New to this- Husband vpap III 5 days but not taking breaths

[dsm]

Banned,

I agree

Certainly worth a try

DSM

[Casiesea]

Hi guys! Me again!

Hubby not doing well again. I need to know how to "break in" to his machine to see whats up. He is on Respironics Vipap auto sv. His settings appear to be: max ipap 14, min ipap 6, epap 6

[Casiesea]

Whoops, sent that too quick...

He was doing great on this machine until a few weeks ago. I have noticed he is having long periods of apnea again (with machine on). How is that possible.

I talked to his dr...(#1 i believe we called her) a few months ago. I was telling her how he seems to do well for a while but then somehow his body adjusts to the machines and things go haywire. Well, I guess we are back to haywire again.

[dsm]

Hi guys! Me again!

Hubby not doing well again. I need to know how to "break in" to his machine to see whats up. He is on Respironics Vipap auto sv. His settings appear to be: max ipap 14, min ipap 6, epap 6

Casiesea,

Pls confirm the below settings & mode his machine is set for.
Am assuming Auto SV mode with ...
Epap = 6
MinIpap = 6
MaxIpap = 10

If correct I feel I can see lots of reasons why I think hubby will have problems esp at his weight.

The Epap = 6 = IpapMin, sets the machine to CPAP mode with Servo support. This is to me an odd way to set the machine for what I believe is hubby's situation. Epap *needs* to be ale to address his OSA *all the time* (which you are saying it doesn't).

The concern is that hubby does have OSA & an Epap of 6 is very very low & you are saying that he goes through periods of not responding to the machine (apneas). That seems a given if Epap=6. My best guess (again I am not any sort of respiratory professional, just a user) is that he needs 9-11 Epap (& MinIpap) & MaxIpap at least at 16 (at least). This being based on his weight & knowing he has OSA events.

The Servo support is a sep issue but from the feedback, that part seems to be ok as long as his OSA isn't kicking in. I sure would love to read the respiratory specialist's rationale for the low epap, esp as applicable to a large overweight man with proven OSA.


Are you able to get the nightly data off the machine ? - that would help greatly.

Good luck

DSM




max ipap 14, min ipap 6, epap 6

[Casiesea]

Hi guys! Me again!

Hubby not doing well again. I need to know how to "break in" to his machine to see whats up. He is on Respironics Vipap auto sv. His settings appear to be: max ipap 14, min ipap 6, epap 6

Casiesea,

Pls confirm the below settings & mode his machine is set for.
Am assuming Auto SV mode with ...
Epap = 6
MinIpap = 6
MaxIpap = 10

If correct I feel I can see lots of reasons why I think hubby will have problems esp at his weight.

The Epap = 6 = IpapMin, sets the machine to CPAP mode with Servo support. This is to me an odd way to set the machine for what I believe is hubby's situation. Epap *needs* to be bale to address his OSA *all the time* (which you are saying it doesn't).

The concern is that hubby does have OSA & an Epap of 6 is very very low & you are saying that he goes through periods of not responding to the machine (apneas). That seems a given if Epap=6. My best guess (again I am not any sort of respiratory professional, just a user) is that he needs 9-11 Epap (& MinIpap) & MaxIpap at least at 16 (at least). This being based on his weight & knowing he has OSA events.

The Servo support is a sep issue but from the feedback, that part seems to be ok as long as his OSA isn't kicking in. I sure would love to read the respiratory specialist's rationale for the low epap, esp as applicable to a large overweight man with proved OSA.


Are you able to get the nightly data off the machine ? - that would help greatly.

Good luck

DSM




max ipap 14, min ipap 6, epap 6

I got those numbers off the bottom of the screen. I am not sure how to get into the clinicians menu on this machine. Can u give me any clues?

[dsm]

PM on way to discuss.

Cheers DSM

[Casiesea]

PM on way to discuss.

Cheers DSM

EPAP 6.0
iPAP MIN 6.0
IPAP MAX 14
AUTO BPM
RISE TIME 2
RAMP 0:15
START 4.0
APNEA 40s
MIN VENT 0.0

[ozij]

Casi, Please keep the discussion public so we can all learn --
O.

[Casiesea]

I don't have the card reader or software. Do you have to buy the card reader from respironics or could I get it at Radio Shack?

[dsm]

I don't have the card reader or software. Do you have to buy the card reader from respironics or could I get it at Radio Shack?

Casi

There are inexpensive suppliers (not Radio Shack). I have bought one in quite a while & the supplier I got mine from stopped selling them anyway. Hopefully a more recent Resp user will tell us of a good low cost source that includes the driver.

Cheers

DSM

[Casiesea]

Does apnea 40s mean that he would have to have a 40 second period of apnea b4 the machine kicks in and makes him take a breath?

[Casiesea]

Is this the reader I need: Mako Infineer DT3500 USB card reader?

[dsm]

Is this the reader I need: Mako Infineer DT3500 USB card reader?

Casisea,

I believe that is it. It does require a special driver to be installed with it for it to work with Encore Pro (which I believe you have).

I'll dig out the info - someone was just talking about it in another thread a day or so ago.

DSM

#2
This thread ...
viewtopic.php?f=1&t=43359&p=384314&hili ... ng#p384314

& This ...
viewtopic.php?f=1&t=43672&p=387729&hilit=Mako#p387729

(make sure you don't buy a 'serial' interface model, get the USB interface model. )

[dsm]

Does apnea 40s mean that he would have to have a 40 second period of apnea b4 the machine kicks in and makes him take a breath?

Casiesea,

Not sure in what context this 40s is ?. Where did you read it ?

To look at your question, 'machine kicks in and makes him take a breath' would mean the machine 'triggering' which in plain English means it switches from epap to ipap pressures to force a breath BUT, your provider has set your husbands machine up in cpap mode so there is some question as to if and when the Bipap Autp SV will do this.

But because the Bipap Auto SV is a 'dynamic' machine, it does have an ability to do the 'triggering' in an unusual way.

Lets go through it step by step.

1) Hubby's machine is set in Cpap mode (epap = ipapMin = 6) but it also has a setting of IpapMax = 10. Also Breathing Rate is = AUTO.
2) Hubby stops breathing (easy to do if epap is as low as 6)
3) No point in switching to IpapMin to get him to breathe as epap & IpapMin both = the same pressure
4) BUT, machine sees airflow slowdown & SV kicks in which in that breath lifts Ipap by approx 3 CMs instantaneously.
5) Hubby may or may not respond to the ipap boost (breathe in), but either way machine then 'cycles' (goes from Ipap to epap) a) because hubby breathed again or b) because the AUTO RR timing did it
6) Assume no breath occurred above, machine begins another breathing pattern, detects no flow & adds another approx 1 CMs to Ipap & cycles again

At this point we are around the preset IpapMax limit of 10 CMs so no further SV support will be added but the machine (I believe) will continue triggering & cycling between 6 CMs (Epap & IpapMin) & 10 CMs (IpapMax) until breathing resumes.

This is NOT a very good way to deal with apneas as all the literature on Biap Auto SV (& all other BiLevels) says the epap pressure MUST be set to clear OSA events whereas it appears your hubby's machine may be trying to use SV to blow a path through his airway to clear any apneas. The way this machine is set up, it will only ever apply an epap/ipap gap of 4 which is optimal for a good bilevel (with a decent epap) & unlikely to do any harm but also is probably not enough to reopen his airway based on the understanding that he is very overweight.

The Bipap AutoSV SV algorithm is designed for normalizing irregular patterns of breathing, not clearing collapsed airways due to apneas.

There are a number of assumptions in the above scenario ...
I am assuming the stopping breathing is OSA (the data from the machine would help determine this).
I am assuming your husband is still (well ?) over 200 lbs in weight
I am assuming there were no other complications detected & documented during the visits to the RTs
I am assuming that my analysis of the Bipap AutoSV behavior is correct (and I am pretty sure it is)

I get back to questioning why Epap / IpapMin is set sooo low ?.

Good luck


DSM

#2 Tidied up some of the numbered comments (what a complex area this is !!!)

[Casiesea]

I read the apnea 40s in the clinicians menu. I believe it was right after the auto setting.

His leak was 42l/m this morning so we obviously have issues there again.

He is approx 6 ft and weighs about 215.

So I need to buy the card reader and the driver? and the encore software? Is this something insurance will pick up (probably not)?

Put a call into his sleep doc today but she is out of town thru friday. I really don't like the lady we deal with at the dme but I guess she is our only option if we want anything to change this week.

I can't tell you how much I appreciate your help dsm!

Is this machine better for him than the vpap he was on?

Where is Banned?