm, and it goes down to as low as 10bpm depending on the minute volume calculations (which I believe are breath by breath).

This is incorrect, the resmed asv offers two therapy option, asv, and asvauto, with asv being nothing to think about, so, practically, one option, with fewer settings, since it's more automatic. It also doesn't have a manual backup rate.

[raisedfist]

more therapy options that you can customize and take control of.

A manual backup rate is a good idea as well, it sounds like the OP was experiencing dyssynchrony in their breaths as their patient triggered breaths took a dive. I believe on the Respironics ASV the default backup rate on "Auto mode" is 15bpm, and it goes down to as low as 10bpm depending on the minute volume calculations (which I believe are breath by breath).

This is incorrect, the resmed asv offers two therapy option, asv, and asvauto, with asv being nothing to think about, so, practically, one option, with fewer settings, since it's more automatic. It also doesn't have a manual backup rate.

when i was speaking about a (manual) backup rate, i was referencing the respironics asv, which you can change the backup rate. i kind of was all over the place though in my post.

i checked resmed titration guide and indeed the backup rate is automatic - that is important to know.

anywho, i agree with getting a resmed if you can - my s9 is worlds better than the trilogy i owned, not to mention a million times smaller/lighter.

[Paper_Nanny]

If you experience an inadequate breathing rate on Auto mode: Set fixed rate of 8 - 10bpm, or 2bpm below spontaneous rate. Then set inspiratory time of 1.5 seconds.

it sounds like the OP was experiencing dyssynchrony in their breaths as their patient triggered breaths took a dive.

I wonder about the inspiratory time setting. It is currently set at 1.2. One thing I notice about the machine is that I feel like my breathing is rushed. I am still inhaling when it drops the pressure for an exhale. I thought it was the flex mode, but even with that off, it feels like the machine wants me to be done inhaling sooner than I am ready.

It happens with the exhale, too I am either still exhaling or pausing between breaths when it starts the pressure increase for me to inhale.

Sometimes in the hypnagogic state, I imagine that I am trying to tame the machine and make it comply to my breathing patters rather than allowing myself to be forced into the pattern of breathing the machine wants.

So, I don't know if it would help to change the Ti or change the backup breath rate. Or maybe I need to submit to the demands of the machine as long as my brain is guilty of dereliction of duty in regards to breathing while I am sleeping.

[Paper_Nanny]

Last night looks a bit better! I am not all bright eyed and bushy tailed, but I do feel somewhat better than yesterday!!

[Paper_Nanny]

Oh my, your machine is definitely due for replacement (but do keep the old one for a back-up). Most insce. co's replace at 5 yrs, and you should talk to yours about that.

I will give the DME place a call tomorrow.

I called them. They said they need a new prescription from the doctor and he needs to state that the old machine is not working well. So, I think I will wait until I go to the new sleep doctor and have that doctor do it. My primary care doctor is sending a referral to the sleep clinic on the other side of the mountain. Not sure how far out they're booking. I guess I will find out when they call me!

[raisedfist]

Last night looks a bit better! I am not all bright eyed and bushy tailed, but I do feel somewhat better than yesterday!!

Your exclamation marks are promising. Did you keep the backup rate on auto? Your average PTB are real low so I assuming yes.

How did the PS of 4 feel? I'd be curious to see what a PS of 6 would do to your AHI, as long as you felt comfortable using it for a night or two. If we could get your AHI under 5 until you get a replacement machine that would be awesome.

[sickwithapnea17]

They found severe obstruction of my soft palate. I'm not sure if that can mimic centrals. I'm experimenting with an EPAP of 9-14cm and a max IPAP of 25cm, max ps=max, maybe 15cm, min ps=0. Maybe I should change the min ps to 5.0 cm or lower the min epap to 4cm?

I always go with the auto setting. Haven't you found that the lower bpm like 8-10 leaves you feeling really weird and impaired the next morning? I still feel really foggy and impaired on these settings but it's better than going with manual bpm.

Some people on here that may know more than me are advising a wide open maximum ipap to treat centrals and to raise the epap for OSA. I did have one good night it seems with the ps min 0, ps max maybe 15cm? and epap min=4cm, but I'm not completely sure. But this seems to be a bad setting for me since I have severe obstruction of the soft palate

[Paper_Nanny]

Your exclamation marks are promising. Did you keep the backup rate on auto? Your average PTB are real low so I assuming yes.

[quote/]

Haha, yes, exclamation marks are a bit more hopeful that some other punctuation marks. I set the BPM to 8. The PTB was higher, but still kinda low.

How did the PS of 4 feel? I'd be curious to see what a PS of 6 would do to your AHI, as long as you felt comfortable using it for a night or two. If we could get your AHI under 5 until you get a replacement machine that would be awesome.

I didn't notice the difference in PS. I sleep very soundly, so soundly it can be scary to people who don't know I sleep like that. I agree that if we could get my AHI under 5, that would be awesome!! Amazingly awesome, even!!!

I think I am going to set the BPM a little lower tonight to see what happens.

[Paper_Nanny]

I always go with the auto setting. Haven't you found that the lower bpm like 8-10 leaves you feeling really weird and impaired the next morning?

I had the BPM at 5 for years and did fine at that setting.

[sickwithapnea17]

I seem to feel a lot better today at 0 min ps, epap min 4 and max ps 15? I don't know if that is masking some centrals and apneas.

but a min epap of 0 doesn't make sense because I have severe obstruction of the soft palate collapsing up in to my nose, I don't know if 14cm max epap is enough to open my airway with the soft palate obstruction