Need ASV support for High Pressure

[Phatsalmon]

At the suggestion of others I have added this post. I am new to BiPAP ASV. my pressure is 28. I have developed centrals at this pressure. I need some advice from fellow 25 and greater BiPAP ASV users. Questions are many.

1 How long did it take to be able to sleep with such pressures?
2 How do you keep the mask from leaking and making squeaking noises? Now my wife cannot sleep because of the noises coming from the mask.
3 What did you do about your ears being sore?
4 What did you do about your cheeks blowing up?

I am just a bit tired during the day. I will die first from this treatment before the OSD. The simple fix is to take a nap for goodness sakes! It just does not make sense to me to torture one self to treat a condition that will never be cured with such drastic misery. I feel that I just need to deal with the condition and get on with life.

Sorry for the venting of frustration.

[Pugsy]

There is more to your settings than pressure of 28. Could you please get all the different settings that will be on the machine? The ASV users will need them to explain things to you.

You may want to investigate mask liners. JohnBFisher says they help him a lot and he uses extremely high pressures..
ASV users can offer ideas on which ones to try.

Do you have copies of your sleep studies? If not, would be a good idea to get them so you can fully understand your problem. A good nap is NOT the solution.

Do you have the clinician manual for your machine? It explains how to get to the settings area to see all the settings.

[ameriken]

Like pugsy said, there are different pressures, such as minimum pressure support, maximum pressure support, minimum EPAP and maximum EPAP. What are all your settings? And can you post a night or two of your reports?

As for the leaks, I've tried the mask liner with no luck. I starting with lanolin last night with moderately good results in controlling the leaks. It seems like when the mask is brand new, it works great, but as the days and weeks go by, it becomes more prone to leaks. You've got to be careful with what you use to clean the mask, no petroleum products, no bleach, no vinegar, just warm water with mild soap. My DME recommended the Clorox bleach free wipes which I've started using. But try the mask liner first, you can find it on www padacheek com . Most folks have good luck with them.

Anyhow, post your settings and a couple of reports and I think you'll get some better input. I share your frustration, these are great machines but it takes a while to figure them out as well as getting all the right settings.

[Pugsy]

OP may not have the software yet to get his reports.
SleepyHead will work
http://sourceforge.net/projects/sleepyhead/

For the PR S1 ASV machine one needs Encore Pro 2.5... 2.4 won't work.

I do not have a source for the PR S1 ASV machine clinical manual though. It is not yet listed on the apneaboard.com usual source for clinical manuals. Anyone have one they could send to OP?

[JohnBFisher]

First, welcome to the forum. Sorry you need to be in the ASV club. But hopefully we can help.

Second, with those high pressures, I find that a full face mask is the only option ... at least for me. I currently use the Resmed Quattro FX full face mask.

Third, at those higher pressures I find a mask liner makes the mask much easier go use. It helps to quiet the leaks that occur and even seems go reduce the leaking. You can find mask liners at padacheek.com, remzzzs.com and quietusliners.com. Essentially, the mask liner acts as a gasket between the mask and your face.

Fourth, it helps to change the mask cushion more frequently than you would with a CPAP or BiPAP unit. Do it as frequently as your insurance and/or Medicare allows. The frequent pressure changes seems to make the mask cushions get stiffer than with CPAP or BiPAP units.

Anyway, I hope those tricks help.

[Mr Bill]

Welcome to the forums. If you normally sleep with your mouth closed get the smallest nasal mask that will fit. My experience is that the smaller nasal mask seals better at any given pressure. Your brain will soon figure out how to block your cheeks from being inflated. You're in luck having an ASV. It will only apply that top pressure if it actually needs to to open your airway. As you start getting some proper sleep, you may find that the pressures fall because your brain, finally getting proper oxygen, will begin to sus out the proper reflexes to make this all work. I was without sleep for long enough that I was having difficulty swallowing. That all came back and now I can even drink water while on my machine. How great is that! Don't worry too much, you are on the road to better quality of life.

[Phatsalmon]

Thanks all for the resposes. I am brand new to this. I do not have any idea what pressures the machine is set at. I do not know how to get the data. I do have a copy of all six studies. No centrals till they turned the pressure uo. I work for Philips. I probably can get the manuals in a day or so. What is this going to do for me. The pressure is too high. My ears are going to explode if I keep this up. My ears are sore from the ear down my jaw line.

Thanks again but there has got to be other options.

[Pugsy]

The pressure is too high. My ears are going to explode if I keep this up. My ears are sore from the ear down my jaw line.

Please contact your physician about the ear situation tomorrow first thing. This amount of pain is not normal. Let him earn is money. We can suppose all night long but you really need to bring all this to your doctor's attention pronto.
Members here can explain pressures and offer ideas on how to help you adjust but ear pain is beyond what we can comfortably advise on. We have no way to see inside your ears via the internet.

[ozze_dollar]

Wow 28??? My top pressure is only 15 and I find that unsettling on the rare occasions it happens.

[JohnBFisher]

Believe it or not, you can adjust to the higher pressure. However, you may need to have them drop the top pressure until you adjust to it. Then you can increase the pressure.

I have one machine (a Resmed) goes to a maximum pressure of 25. The other machine that I have (a Respironics) can go to a maximum pressure of 30. I know that both reach that pressure - both my checking the data and with my wife. My wife notes that she can tell those days I am having problems with the patient triggered breathing. She says that when it sounds as if I've tethered the shop vac to my face, then it's a sign I am having more than my normal set of problems!

You've got to keep sense of humor about this. It helps make it all a bit more acceptable.

So, do chat with your doctor about the high pressure. Though you will adjust, there is no need for extreme discomfort at the start. As you adjust (over the next year or so), you might increase the pressure back to the higher setting. Or you might find that you can just not tolerate those higher pressures.

[LittleRedTruck]

Im on a Resmed S9 ASV since July 20 th. My setting can ramp me up to 29. The first several weeks, I was fully aware of these high pressure bursts. But now, I dont seem to notice them any more. I feel a few pressure bumps as im falling asleep, but once im sleeping Im good for 8 hours ! Im having awesome results with Swift Fx pillows, they do hold the high pressures without leaking, if adjusted properly. This morning my leak rate on the machine was 8 L, sleep 8.2 hours and Ahi 0.0. You can do this as well. Suck it up, work with your Dr and ask alot of questions on here. Best wishes and welcome to learning how to manage your health. Dan

[jamiswolf]

Phatsalmon,
Like others have said, your machine should only reach those high pressures when triggering a breath during a central apnea. You should be sound asleep when that occurs. If your machine is constantly at 28, then I think something is wrong. Take the machine to your DME and have them check the pressures...that's where I'd start. And ask them to write down all those pressures for you too.
Jamis