Any Adapt SV Data Experts?

[geoffc]

Hey everyone, I'm curious is anyone has suggestions on dealing with Hypopneas? The Adapt SV Completely takes care of my Centrals, and in my 3 sleep studies, I only had 1 obstructive all night long on each. My AHI was 117 during my initial study. The Adapt SV's settings are a minimum of 7 with a boost of 6. Here is my data from last night, it's pretty similar to the other days that I have detailed data for. I've been on therapy for about 3 weeks now.



Thoughts?

Thanks,

Geoff

[unadog]

Your upper pressure is already pretty high. Are you tolerating that OK, without too many leaks? I had to pull my upper pressure in to control leaks. With CPAP, higher pressure can actually cause centrals.

My EPAP is 8.4 My IPAP min is 11.4 (PS min = 3.0) My IPAP max is 17.4 (PS max is 9.0) On good nights, I will have 3 hypopneas for the whole night. Maybe 70% of the time.

Under standard titration guidelines, I would advise you to raise the IPAP. This is from another site:


"set the EPAP at the pressure at which the complete obstructions (ie: apneas) were eliminated. ...... Set the IPAP pressure at the same setting...... THEN.....raise the IPAP....it must be at least 2 cm H2O above the EPAP (or in effect you just have a CPAP). Continue to raise the IPAP until you have eliminated the PARTIAL obstructions......such as hypopneas, snoring etc.....SaO2 desats, and arousals. If there are complete obstructions later......because of sleep stage or body position change etc.......increase the EPAP....as needed......."


Because your upper IPAP is already so high, I would recommend raising the EPAP slightly instead. I would only change 1 thing at a time, but you might also try lowering the upper IPAP. It might be causing arousals that are causing the hypopneas. I might try lowering that first? Under the "Advanced" settings.

Good luck!
Michael

[geoffc]

Thanks Micheal,

I do see it looks like the I'm having hypopneas at the time the machine is at max pressure, I'm trying lowering the max support from 15 to 14.

I don't think I having major leaks, and comparing the leak graph above to some that I have seen, the data appears to agree.

I'll give it a few days and see if I have a different results.

Geoff

[unadog]

I don't want to encourage you to get too wild with changes. But I didn't have doctor support when I started on the ASV. Needed it, but the path to get insurance company to pay was too long.

I was titrated on CPAP at 12.0 and retitrated at 13.0. My machine averages between 12.4 (Resmed) and 12.8 (Respironics) for IPAP.

Did you have a titration on the ASV? Were you on CPAP or BiPaP before that? Any titration there?

I had my BiPap Auto set around the same as my ASV. Don't remember all of my history, but my Respironcs ASV is set at EPAP=8.0, and IPAP of 11.0 to 15.0. Your PS min of 6.0 is a bit high, that could also cause more arousals, the larger base diff in temp. But go first by what yor doc told you. Good luck!

Michael

[dsm]

Your upper pressure is already pretty high. Are you tolerating that OK, without too many leaks? I had to pull my upper pressure in to control leaks. With CPAP, higher pressure can actually cause centrals.

My EPAP is 8.4 My IPAP min is 11.4 (PS min = 3.0) My IPAP max is 17.4 (PS max is 9.0) On good nights, I will have 3 hypopneas for the whole night. Maybe 70% of the time.

Under standard titration guidelines, I would advise you to raise the IPAP. This is from another site:


"set the EPAP at the pressure at which the complete obstructions (ie: apneas) were eliminated. ...... Set the IPAP pressure at the same setting...... THEN.....raise the IPAP....it must be at least 2 cm H2O above the EPAP (or in effect you just have a CPAP). Continue to raise the IPAP until you have eliminated the PARTIAL obstructions......such as hypopneas, snoring etc.....SaO2 desats, and arousals. If there are complete obstructions later......because of sleep stage or body position change etc.......increase the EPAP....as needed......."


Because your upper IPAP is already so high, I would recommend raising the EPAP slightly instead. I would only change 1 thing at a time, but you might also try lowering the upper IPAP. It might be causing arousals that are causing the hypopneas. I might try lowering that first? Under the "Advanced" settings.

Good luck!
Michael

Michael,

Good line of thinking, but I think the description you posted was for a Bipap Auto SV & not a Vpap Adapt SV. In the past the 2 of them differed in titration protocol. The Vpap Adapt SV doesn't (or doesn't on my model) allow ipap to be set less than 3 CMs above EEP (epap). That 3 CMs is the defaul PS (pressure support) setting. However the Bipap Auto SV allows any gap to be set (in increments of 1 CMs ).

Cheers

DSM

[geoffc]

Hey ,

My prescription on the Resmed Adapt SV just said EPAP 6 IPAP +7 or (6/13). There was no Max pressure on the RX, it is set at machine default of +15 (or 6+15=21)

I Did a titration on a Bi-pap and my AHI went from 117 (No machine, 1 OA, the balance were Centrals & Hypopneas) to 87 (Again all centrals and Hypopneas) it was determined to be ineffective. Then I did a titration on the Adapt SV, and my AHI was down to 20 with 0 OA and 0 centrals, but still hypopneas. I was told they would review the data in 30 days (My appointment is actually at 45 days), they believed the hypopneas would go away as I got used to the machine and they weren't playing with the pressures all night long. I don't want to wait 45 days, I'm at about 25 days, and I'm making my own adjustments.

I just got the software and cable working in the last few days, so I see my AHI has been in the 18-22 and my AI has been 0.

After I posted yesterday and lowered the max pressure from +15 to +14, I checked the data this morning and my AHI was down to 8.1 w/ AI still at 0. So I'm reducing the max pressure to +13 for tonight and see how the night progresses.

Thanks,

Geoff

[dsm (guested)]

Hey ,

My prescription on the Resmed Adapt SV just said EPR 6 IPR +7 or (6/13). There was no Max pressure on the RX, it is set at machine default of +15 (or 6+15=21)

I Did a titration on a Bi-pap and my AHI went from 117 (No machine, 1 OA, the balance were Centrals & Hypopneas) to 87 (Again all centrals and Hypopneas) it was determined to be ineffective. Then I did a titration on the Adapt SV, and my AHI was down to 20 with 0 OA and 0 centrals, but still hypopneas. I was told they would review the data in 30 days, they believed the hypopneas would go away as I got used to the machine and they weren't playing with the pressures all night long.

I just got the software and cable working in the last few days, so I see my AHI has been in the 18-22 and my AI has been 0.

After I posted yesterday and lowered the max pressure from +15 to +14, I checked the data this morning and my AHI was down to 8.1 w/ AI still at 0. So I'm reducing the max pressure to +13 for tonight and see how the night progresses.

Thanks,

Geoff

Geoff,

Sounds like you have a line of adjustment that is working well. The implication from your results is that the SV pressures are lifting the HI numbers.

Good luck with that line of experimenting.

Cheers

DSM

[unadog]

After I posted yesterday and lowered the max pressure from +15 to +14, I checked the data this morning and my AHI was down to 8.1 w/ AI still at 0. So I'm reducing the max pressure to +13 for tonight and see how the night progresses.

That is good news! Congratulations!

I don't know how you are feeling, but hopefully getting the HI's down will get you that final bit of rest so that you can heal!

It is good, too, that you are "tweaking" numbers that they didn't set for you. Less likely to create a conflict. Good luck! Let us know tomorrow how it goes.

DSM, FWIW, you are right, the PS min on my VPAP Adapt SV Enhanced is also 3.0 I copied that text more for the "logic" of what each setting treats - EPAP and IPAP - for Geoff. Cheers!

Best,
Michael

[dsm (guested)]

After I posted yesterday and lowered the max pressure from +15 to +14, I checked the data this morning and my AHI was down to 8.1 w/ AI still at 0. So I'm reducing the max pressure to +13 for tonight and see how the night progresses.

That is good news! Congratulations!

I don't know how you are feeling, but hopefully getting the HI's down will get you that final bit of rest so that you can heal!

It is good, too, that you are "tweaking" numbers that they didn't set for you. Less likely to create a conflict. Good luck! Let us know tomorrow how it goes.

DSM, FWIW, you are right, the PS min on my VPAP Adapt SV Enhanced is also 3.0 I copied that text more for the "logic" of what each setting treats - EPAP and IPAP - for Geoff. Cheers!

Best,
Michael

Michael,

Yup - if his adjustments are producing the right results all explanations are helpful

Cheers

DSM