How to home titrate the adapt sv?

[Guso]

In my other thread (viewtopic.php?f=1&t=53589&st=0&sk=t&sd= ... aybe+bipap) I wrote about cpap wasn't working.
I had a respironics autocpap machine and a respironics mask too small (the insurance company just gives people size M). I barely reached 3 hours per night of use.

Even with this low use I though cpap wasn't working. I never felt great. After six months using that machine, I went untreated for three or four months.
I though I may had complex apnea, hence I bought a second hand adapt sv machine.

I have been using this machine for two weeks, and now I have a resmed quattro mask that is my size. (at last).
I'm now capable of using the machine for the entire night, probably because of the bigger mask.I have been messing with the settings, I have slept several nights in cpap mode with my prescribed pressure (8) and some nights 10. I don't feel any better when in cpap mode than untreated.
I have slept in asv mode several nights (with differents settings each night), it seems that after every night in asv mode, I feel more tired and sleepy than usually.

Unfortunately the machine doesn't reduce breathing effort. The resmed spirit II is the only machine that felt "in phase" and made breathing truly effortless.
Like it was a "breathing amplifier". However I just used it the titration night.

Maybe I don't have complex apnea, but anyways I have this machine now and I have to check if it works or not.
So do you have any idea on how to titrate myself for asv?. Probably by trial and error, but how many nights to spend in each setting?.

Could be dangerous to use a too high MINPS? (maybe hyperventilation).MINPS ranging from 3 to 4.5 doesn't feel any strong). I have yet to test the machine at MINPS=6 (the maximum value) while sleeping.

I also download the night data to my computer often and review it. This machine doesn't tell ahi.I often look minute ventilation as the best indicator of "events", since I simulated apneas and they were most recognizable in this graph. I can post sleeping data if you want it.

Please don't tell me I don't have complex apnea, I have to check if this asv thing "cures" me or not.

NOTE: I sucessfully "learned the circuit" with the quattro mask, although I don't use the original tubing as I don't like it.

[Banned]

In my other thread (viewtopic.php?f=1&t=53589&st=0&sk=t&sd= ... aybe+bipap) I wrote about cpap wasn't working.
I had a respironics autocpap machine and a respironics mask too small (the insurance company just gives people size M). I barely reached 3 hours per night of use.

Even with this low use I though cpap wasn't working. I never felt great. After six months using that machine, I went untreated for three or four months.
I though I may had complex apnea, hence I bought a second hand adapt sv machine.

I have been using this machine for two weeks, and now I have a resmed quattro mask that is my size. (at last).
I'm now capable of using the machine for the entire night, probably because of the bigger mask.I have been messing with the settings, I have slept several nights in cpap mode with my prescribed pressure (8) and some nights 10. I don't feel any better when in cpap mode than untreated.
I have slept in asv mode several nights (with differents settings each night), it seems that after every night in asv mode, I feel more tired and sleepy than usually.

Unfortunately the machine doesn't reduce breathing effort. The resmed spirit II is the only machine that felt "in phase" and made breathing truly effortless.
Like it was a "breathing amplifier". However I just used it the titration night.

That's odd, or you are odd.. The ResMed Spirit II should pale in comparison to the Adapt SV.

Maybe I don't have complex apnea, but anyways I have this machine now and I have to check if it works or not.

Anybody on CPAP should be prescribed an Adapt SV as a standard machine.

So do you have any idea on how to titrate myself for asv?. Probably by trial and error, but how many nights to spend in each setting?.

Self Titration on the Adapt SV begins with EEP set at your prescribed CPAP setting. Set Min PS at 3cmH2O. Set Max PS at 10cmH2O. Maintain those settings for 7 nights. Tell us how you feel.

Could be dangerous to use a too high MINPS? (maybe hyperventilation).MINPS ranging from 3 to 4.5 doesn't feel any strong). I have yet to test the machine at MINPS=6 (the maximum value) while sleeping.

Min PS at whatever setting (high or low) will never hurt you. These machines are flow generators and flow will never hurt you in the slightest. On the other hand, AVAPS (in AVAPS mode) is a volume generator. Too high of a setting in AVAPS mode can do severe lung damage and possibly kill you.

I also download the night data to my computer often and review it. This machine doesn't tell ahi.I often look minute ventilation as the best indicator of "events", since I simulated apneas and they were most recognizable in this graph. I can post sleeping data if you want it.

Probably not necessary to post.

Please don't tell me I don't have complex apnea, I have to check if this asv thing "cures" me or not.

ok

NOTE: I sucessfully "learned the circuit" with the quattro mask, although I don't use the original tubing as I don't like it.

ok

[Mary Z]

Are you using your machine in timed mode or spontaneous mode? I would highly recommend either an in lab sleep study or a HST. You'
re operating in the blind. An Adapt SV is essentially a servo vent for people with complex or central sleep apnea. Though it can be used in Spontaneous mode (ResMed machines anyway) with a set EPAP and IPAP. Changing things every night doesn't give you a chance to see what works. Are you changing pressures, or modes of operation.
I wish you the best of luck and skill in getting this to work for you, but please consider seeing a sleep doc.

[Guso]

Self Titration on the Adapt SV begins with EEP set at your prescribed CPAP setting. Set Min PS at 3cmH2O. Set Max PS at 10cmH2O. Maintain those settings for 7 nights. Tell us how you feel.

Ok, last night I set the machine to EEP=8 MINPS=3 and MAXPS=10. In six nights I will comeback.

[Guso]

Ok, I spent last 7 nights sleeping in these settings and I have used the machine for the entire night. I have felt very tired these days, more than usual.

What now?.

Are you using your machine in timed mode or spontaneous mode?

This machine cannot be set in timed or spontaneous, I guess is a mix between the two.

I would highly recommend either an in lab sleep study

I already had it.

[Banned]

Ok, I spent last 7 nights sleeping in these settings and I have used the machine for the entire night. I have felt very tired these days, more than usual.

What now?.

Bump up EEP to 9cmH20. Leave Min PS and Max PS at their current settings. Maintain these settings for 5 nights.

While using the Adapt SV in SV mode, as you are currently doing, Max PS will always remain at 10cmH2O. You will only be using EEP and MinPS to fine tune your therapy.

(3) Questions for you to answer, now, with respect to your first trial:
1. Roughly, how many times did you get up each night to go to the bathroom?
2. Did you have any dreams during your first trial?
3. if you are not using the standard CPAP hose, What kind of hose are you using?

[JohnBFisher]

Guso, I recognize that you were not diagnosed with a disorder that requires this ASV unit. That being said, I have a general caution for other readers of your post.

If you have been diagnosed with a disorder that requires use of the ASV unit, do NOT try to titrate yourself? There are substantially more "knobs" on the ASV units. This is ESPECIALLY true if the unit was prescribed to help address Cheyne-Stokes Respiration (CSR) or Periodic Breathing. Both are indicative of heart related issues. An improperly set unit increases the stress on the heart and can make matters MUCH worse.

In other words, the general rule of thumb for a ASV unit is:

Don't try this at home!

Now, Guso, to your specific situation... You note:

... I bought a second hand adapt sv machine. ... NOTE: I sucessfully "learned the circuit" with the quattro mask, although I don't use the original tubing as I don't like it. ...

From this, I assume you have a Resmed VPAP Adapt SV Enhanced unit. If that is the case, you MUST use the original tubing (with the pressure sensing line). That's not just a "it would be a good thing". That tubing is needed to sense the pressure at the mask. The results will be unpredictable and wrong without the original hose and pressure line.

Yes, it can be uncomfortable to use that tubing "as is". However, you can and should use it with a hose cover. This both helps insulate the tube as well as make it much easier to live with it.

[Guso]

(3) Questions for you to answer, now, with respect to your first trial:
1. Roughly, how many times did you get up each night to go to the bathroom?
2. Did you have any dreams during your first trial?
3. if you are not using the standard CPAP hose, What kind of hose are you using?

1- With or without cpap or asv, I rarely go to the bathroom when sleeping.
2- One night I had a nightmare, I don't remember if had other dreams.
3-I'm using the tubing that came with a respironics machine, which is thicker.

While using the Adapt SV in SV mode, as you are currently doing, Max PS will always remain at 10cmH2O. You will only be using EEP and MinPS to fine tune your therapy.

Any reason for this?

From this, I assume you have a Resmed VPAP Adapt SV Enhanced unit. If that is the case, you MUST use the original tubing (with the pressure sensing line). That's not just a "it would be a good thing". That tubing is needed to sense the pressure at the mask. The results will be unpredictable and wrong without the original hose and pressure line.
Yes, it can be uncomfortable to use that tubing "as is". However, you can and should use it with a hose cover. This both helps insulate the tube as well as make it much easier to live with it.

I use the original pressure sensor tubing and the proximal cuff, if I didn't use it the machine would beep and blow like crazy. I just don't use the original tube because it has a plastic stench in it and it feels filmsy, the cowboy method to dry the tube would damage it. It is supposed to be new but I just wanted to use the bare minimum of second hand equipment. Perhaps I should use it. I have don't have the enhanced model.


The clips are a bit small for the tube I'm using. I have the hose cover.
I wake up with dry mouth, maybe I should use the humidifier, but first I have to wash it thoroughly.
I'm going to take a break of a couple of days from the machine, to rest better and to let my sore nose bridge heal. (The quattro signature)

[Banned]

1- With or without cpap or asv, I rarely go to the bathroom when sleeping.

Just trying to assess if you could use number of trips to the bathroom at night as a 'marker' in your therapy. Fewer trips may mean you are closer to the correct settings. Guess we can't use bathroom trips as an indicator.

2- One night I had a nightmare, I don't remember if had other dreams.

Just trying to assess how much REM sleep you are acheiving. Generally, the more you dream the more REM sleep you are getting. Nightmares probably count as REM sleep.

3-I'm using the tubing that came with a respironics machine, which is thicker.

Your hose sounds fine, so to speak.

Any reason for this?

Max PS is the top pressure limit to mitigate a central event. Your Adapt SV will clip Max PS at 20cmH2O regardless, as I believe 20cmH2O is the highest pressure your device can achieve. Max PS 10cmH2O (default) is not a parameter that will need further adjustment. Set it and forget it.

EEP in your Adapt SV is equal to EPAP in other BiLevel devices. EPAP is set to mitigate obstrutive occurances.
Min PS in your Adapt SV is equal to IPAP in other BiLevel devices. IPAP can be set to mitigate hypopnea occurances.
The difference between Min PS and Max PS in your Adapt SV mitigates central apneas.

At your new EEP 9cmH2O setting, you will be trialing to see if you can clear any additional obstructions.