BiPap S/T cycles too quick

Nazareth wrote: My numbers are 12/8 with respiratory rate of 14 bpm's, rise of 3, inspiratory time of 1.5- the report goes on to say that at these rates, central events subsided and sustained sleep was achieved.
.... the machine just acts really wierd. the machine breaths are erratic- it Ipaps for about 1.5 seconds, then epaps for about 2 seconds, then 2 seconds Ipap, 2 second Epap, then 4 seconds Ipap, 3 second Epap, back to 1.5 repat this sequence.

If I breath out after the 4 second one, and keep breathing out while the 1.5 second machine inhale takes place, it will go right back to the 4 second machine inhale- but I have to keep breathing out while the machine does it's 1.5 Ipap.

Its your backup rate (BR) that's getting you in trouble. Do you have someone who could observe what your resting rate of breathing is while you're watching TV or reading or the like? I'm willing to bet its going to be at 14ish, possibly even lower (mine tends to be, always has been too). With regular BiPAP ST, I was started with a too low of a backup rate originally, but then it was upped to a range of 10-12 (my sleep doc tends to script most things in ranges, letting the patient find what works best). For me, 10 was were I did best, any faster and I was fighting the machine like you're describing, but my typical resting breathing rate tends to be around 12 BPM. We were able to see a difference from the data downloaded from my Synchrony that I needed a higher BR and once we made the switch, my percentage of patient triggered breaths actually increased, because it helped stabilize my breathing even more (though not as much as the VPAP Adapt does).

Let's play with the numbers a little and you'll see what is happening:
BR=14, 60 seconds/14=4.28seconds per breath, and that is not from the end of exhale to the beginning of inhale, but rather each breath should take that long period.
Normal breath ratio is about 40% inhale & 60% exhale, so that makes inhale (IPAP) about 1.71 seconds, which is pretty close to the 1.5 seconds you reported. Exhale (EPAP) would be 2.6 seconds. Sound about right for what you're experiencing? You're not going to see any regular, spontaneous BiPAP time unless your BPM is over 14; as soon as it drops below 14, TIMED mode kicks in to try to keep you breathing. Something you can try is after you hook up & have been breathing for a minute or so, is to hold your breath to see what Timed mode feels like as it cycles. It should kick in pretty fast, and within 10 seconds it would cycle 2 1/2 times. I usually did it while watching a second hand just to see the timing whenever I switched machines or my BR was adjusted.

Another thing that can be helpful when you're new to BiPAP, or anytime it feels like the machine pushing you around when it shouldn't, is to breath in through your nose & out through your mouth about 10 times. It helps slow you down and get in synch- or rather let the machine get in synch with you (but I know it can feel the other way around sometimes). This probably won't help much right now, if your BR is too high, as I believe it is, but the fact you said it felt easier when you woke up & wasn't fighting you then, makes me think there is some component of anxiety coming into play too. I know for me, I did the in through the nose & out through the mouth a lot in the beginning, and now I only need to do it when my nose & sinuses are clogged- usually a few breaths that way will help clear them enough so that air flow is high enough to not affect treatment or trigger early flipping to EPAP, like DSM mention. I know if I don't do that, the feeling of the machine pushing me gets worse & worse until it makes me want to take off the mask & say screw it for the night, even with my VPAP Adapt. Its funny, now I actually look forward to going to bed and being able to breath through my nose when I'm stuffy, when it use to be that I would get so stuffy sleeping due to allergies that by morning I would be mouth breathing.

I'm appalled at your DME & doc letting you go that long without treatment well they had a supposed pissing contest with Medicare, which won't do anything until they get billed. It sounds like the DME didn't want to take a risk of not getting approved or something- who knows? The only change recently in Medicare requirements happened early in 2006. They dropped the O2 desat below 88% for 5 consecutive minutes and the addition of Complex Sleep Apnea, which is when central apneas occur consistently & persistently as a result of CPAP to treat OSA. I barely squeaked by the O2 desat originally, even with 60+ centrals per hour- centrals don't tend to cause desats as much as obstructive apneas tend to, especially if they happen very rapidly. Because there was a question if I would meet the then required desat and because BiPAP ST only reduced my centrals from 60+ per hour to 30+ per hour, my sleep doctor didn't even want to get Medicare involved at first, until he knew for certain it would actually help. So he arranged for me to use an older model BiPAP ST from the sleep labs attached DME for a month, free of charge- and considering one months rent is over $600 & they knew ahead of time I would not be using that DME for my final equipment, it was very considerate. Of course it also made it easy for my doctor to document that BiPAP ST was needed when I came back in a month telling him there was no way I would dream of sleeping without it again & had a typed list of a dozen or so improvements I had noticed (sleeping less, no naps, less sleep meds, improved cognitive function, etc). I had no problem getting my BiPAP ST rental approved, and last fall, switched to VPAP Adapt, with my DME. In fact, there was a mix up in billing my heated humidifier, so my DME wrote it off and didn't blink an eye when they had to provide me with a ResMed VPAP Adapt integrated humidifier, also at no charge. They did get more then adequate reimbursement on my BiPAP ST, as I was under the old, rental for life for several years, until April 2006, when BiPAP ST was switched to capped rental, like the rest of xPAP machines have always been.

Let me know if that helps & what your resting BPM is, if you can. It sounds like you will be needing to contact your sleep doctor to have your backup rate changed (if you do, ask if can write a range, so you & the DME don't have to bug him every time). And then you DME will have to change the BR, unless your doctor & you are comfortable with you changing your prescribed settings- some doctors are & some are not.

dsm wrote: However in S/T mode (versus T mode) as you change your BPM during sleep (IIRC) the machine should try to follow your BPM based on your spontaneous breathing.

But it would only be in Spontaneous mode if BPM was higher then 14, in this case. Any time it dropped below that, it would be in TIMED mode. Add in BiPAP newbie anxiety & synching issues with a too high backup rate, and you've got a major problem. BTW, did you ever try the breathing in through your nose & out through your mouth for 10 breaths or so when you first put on one of the Respironics machines you feel flips too quickly? I find I have to do it still with my Adapt if I have more congestion then normal, otherwise that anxiety feeling from the machine 'pushing' me starts up, and from there its a downward spiral that has to be stopped ASAP, least the mask & machine end up across the room. And if I can experience that with the Adapt still, we know its bad-lol...thank goodness it only happens occasionally now, between all my allergy meds & air purifiers, but somehow that awful feeling of being out of synch can sneak up so fast when it does that it can take me a minute to realize what is going on, even now. It makes me wonder since its something we've heard described with BiPAP frequently, if it will be more & more of an issue as more CPAP's have exhalation relief now.

christinequilts wrote: <snip>

Let's play with the numbers a little and you'll see what is happening:
BR=14, 60 seconds/14=4.28seconds per breath, and that is not from the end of exhale to the beginning of inhale, but rather each breath should take that long period.
Normal breath ratio is about 40% inhale & 60% exhale, so that makes inhale (IPAP) about 1.71 seconds, which is pretty close to the 1.5 seconds you reported. Exhale (EPAP) would be 2.6 seconds. Sound about right for what you're experiencing? You're not going to see any regular, spontaneous BiPAP time unless your BPM is over 14; as soon as it drops below 14, TIMED mode kicks in to try to keep you breathing. Something you can try is after you hook up & have been breathing for a minute or so, is to hold your breath to see what Timed mode feels like as it cycles. It should kick in pretty fast, and within 10 seconds it would cycle 2 1/2 times. I usually did it while watching a second hand just to see the timing whenever I switched machines or my BR was adjusted.

<snip>

CQ,

This really caught my eye - for me it is more like (nasal) breathin = 60% & breathe out = 40%.

Long slow breath in - then quicker breathe out. If am breathing in too fast - nose congestion will worsen.

Might explain a few things

DSM

christinequilts wrote:
Its your backup rate (BR) that's getting you in trouble. Do you have someone who could observe what your resting rate of breathing is while you're watching TV or reading or the like? I'm willing to bet its going to be at 14ish, possibly even lower (mine tends to be, always has been too). With regular BiPAP ST, I was started with a too low of a backup rate originally, but then it was upped to a range of 10-12 (my sleep doc tends to script most things in ranges, letting the patient find what works best). For me, 10 was were I did best, any faster and I was fighting the machine like you're describing, but my typical resting breathing rate tends to be around 12 BPM. We were able to see a difference from the data downloaded from my Synchrony that I needed a higher BR and once we made the switch, my percentage of patient triggered breaths actually increased, because it helped stabilize my breathing even more (though not as much as the VPAP Adapt does).

That's sounds liek it might be it right there- I'm going over tomorrow to see if I can talk with the sleep tech (although it might be tough getting ahold of Tech as it's a small town and the actual sleep studies are only 2 nights per week IF there are enoguh people to take hte test lol, and he also runs on ambulance- tough person to get ahold of) and I'll mention that to him and see if I can get it adjusted

Normal breath ratio is about 40% inhale & 60% exhale, so that makes inhale (IPAP) about 1.71 seconds, which is pretty close to the 1.5 seconds you reported.

The inhale/Ipap goes anywhere rom 1.5 or so seconds to 4 seconds (roughly- time taken by counting one onethousand two onethousand etc.)

You're not going to see any regular, spontaneous BiPAP time unless your BPM is over 14; as soon as it drops below 14,

The spontanious is for centrals aren't they? My major apneas are because I just stop breathing, and not from physical prob. Something RestedGal mentioned makes sense- that perhaps I'm needing the SV machine to keep enough CO2 in system- thinking it through, it seems like brain is getting a signal of too much O2 (and perhaps not enough CO2?) and just shuts down breathing? I think you're saying that lowering the BPM would stop the spontaneous and wouldn't that mean the machine wouldn't kick in a more powerful Ipap if I stop breathing?

I agree there is anxiety at work a bit (I have asthma, and have always feared not being able to breath right, and being on the machine fighting it intensifies the feeling that I'm going to not breath well)

You mention the nose br3eathing- I have deviated septum and always stuffy and just can't breath through nose

I'm appalled at your DME & doc letting you go that long without treatment well they had a supposed pissing contest with Medicare, which won't do anything until they get billed. It sounds like the DME didn't want to take a risk of not getting approved or something- who knows?

Yup- that's exactly what it was, a pissing contest- the Doctor's direct quote to me (through his secretary of course who told me it was his quote was "I'm (the doc) not moving on this until I get a varience, and I'm sticking to this descision". Also- The provider was definately trying to cover themselves, anticipating being denied by Medicare. I'm pretty sure it was the desat that they were concerned with (although they wouldn't tell me exactly what was holding htem up- but the sleep tech said the desat was kinda iffy- borderline.) Not sure why they mentioned that Medicare just changed some requirement- Maybe I'll call Medicare and ask them if they did- see if the provider is being on the up and up with me. Seems I always run into some major problems like I described when it comes to my health- I had an ostomy done at 17 due to Crohn's, and I was sent home without a word abotu the ostomy itself or any guidance or anything- I even went for years not knowing htere was such a thing as nurses who specialized in ostomies and could answer any questions I might have had. I just seem to get one bad doc after another when it coems to bedside manners. But I'm at hte point I just don';t care anymore. I just sit and laugh when the patient in hospital bed next ot me has there docs coem in every day and sit for 20 minutes while the patient gets to ask tons of questions, while I on the other hand don't see my doc for days, and then when they show up, they're rushed for time and act like I'm bothering htem asking questions.

When I had pit tumor out- I had researched the best surgeons as the surgery is a tricky one, and finally settled on a surgeon in Boston because I'd read good reports from patients of his and he had great record for success. So, Me and folks go out htere, go for the consultation, and I'll bet he never said more than 20 words to us- we left hte room thinking "Hmmm- chatty fella" and just laughed thinking "Typical, why are we not surprised" lol. I think somewhere along the line someone musta put a hoodoo curse on us lol.

Anyway, Sorry for rambling. My resting BPM's is just about 11 BPMs, my anxiety BPM's are about 755 BPM's (just kidding) Thanks Christine- sounds like we're onto a cure for the freaky fast ghost in the BiPap machine lol

One thing that has me curious though, if I'm breathign on the machien easier when I wake up during night, could that mean the machine is actual at the right settings for my asleep breathing patterns? Maybe My BPM's are higher because I'm dreaming about being chased aroudn the mall by hoseheads and giant BiPap machines? But seriously, wondering if the machine is set correct for sleep breathing?

Nazareth wrote:One thing that has me curious though, if I'm breathign on the machien easier when I wake up during night, could that mean the machine is actual at the right settings for my asleep breathing patterns?

Not necessarily, but you are more relaxed then....and usually half asleep too, which helps My sleep doc had me try higher BR, up to 15BPM, late last summer, in anticipation of switching to the VPAP Adapt. I was use to BiPAP ST enough by then that it didn't bother me that much while I was awake, but I'd been on BiPAP ST for 3 years by then. I could tell it was harder to synch with the machine & I was rarely in Spontaneous breathing mode. Of course it probably made it easier for me to tolerate knowing it was only for a few nights at a time and if worst came to worst, I could get up & change the BR to a more reasonable number. The ironic thing in the end is that the default BR of 15 on the VPAP Adapt is a failsafe backup rate- most of the time it bases the backup rate on own recent breathing rate and will only go to the BR 15 if it doesn't have enough data.

The spontanious is for centrals aren't they? My major apneas are because I just stop breathing, and not from physical prob. Something RestedGal mentioned makes sense- that perhaps I'm needing the SV machine to keep enough CO2 in system- thinking it through, it seems like brain is getting a signal of too much O2 (and perhaps not enough CO2?) and just shuts down breathing? I think you're saying that lowering the BPM would stop the spontaneous and wouldn't that mean the machine wouldn't kick in a more powerful Ipap if I stop breathing?

Spontaneous is when the machine is following your lead for changing from IPAP to EPAP. Timed comes in when you have a central and need a kick start- the problem being that it isn't always that successful at giving those of use with significant central apneas enough of a kick start unfortunately. The whole goal with centrals is to stabilize your breathing, which both the Spontaneous & Timed modes do in different ways, the more you can stay in spontaneous the better. Timed mode is not preventative, its reactive- it doesn't do anything usually until a central has already happened. Think of it as a life jacket- good thing to have if you need, but its better to not fall in the water to start with (or in this case, stay in spontaneous mode as much as possible). The problem is if the Timed rate is set to high, you're probably not spending much time in Spontaneous mode...you're 'in the water' most of the night and your percent of patient trigger breaths is probably very low. And throw a little anxiety in, and you know how easy it is to feel like you're downing even in very little water.

You really need to get a copy of your both your diagnostic PSG & titration PSG (sleep study) to see what is going on. Do you know if your diagnostic PSG showed only centrals or was it a mix of obstructive & central apneas? ie- mine showed a central AHI of 62, obstructive AHI of 1.5, which is pretty obvious obstructives are not an issue at all as they are within the normal level, but the centrals are severe. Also, how well did BiPAP ST take care of your central apneas? Its not uncommon with centrals to be left with a fairly high residual AHI, even with BiPAP ST (heck, I still had a double digit AHI on my VPAP Adapt titration). If you're left with significant centrals on BiPAP ST or there are other indications your sleep quality isn't as good as it could be, you may want to pursue the VPAP Adapt- it may be easy to push for it now then later with your DME. It might mean you have to seek a second opinion with another sleep doctor. You may want to make some calls fairly quickly to see if you're stuck with your current DME or not- I know there was a change with Medicare that you would have to stay with who you started with, but I'm not sure if there is a number of days/weeks to decide if its the right one for you. If you can find another DME- and most accept Medicare- you would probably be better off. I only wish you would have come here 6 months ago when your doctor & DME decided to stand off, ignoring the fact you were getting no treatment in the mean time- that makes me so mad that they did that to you.

For me, the Adapt has been miracle- I never new I could sleep all night, every night...it still seems strange when I wake up in the morning & I realize I haven't woke up all night. BiPAP ST was a great option for me, it was the only option for me really for those 3 years. I jokenly say it allowed me to tread water until the Adapt came out; without it, my health would have continued to deteriorate more & more due to a lack of restorative sleep. It wasn't as successful as either my doctor or I would have liked, but it was better then nothing. I'm just thankful my sleep issues were finally addressed and that now, technology is improving. Its amazing how much easier it is to deal with other health issues, and even how much less debilitating they can be, once you start getting quality sleep. It sounds like you're dealing with a lot of other 'stuff' too. Its not easy, even for me, and I was medical & vocation case manager before I became disabled- the medical system sure is confusing & frustrating when you don't have a nice, simple, commonly understood problems, is it? And heaven forbid if you decide to have more then one unusual medical problem-lol

Another thing on the change with Medicare is that BiPAP ST, which they call RAD with Backup Rate (Respiratory Assist Device)...don't ask, I've never figured it out either. Last April 2006, BiPAP ST were moved from rental for life at over $600 per month or $7500 per year for as long you used it, to a capped rental, like regular BiPAP & CPAP. Now they pay for 15 months & its yours, plus the monthly amount drops slightly after the first 3 months- it ends around $7500 total, or what they use to get per year. Can you see why they might not like providing them as much now? Before the change was made, by an actual act of Congress no less, my DME had received over $22,000 for mine...of course they had to switch me to the Adapt at no additional charge since it was medical necessary & the same billing code & masks & hoses were part of that fee, but they still made a lot of $$$$. Can you imaging what my lifetime total could have ended up being, since I started on BiPAP ST at age 31? Yikes!

Hopefully you can get your BR turned down a little so you can give BiPAP ST a real chance, but in the mean time, I would be perusing if the Adapt may be a better option, if I was you.

christinequilts wrote:

Spontaneous is when the machine is following your lead for changing from IPAP to EPAP. Timed comes in when you have a central and need a kick start- the problem being that it isn't always that successful at giving those of use with significant central apneas enough of a kick start unfortunately.[/quote]

I guess I had that backwards- That was one of my thoughts- it felt like the increased pressure kicking in isn't enough to kickstart my breathing again- I'm thinking maybe it has to do with the air being diffused in the mask before I breath it in- I'm going to be switching to an Oracle oral mask and it will be a direct input, so maybe that will be enough to get me kickstarted hopefully.

And throw a little anxiety in, and you know how easy it is to feel like you're downing even in very little water.

Yup- good description- with the asthma, it just aggravates that drowning feeling.

You really need to get a copy of your both your diagnostic PSG & titration PSG (sleep study) to see what is going on. Do you know if your diagnostic PSG showed only centrals or was it a mix of obstructive & central apneas? ie- mine showed a central AHI of 62, obstructive AHI of 1.5, which is pretty obvious obstructives are not an issue at all as they are within the normal level, but the centrals are severe.

I have both- mixed and centrals, but mostly centrals- almost exclusively centrals. I've got a copy of my report- I made sure to get it as I had a feeling I'd be needing it, not knowing anything about apneas and such. The only AHI number I can find says it was 9 while on BiPap with a note saying that was because I only got 1 1/2 hours sleep (had too much difficulty with face masks that I tried, had to switch to Oracle, and by that time, I only got 1 1/2 hour sleep)- Dumb question- what does AHI stand for?

If you're left with significant centrals on BiPAP ST or there are other indications your sleep quality isn't as good as it could be, you may want to pursue the VPAP Adapt- it may be easy to push for it now then later with your DME. It might mean you have to seek a second opinion with another sleep doctor.

The sleep Tech is really pretty good about getting the best results, so I think he'd be ok with trying another line of defense if I have to- His report did state he thought I shoudl have another sleep study just to try ironing a few things out. I may switch DME's if I can htough as the one I have has shown they're not too knowledgeable about the BiPap S/T and I think may have not been too honest. Plus I didn't appreciate the fact that they held off for prior Medicare approval when they should have known, having dealt with sleep apnea patients for many years, that Medicare doesn't issue prior approvals. At the very least, they should have called Medicare to check into wether they issued prior approvals or Variances right off the bat instead of making me do all the legwork in finding out

For me, the Adapt has been miracle- I never new I could sleep all night, every night...it still seems strange when I wake up in the morning & I realize I haven't woke up all night. BiPAP ST was a great option for me, it was the only option for me really for those 3 years. I jokenly say it allowed me to tread water until the Adapt came out; without it, my health would have continued to deteriorate more & more due to a lack of restorative sleep. It wasn't as successful as either my doctor or I would have liked, but it was better then nothing. I'm just thankful my sleep issues were finally addressed and that now, technology is improving. Its amazing how much easier it is to deal with other health issues, and even how much less debilitating they can be, once you start getting quality sleep. It sounds like you're dealing with a lot of other 'stuff' too. Its not easy, even for me, and I was medical & vocation case manager before I became disabled- the medical system sure is confusing & frustrating when you don't have a nice, simple, commonly understood problems, is it? And heaven forbid if you decide to have more then one unusual medical problem-lol

Yep- got a few health issues that haven't been easy- That Pit tumor I had- it caused Acromegally- only 1 in something like 600,000 get Acromegally- (It's the same hting Andre the Giant had- only mine came after the growth plate shut off so I didn't get giantism, but did suffer from organs getting larger and some bone deformity, although it';s slight thankfully- but thank goodness a Doc looked into it after 14 years of telling Docs I'd been weak, exhausted etc- this one Doc asked about a hormone related question, I answered in the negative, and he said "Gosh, sounds like it might be a hormonal issue- better get htis checked out- bingo- had a pit tumor causing messed up hormones)

Is the Adapt machine you got the Adapt SV? Been reading some about this machine- sounds like it treats conditions that are hard to treat with other type machines, including the BiPap S/T.

Nazareth wrote:
I have both- mixed and centrals, but mostly centrals- almost exclusively centrals. I've got a copy of my report- I made sure to get it as I had a feeling I'd be needing it, not knowing anything about apneas and such. The only AHI number I can find says it was 9 while on BiPap with a note saying that was because I only got 1 1/2 hours sleep (had too much difficulty with face masks that I tried, had to switch to Oracle, and by that time, I only got 1 1/2 hour sleep)- Dumb question- what does AHI stand for?

AHI=apnea per hour, number of apneas on average per hour. Did you have 2 separate sleep studies or did they try to do your diagnostic & titration all in one? If its the later, then you definitely need another one with centrals & that little sleep on BiPAP ST. Its a lot more complex then splinting the airway for obstructive apnea. As for the mixed apneas, they start as centrals, but then the airway collapses because there is no air moving through it to keep it open, so they end up up as obstructives. In someone who has primarily central apneas, they are just more of the same...with a slight variation.

The sleep Tech is really pretty good about getting the best results, so I think he'd be ok with trying another line of defense if I have to- His report did state he thought I shoudl have another sleep study just to try ironing a few things out. I may switch DME's if I can htough as the one I have has shown they're not too knowledgeable about the BiPap S/T and I think may have not been too honest.

It sounds like you have a good sleep tech- they can be worth their weight in gold. At least someone on your team knows what they are doing, even if the doctor & DME want to act like kids. I would print off the brochures & info on the ResMed VPAP Adapt SV and see if they have even used it yet. Not all labs are equipped to do studies with it yet as its only been on the market since the last August. It may mean you have to travel to a better equipped sleep lab- it sounds like you're in a fairly rural area. And yes, the VPAP Adapt SV is the Adapt- I get tired of typing the full name out, and knowing that Respironics was going to introduce their own ASV, I figured it would best to use 'Adapt' so there was no question which one I had. Calling it a VPAP doesn't work, since ResMed calls all their BiLevelPAP VPAP (BiPAP is actually Respironics trade name, though its become the common name, like Kleenex or Bandaid). The Adapt not only helped with my centrals & periodic breathing, it also greatly reduced my Alpha Intrusion & CAP- both other neurological/brainwave issues that indicate very poor sleep quality. My sleep was pretty messed up, even on BiPAP ST, but the Adapt makes such a difference. We're still not sure what causes my centrals, though there is some thought they are related to the neuropathy that damaged the nerves to my stomach & left me on a PEG/J feeding tube for the past several years. I also see an increase in them even now if I'm exposed to corn/corn derivatives, which I'll be seeing yet another allergist at a major teaching hospital next month to see if they can figure out what is going on & why my body is reacting in such unusual ways.

I had two sleep studies done- one without Bipap, one with (Which they started off using like a CPap, only to have to switch to BiPap S/T mode toward the end)

I just came back fro mthe sleep lab, and unfortunately the Sleep Tech wasn't there, but I spoke with the medical provider (which is right in the hospital) that deals with ordering hte machines, and they hadn't heard of the Adapt SV. I'll speak with the actual sleep Tech tomorrow, as I feel he might at least know about htem as he seems to like investigating newer technologies and keeping up on things regarding apneas.

Sorry to hear about your nerve damage in stomach- Stomach problems are the pits. It's interesting that yopu mention neurological caused apneas maybe being related to nerve problems elsewhere in body possibly. I've got something going on with my muscles- Docs aren't sure yet, but htink there is a problem turning glycogen into fuel to fuel the muscles and keep them going. They also think there might be something neurological going on that is causing the pain and a condition called excersize intolorance where muscles start to hurt within only just a very few minutes- 1-4 minutes. Docs aren't sure yet if it's a Glycogen storage/conversion/utilization problem, or if it's a neurological problem, a neuropoathy or something liek Polymalgia, Polymiositis, or something like McArdles, causing the muscle pain-. So I guess I'm kinda in same boat as you inthat it might be a complex neurological problem causing apneas. My hope was that the pain is caused by years of not sleeping proper and somethign getting messed up, and perhaps correcting after being on a machine/Bipap for awhile, but I don't hold out much hope for that happening really.

I'm glad to hear you had two separate studies- I couldn't imagine doing a split night study for Dx & titrating CSA on BiPAP ST...hard enough sometimes with OSA to get a decent titration in a split night.

I can tell you with my situation, my chronic pain was much easier to control once I started on BiPAP ST. Mine was caused by damage to my knee from an injury in physical therapy following surgery as a teen, but I also had the normal muscles aches & pain all over you get from lack of restorative sleep. I was able to reduce my pain medication by about 30-40% when I started BiPAP ST almost 4 years ago, and this past fall, since going on the VPAP Adapt, I've also been able to reduce them even more and pretty much stop using a cane to walk.

When you talk to your sleep tech, ask if he saw any Alpha Wave Intrusion or anything else that indicates your sleep quality is less then optimal. AI is often seen with chronic pain, but its a chicken & egg- does it cause the pain from lack of restorative sleep or does the pain prevent the restorative sleep? I've got a feeling there is more to your sleep study then just the central apneas, but a lot sleep labs only focus on the apneas since they are quantifiable & fairly easy to treat. Also, ask them to talk with their ResMed sales rep about the Adapt too- they are usually willing to come & educate them on it, and even sit in on the first couple of titrations even. Check this recent article out on CSA/CSDB & the Adapt: http://www.sleepreviewmag.com/issues/ar ... -06_03.asp

Hi=- sorry for late reply- been running round a bit-

Called the sleep lab today, and oen of hte questions right off the bat to me was "Have you heard about the new Respironics machine that they hare suppsoed to be comming out with?" I asked if hte machien was similiar to the Adapt SV, he said "I dunno let me check quick, went online and then told me it was.

I told Him I had read a little about hte Adapt SV and that it was easier on folks who have trouble with the Bipap S/T- we talked abotu the SV for a bit, but he didn't feel his boss would approve buying one for the hospital (again, it's a small town and grants are hard to come by), but He told me I should fdirst try to see if changing settings on S/T would help first, if not, then Go to the Doc and ask for SV machine (it would be the same doc that got all stubborn and held off on writing perscription). My chances of getting another machien through that doc are abotu as good as hitting lottery.

My test results had what the Tech told me were indications of Fibromyalgia which were also causing events during hte night- patterns that were typical for that, which I would imagien would be pain induced brain patterns. I've had the painful muscles/excersize intolorance for about 14 years now, and when I ask docs for pain control regimine, they balk as though I'm a 'drug seeker' or something- never could get on a pain management regimine despite hte fact that I've got Crohn's, Asthma, had Acromegally, and developped the painful muscle problem- Peraps if I were standing in the office and one of my arms fell off, they might consent to send me home with a baby aspirin- Seems liek soem people can go to docs with an aching knee, and the docs fall all over themselves writing perscriptiosn for pain management fore them- oh well, life is interesting if not whacky I guess.

I'm sure htere must be pain induced readings in the sleep results (Also got restless leg syndrome which kinda goes along with pain problems sometimes I guess)- and I know I'm tossing and turning because of pain as sometimes it's wakign me up- Not sure if it was alpha intrusions though- but the tech did mention the events that were indicative of Fibro- (Althoguh I don't have classic Fibro trigger points- that's why some of my docs thought another condition like perhaps Polymiositis or something was causing hte muscle pains) You owuldn;'t be willing to send me your SV machine and tell your docs accidntly threw yours away would ya? Lol j/k.

I think my next step will be to get the Breathe Rate adjusted, see if that helps, but that will probably take a month or more getting in to see the doc to get the rate adjusted. Maybe he'll agree to call Lincare without an appointment, but I dunno- hopefulyl anyway. After all I went through to get the Bipap in the first place, The doc will probablly look at me like I'm nuts if I metnion perhaps trying the SV machine- I'll probably get a "YUo're kidding... right?" That's IF he's even stil talking to me after all this lol

My father was just diagnosed with sleep apnea, and he just got a CPap machine, and I tried it out just briefly, and it was like heaven not haivng to fight against neurotic pressure variables. Sure woulda been nice to only have required a Cpap myself,.

couple quick questions- I know I'm asking lots of questions, and I thank you for your patience

Do you know how much those Adapt SV machines cost? or where to get them? I can't find any prices online for them

Also- Is the Respironics Auto SV the same thing? I notice the Respironics is like $4800

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, auto

The Respironics BiPAP Auto SV machine: https://www.cpap.com/productpage-bundle ... undle.html

Again, I'm no expert on the Adaptive Servo Ventilation machines; but yes, that's the Respironics ASV machine, designed with the aim of better treating central apneas than with the usual S/T machines. Respironics' answer to the resmed ASV machine. Both were designed especially to help patients with central apneas, and the Cheyne-Stokes respiration pattern associated with so many CHF (congestive heart failure) patients.

As best I can tell from reading what people have posted so far about the two machines -- the ResMed VPAP III ASV and the Respironics BiPAP Auto SV -- it sounds to me that IF the Respironics machine can do as good a job handling centrals as the resmed machine does, the Respironics machine might be easier to set up, that it might be capable of being used with a wider variety of masks, and that it might have better settings for handling obstructive apneas than the resmed machine has.

Again, I may be wrong, but what I've read about the two so far sounds like the resmed machine was developed almost exclusively to treat central apneas, while the Respironics machine was developed to treat not only centrals but obstructives as well. Perhaps the Respironics machine would be a better treatment machine for a person who had obstructives AND centrals in their sleep study...assuming the sleep study "got it right" in the first place.

Either machine takes expert knowledge whether titrating with the machine in the sleep lab or in setting it up at home. The average sleep lab and average DME RT (and the average doctor, even one who specializes in "sleep") is not necessarily going to know how those machines should be used.

I've got a feeling though, that the "professionals" would have less difficulty setting up the Respironics BiPAP Auto SV machine than they would setting up the resmed VPAP III ASV machine.

struggling with new BIPAP ST. I feel like the machine is rushing me to breathe and not synched to my natural breathing. Feels very stressful, like I need to take off the mask and rest. Also, I can tell the pressure after ramp is too high, causing me to gulp the air. I know I need an adjustment, but don't yet know the terms. Am i needing increased rise time or timed Insp? or something else altogether.
IPA 20
EPAP 16
Rate: 14
Timed Insp 1.2 secs
Rise Time: 3