Optimising Vpap Adapt SV therapy using my ResScan data

Hi folks - a big thank you to all who have helped me so far - directly and indirectly - on my journey to wellness with CPAP, APAP and finally VPAP.

I now have my very own shiny new Resmed VPAP Adapt SV, ResScan software ("acquired" for free) and null modem serial cable (that I did not buy from Resmed =))

I am much improved, but still have variable AHI results from night to night, between 1.8 and 10.0 - and am still somewhat symptomatic. I simply want to be well (as much as possible) after nearly 20 years of untreated OSA (which is now CompSA) and over 1 year of patchy therapy and much heartache.

I am faithfully downloading all available data every 5 days but not getting around to learning how to analyse it and tweak my therapy. Before you ask, I am almost entirely without sleep dr or dme support, and I have come to value the advice of fellow patients who usually seem to know more about this therapy than the professionals do. At a pinch, I could email some data to my sleep dr and ask for advice - but if any of you can help advance my knowledge in the meantime, that would be really great.

Would you like to see a night's worth of data in a .pdf? How do I upload it?

Can you please point me to some information so I can read about how to understand the data?

Thanking you in advance. ((grateful expression))

BlueSky72,

Good for you re the machine & software etc: - always a good move.

I am happy to look at any data you have but 1st want to comment that your machine has very few parameters to adjust.

In very basic terms, you can vary the EEP (exhale pressure) and can vary the PS (Pressure Support) which sets the minimum gap between exhale & inhale pressures.

The main reason you might want to vary EEP is if your OSA component (assuming you have one) is being adequately treated. Varying EEP can interact with other facets of your therapy. Only vary EEP if you are confident you can see what effect it is having & can revert back.

I would offer a similar caution on PS as that gap is usually chosen carefully in the titration phase - so again only change it if you are confident you can measure the effects & can quickly revert for comparison. The PS gap can impact things like inducing Centrals vs clearing Centrals & they are 2 opposites that can come from varying it.

But, cautions aside, do you know how to take a screen grab ? - I am happy to host any grabs for you if you don't have a website you can do so for yourself. Also if you extract an PDF reports an happy to host them for you too plus am willing to add any observations as long as you understand that I am a complete amateur (but none the less willing to point out what I see).

Can post here what your current EEP & PS settings are ?

Cheers DSM

Thanks DSM, I'll do a screen grab when I'm next able to - probably about 12 hours from now.

Interesting you mention titration - I have not had a VPAP titration because there is no suitable clinic in my city and I'd have to fly to another city, and then pay the full cost of the study myself. As the parameters are fairly limited, as you note, I felt it was better to put the money into buying the machine. My sleep dr set the parameters based on previous studies and data from CPAP and APAP.

I'm also interested in what other variables I can influence - eg better managing congestion and asthma... and even obvious things like how often i need to do a learn circuit, any new ways to minimise leak etc.

One thing I know from my data is that I am hyperventilating at times - well over 30 bpm, sometimes, 40! We will work through the data as we go.

My settings are 10 + 3 + 12 (that's how I like to understand and express them - I think it's EEP 10, Min PS 3, Max PS 15?)

Many thanks again DSM and others. You are worth your weight in gold!

Bluesky72

The hyperventilation is something that needs addressing. Lets see how we can help you there.

Re the learn circuit. That is a very easy to do exercise & only needs to be done once for a new mask.
You just connect the mask. Put it on the bed open side upwards (no obstructions to the airflow) and
run the test.

The machine sends out increasing levels of pressure in quick steps. Takes about 1 min or so. What it
appears to be doing is using the proximal sensing line (the small 2nd tube that goes to the mask) to
sample the changes in the steps to determine that the flow is acceptable to its algorithms.

I have run tests where I reset the machine & didn't run the learn circuit & while the pressure behaved
oddly for a night or two, eventually it adjusted itself by itself until all was normal. What this told
me is that the learn circuit test is just a very quick way to adapt to the mask. Also I believe the
learn circuit really seeks to pick out masks it can't work with (which might never come right if
used).

But, hopefully re the hyperventilation, we here can help you with a strategy / approach to deal with it.
The settings on a machine can be the culprit.

DSM

Some thoughts (amateur) on the hyperventilation.

Apart from trying to figure out what is driving it (i.e. reaction to difficulties in breathing deeply ?) I would 1st
be looking at your tidal flow during esp in the fast breathing spells. If that is within normal range then the rate
may not be such a big issue (I have some early Bilevel charts where I was at 40+ BPM).

The congestion & asthma are a concern.

DSM

Some more thoughts. Has your doctor put you through any kind of heart checkup ?.
If yes are you able to comment on any issues in that area ? If no has it been
discussed ?

Tks

DSM

#2

Just an idea that should not cause any other complications - lower EEP to 9.4 and see if that has any noticeable effect on your rate.

Cheers

DSM

Thanks DSM. I wanted to rule out whether repeating the learn circuit test would help - good to know it's not a factor.

My sleep dr said that the 'cardiotoxic' effects of untreated sleep apnea were unlikely to be a feature in my case - from memory i think because i'm only 35, technically obese but not severely obese (BMI about 40), have no cardiac family history, and only mildly elevated BP easily controlled with one drug, and no cardiac symptoms at all (or signs in the PSG). I am of course open to having tests such as an echo if it's warranted. That's why I asked him about it, but he seemed unconcerned at that time.

I strive to manage the congestion and asthma as best I can with medication, heated humidification, and lifestyle changes (eg staying out of the cold). They seem to worsen with xPAP, and interfere with xPAP at the same time =(

Can't access my data where I am right now but will provide it later today. Thanks again for your thoughts.