Switched to ASV

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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KatieW
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Re: Switching to Bi Pap, any advice?

Post by KatieW » Sun Sep 01, 2019 9:36 am

Pugsy wrote:
Sun Sep 01, 2019 8:33 am
KatieW wrote:
Sun Sep 01, 2019 8:20 am
Yes, I had thought of this. But I was concerned that fixed 10 would not treat my apneas, since my average pressure for the week on apap was 12.7. I have no idea if I had apneas on a 10/5 in the hospital, and probably that was not their primary concern.
Using bilevel with a substantial IPAP with the aid of PS might be enough to do a better than you thought job at reducing the obstructive stuff.
When using apap you are using a single pressure and it takes a while to go anywhere.
With bilevel and IPAP happening with every breath...it might help more than we first think it would even if it is less than what we normally see on apap. Probably not ideal but given the situation here which is rather unique...I think it would be worth trying at least one night just so you see what it can or can't do.

Or just do auto mode with a small range and make the IPAP max 13.
Minimum EPAP 5 and PS of 5 to give you the 5/10 but it could go up to 8/13 if needed.

The DreamStation Auto BiPap is compatible with SleepyHead 1.0 (don't remember if you ever got that version or not) and of course OSCAR which is based on SleepyHead 1.1.
You can easily see how fixed bilevel happens to work or not. Worth trying IMHO.
I have Sleepyhead 9.2-2. Need to download some software, and see what's happening. Good to see you Pugsie!

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Re: Switching to Bi Pap, any advice?

Post by KatieW » Sun Sep 01, 2019 9:38 am

raisedfist wrote:
Sun Sep 01, 2019 8:31 am
KatieW wrote:
Sun Sep 01, 2019 8:20 am
raisedfist wrote:
Sun Sep 01, 2019 8:06 am
Considering there is fluid in your lungs, and 10/5 seemed to be helping you, why not just set the BiPAP to 10/5 in the fixed spontaneous mode for now? The EPAP keeps your airway open, and the IPAP helps with the work of breathing and augments your spontaneous ventilation. By supporting your breathing it gives your body more energy to more easily carry out its necessary functions like maintaining a proper fluid balance.
Yes, I had thought of this. But I was concerned that fixed 10 would not treat my apneas, since my average pressure for the week on apap was 12.7. I have no idea if I had apneas on a 10/5 in the hospital, and probably that was not their primary concern.

Thank you for your suggestion. And it will be the next thing I try.
You can download OSCAR sleep software and check your data after a night of sleep if you have an SD card reader. If you post your OSCAR charts here there are members here that can recommend what changes to make to the settings if any. Once there is a general idea of how things are, someone here can tell you how to set up the parameters in the auto mode.
Thank you, I will download software today.

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Re: Switching to Bi Pap, any advice?

Post by palerider » Sun Sep 01, 2019 1:53 pm

KatieW wrote:
Sun Sep 01, 2019 8:20 am
raisedfist wrote:
Sun Sep 01, 2019 8:06 am
Considering there is fluid in your lungs, and 10/5 seemed to be helping you, why not just set the BiPAP to 10/5 in the fixed spontaneous mode for now? The EPAP keeps your airway open, and the IPAP helps with the work of breathing and augments your spontaneous ventilation. By supporting your breathing it gives your body more energy to more easily carry out its necessary functions like maintaining a proper fluid balance.
Yes, I had thought of this. But I was concerned that fixed 10 would not treat my apneas, since my average pressure for the week on apap was 12.7. I have no idea if I had apneas on a 10/5 in the hospital, and probably that was not their primary concern.

Thank you for your suggestion. And it will be the next thing I try.
Because 10/5 was likely an *awake* treatment, and an EPAP of 5 won't treat your sleep apnea.

the 10 isn't want prevents apnea, it's the *lower* number that prevents apnea, not the upper one. The machine will never switch to the higher pressure until you initiate a breath, which you can't do when you're in apnea.

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Re: Switching to Bi Pap, any advice?

Post by KatieW » Mon Sep 02, 2019 11:00 am

Good morning. I had a good night, 9 hours using the Bi Pap. Am still learning how to post a report, so that will be later.

I set the Bi Pap at: IPAP Max 13, EPAP Min 5, PS Min 5, PS Max 5

The Oscar statistics said:
AHI 5.5 (Obs 2.19, Hyp .98, Clear Airway 2.3, Flow Limitation 1.31, RERA .33)
Leak: 1.11, 95% Leak 12., % of time above Leak threshold .36%
Pressures: Average EPAP 6.02, Min EPAP 5.00, Max EPAP 8.00
Average IPAP 11.03, 95% IPAP 13.00, Min IPAP 10., Max IPAP 13.

But the difference in how I feel is: from a 7 (0-10) in discomfort to 2! I am very pleased, and thank you everyone who replied with suggestions.

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Re: Switching to Bi Pap, any advice?

Post by Pugsy » Mon Sep 02, 2019 11:09 am

That time over red line percentage probably is an error.
OSCAR and SleepyHead both default to the ResMed line in the sand of 24 L/min and Respironics machines don't use the same red line threshold. ResMed machines report excess leak only...Respironics reports total leak which is the mask's expected vent rate plus any excess leak.
Ignore it or change the threshold to something more in line with a Respironics machine.
Preferences/CPAP tab and maybe set it to 60 or 70 L/min instead of the 24. It's hard to get an exact number because Respironics machines don't have a fixed large leak threshold. It varies with the mask used and the pressure used.
60 or 70 is probably a very conservative number at your pressures but it won't hurt to use a conservative number.
As long as you don't see LL (large leak) flagging in the Events graph you didn't have any large leaks despite what OSCAR might say.

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KatieW
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Re: Switching to Bi Pap, any advice?

Post by KatieW » Mon Sep 02, 2019 1:03 pm

Pugsy wrote:
Mon Sep 02, 2019 11:09 am
That time over red line percentage probably is an error.
OSCAR and SleepyHead both default to the ResMed line in the sand of 24 L/min and Respironics machines don't use the same red line threshold. ResMed machines report excess leak only...Respironics reports total leak which is the mask's expected vent rate plus any excess leak.
Ignore it or change the threshold to something more in line with a Respironics machine.
Preferences/CPAP tab and maybe set it to 60 or 70 L/min instead of the 24. It's hard to get an exact number because Respironics machines don't have a fixed large leak threshold. It varies with the mask used and the pressure used.
60 or 70 is probably a very conservative number at your pressures but it won't hurt to use a conservative number.
As long as you don't see LL (large leak) flagging in the Events graph you didn't have any large leaks despite what OSCAR might say.
Thanks Pugsy. i will do that. Now I recall that Respironics reports leaks differently. I have always had Resmed.

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Re: Advice re Resmed Aircurve 10 VAuto

Post by KatieW » Thu Nov 28, 2019 9:19 am

KatieW wrote:
Sat Aug 31, 2019 8:10 pm
Hello everyone. I have been using CPAP since 2008, very successfully, and was quite active on this forum for a few years, then faded away around 2012.

Recently, I had an episode of food poisoning which led to a visit to Urgent Care; dehydration pushed me into Atrial Fib, and then the IV fluids led to Acute Pulmonary Edema. Close call, but I am fine now.
Part of the treatment was a Bi-PAP Machine, set at 10 inhale, 5 exhale, and a full face mask, which I used several hours during the day, and during sleep. I went from 15 liters of oxygen to 2 liters, at discharge after 6 days in hospital. I have now been home 2 weeks, and am recovering well. Am down to 1.5 liters of oxygen, which I also bleed into my CPAP at night. I still have fluid in my lungs, which is slowly dissipating with diuretics. And am being monitored by a cardiologist (who claims no knowledge of CPAP and will refer to a Pulmonologist).

Currently using ResMed Air Sense for Her, which I love, set on APAP 9-13, EPR 3. I have always been my own respiratory therapist, and my AHI is .5, with maybe .1 Obstructive Apnea, no Centrals, most nights. I currently use the Philips Respironics Pico Nasal Mask.

A friend has given me a barely used DreamStation Auto BiPAP, with Humidifier. Searching on-line, I have located the User Manual and Clinical Manual, and am washing and drying the parts of the machine. And I have ordered a heated hose and new filters. Meanwhile I am researching what would be the best settings. 9-13 works well for me, but even EPR 3 is difficult for me right now, (difficult to exhale and accumulation of gas) so I am thinking the the Bi-Pap would make it easier to exhale. Should I stay at 9-13, with an EPAP of 5?

Any advice would be appreciated.

Thank you.
Katie

Edited to add:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244615/ Positive airway pressure therapy for heart failure.

Update November 28, 2020:

I used the DreamStation Auto BiPAP, and while it did the job, it did not give the ease and comfort that I got with Resmed. On Oct 24, I was able to get off oxygen, after an X-ray showed no more fluid on lungs. And I also went back to using my Resmed Air Sense for Her, and am able to tolerate EPR of 3. Settings 10-13, no ramp.

Meanwhile, I have been seeing my cardiologist to monitor the seriousness of my heart/lung issues. And I am getting an appointment with a pulmonologist, which will probably in mid-January.

My question to the forum is, I am considering buying a Resmed Aircurve 10 VAuto from someone on this Forum, to use until the pulmonologist suggests otherwise, perhaps a ASV. From my reading, there are pros and cons of using a ASV when there is chronic heart failure. While mine is not chronic, I have concerns about proceeding with an ASV "on my own".

I am having a large number (20-30) Centrals, and while I don't expect the Vauto to treat this, I am wanting more flexibility in my settings for comfort and duration of sleep. Since it will probably be several months before the pulmonologist has a definite recommendation. If he/she recommends Bi-Pap, then I will have a back-up machine. If he/she recommends ASV, then I will have been getting better sleep for a few months.

Your thoughts please?

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Re: Switching to Bi Pap, any advice?

Post by Pugsy » Thu Nov 28, 2019 9:44 am

What is your ejection rate? More than 45?

The beauty of the ASV....if need be it can be dumbed down so it essentially functions like the auto bilevel AirCurve 10 VAuto.

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Re: Switching to Bi Pap, any advice?

Post by raisedfist » Thu Nov 28, 2019 10:03 am

We can't suggest anything without seeing all of your current settings and the data :mrgreen:

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Re: Switching to Bi Pap, any advice?

Post by KatieW » Thu Nov 28, 2019 10:03 am

Pugsy wrote:
Thu Nov 28, 2019 9:44 am
What is your ejection rate? More than 45?

I will try and find out. I had an echo fairly recently.

The beauty of the ASV....if need be it can be dumbed down so it essentially functions like the auto bilevel AirCurve 10 VAuto.
Oh, I didn't know that!

Thank you Pugsy.

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Re: Switching to Bi Pap, any advice?

Post by jnk... » Thu Nov 28, 2019 11:07 am

If my sleep was OK with what I was using, I would hold off buying different equipment until I had a cardiologist and pulmonologist familiar with my personal situation, personal history, and family history--and familiar with how various PAP modalities and ASV implementations might help/hinder with present comorbidities and possible/likely future ones.

But maybe that's just my frugality/cowardice talking.
-Jeff (AS10/P30i)

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Re: Switching to Bi Pap, any advice?

Post by KatieW » Thu Nov 28, 2019 12:14 pm

jnk... wrote:
Thu Nov 28, 2019 11:07 am
If my sleep was OK with what I was using, I would hold off buying different equipment until I had a cardiologist and pulmonologist familiar with my personal situation, personal history, and family history--and familiar with how various PAP modalities and ASV implementations might help/hinder with present comorbidities and possible/likely future ones.

But maybe that's just my frugality/cowardice talking.
Thanks jnk. I can see both sides, and that's why I put the question out to the Forum.

The past few months have been challenging, and I would like to do what I can to improve my sleep sooner, while waiting for an appointment. And, based on past experience, I don't have a lot of faith in sleep docs--though I hope I am proved wrong in this opinion.

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Re: Advice re Resmed Aircurve 10 VAuto

Post by palerider » Thu Nov 28, 2019 12:18 pm

KatieW wrote:
Thu Nov 28, 2019 9:19 am
My question to the forum is, I am considering buying a Resmed Aircurve 10 VAuto from someone on this Forum, to use until the pulmonologist suggests otherwise, perhaps a ASV. From my reading, there are pros and cons of using a ASV when there is chronic heart failure. While mine is not chronic, I have concerns about proceeding with an ASV "on my own".
A VAuto is not an ASV.
There's this whole arm waving "the sky is falling" overreaction about ASVs and heart failure all due to ONE terribly flawed study that threw the whole industry into an unjustified panic.

For a more sane view on that "study": https://journal.chestnet.org/article/S0 ... 5/fulltext

Some highlights, it was about 2.5% higher fatalities among a group of VERY sick people who were using generations old ASVs, and using them very poorly (AHIs we'd consider terrible here, and compliance that wouldn't even keep insurance companies happy)... hardly real world conditions.
KatieW wrote:
Thu Nov 28, 2019 9:19 am
I am having a large number (20-30) Centrals,
Do you mean '20-30 a night? (not a big deal) or a CAI of 20-30? ( a concern).
KatieW wrote:
Thu Nov 28, 2019 9:19 am
and while I don't expect the Vauto to treat this, I am wanting more flexibility in my settings for comfort and duration of sleep.
The VAuto is the most customizable machine for general purposes.

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Re: Switching to Bi Pap, any advice?

Post by jnk... » Thu Nov 28, 2019 1:17 pm

KatieW wrote:
Thu Nov 28, 2019 12:14 pm
I would like to do what I can to improve my sleep sooner,
THAT, I would gladly sign off on. Although my signature wouldn't be worth anything to anyone, of course.
KatieW wrote:
Thu Nov 28, 2019 12:14 pm
I don't have a lot of faith in sleep docs
My faith is only in their ability to diagnose sleep issues in a way that payers must support, because that is the training. If that diagnosis is a simple sleep-breathing issue of an obstructive nature, that diagnosis represents the end of that doc's usefulness to me, in all likelihood. From that point on, now that I know it is basically a simple plumbing issue with no tricky electrical components or load-bearing walls, I'm good with taking it from there, thank you very much. I can read my own data about how well stabilized my airway is, just like I can probably figure out how to change the washer in my faucet.

But heart docs and lung docs (much like master electricians and structural engineers) can sure come in handy for people who have a history of heart issues or lung issues, in my opinion. I am less quick to dismiss them or attempt to preempt them, since THAT part of the fleshly house can often be a little more complicated than the upper airway.

The studies and alarms on ASV are a flag being raised that says, 'Hey, wait a minute guys, you think maybe some of this heart and lung stuff is more complicated than we thought, so that maybe other health aspects take some precedence, or require some consideration, over simply getting the AHI as low as possible for CSA people and then calling it a day?' ASV can hide some useful symptoms instead of treating what is actually wrong, after all.

I would at least let the office(s) know what you are considering doing in the meantime. (If not for permission, at least to inform.) It might come across as collaborative, respectful, and helpful. And I certainly wouldn't hide what I did from them after the fact either, since anything and everything you have been doing in the meantime, between visits, may have an effect on how you are doing when they finally do see you and may have an effect on what they recommend doing in the future for the long term. It is a similar principle to not hiding alternative-medicine approaches/supplements from a guy about to make a choice about which mainstream med to recommend/prescribe.

When it's simple OSA, I say grab the nearest machine and start winging that dial! But whenever history and comorbidities start piling up, I tend to ride the brake both with myself and with comments to fellow patients.

Sleep is highly important. But it ain't the only thing.

Hey, just me.
-Jeff (AS10/P30i)

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KatieW
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Re: Advice re Resmed Aircurve 10 VAuto

Post by KatieW » Thu Nov 28, 2019 2:29 pm

palerider wrote:
Thu Nov 28, 2019 12:18 pm

KatieW wrote:
Thu Nov 28, 2019 9:19 am
I am having a large number (20-30) Centrals,
Do you mean '20-30 a night? (not a big deal) or a CAI of 20-30? ( a concern).
KatieW wrote:
Thu Nov 28, 2019 9:19 am


CAI of 20-30.

Will post reports soon.

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