Using a Bipap Auto SV and using a Vpap Adapt SV

dsm · Post by **dsm** » Thu Jul 03, 2008 2:31 pm

This post is to SWS & RG & is my thoughts on what might make my therapy just a little different.

We have had some long hammered out debates over just what might be there - SWS & RG have said PB & Centrals & I say the evidence from PSGs and the machine itself doesn't (IMHO) back up that argument.

I have always said I believe that chronic nasal congestion is one aspect but this morning while out for my morning run, the other obvious & forgotten aspect came back into my consciousness.

Yesterday Snoredog posted an excellent item on GERD and what it does in particular cases - I am on GERD meds & last night decided I needed to adress what seemed like a stronger than usual feeling in my stomach so took a swig of gaviscon plus one of my gerd tabs before bed & last nights data from the machine is about as good as one might hope for from a night's cpap.

(SnoreDog's post - see in this thread viewtopic/t32564/Is-Aerophagiasp-dangerous.html )

Last nights SV data - see item 43 -
http://www.internetage.com/cpapdata/dsm-bipap-autosv/

The total AI count for the whole night was zero Hypops & 4 AIs which should score as 0.5 AHI. The night before was a rough night & I put that down to a GERD attack.

So, I am betting that the only complications I am dealing with on a regular basis is chronic nasal congestion & marginal GERD management & I am of the opinion that if I manage the GERD just a bit better, the nasal congestion may also ease.

DSM

PS SWS & RG, I believe that the debates we have do help greatly in cementing understandings & thoughts as to what any of us are really experiencing.

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, AHI

dsm · Post by **dsm** » Fri Jul 04, 2008 3:43 pm

Again

Last night I took my GERD tablet before dinner (I usually take it 1st thing in the morning) plus a small swig of Gaviscon & again the BipapSV data is quite different from prior typical patterns

The number of times it went to IpapMAX was much lower that what has been typical. This was despite a lot of leaks last night (changed straps on the mask).

The AHI as scored was 1 hypop at the start of sleep & a mere total of 2 AI events for the entire night. In reality something like AHI of 0.25 (ignoring the sleep onset hypop).

So what I am seeing here is a significant change in the data patterns by taking GERD medication at night rather than in the morning.

Also nose was not congested last night & I used no nasal spray.

DSM

#2 compare last 2 nights data with the night before where I hadn't taken any GERD meds taht day at all. Very big difference in data.

http://www.internetage.com/cpapdata/dsm-bipap-autosv/
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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI

wlo2008 · Post by **wlo2008** » Tue Jul 08, 2008 3:01 pm

Hello,

I just got my Bipap Auto SV. It has been four days using it. My question is. I find that sometimes that the pressure almost goes to the max and it feels like it breaths for me. Why does it do that?

Then a minute or so later it goes back to normal. This wakes me up.

Another question. I have the providers manual. But I do not see any were to check what my AHI is. Is there a screen that will let me know. Or do I have to print my smart card info out to know what is going on.

I don't have the reader or the software yet to do that.

Thanks so much. This is all very new to me with this new machine. But I like it better then just the Cpap. That was making my centrals so much worse.

dsm · Post by **dsm** » Tue Jul 08, 2008 3:57 pm

[quote="wlo2008"]Hello,

I just got my Bipap Auto SV. It has been four days using it. My question is. I find that sometimes that the pressure almost goes to the max and it feels like it breaths for me. Why does it do that?

Then a minute or so later it goes back to normal. This wakes me up.

Another question. I have the providers manual. But I do not see any were to check what my AHI is. Is there a screen that will let me know. Or do I have to print my smart card info out to know what is going on.

I don't have the reader or the software yet to do that.

Thanks so much. This is all very new to me with this new machine. But I like it better then just the Cpap. That was making my centrals so much worse.

wlo2008 · Post by **wlo2008** » Tue Jul 08, 2008 4:01 pm

Here are my settings

Ipap max 14
Ipap Min 8
Epap 4
BPM 10
Ti 20

dsm · Post by **dsm** » Tue Jul 08, 2008 4:03 pm

Last night reverted back to the Vpap Adapt SV - since adjusting GERD meds, have been noticing a significant improvement in the data from both machines. (Bipap SV and Vpap SV).

Last night I was able to drop the PS back from 4.6 to 3.6 but left EEP at 10. This worked well and felt pretty comfortable and much easier to sleep with than most of the prior goes with it. I did have to tighten the mask straps during the night but still had a very restful sleep and this time did not feel that the sleep was 'restless' as had reported before.

(equiv to ...
Epap of 10 CMs
Ipap of 13.6 CMs )

Am seeing doctor today to discuss the GERD meds. Am now pretty sure that GERD & silent GERD effects are the main issues affecting my own therapy effectiveness.

Here is an extract from the Adapt SV that covers last night and compares with 4 prior nights. As mentioned - last night was fine & the machine was very nice to use.

http://www.internetage.com/cpapdata/dsm ... -jul08.pdf

The data shows one interesting aspect worth understanding & that is that the leaks shown were clearly adequately compensated when you look at the matching periods for pressure minute-ventilation & tidal-volume. That says to me that the machine handles leaks better than I had previously thought it did.

DSM

dsm · Post by **dsm** » Tue Jul 08, 2008 4:09 pm

wlo2008 wrote:Here are my settings

Ipap max 14
Ipap Min 8
Epap 4
BPM 10
Ti 20

Wendy,

That Epap is far to low. There is a 3 year old girl in Brazil on a higher Epap than that (she is on 5). She has Centrals but as a result of a medical condition.

I would expect you to be significantly disturbed by that Epap being so low. The Ipap Min is fine allowing for the low Epap. The Ipap Max again is fine allowing for the other settings.

The most important question in your case is why did they prescribe a Bipap SV ? -- that may explain the Epap at 4.

Do you have no OSA whatsoever ? - just Centrals ? - also those settings are unlikely to be for someone with periodic breathing issues so my guess is pure Central SDB.

DSM

wlo2008 · Post by **wlo2008** » Tue Jul 08, 2008 4:13 pm

I have mixed my AHI showed for OSA 116.4 and for total mixed with my centrals 190.

during my study even on the pap I was still having severe centrals. I have had them sense I was a kid. They are still trying to figure out what is causing them.

But the full diagnosed term was Severe Central and Obstructive diordered breathing.

dsm · Post by **dsm** » Tue Jul 08, 2008 4:20 pm

[quote="wlo2008"]I have mixed my AHI showed for OSA 116.4 and for total mixed with my centrals 190.

during my study even on the pap I was still having severe centrals. I have had them sense I was a kid. They are still trying to figure out what is causing them.

But the full diagnosed term was Severe Central and Obstructive diordered breathing.

wlo2008 · Post by **wlo2008** » Tue Jul 08, 2008 4:29 pm

I do have the full sleepy study. What info would u like from it?

dsm · Post by **dsm** » Tue Jul 08, 2008 4:30 pm

wlo2008 wrote:I do have the full sleepy study. What info would u like from it?

Do you have it in image form (PDF?). Are you able to email it ?

I can send you my email address via PM.

DSM

wlo2008 · Post by **wlo2008** » Tue Jul 08, 2008 4:31 pm

I don't it is all on paper.

dsm · Post by **dsm** » Tue Jul 08, 2008 4:39 pm

wlo2008 wrote:I don't it is all on paper.

Hmmm, thats a challenge

I am initially interested in any OSA data. AIs HIs AHI index but those numbers make best sense when co-related to data from the PSG
Other coresponding info such as tidal flow & breathing effort right at those times also helps qualify the HI AI data.

DSM

wlo2008 · Post by **wlo2008** » Tue Jul 08, 2008 4:55 pm

Here is what is on my report

My sleep Efficiency was 77%
Sleep onset latency was 7.4 Minutes
REM did not occur into the therapeutic portion of the study. The absence of REM sleep during the diagnositc portion of the stufy resulted in an underestimation of true indices usually reflected during a full night of diagnostic recodring

There were 149 sleep stage shifts, 61 stage 1 shifts and 40 awakenings. 17 indeterminate arousals occurred and the indeterminate arousla index was 3.7

I never entered stage 2 through REM. Once on the pap I had one REM that was 37 minutes long and then once on treatment I had 176. minutes in stage two and stage three 21 miuntes still no stage 4

My AI was 86.4
AHI 116.4
RDI 116.4

ALL the rest were centrals. But they were not able to tell how many in REM sense I never had REM that night. So they said it could have been much higher.

on my back it was 132.5
Non-Supine 64.8

179 Respiratory arousal and the index was 81.4

No periodic limb movements occured at all
lowest saturation was 88.0% and high was just over 95%

Arousal index was 84.1

Arousal index with treatment was 10.2 11 indeterminate arousals and 14 were respiratory realated arousals

Comments were that

This patient has relatively severe disease of Central and Obstuctive Sleep disordered breathing

Epworth sleepiness scale is 23

wlo2008 · Post by **wlo2008** » Tue Jul 08, 2008 5:01 pm

Oh I forgot that
there were 118 Obstuctive apneas 66 were Hypopneas

67 were Central 3 were mixed

With a total of 190 an hour

But the Centrals are seperate from the AHI for the OSA which was 116.4