New BIPAP AVAPS user, totally clueless!

[dogmum]

Hi! I recently (2 weeks ago) got a my first breathing machine and am hoping to meet some with greater knowledge that will help me use it with greater success.

The machine is a Dreamstation BIPAP AVAPS with the full face Dream Wear mask. I do ok with it when I'm awake, but every night am waking up, or rather being awakened by my husband to the machine sounding like a donkey's bray while pushing 25 cm of air instead of the usual 9-10 and no amount of fiddling will get it to stop.

My RT says this is caused by a leak, but we haven't been able to find one and are waiting for him to get back with us.

Can anyone's tell me what I'm doing wrong and maybe what a fix might be?

Many thanks!

[palerider]

Can anyone's tell me what I'm doing wrong and maybe what a fix might be?

Many thanks!

Well, there's no way to tell without more information.

Fill out your equipment profile so we know what kind of mask you've got, exactly what machine, etc.

If it's leaks making noise, which most people refer to as squealing sounds, then mask liners will make a huge difference, they were a game changer for me. Karen, over at padacheek.com makes the best ones, they're more expensive at first, but they last, unlike the cheaper throw away ones from other places, that end up costing more.

[raisedfist]

Can you please list your settings or upload an image of them.

If you are in S/T mode with AVAPS enabled, one possibility is that you have an inappropriately high tidal volume target programmed in, causing your IPAP pressure to increase to, and stay at, 25 cm h2o, because it's trying to maintain said target but can't.

It could also be that your IPAP min is too low. In theory with the AVAPS algorithm the IPAP will adjust automatically to maintain a target tidal volume, but in reality it doesn't always work out perfectly. AVAPS wasn't designed to make fast adjustments, since it's not a servo-ventilator, although you can indeed increase the AVAPS rate (instead of increase IPAP 1 cm h2o per minute, it can increase it by 5 if necessary, for example).

You will also need software to be able to read and analyze the data from your SD card. I doubt that machine is capable with SleepyHead - you probably need DirectView software from Respironics but that is made for clinicians and is not available on the web to my knowledge.

You should ask your RT to look at your data, but I imagine on the machine itself it will show you summary data from a night of therapy, including your leak levels which is a possible culprit like your RT said. I believe that machine reports total leak, meaning intended and unintended leak, so anything below 60 l/m leak level can be compensated for by the machine I believe.

Try using the machine while awake and turn AVAPS off. Crank the IPAP up to say 20 cm h2o, see what the leak levels are and also work on your mask fit, and then slowly work up to 25 cm h2o. 25 cm h2o is a lot but a properly fit mask can handle it without any gross disturbances in my experience.

[dogmum]

Fill out your equipment profile so we know what kind of mask you've got, exactly what machine, etc.

If it's leaks making noise....

Thanks for pointing me towards the profile. I've updated it now.

My mask doesn't seem to make noise, it's the machine itself.

[Barb (Seattle)]

.

[dogmum]

Can you please list your settings or upload an image of them.

If you are in S/T mode with AVAPS enabled, one possibility is that you have an inappropriately high tidal volume target programmed in, causing your IPAP pressure to increase to, and stay at, 25 cm h2o, because it's trying to maintain said target but can't.

It could also be that your IPAP min is too low. In theory with the AVAPS algorithm the IPAP will adjust automatically to maintain a target tidal volume, but in reality it doesn't always work out perfectly. AVAPS wasn't designed to make fast adjustments, since it's not a servo-ventilator, although you can indeed increase the AVAPS rate (instead of increase IPAP 1 cm h2o per minute, it can increase it by 5 if necessary, for example).

You will also need software to be able to read and analyze the data from your SD card. I doubt that machine is capable with SleepyHead - you probably need DirectView software from Respironics but that is made for clinicians and is not available on the web to my knowledge.

You should ask your RT to look at your data, but I imagine on the machine itself it will show you summary data from a night of therapy, including your leak levels which is a possible culprit like your RT said. I believe that machine reports total leak, meaning intended and unintended leak, so anything below 60 l/m leak level can be compensated for by the machine I believe.

Try using the machine while awake and turn AVAPS off. Crank the IPAP up to say 20 cm h2o, see what the leak levels are and also work on your mask fit, and then slowly work up to 25 cm h2o. 25 cm h2o is a lot but a properly fit mask can handle it without any gross disturbances in my experience.

I use the machine awake for a few hours each evening as I'm trying to get the hang of this. I've called my very nice RT a few times and he's not calling me back. He also disabled all menu options, so I can't see anything beyond how many hours I've used it over the last three nights and that the AVAPS setting is avtive. Is there a way to re-enable these menus so I can view this stuff?

Thanks

[dogmum]

what is AVAPS? I keep hearing terms that I have seen before, but this one is new

Someone else will know the specifics better than I do, but it's used as a non-invasive ventilator (NIV) to treat respiratory weakness in neuromuscular disease.

[Barb (Seattle)]

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[Barb (Seattle)]

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[dogmum]

Can you please list your settings or upload an image of them.
....

I use the machine awake for a few hours each evening as I'm trying to get the hang of this. I've called my very nice RT a few times and he's not calling me back. He also disabled all menu options, so I can't see anything beyond how many hours I've used it over the last three nights and that the AVAPS setting is avtive. Is there a way to re-enable these menus so I can view this stuff?

Thanks

if it works like my old DreamStation.....you push the ramp at the same time as the large button for a bit...then, the clinicians menu comes up.

Thanks... I'll try to get the settings that were mentioned above as helpful.

[BTS]

what is AVAPS? I keep hearing terms that I have seen before, but this one is new

https://www.resmed.com/us/en/healthcare ... 0-sta.html

[palerider]

He also disabled all menu options, so I can't see anything beyond how many hours I've used it over the last three nights and that the AVAPS setting is avtive. Is there a way to re-enable these menus so I can view this stuff?

Thanks

Try the link at the top of the page over on apneaboard.com, it has instructions on how to request the clinical manual with all the secret settings.

[palerider]

My mask doesn't seem to make noise, it's the machine itself.

If the machine is making loud noises, it's defective... it should be nearly silent... at most quiet air sound, and maybe a little faint whining.

[Holden4th]

For clinical settings try this

https://www.youtube.com/watch?v=DrNaoD783Po

[dogmum]

My mask doesn't seem to make noise, it's the machine itself.

If the machine is making loud noises, it's defective... it should be nearly silent... at most quiet air sound, and maybe a little faint whining.

This is what we were thinking. We've been up nearly every night trying to "calm the screaming baby" but even with holding the mask to my face and looking at it with the lights on, we can't figure out what the deal is to make it run so hard and make so much noise. My RT says there are "comfort settings" that can be adjusted, but I've called him twice now and haven't heard back about this.

This evening I'll spend some time with the link above and see if I can find these settings that will hopefully provide some insight. Thanks so much! I'm a little desperate as if I don't wear it enough, apparently insurance won't let me keep it.