Newbe with Complex Apnea

[racprops]

Ok here we go:

Got all the goodies together yesterday and got is set up by the Doc. Today.

I also did little dry run with it watching a movie to get used to it a little and to learn how to turn it on and off. All seemed fine then.

I have just spent the last 45 minutes on it for my first try at going to sleep. The ramp setting is nice…but did not fall asleep.

Run into a small problem, my mouth when dry even with the Humidifier turned on full.

Is that normal??

Also mask seems to hurt my face a little..I hope I can get used to it.

Rich

[racprops]

WOW first sleep under ASV, got to sleep for a couple of hours, back in my old bed.

AS I feared I am spoiled to my recliner.

Woke up to all kinds of pains, chest, right leg, right foot, left arm and lower back. Mouth not dry this time.

Taking a couple of pain pills and moving back out into the living room and setting up to sleep with the AVS machine in my recliner.

Hope to get good night's sleep there.

Rich

[Julie]

I haven't read your whole thread, so don't know what mask you're using (fill in your profile please), but if your mouth is dry and you have a nasal mask, you're probably losing all the cpap air that way and not being treated. You may need a full face mask.

[racprops]

Sorry I just tried and the system does not correctly show or list my stuff:

I am using:

Machine: Respironics DS950HS BiPap ASV
Mask Type: Full face mask
Mask Make & Model: Respironics FitLife FFM (Full Face Mask)
Humidifier: Respironics
CPAP Pressure: 4 to 10 ramp up then 10/20
CPAP Software: SleepyHead and EncoreBasic

So mouth, nose and eyes are covered and pressurized.

Dry mouth was a problem most of the night, I get hay fever so fear using a chin strap in case my nose should plug up.

Otherwise I was able to keep system on all most all night..I did fall asleep for about a hour once before I put the mask on again.

I was resting and getting my mouth wet and checking my Blood Pressure and fell asleep...

I will now try to read the SC Card.

Rich

[racprops]

OK I have my first report:

Still trying to fully understand all of this:

I had a reading of:

AHI 18.92

Break down:

Hyponea 3.78

Obstrutive 1.06

Clear Airway 15.08

RERA & Flow Limit 0

VSnore 2.73

PB/CSR 7.52

I take it the machine treated all of these.

It reports 6.36 hours of sleep (I fell asleep once so lost a hour or so)
My charts are on and off all night as I kept waking to wet mouth. (and the visit bathroom)

I take it a fair beginning??


Rich

[racprops]

Well I think I will have to override the Docs settings…

Using the ramp feature I am fine. In fact I have already reset it for a higher start pressure.

But once it reaches the Doctor’s prescribed 10cm full pressure I have many problems…first at times I seem to have trouble breathing, specially exhaling, I think the 10 cm is too high for me. I noted that I had a lot of clear air apneas the first night and as I have centrals DUE to CPAP, think the too high pressure is causing them.

Second at 10cm my mask keeps pulsing and leaking and waking me.

The ramp up feather is great and I can see how each pressure affects me.

At around 8cm I start having breathing problems, so I am thinking I will go with 7cm.

Last night was not as good as the first, I have some coughing and had to take the mask off a few times, and around 1.30 I fell asleep without it and lost a couple of hours without help.

Feedback?


Rich

[JohnBFisher]

Unlike CPAP or BiPAP the pressure you face with an ASV unit is NOT steady. Even and Auto CPAP or Auto BiPAP which change pressure to the need of the patient (in an effort to eliminate obstructive apneas that the unit observes), the ASV therapy changes the pressure fairly dramatically over a very short period of time. This will cause ANY mask to leak. As a result, I tend to recommend the use of mask liners to help (a) reduce the number of large leaks and (b) reduce the sound of the leak. You can get mask liners at:

http://www.remzzzs.com/
http://quietusliners.com/
http://padacheek.com/PAC_Maskliners.html

I use the first and have used the third. I can recommend both. I have not used the second, but have no reason to believe that it does not work well. And I only change the RemZzzs mask liner on a weekly basis (or more frequently if my skin is very oily). This helps reduce cost of these disposable mask liners.

By the way, you might find that over time you can tolerate a higher pressure than you can now. But I would do what you are doing .. hunt for something that works now .. and get to a good stable point where you get good sleep. Your body will thank you for the chance to rest.

Hope that helps.

[racprops]

That is a funny thing about the ASV BiPAP machine.

They still want to set a low pressure, in this case 10CM, and then the machine is surpost to intervene only when I fail the take a breath.

For that they set a max. high of 20cm.

Then there is the starting ramp pressure and how long it takes to reach full baseline pressure and there is a BiFlex setting 1,2 and three.

And there is a breath ramp up feature but it is not on due to using the BiFlex feature.

There is a setting for a auto start where I only have to put the mask on and start breathing..and it will turn on.

Last is a setting for Breaths Per Minute from Off, AUTO (perfired) or to 4 thought 30 BPM in 1 BPM settings.

All in ALL a rather simple system to set up...NOT as complex as the Doctor Made OUT!!!

Rich

[Pugsy]

I take it the machine treated all of these.

Nope...what you see flagged on the reports are whatever has slipped past the defenses. You don't want to see much on the AHI...

Now it might have learned a bit trying to fight those events but anytime you see AHI and the event categories for those different components....that means that those flagged events happened and the machine was NOT able to prevent them from happening.

The events that the machine treats...you never see them flagged because they are prevented. That's the main goal...prevention and not playing catch up after the fact.

Mouth breathing with a full face mask is going to dry out the mouth sometimes even with the humidifier maxed out.
The humidifier simply can't manage to rehydrate the oral cavity optimally sometimes because it is just larger and if pressures are higher more air moves so between the pressures and the mouth breathing itself...the mouth dries out.

It doesn't take a lot of mouth breathing to dry out the mouth either. Biotene makes some products designed to add moisture to the mouth. Normally found in the mouthwash aisle of most stores or pharmacies.

If you had a lot of awakenings with the dry mouth and comfort...your machine may be flagging some of the awake time by mistake. I wouldn't worry about the numbers so much right now till you get more comfortable in general.
Sleep where you can sleep the best and try to get the mouth so that dryness doesn't wake you up.
Also if leaks caused you to wake up often...again greater chance for the machine to maybe flag some awake events.

ASV users simply take sometimes a lot more time getting used to their machine than the rest of us.
Work on getting decent uninterrupted sleep first..or at least with minimal disruptions then your AHI numbers will better reflect what is going on during sleep. Right now with a bunch of awakenings known we don't know how much of that AHI was real or just awake stuff getting flagged by mistake.

I will let JohnBFisher other ASV users handle machine settings questions in general. They know a whole lot more than I do about those various settings and what does each setting do to what on the reports. Not something I am very good at.

[racprops]

Thanks.

I tried contacting JohnBFisher but was stopped. Can you PM them and ask them to drop by and help me?

Rich

[Pugsy]

Did you get stopped by the Private Message Captcha thingy? Those are a PITA for sure but eventually they go away.

John will stop by here again when he has time. He always follows threads like this. He just doesn't spend a lot of time online.
Also there are others here that can help too.

[racprops]

Yes BUT I also found I could search for him and sent a PM.

Rich

[JohnBFisher]

Rich, I will take a closer look at your settings. From what I had quickly glanced, you seem to be headed on the right path. But a general caution about ASV therapy... it can take several months to fully adjust to the therapy. But more on that after I take a closer look at what you posted.

[racprops]

Thanks.

Rich

[racprops]

One correction, the tech said she was setting the machine for 10/20 but when I went in I found it was 10/15.

Rich