Using a Bipap Auto SV and using a Vpap Adapt SV

wlo2008 wrote:Don't know why I had trouble finding this thread again. But Banned & DSM I got the software up and running that you sent me. I downloaded my data

DSM here is what my data is from the smart card

My current setting are Ipap max of 14, Ipap Min of 8 and Epap of 5, Rise time at 3

My Average Peak of Ipap pressure is 11.2cm
My Average Breath rate is 19.5 BPM
Average triggered breaths is 99%
Average Tidal volume is 349.2 ml
Average Peak Flow 25 lpm
Average Apnea Index 3.5
Average Hypopnes Index 0.5
Average AHI 4
Average Leak 28.6

Wendy,

Can you print off the nights data in pdf format & email it to me
dsm@internetage.com

If I can view a few nights data (even a week) as it becomes available, I may be able to make some
suggestions. I'll also be seeking some other info which I can do through PM.

I believe that is the Bipap Auto SV can't keep you sleeping well, then there are deeper issues beyond the scope of
xPAP that may need addressing.

DSM

I am sending it over as I type

wlo2008 wrote:Don't know why I had trouble finding this thread again. But Banned & DSM I got the software up and running that you sent me. I downloaded my data

DSM here is what my data is from the smart card

My current setting are Ipap max of 14, Ipap Min of 8 and Epap of 5, Rise time at 3

My Average Peak of Ipap pressure is 11.2cm
My Average Breath rate is 19.5 BPM (this seems too high to me, would ask SAG/SWS what they think)
Average triggered breaths is 99% (this is User or spontaneous breaths I believe, should be what you want)
Average Tidal volume is 349.2 ml
Average Peak Flow 25 lpm
Average Apnea Index 3.5 (bit high but not real bad, could be improved on)
Average Hypopnes Index 0.5 (too low in my opinion, would rather see HI and AI reversed in residual events)
Average AHI 4
Average Leak 28.6

my comments shown in blue above

My suggestion is/was:

1. Increase EPAP from current 5.0 cm to 6.0 cm (current AI=3.5, that should bring it down, should also reduce sleep onset events).
2. At same time lower IPAP Min from 8.0 cm to 7.0 cm or 1 cm higher than EPAP maintain delta (normal when titrating new EPAP).
3. Set IPAP Max 10 cm higher than EPAP or 16 cm (protocol calls for it to be 10 cm higher than EPAP setting).
4. Set Backup Rate =Auto (machine should find that automatically using Digital Autotrak or 2 less than spontaneous rate).
5. Observe new AI, get it down closer to 1 for AI indice. Observe new HI, it should change, if HI is above 5 increase IPAP Min by 1 cm to 8.0.
6. If centrals are persistent lower Start I time from current 3, backup rate should be Auto.

I would also try a different mask interface.

I did change my settings for the night. I noticed when I was looking over the data that the dips in the spontaneous breathing when the machine triggered breathing seem to be more around the last several hours of my sleep. I would say the last three or four.

So I will give the new setting a week and see what it does

wlo2008 wrote:I did change my settings for the night. I noticed when I was looking over the data that the dips in the spontaneous breathing when the machine triggered breathing seem to be more around the last several hours of my sleep. I would say the last three or four.

So I will give the new setting a week and see what it does

that is sorta a good sign, you are probably getting to REM. Remember any dreams? Those early morning hour awakenings could also be from the marginal EPAP=5.0 setting. For most OSA patients they can live with a higher AHI but I think with your disorder those frank apnea are more critical to get rid of vs the residual Hypopnea.

Those sleep onset centrals can be annoying can't they? I have them all the time, I cannot get to sleep at all without the machine.

The sleep on set drive me nuts. Sometimes it can take me a while to fall a sleep. Because I am aware that I am holding my breath. I do remember some dreams. But then I dream as soon as I hit the pillow as well and have a lot of hulisinations. The other night I woke up with the front door opened trying to toss my mask out the door. LOL....Not sure what that was about, but my husband had to get up and stop me from going out side.

I have fallen down a flight of stairs once before do to those darn things. LOL

Wendy,

I can show stacks of nights data from this machine that produce a somewhat similar pattern to what you are describing & I think Snoredog has nailed it pretty well.

Try his suggestions but in the meantime I'll do some looking at your charts.

Cheers

DSM

PS One of the magic aspects of this machine with its PS (pressure support) mechanism, is that HI events seem to almost disappear.
My HI is usualy 0.0 or 0.2 hardly ever rises higher unless I turn PS off (reduce MaxPS to the same as MinPS).

Don't worry about HI number.

D

Falling a sleep will be the hard part sense I have a cold and my throat is killing me. The air hitting it hurts. I had to get back up. uggggg

Wendy,

Have looked at the data you sent me. The following are some observations.

Why is the machine set to a back-up rate ? - did the RT explain why ? reason I ask is that your
own breathing seems to be pretty normal in terms of you driving it. I am tempted to suggest
you set BPM to Auto (I think SD suggested that too & it is something I'd try).

Your breathing rate does seem highish and your Av tidal volume lowish (Little Laryssa breathes that
way - she has a very high rate & very tiny breaths). To make better sense of that data I would need
to know if you are a tiny person (small build) or average build. Also how would you describe your
weight to height (high, average or low (thin)).

Another observation is how much your data changes from night to night. That suggests some physiological
reasons - do you do anything during the day that might change the way you sleep from night-to-night ?.
Any meds that get varied ?.

Also again as already mentioned by SD, the epap seems low - would really like to ask your RT why it
was set soooo low. I would be raising that (atleast 7 or 8 CMs). Also I would lift your Ipap MIn by the
same number as Epap is raised by - keep it 2-3 CMs above Epap. And Ipap Max.

BUT, If you have medical complications & are being treated by a good RT, I would take his advice over
mine any day.

How effective do you feel your RT is ? - is the RT looking at your data & advising you ?

DSM

dsm wrote:Wendy,

Have looked at the data you sent me. The following are some observations.

Why is the machine set to a back-up rate ? - did the RT explain why ? reason I ask is that your
own breathing seems to be pretty normal in terms of you driving it. I am tempted to suggest
you set BPM to Auto (I think SD suggested that too & it is something I'd try).

Your breathing rate does seem highish and your Av tidal volume lowish (Little Laryssa breathes that
way - she has a very high rate & very tiny breaths). To make better sense of that data I would need
to know if you are a tiny person (small build) or average build. Also how would you describe your
weight to height (high, average or low (thin)).

Another observation is how much your data changes from night to night. That suggests some physiological
reasons - do you do anything during the day that might change the way you sleep from night-to-night ?.
Any meds that get varied ?.

Also again as already mentioned by SD, the epap seems low - would really like to ask your RT why it
was set soooo low. I would be raising that (atleast 7 or 8 CMs). Also I would lift your Ipap MIn by the
same number as Epap is raised by - keep it 2-3 CMs above Epap. And Ipap Max.

BUT, If you have medical complications & are being treated by a good RT, I would take his advice over
mine any day.

How effective do you feel your RT is ? - is the RT looking at your data & advising you ?

DSM

I am not sure why they put me on a back up of 10. I changed that last night. My orginal study with strait Cpap was set at 7cm that is the only explination I have. And my Sleep doc who is also my Neurologist thought maybe I was having increased centrals from the pressure breathing out was to high. So at first he set it at 4 but I changed it to 5. The RT is ok, But I do not have much contact with her at all.

As far as my body type. I am 5 fot 4 and I would put my catergory as medium build, but I am chest heavy. LOL. I do have some weight I would like to lose. But it is not extreme. As far as medications go, I am on lasix for my edema and potassium, I take my asthma medication, and for my day time sleepyness I was on some medication, forgive me I tossed the bottle sense the Neuro doc was going to give me something new. So it has been a few weeks. I think it started with a P or something like that. And then I take my mulitvitamins and the B12 injections.

But I thought that was odd for each day being so diffrent from the next.

This was last nights data. I did have some high leaks but that is because I riped my mask off with this cold. But I put it back on.

The new settings that SD suggested were Ipap Max of 16 min of 7 and Epap of 6 with it on Auto

With that said here is what happened
My Avg Peak was 12.8
Apnea was at 5.8
Hypopneas were at 1.0
Average breath rate was 17.0
Avg tidal Volume was 348.4
Avg Peak flow was 23.1
Patient triggered breathing was 97.8

Wendy

If you are willing to experiment a little try this

Epap 7
IpapMIN 9
IpapMAX 17
BPM=AUTO
Also set your rise time to 4

But perhaps get over your cold first as that is going to skew your data

Let me know if you try this further adjustment.

From last nights data it seems your BPM has gone up a bit. That shouldn't be happening
but lets see the data from a couple more nights once you tame your cold.

DSM

dsm wrote:Wendy

If you are willing to experiment a little try this

Epap 7
IpapMIN 9
IpapMAX 17
BPM=AUTO
Also set your rise time to 4

But perhaps get over your cold first as that is going to skew your data

Let me know if you try this further adjustment.

From last nights data it seems your BPM has gone up a bit. That shouldn't be happening
but lets see the data from a couple more nights once you tame your cold.

DSM

Yep that was going to be my next suggestion. However increasing EPAP from 5.0 to 6.0 produced a higher AI (from 3.5 to 5. and HI increased from .5 to 1 but her spontaneous breathing dropped from 99% to 97%, but that may be due to switching it to Auto mode, machine wanted to test the backup auto mode to establish its values in case it was needed.

I was concerned with prior settings that the machine wasn't seeing her Centrals and never switching to backup mode. My suggestion
was to get AI down to around 1 if possible establish EPAP pressure (she is close) then adjust IPAP Min upward. She doesn't appear to have any periodic breathing which is good.

If her prior CPAP pressure was 7.0 cm, that is probably where EPAP should be. and if we can get her to take deeper breaths and slow that BPM down a bit that may help her not exhaust so much Co2.

Best part of this is Wendy is developing a better understanding her disorder and can fine tune things herself and base it on how she feels. While her AI increased from the prior 3.5 AI, that could have been from her relaxing more hopefully from better sleep so it may go up before it goes down.

About the only thing I find automatic on this machine is the IPAP working pressure that moves between IPAP Min and IPAP Max. Backup rate is pretty much auto when enabled. I would suggest using the Auto mode for that until things get dialed in.

Personally, I'd like to see her breathe deeper and slower.

I will stay on the current setting that SD gave prior for the next couple of days. I don't want my cold fooling the machine. These settings may do the trick and my cold is just making the apenas worse. That is what I am hoping for. If my the end of the week it gets worse or not better, I will do the new settings to see what happens. I did have some more brain fog today, but I think that was because my apneas were up. Just enough to cause me to be more tired and not focused. Almost got into a car accident. But I still swear that car came out of nowhere. Its never my fault.

One thing we all need to appreciate is that with such a small gap between epap & ipap, the mechanism for dealing with centrals is all but negated.

To explain ...
The PS mechanism doesn't respond to centrals only to the 4 min Peak Flow Target. The Central mechanism is purely the breathing timing (set from the back-up rate) & probably the reason why the RT set a back-up BPM of 10 - if Wendy drops below 10 BPM then the Central mechanism kicks in but if the epap to ipap gap is a mere 1 CMs or 2 CMs the central mechanism has little pressure to get Wendy breathing again. If Wendy doesn't breath in (due to a central) the PS algorithm sits there waiting until she does, it is not time driven but is flow target driven. The back-up rate is the timing by which the machine on its own flips from epap to ipap but if the pressure isn't enough & the central persists then PS doesn't get activated.

To me a
- 2 CMs gap is the bare minimum epap to ipap gap for a normal user
- 3 CMs is more optimal for normal users
- 4 CMs starts to benefit people with centrals
- above 4 CMs gap is best recommended by an RT & they can set it as high as 8 CMs for serious cases

The actual AI & HI numbers if relatively small (say under 4 or 5) can be acceptable if the centrals are being dealt with & no desats are occurring.

I agree with SD's desire to get Wendy breathing deeper & slower. But, we do need to think about the extent that backup rate is needed.

Cheers

DSM

So are you saying that I need to go back to the back up rate that the RT gave me? Or should I keep it on Auto?