87 yo f w/ Respironics BiPAPautoSV Advanced

[Artimus60]

Hi all,

I'm a new and rather awkward user on this site and I posted a msg yesterday looking for help for my mom. She is being treated obstructive and central sleep apnea. In the subject line I vaguely referred to the machine she's using as a Respironics BiPAP machine rather than the more specific 'Respironics BiPAPautoSV Advanced'. Even so I recieved a lot of kind and helpful responses but I couple of folks wisely suggested that I repost with the correct machine listed in the subject heading. If you have experience with this machine I'd be thrilled if you'd take a look at the original thread and comment as you see fit. I'm going to paste my most recent posting to the thread below as it contains what I hope is the bulk of the data that I left out of my original posting. Sorry for the confusion and thanks in advance.

artimus60

-----------------------

Hello all,

Thank you all for taking in interest in our situation. In retrospect my original post was heavy on whining and low on detail. I hope this helps me get it back on track.

Equipment:
The machine that my mom is currently using is the Respironics BiPAPautoSV Advanced. It has the humidifier attached and contains an Encore Pro Smart Card. She is currently using a Mirage Quatro full face mask. I think the equipment supplier suggested this mask as she breathes primarily through her mouth. She started with a Quatro FX mask (the one that doesn't have a ‘stabilization apparatus’ that rests on the brow) but it seemed to get moved during the night and they opined that a full face style mask would remain anchored more securely.

I asked for and received that results of both my mom's sleep studies and her subsequent consultations with her sleep doctor. My mom initially took a 'home sleep study' using a portable device that her primary care doctor provided. The home tests seemed to indicate to the sleep doctor that my mom had moderate to severe obstructive apnea. They prescribed a CPAP machine with a tritation study for follow immediately. The CPAP machine was initially set to a pressure of 6-9cm. When we went into the office they downloaded the data from the CPAP machine and it reported AHI of 44.3. I told the doctor that I could visually observe my mom gasping in her sleep while wearing the mask.

First Sleep Study
Total Number Apneas: 176
Total Number Hypopneas: 5
Apnea Index: 31.5
Total AHI 32.4
REM index: 9.5
Supine index: 32.3

Interpretation: patient titrated from 6 to 16cm of water with heated humidification. Application of positive airway pressure resulted in dramatic appearance of central apneas and central hypopnea events. Therefore, an optimal pressure setting to obtain normal breathing and oxygenation levels above 90% could not be obtained. The patients clinical use of opiod pain medication likely contributes to this effect. Rare premature ventrical contractions were noted, otherwise there were no cardiac arrhythmias on a single lead EKG recording. The patient should be titrated on BiPAP SV Auto Advanced therapy.

…so we went back for a second overnight sleep study…

Second Sleep Study
Total Number of Apneas: 157
Total Number of Hypopneas: 4
Apnea Index: 22.8
Hypopnea Index: 0.6
Total AHI: 23.4
REM index: 22.4
Supine index: 0.6
Interpretation: This is a BiPAP SV auto advanced titration study performed for obstructive and central sleep apnea (i.e. complex sleep syndrome). The patient was titrated from EPAPmin=5-9, EPAPmax=15, Pressure Max=25, PS=0-10, BUR = auto with heated humidification and a Mirage Quatro FX small mask. Sleep disordered breathing was improved at the lowest pressure with subtle central hypopneas noted in the setting of the mask leak. Rare PVC’s were noted, otherwise there were no cardiac arrhythmeas on a single lead EKG recording. The patient should be initiated on BiPAP SV auto advanced therapy at EPAPmin=5, EPAPmax=15, Pressure Max =25, PS=0-10, cm of water, BUR=auto with heated humidification. Mask refitting is recommended at the time of set up. A Mirage Quatro standard may be better for achieving a good air seal.

We used the BiPAP faithfully for a couple weeks and went back in to see the doctor…

From her notes: download shows she is using it 92.3% of nights for an average of 7 hours and 32 minutes a night. Average EPAP=10.6, 17% of the night in periodic breathing, average time in large leak=9 minutes, average breath rate 12, minute ventilation = 5.8, AHI = 30.6 (mostly obstructive events recorded by the device). Recomendatons: add BURR=10, increase EPAP min to 8cm of water, EPAP max to 18

After using the machine for another 3 weeks we went back in for another consultation…

From the doctor’s notes: compliance download reports that she is wearing it 100% of the night. Average usage is 6 hrs and 21 minutes, 90% EPAP=12.4. Periodic breathing=12.6%, average breath rate=12.9%, average minute variation= 4.8, AHI=33.7. Detailed report shows the majority of AHI are obstructive apnea. Recommendations: change settings to EPAP 12-22, PS=3-10, Max pressue=25, BUR=10, flex=off.

Those changes were made 3 days ago. I haven’t noticed any changes during this admittedly short time period.

I hope this provides the information that was missing from my first post. Just going through the process of reviewing the notes from the doctor and compiling them for this msg has helped me understand this stuff a little better, but I realized that I have a long way to go before I can effectively advocate for my mom. I would really like to be able to evaluate how she’s doing/if she’s improving, during the time between visits to the doctor’s office. We're 6 weeks in and she seems just as fatigued as when we started. On the positive side, I think we have a good doctor, my mom wants to get better, and I'm thrilled to have found CPAP talk. Thanks in advance for any future thoughts and/or advice. I'm going to respond to some of the other replies I've recieved in seperate msgs to follow as this one is getting frightfully long!

Thanks again - Mike in Seattle

[Pugsy]

Check your private message box for information on the software and card reader needed to get the data off the machine.
Do you need or want the provider/clinical manual? I can get you a link for that also.

[Artimus60]

Hi - I would be interested in the link for the provider manual if you have it handy. I don't know if it would be greek to a layperson such as myself but maybe there's something in there I could use to move the ball forward a few yards.

Thanks,

artimus60

[JohnBFisher]

Greetings Mike ... I posted the following in your other note. To make it easier, I cross posted that reply here as well ...

Greetings Mike in Seattle! Welcome to the forum. I'm really sorry that your mother is having problems adjusting to her ASV unit. The Respironics BiPAP AutoSV Advanced is an Adaptive Servo-Ventilator (ASV) unit. That is, not only does it act as a BiPAP that will switch to inhalation pressure if she does not breathe in a timely manner (a BiPAP S/T), but it will also increase the pressure it delivers to help sustain respiration when she fails to breathe. However, it uses her breathing to help determine that process. That's the "Adaptive Servo-Ventilation" part of it. It adapts to her breathing or not breathing (that's the adaptive part). It is tied to her respiration (that's the servo part). And it helps sustain respiration by increasing the pressure (that's the ventilator part).

First, I'ld like to offer some reading for you. You might want to understand better some of the issues around Complex Sleep Apnea (what your mother has). It is a type of central sleep apnea that only arises when pressure is applied.

viewtopic.php?t=3025

Second, you might want to watch the following short YouTube article. You might be wondering "Just what is Complex Sleep Apnea?". I found the following YouTube video that does a great job of explaining Complex Sleep Apnea:

http://youtu.be/CU-XTcfg3M8

Though written by Resmed, it is not product specific. Also, though it is written as if it is for a medical practice, it uses layman's terminology, so most anyone can watch and learn.

And here's how it is recognized during a polysomnograph (PSG) [Sleep Study]:

http://youtu.be/0WpZka7wYow

Now, let me offer some suggestions about the mask and how your mother might tame it. She's right that it can make your face very sore when you have to crank down the straps to keep it from leaking during the night. I *highly* recommend you check out Pad-A-Cheek for the forehead cushion, mask liner and anti-leak strap.

Forehead pad (but you might want the mask liner, which includes a forehead pad):

http://padacheek.com/Forehead_pads.html

For the straps at the temple:

http://padacheek.com/PAC_Temple.html

For the straps across the cheeks:

http://padacheek.com/PAC_Original.html

For the straps across the back of the neck:

http://padacheek.com/PAC-Neck.html

For the silicone cushion (and integrated forehead pad):

http://padacheek.com/PAC_Maskliners.html

For the anti-leak strap (to keep the mask in place):

http://padacheek.com/PAC_AntiLeak_Strap.html

For the hose cover (because that ribbed hose can be a nuisance):

http://padacheek.com/PAC_Hosecover.html

And of course, feel free to call Karen. She's a great help .. and lots of us use her products. I don't get anything out of endorsing her products other than the pleasure of knowing you won't be disappointed by the quality or service you will receive.

I don't mean to overwhelm you, but do hope this information will help your mother as she struggles to make the therapy work. Plus, it will help you not feel as helpless as you see her struggle with the therapy.