No Answers Yet For Problems With ASV

[avi123]

U.S. version of the dead space issue:


http://www.ncbi.nlm.nih.gov/pmc/article ... .6.539.pdf

That is not "the" dead space issue, that is "a" dead space issue.

And to be more specific, it is not "this" dead space issue.

OK, you are talking about the Dynamic Dead Space. If so do you change it just by the reorientation of the gaseous air flow?

Excellent.

I think we've found Curly.

Yes we did:

http://www.ncbi.nlm.nih.gov/pubmed/12973177

But, how could it help Nanny ?

From the link above: CONCLUSION: Facial-MEP with its exhalation port within the mask and the smallest mask volume demonstrated less rebreathed CO2 and a lower PDR than either the Facial-WS or Total Face masks. Additional studies are necessary to confirm if mask design can clinically affect patient's inspiratory effort during noninvasive positive pressure ventilation.

This leads to Quattro FX for low rebreathed CO2.

Resmed Mirage Soft Gell, nasal, has a small volume but vent goles are not in the mask area.

[Banned]

I think we've found Curly.

I resemble that remark..

And we don't need no Mo'.

Sleepy Dave is Mo

Banned

[StillAnotherGuest]

I think we've found Curly.

I resemble that remark..

And we don't need no Mo'.

Sleepy Dave is Mo

Banned

I think Larry needs some ginkgo.

[StillAnotherGuess]

I think Larry needs some ginkgo.

You must be an original. Are you the one who gets RG's panties all knotted up in a bunch?

[dsm]

To StillAnotherGuess,
I won't quote your post above as it is too far over the top. I seriously hope you rethink/reword it.

This thread has been very informative over the past few days & reading NotMuffys helpful advice
to Paper_Nanny has been a 1st rate learning opportunity. Rested Gal (despite any other issues)
is seriously trying to keep the thread on track and her supporting links are spot on.

Please rework your post & consider the extent you are reasonably adding value by what you say.
It is very hard to see your added value at the moment.

DSM

[Paper_Nanny]

My Sleep Doc asked me, the other day, if I get up b/c I really need to urinate or b/c awakening from a sleep event? I replied that I am not sure.

You could put a urinary catheter in for a few nights. Just self cath at night, take it out in the morning, and put it in again the next night. Do that for a few nights and you could rule out waking from the need to urinate.

Every new Doc that I see adds an Rx or two.

They can only add what you allow them to add, Avi. Every doctor I see has something to say about the medications I am on. Now when they talk about it, I imagine myself somewhere inside, fingers stuffed in my ears, humming loud yet intensely comforting tunes to myself. I can tell when they are done with their commentary on my medication regimine because they make the "I am now done with my commentary on your medication regime" face. I think they learn that expression in the third year of med school.

There are a couple of my doctors who I listen when they do their commentary. But mostly I go in and tell them what to do and act like the scheduled appointment is too short and my time too valuable to listen to their uninformed input into my situation.

Deborah

[Paper_Nanny]

Oh right, there it is.

I should have searched instead of watching "Matrix Reloaded".

J/K, Neo-phytes! Calm down already!

I don't understand. What does that mean?

There are 2 characteristics of masks that may have ramifications in xPAP breathing physiology.

• The volume of the mask. This can be individually calculated with a box of salt. This volume becomes a part of your respiratory physiology and needs to be accounted for as "Dead Space". Dead Space is air that is rebreathed and does not participate in ventilation. It is high in CO2.

Why is the calculation for Dead Space not (Total Mask Space) - (Filled Space) = Dead Space?

[note to self: dead space can be calculated that way using water. it is important to plug the nose if using water in this way because water will flow into an unplugged nose. if that nose was recently broken, this flow of water can cause severe pain. this self speaks from experience.]

That FitLife TFM looks like it has a huge Vd and inefficient purge characteristics.

First my little yellow yums, now My Private Sleep Bubble?? Could it be everything I love and care about is a potential suspect??

Do you still have a Quattro floating around?

Ja, sitting right next to me, laughing.

Another worthwhile investigation might be to see is the PTB stays consistent (at 100%) when using a mask with a smaller Vd.

Option One: Mirage Quattro
WeeWah. It leaks so much. It has a less Dead Space than the TFM.

Option Two: Unnamed Nose Mask
The velcro on the chin strap gets tangled up in my dreadlocks. It's a comfortable mask for a few days at a time. It has very little Dead Space.

Option Three: Reduce the dead space in My Private Sleep Bubble aka That FitLife TFM with something.

Is that actually a viable option? With what would I fill it? Would that even work??

My New and Improved Reduced Dead Space Sleep Bubble... I am picturing me wearing swim goggles, sleeping peacefully inside That FitLife TFM, which has been filled with Trix, Cocoa Puffs, dog kibbles, or maybe gum balls.

Perhaps machine sensitivity is affected.

By the increased amount of Dead Space?

Deborah

[Paper_Nanny]

NotMuffy-- When I get my PFT done on Tuesday, are there results that can be given to me at that time which would of use to you? I know whoever is doing the testing will not be able to interpret the results, but shall I try to get some raw data?

Deborah

[NotMuffy]

...When I get my PFT done on Tuesday, are there results that can be given to me at that time which would of use to you?

They're all useful. Given your smoking history, even the flows could be askew. But try to grab the MIP - MEP.

In re: mask characteristics, the Dead Space Theory requires a number of variables, and while there are still a couple of unknown knowns, the easiest thing to do is simply try the Quattro and see what happens.

[NotMuffy]

Oh right, there it is.

I should have searched instead of watching "Matrix Reloaded".

J/K, Neo-phytes! Calm down already!

I don't understand. What does that mean?

Neo is the central character in the Matrix Trilogy. The Matrix Fanatics believe that an opportunity to partake in any Matrix-based event would supercede any other activity.

[avi123]

Given your smoking history, even the flows could be askew

Some long time smokers develop COPD, and an ASV machine is bad for them.


See this warning from Resmed:


At its core, the Adapt SV is a highly evolved bilevel device. The IPAP is variable and responds rapidly within 2 or 3 breaths to significant changes in patient tidal volume. When patient tidal volume increases, the device IPAP decreases. When patient tidal volume decreases, the device IPAP increases. Thus the marked fluctuations in patient tidal volume that characterize complex sleep apnea are attenuated and usually the tidal volume is stabilized by the device.

A longer-term correction is effected by the trailing 3-minute memory of minute ventilation and pattern of breathing. After a 3-minute initial collection period, the Adapt SV then sets a minute-ventilation target that is 90% of the previous minute volume. Hence there is a weak downward force on total minute-ventilation that nudges the PCO2 upward 2 or 3 millimeters of mercury, decreasing or eliminating the frequent CO2 dips below the apnea threshold that drives the central events. Because of this 90% target, the manufacturer cautions that the device should not be used in patients who have a condition that might result in hypoventilation (severe COPD, neuromuscular disorders, etcetera). At least theoretically, the downward force on minute ventilation could worsen hypercapnia in this patient group and perhaps even precipitate respiratory failure. We have not seen this potential complication, even though several patients we have studied have had PaCO2 values at, or a little above, the upper limit of normal.

Stephen Brown, MD,
Medical Director, Memorial Care,
Sleep Disorders Centers, Long Beach, CA
Associate Clinical Professor of Medicine,
University of California, Irvine, CA

Source:

http://www.sleepdt.com/adaptive-servo-v ... hen-brown/

[NotMuffy]

See this warning from Resmed:

What warning is that?

[rested gal]

Long time smokers develop COPD

All the long time smokers?

"Almost 90% of COPD is caused by long-term cigarette smoking, yet only 25% of chronic tobacco smokers will go on to develop COPD."
http://www.sciencedaily.com/releases/20 ... 223425.htm

"While only about 20% of smokers and a very small percentage of non-smokers get COPD, approximately 80% of those who are diagnosed are either current or former smokers."
http://copd.about.com/od/fa1/a/asthmaorcopd.htm

I'm not saying smoking isn't bad. It can contribute to many health problems and early deaths.

But your flat statement (which would include all long time smokers) is not accurate, avi.

[NotMuffy]

"Almost 90% of COPD is caused by long-term cigarette smoking, yet only 25% of chronic tobacco smokers will go on to develop COPD."
http://www.sciencedaily.com/releases/20 ... 223425.htm

Nor is it known how much PN had smoked before she quit (if it was only a couple cigarettes per day for a few years, then it's NBD).

Or, if she does have a touch of COPD but it's mild (no CO2 retention), then she is not automatically excluded per ResMed Algorithm Rules.

[avi123]

"Almost 90% of COPD is caused by long-term cigarette smoking, yet only 25% of chronic tobacco smokers will go on to develop COPD."
http://www.sciencedaily.com/releases/20 ... 223425.htm

Nor is it known how much PN had smoked before she quit (if it was only a couple cigarettes per day for a few years, then it's NBD).

Or, if she does have a touch of COPD but it's mild (no CO2 retention), then she is not automatically excluded per ResMed Algorithm Rules.

Question:

Why don't you ask if Nanny was tested for COPD? A simple Spirometry test and X-Ray could indicate?