been on new PR ASV machne a week ahi going up

I have been on my new CPAP machine for xxx days now. My AHI has been going up instead of down. ). I started June 1.
1.61, 1.62, 1.97, 0.91, 2.53, 2.26, 4.74.
Overall the numbers are not bad, I am not overly concerned, but I am finding it odd. On the RESMED I was running 0.0 to 0.2 on about the same pressure settings .( resmed was eap of 4 with a ps of 3-8)

I know that the numbers are not really bad, but I am wondering if I need some adjustments. I got the respronics machine because it can do both asv and BIPAP. y wife has a BIPAP machine and we have no backups. If something goes wrong with here machine, I will give her my machine, and I will go back to my resmed.
My insurance company has changed how they buy the machine, you have to rent it for 3 months and show compliance, then they buy it. After I have proven compliance I will probably go back to my resmed, and let this machine be the backup that is on the shelf. But during that time I might as well try and see if I can make any adjustments to improve things
When I first started ASV Pugsy recommend the RESMED because it was more aggressive. It looks like she made a good recommendation.
Here is a screen print of sleepy head data. Me events have always been in clusters, and usually got worse between 5-7 AM.

I am not feeling as rested the past few days and have been more fatigued during the day. I am also still fighting trapped gas, so I am not sure which is worse, tired or gas and the cramping and pain that goes with it.




Since I am not hitting my max pressure, I think that the only real adjustment I can make would be to raise the minimum (either eap or mn PS) ON the RESMED the min PS was set to 3, but that was was low as it would go (it is several years old.)

Thanks again for all of the support over the years.

wilsonintexas wrote: I got the respronics machine because it can do both asv and BIPAP. y wife has a BIPAP machine and we have no backups. If something goes wrong with here machine, I will give her my machine, and I will go back to my resmed.

hmm, I can't find any indication in the manual of this feature *scratching head*

I got similar ugly looking reports when I changed from my S9 Adapt to the PR S1 960.
What I found was that the PR S1 machine's way of going about its job (remember different algorithm) at the same settings as I was using on the Adapt wasn't getting the job done.
Where I could use 6.6 minimum EPAP on the Adapt I needed 10.0 minimum EPAP on the 960 to corral the OAs and snores and stuff.
I think its kinder, gentler, slower approach to things just needs a better head start...hence the higher minimum EPAP.
Think of it as an apap machine and the minimum pressure needs to be set high enough to give the machine a better head start on holding the airway open.

It took me a while to get the reports to looking better but they still don't look as "clean" as with the Adapt but I am sleeping great and feeling decent or as decent as I can with some new joint pains that I can't seem to get under control.

I suspect that if you want to clean things up a little you are going to need a little more minimum EPAP but it may not be a critical issue as long as you are sleeping good and feeling good during the day. My AHI was in the 8 to 10 range when I first started on the 960 and now I am doing good to get it in the 2 to 3 range where with the Adapt it was rarely over 1.0. I did have to increase the EPAP from 6.6 to 10.0 to get the AHI down to between 2 to 3 though.
Funny thing though...even when the AHI was 8 ish I felt and slept great. Came as a total surprise that the AHI was so ugly...go figure that one.

palerider wrote:hmm, I can't find any indication in the manual of this feature *scratching head*

My 960 only has the ASV mode but it would be real easy to dumb it down to work like a fixed bilevel or auto bilevel machine or even cpap or apap settings.
I don't think there are 2 separate modes of operation though so I don't know where he got the idea about plain bipap unless he was thinking of dumbing down the settings.
Unless Respironics have changed the 960 models which I haven't heard about.

Thanks for the pointers. I will try increasing the minimum pressure a little.

On the bipap autobipap feature. One time I saw a table with the different modes for the various machines, and from what I remember (which may be faulty) was that the PR could do cpap, auto cpap, bipap, autobipap and ASV.

I know on the RESMED, there is a mode and you can select cpap or ASV (forget the actual option) but it can not do bipap.

The title of the PR 60 is BIPAP AUTO ASV. I think to get the carious modes you adjust a few of the parameters:

from the manual:
• Max pressure - This screen displays the current Maximum pressure setting. You can adjust the setting from 4 to 25 cm H2O in 0.5 increments.
• EPAPEPAP - This screen allows you to modify the Minimum EPAP setting. The setting specified here will be the minimum level of pressure applied during the expiratory breath phase. You may adjust the setting from 4 cm H2O to the Maximum pressure setting.
• EPAP max - This screen allows you to modify the Maximum EPAP setting. The setting you specify here will be the maximum level of pressure applied during the expiratory breath phase. You may adjust the setting from the Minimum EPAP setting to the Maximum pressure setting. •

PS min - This screen allows you to modify the Minimum Pressure Support setting. This setting is the minimum difference that is permitted between IPAP and EPAP. You may adjust the setting from 0 cm H2O to difference between the maximum pressure setting minus the maximum EPAP setting.
• PS max - This screen allows you to modify the Maximum Pressure Support setting. The maximum pressure support is the maximum difference that is permitted between IPAP and EPAP. You may adjust the setting from PS min to the difference between the maximum pressure setting minus the minimum EPAP setting.

• BPM - This screen allows you to modify the Breaths Per Minute setting. You can choose between Off, Auto, or 4 through 30 in 1 BPM increments. Note: This setting only displays if PS max is greater than zero.

• Ti - This screen allows you to modify the Inspiratory Time setting. You may adjust the setting from 0.5 to 3.0 seconds in 0.1 increments. This setting only displays if PS max is greater than zero and BPM is not set to Off or Auto.

• Flex type - This screen displays the comfort mode setting. You can select None or Bi-Flex.
• Bi-Flex - You can modify the Flex setting (1, 2 or 3) on this screen if you enabled Bi-Flex. The Bi-Flex comfort feature allows you to adjust the level of air pressure relief that the patient feels when exhaling during therapy. The setting of “1” provides a small amount of pressure relief, with higher numbers providing additional relief.


I think that if you put bpm to off, you take out the asv mode and are you get auto bipap.

If you put eap min and eap max to the same (say 6) and you put ps min and ps max to the same number (say 12) you are fixed bipap. with 6 and 12.


if you set ps min to zero and ps max to zero o but you leave eap min at 4 and eap max to 12, you get a auto cpap machine

If you put eap min and ea max to the same, with ps min and max at 0, you get straight cpap.

That is the best I can figure out for now. Not sure it is right.

I will increase the minimm eap a little and see how the trapped air goes. I suspect that the trapped air in the morning is from the IAP and not the lower eap.

Thanks for the and support.

Pugsy I agree with you this seems to be a softer algorithm than the RESMED. On the RESMED is quick to switch to the IAP. I could feel the kick from the IAP with every breath as I was falling asleep. With the PR, I have to feel the mask (I have a cloth elan) to see if the machine is on. The PR lets the breath linger a lot longer before it kicks up the IAP.

I know on the night reported here, I felt really bad in the morning and remember waking up a few times and looking at the clock.

lately I have been waking up around 3:30 or 4:00 and again about 6:30 and having problems going back to sleep. The other day, I went ahead and got up and it was only 5:00 AM. When my ZEO was working, I remember that I use to wake up about 6-8 times a night, until I adjusted to the ASV on the resmed. After a few months, I was doen to 0 awakes most nights. I know it is back up there, but my zeo module gave up the ghost.

so, I am continuing to ramber, I will adjust the minimum pressure a little. I have to give the machine 3 months anyhow to show compliance and get the insurance company to buy it. After they buy it, I may go back to the RESMED and let this oRESMEDthe backup machine for both of us. I hate to be using the only machine that is a backup machine for my wfe's bipap.

I do think that there is a little less trapped gas with the PR than the RESMED. But it is still a problem. Last night I woke up about 3:30 with a bad cramp and it took a few belches to let the gas out. I also think that the trapped gass is irritating my IBS. It has kicked in the past week, after being quiet for a while. But with the IBS you are never sure what it kicks off. I had to make an emergency stop while shopping today, and am back on some IBS pills, that I keep with me.

Next year, I will get layed off from work since I will have been on disability for 2 years. I will loose insurance, and end up one of the medicare plans. Maybe on the new plan, I will be able to get a RESMED ASV for myself and this can be my wife's backup bipap machine.

Anyhow still rambeling, sorry,
)
(I have to stop, this post took an hour, and there are still a lot of typos.... Avoid brain surgery if you can, or more likely, try not to get a brain tumor to begin with.

wilsonintexas wrote: One time I saw a table with the different modes for the various machines, and from what I remember (which may be faulty) was that the PR could do cpap, auto cpap, bipap, autobipap and ASV. '

the only machine that would do that is a laboratory machine. like one of the ones I have.

wilsonintexas wrote:I know on the RESMED, there is a mode and you can select cpap or ASV (forget the actual option) but it can not do bipap.

The title of the PR 60 is BIPAP AUTO ASV.

"BIPAP" just means "bi-level". it's a sales term by respironics.

VPAP means bi-level, it's a sales term by resmed.

you can't get "BIPAP" on a resmed, because you have VPAP.

There are some Respironics machines that will do all the various modes but the 960 isn't one of them.
Those machines are used in places like a sleep lab.

But as you already have figured out the 960 can be dumbed down with some tweaking of the various settings available so that it will function like a regular bilevel machine.

Thanks for the additional info. I am still learning. I wish I cold find the chart that led me to believe t could do the various modes. But even if I do the machine is what it is.


So let me try one more time, can you tell me where I am wrong.
I am also ignoring max pressure which also kicks into the calculation)

For straight CPAP, EAP min and max set the same. PS mn and max to 0, BPM off.

Auto CPAP EAP min at x, EAP Max at Y PS min and max at 0, BPM off

straight bipap (eap min and max at 6, PS min and max at 4 would give you straight bipap at 6 and 10. BPM off)

auto bipap (eap min 4 eap max 10 PS min 4 PS max 6, would give you auto bipap with eap from 4-10 and iap from 8 to 16)

Then with the BPM set to a fixed number added in at any of the above settings you would have that mode with ST.

And if you put BPM to auto, you would have an ASV mode.

I am NOT trying to be a smart a#$% with this post, I really want to understand this. If I have it wrong, I want to learn.

It could also be that some of the terms are specific to a company, and the result is the same......

Thanks. I do want to learn.

wilsonintexas wrote: auto bipap (eap min 4 eap max 10 PS min 4 PS max 6, would give you auto bipap with eap from 4-10 and iap from 8 to 16)

Then with the BPM set to a fixed number added in at any of the above settings you would have that mode with ST.

And if you put BPM to auto, you would have an ASV mode.

your idea starts to fall apart when you give it a ps range, because the asv is programmed differently than an auto bipap, or a bipap st.

the asv responds to the amount breathing effort you're making, auto and st do not. you can't change that behavior.

you also misunderstand the BPM, because that's a minimum amount of time before it forces a breath, in auto mode, it varies, but the ASV part is the varying PS as your breath by breath needs change, not the backup rate. (bpm)

so, in order on the above, no, that'll be a VERY limited ASV, still asv, and still asv.

Thanks... Beginning to understand.

I appreciate that you are taking the time to help me understand it.

When I have some time I will play with my 960 and see what I can come up with that would make it work like a bilevel fixed and auto machine and cpap/apap mode machine.
Remind me next week as I sort of have a full plate right now and my mind is having a hard time picturing your setting ideas and I do better when I actually play with the machine.
I am pretty sure that we can dumb it down so that it is close enough to what you are wanting that it will work.

Thanks for being willing to look into it, but it was more of a discussion on trying to understand what was possible.

I only need the machine in one of 2 modes, ASV (for me) and fixed bipap for my wife. They are pretty easy to set up. I wanted to try my wife on auto bipap, but she is happy with the fixed bipap and does not want to play with it. Her AHI is well controlled, and she is sleeping well, so I will let it be.

As for myself, I raised my minimum eap to 5 last night. My ahi is down to 2.5, but the problem with trapped gas is worse this morning. I am going to have to use some gas-x as well as nausea meds to make it through the morning. A little disappointing. So far 15 burps and counting, make that 16..... 17...... 18...... miserable morning.

I increased the min eap to 5. For 2 nights my ahi improved, and I was sleeping better, but the gas in the mronign was worse. Last night was a bad one for me, I did not sleep well. Tis morning, I was not surprised to find that the AHI was 13 for the nght, peaking to 45 during clusters. There is also an increase in both centrals and CRS.

NOt sure that his machine is right for me...

The max pressure is set to 10, but it never gets up there.

Here is the whole night.




Here is one set of clusters. I notice that even when the machine levels out on the IAP (5:14) , the events continue. I am not sure why the machie is not making adjustments, it can still go up on both the eap and IAP. But it is not doing it. My leaks are low, so it is not that.








Any recommendations on what next? I can increase the max pressure and min ps, but I know that the gas will get worse. I am not sure why the machne is not increasing the pressrues after say 5:14 when there are still events.




One of the DMEs said that of 4 of these machines she had gotten, 3 people had returned them. I am beginning to understand why. I am disappointed.

Since the insrance is renting it for the frst 3 months, I should be able to switch it out without to much trouble. I will give it at least another week and see if we can get it working better.

In general I am much more tired the past few weeks than I was before. But to be honest, some of that is because I have forgotten to take my morning meds a few times, which includes a nuvigil.... but the fact that I forget to take it is an indication that I am not doing as well.

Hi Wilson,

First I would suggest that you put ASV somewhere in the title, so you can catch the attention of experienced ASV users. As for your datas, the first thing I noticed is your odd pressures settings for this type of machine (particularly the IPAP max and the low PS max)... My understanding is that your new machine is a PR S1 Bilevel AutoSV that replaced a old Resmed VPAP Adapt. Was your EPAP on your old Resmed Adapt fixed (at 4) or variable ( 4 to x)? If it was fixe here what the pressures settings should be on the AutoSV to match (pressure wise anyway) your Resmed Adapt (with fixe EPAP):

AutoSV pressures settings to try (supposing your previous EPAP was fixe at 4)
Max pressure (or IPAP max): 12 (that would permit your PS to go up to his max of 8 ) ( I will use IPAP max for this setting in my post)
EPAP min: 4
EPAP max: 4
PS min: 3
PS max: 8

Also note that the algorithm to adjust pressures during the night are not exacly the same on the AutoSV and the Adapt and you might need some tweaking. Also there is no "confort" setting on the Adapt (like EPR) but on the AutoSV you have to chose between Bi-Flex or Rise time and for each of those 2 choices you have sub-setting. In your case you seems to be able to sleep tru the night with the machine so I would not play with those 2 "confort" setting for now. Also the BPM setting on AutoSV should be at Auto, since on the Adapt it's auto by default (no setting to change it).

From the screenshoots in your last post your setting seems to be EPAP min 5 to ???, PS min 1, PS max 6 and IPAP max 10. First, your PS max of 6 seems low to me (and lower than your previous setting of 8 on your Adapt) and your IPAP of 10 juste doesn't let the AutoSV go to that PS max of 6 because even at a EPAP min of 5 (EPAP min 5 + PS max 6 = 11) the max PS you can get is 5... Now, if your EPAP go higher during the night (i.e. EPAP max > 5) you can guest that's even worst (max PS even lower). PS is important to treat the central apnea and periodic breathing.

I would start with the setting I suggest for a few days and tweak from there, but remember that when you change EPAP max and/or PS max you have to change IPAP max accordingly on the AutoSV (in most case IPAP max should be equal or greater than EPAP max + PS max).

Also, if you have problem falling asleep (like you fight the machine to breath) you can start your PS min at 1 and work your way up to 3 slowly on several days to get used to it (no change to the others pressures settings). I have both machine and I have very hard time falling asleep on the AutoSV with PS min > 1 but no problem at all with PS at 4 on the adapt.

This is "my" understanding to what "might" be your problem but I'm not an expert and certainly not a doctor, so use your own judgment.

just hope it will help you

PS sorry for my spelling, my first language is french...

Thank you for the reply.

I edited the title to add ASV into it as you suggested.

In the current pressure settings:

The setings are the following:

MAX Pressure 10
Min EAP 5
Max EAP 5
PS Min 1
PX max 6


The machine is adjusting the eap a little over the night, and adjusts the IAP but the most it goes up to is 9.

I have a lot of problems with aerophagia, and I was trying to lower the pressures to improve things. Originally I had the Max PS to 12. When I lowered it to 10, the machine automatically adjusted the max ps to 9.


on the RESMED the last settings were:
eap of 4 woith a PS of 3-9.

It is strange, because before I got the new machine, I tried lower pressures on the RESMED S9 ASV, and even with a fixed pressure of 4.

Here is a shot of the setting history.

The first noght of the new PR system on March 31 was good, my ahi was 0. snce then it has been rising.

My centrals and CSS has also been increasing, with little change in the pressure. I chopped of the headers, sorry. The 4th column is theAHI.



By the way, your spelling is just fine, I am having more problems than you are.