VPAP Adapt prescription for BiPAP Auto SV machine

[choich]

Hi All,

I had my sleep study with a VPAP Adapt. For monetary reasons I wound up with a used Auto/SV that was supposed to have been pre-programmed. I spend 15-30 minutes a night fighting the machine before I fall asleep. I sleep about 5 hours then wake up, start fighting the machine again and don't get back to sleep. I didn't have anywhere near this amount of trouble at the lab and am wondering if the prescription was mis-translated from Resmed to Respironics...

[cflame1]

not that I'd know your answer... but to start this off for the experts that'll come later...

What was your original script for? And what's your current machine set to?

[ozze_dollar]

I have a S9 VPAP Adapt and I can remember when I first started using it I used to fight a bit at the start of the night. Now I am much more used to it(or it is used to me) it doesnt happen any more. Lots of things just get better with time.

[JohnBFisher]

Post the prescription. We can help you check your current machine to be certain that it is correctly set. However, we would *highly* recommend (insist in fact) that you talk with your doctor before changing the settings. As others say, it sometimes takes a while before you are accustomed to the unit. Shoot, since I stop breathing when I fall asleep, I often have the increased pressure awaken me as I fall asleep. It takes time to become accustomed to using the unit.

[choich]

Here's what I came up with

VPAP prescription: EEP +5, min 3, max 10, backup 15

Auto/SV settings: EPAP 5.0, IPAP min 3.0, IPAP max 10.0, BPM 15, 1.2 superscript S or Ti (not sure what this is), Start 4.0

I was thinking of turning the Start down to 3...

[jamiswolf]

Hi Choich,
Ti is the inspiration time. The maximum length of inspiration before the machine will kick down to epap. Long Ti times rarely cause difficulties but if it's set too short, it can feel like your inhalations are cut short. Yours is set at 1.2 seconds? I personally run my ST Ti setting to 3 seconds.

And similarly, your BPM rate of 15 seems too high and can cause the machine to insert a machine triggered breath too early. Check out Kody's report here...

viewtopic.php?f=1&t=73260&p=673251#p673251

His BPM rate is set on auto which allows the machine to automatically set BPM rate to a setting 2BPM lower then the bodies natural rate. I would guess that your PTB is fairly low reflecting that the machine is kicking in breathing for you more often then it should. I would either set your BPM rate to auto or to a lower manual setting.

Do you have the software or are you planning on getting it? Does your machine have a Smartcard?


Also, double check on the pressure settings. None can be below 4.
Jamis

[choich]

Jamis,

You're right IPAP min is 5.0. I have a smart card, do not have software yet. I set the BPM to Auto and no longer get Ti as an option.

Choich

[Pugsy]

Please check your private message box.

[choich]

You guys (and gals) are awesome! Thanks for all the help. I'll let you know how it goes.

[jamiswolf]

JohnFisher wrote: Post the prescription. We can help you check your current machine to be certain that it is correctly set. However, we would *highly* recommend (insist in fact) that you talk with your doctor before changing the settings

John, Choich is a VA patient who has been diagnosed but bought the ASV because he was suffering and couldn't wait for the VA system to respond (which could be months). As I understand it, his issues are the machine fighting his breathing. I think it would be reasonable to help him get the machine set up so he can sleep with it. No changes to the basic pressure setting should be needed. Your experience and knowledge would be helpful.
Jamis

[JohnBFisher]

JohnFisher wrote: Post the prescription. We can help you check your current machine to be certain that it is correctly set. However, we would *highly* recommend (insist in fact) that you talk with your doctor before changing the settings

John, Choich is a VA patient who has been diagnosed but bought the ASV because he was suffering and couldn't wait for the VA system to respond (which could be months). As I understand it, his issues are the machine fighting his breathing. I think it would be reasonable to help him get the machine set up so he can sleep with it. No changes to the basic pressure setting should be needed. Your experience and knowledge would be helpful.
Jamis

Thanks for the clarification. In this instance, I will definitely be happy to help. ... More in the next post.

[JohnBFisher]

... Ti is the inspiration time. The maximum length of inspiration before the machine will kick down to epap. Long Ti times rarely cause difficulties but if it's set too short, it can feel like your inhalations are cut short. Yours is set at 1.2 seconds? I personally run my ST Ti setting to 3 seconds. ...

JamisWolf hit the nail on the head here. I do not think that the Ti is actually needed. I just checked the manual. If you set the BPM (Breath Rate) to Auto, the Ti is automatically determined.

... similarly, your BPM rate of 15 seems too high and can cause the machine to insert a machine triggered breath too early. ...

The Respironics unit uses very sophisticated algorithms to help determine when you should breathe. It encourages normal respiration if at all possible. By setting the backup rate, rather than using "AUTO" you disable much of this algorithm. As JamisWolf noted, while sleeping, most people only breathe 12 times per minute. Setting this value to 15 would cause you to fight with the machine.

... His BPM rate is set on auto which allows the machine to automatically set BPM rate to a setting 2BPM lower then the bodies natural rate. I would guess that your PTB is fairly low reflecting that the machine is kicking in breathing for you more often then it should. I would either set your BPM rate to auto or to a lower manual setting. ...

I would suggest using AUTO rather than any manual setting. I had a longish discussion with my neurologist about this (discussing the difference between Resmed and Respironics ASV units) and he noted the AUTO setting was the most effective for most people.

Choich, do you know how to change the settings? I saw that a PM was sent. If you do not, let us know. We will be happy to help. So, I would suggest changing the Respironics ASV settings to Auto/SV settings: EPAP 5.0, IPAP min 3.0, IPAP max 10.0, BPM AUTO, Start 4.0

Hope that helps.

[jamiswolf]

Choich,
Keep in mind that my reference to Ti setting and BPM for my own machine refers to a BiPap ST which is a simpler machine...a basic BiPap unit with a timed back-up rate. I did use an asv for a short while but felt my relatively mild apnea didn't need such sophistication. So I sold it and have come to regret that decision.
J

[choich]

Slept good last night with BPM on auto. Didn't fight the machine at all. All other settings the same.

[teknomom]

So glad you had a good night. I use the Auto setting and feel the machine does a great job of matching my pattern.