My first night on ASV

Banned wrote:Ok, now crank IPAPmin to 13.

Yes I think I will try that tonight.

I continue to wonder if the fact that I am breathing though my mouth impends effective thearpy. I often find myself breathing though a small slit in my mouth as I can't seem to keep my mouth open wide during sleep.

Banned wrote:Ok, now crank IPAPmin to 13. And give yourself some extra ceiling, raise IPAPmax to 25.

Banned

You should never exceed 10 cm from EPAP you can do lung damage.

Banned wrote:dsm,

What is your rationale for clipping IPAP Max at 20?

Banned

Banned,

I am satisfied for myself that 20 is a more than adequate maximum pressure - I did run the machine for a week at 22 & 24 IpapMax but the pressure never went above 20 (actually 19) for that week so I reverted back to 20.

James, In looking at your chart the 1st thoughts that come to mind are

1) I see the pressure dropped below the epap line in the report at the start of the night. Bev's machine was doing that too. I have never seen that on mine even with ramp activated.

2) You are sure scoring a lot of HIs

3) The machine considers you are having repeated (but not excessive) periods of PB

4) The av peak flow seems to me to be a low number but your tidal volume doesn't seem that big an issue - the BPM
and the apf & tv data suggests you take a lot of short breaths (if compared to my own data) but get there just the same

I'll catch up with the rest of the posts as I am guessing you will have posted another chart for the night just passed.

Glad you zeroed the alarms - that was my reaction when I kept getting woken on the 1st night.

DSm

James,

Just read your second night. Also, I will not be making any suggestions to you to change your settings. To be honest I think that is a mistake we make here on cpaptalk - what SAG calls dial-winging & on that matter he has a good point. Just get used to the machine for now as you have a few issues to get worked out before you want to start that practice.

a) Set all the alarms to = zero - they are really only needed for hospital use. setting to zero disables them - the alarms will do more to disturb your sleep than anything else

b) re mouth breathing - I spend an awful lto of time doing that on my machine & it works just as well. I found my best F/F mask to be the quattro - I started ff with a UMFF but the quattro is so much more adjustable & seals better.

c) again the data is very much like the 1st night

Here are some thoughts on what we are seeing this far.

The PB scores are from what I understand, because you are going through bursts of breathing - Respironics illustrate PB as periods of breathing with gaps (centrals) in between. You are showing lots of hypopneas which afaict means you are a real candidate for an SV machine.

When you have the alarms sorted out & feel more comfortable with your mouth breathing (I ended up practicing it just to get used to it & I believe I can switch at will & not be bothered) you might then consider raising IpapMin at least 2 CMs above epap just to see if that helps clear the multiple HIs (it is reasonable to assume it would). But I would really advise sticking to your doc's guidance but you have been at this game long enough to be able to look after yourself.

Good luck but the prognosis thus far is sounding V.good.

DSM

Snoredog wrote: You should never exceed 10 cm from EPAP you can do lung damage.

The recommendation is no less than 10 cm separation from IPAP Min to IPAP Max. The literature recommends setting IPAP Max at 25 cm or 30 cm. There is no benefit in giving yourself the opportunity to clip IPAP Max. IPAP Max is merely an upper limit Pressure Variable (not Flow/Volume Variable). By its very nature, Pressure Variable will never exceed what the pts. lungs can't easily handle. As far as I know, I'm the only one on the forum who needs to consider machine induced lung damage.

dsm's intentions are good, but thank you for throwing your machine into SV mode, tonight. I wouldn't anticipate any problems for you, and you may actually see some benefit.

Banned

dsm wrote: 1) I see the pressure dropped below the epap line in the report at the start of the night. Bev's machine was doing that too. I have never seen that on mine even with ramp activated.

Yes I did use Ramp on the first night. I don't normally but was just trying to get used to the new machine.

dsm wrote: To be honest I think that is a mistake we make here on cpaptalk - what SAG calls dial-winging & on that matter he has a good point. Just get used to the machine you have a few issues to get worked out before you want to tart that practice.

Upon reflection I think that is good advice. I will hold off on any changes for a bit. I need to at least make it though a night without alarms first.

jskinner wrote: I need to at least make it though a night without alarms first.

Another way to quiet the alarms maybe to setup the machine properly for your particular breathing.

Banned

Banned wrote:Another way to quiet the alarms maybe to setup the machine properly for your particular breathing.

Well yes that is the goal

Night three: http://james.istop.com/apnea/reports/AsvNov22.pdf

Things are looking pretty consistent so far. I completely disabled the alarms last night which made for a much less disrupted night...

jskinner wrote:Night three: http://james.istop.com/apnea/reports/AsvNov22.pdf

That report looks pretty good.

Banned

James, despite the residual events your AHI seems to be significantly reduced using the autoSV modality. Does this modality seem to offer any improvement to daytime symptoms yet?

We're pullin' for ya!

-SWS wrote:James, despite the residual events your AHI seems to be significantly reduced using the autoSV modality. Does this modality seem to offer any improvement to daytime symptoms yet?

Yes defiantly an improvement. Not as dramatic as my first response to CPAP back in 2006 but significant none the less. I don't think I will really feel fully better until I can breath more normally during the day as well (the nasal congestion and the narrowed airway) but I am very thankful that my head is clearer and less tried. After two years of this its probably going to take a while to fully recover.

Over all I am pleased with the ASV results so far.

PS Its funny, I felt quite a difference between the AHI of 4 Friday and the AHI of 2 on Thursday & Saturday. I wouldn't think one could tell much difference between that small difference.

James,

That is looking a lot better - peak av flow seems low to me - maybe SAg can add a comment as to how normal that is - i.e. is it ok allowing that your tidal flow seems ok.

Also, I am certain the alarms would have made that 1st nights sleep very disrupted & that would show in the data and how you felt next day.

The 2 periods of PB are of interest (naturally) but I suspect there are ways they might be dealt with once you settle down with the new machine. When I went on mine, it was not the 'miraculous' experience I felt when 1st going on cpap but the Bipap Auto SV did deliver steady & consistent results that have made a significant difference over time. If you are starting to feel good & that continues then the whole exercise will have been worth it.

Keep up the good progress.

DSM

well that night don't really look any better. Use it for a week to get used to it and let it retrain your breathing, once that is done with.

What was the pressure on your Cflex that produced the lowest AHI vs. Pressure curve report?
What was the absolute lowest OA you have seen in the past (excluding any HI)?

Are you SURE it was 10 cm? Only looking for the Cflex pressure that eliminated the obstructive apnea OA. I know you
ran your machine in CPAP mode so that would be what I would want to see. It is absolutely critical on this machine you get
EPAP nailed.

Right now you are 13/10 (on avg.). So obviously you can take a fixed 13/10 pressures, but some of your HI's appear obstructive, some are central, . But machine didn't respond with IPAP to the ones resembling obstructive. Things can change rapidly when you add that pressure support.

You will notice when you start off with the machine that peak and tidal volumes are way up there at 41 peak, breaths per minute at 21 then you settle down, are you breathing that deeply or rapidly when you are starting out? Try to pay attention to all the data you are looking at (BPM, peak and tidal volumes, PTB), you will notice right after therapy hour 1 you had a few minutes of really deep breathing up to 40ml peak, tidal also came way up, then PB showed up shortly after.

If you notice the HI right before hour 3, that one is a obstructive, machine didn't respond to it. If you now compare it to the HI that appeared right before therapy hour 5 that clearly is a central Hypopnea, you will see the machine went into Machine Triggered breathing (BPM=Auto) mode, you will see that the longer it stayed there, the more it stair stepped down, then the machine increased IPAP pressure (while in BPM mode) by 3 cm and dropped back down. Peak and tidal volumes also came up, almost like they did in recovery from a central (gasping for air for example or taking in a deep breath). Just trying to analyze how that machine responded to that event. Keep in mind those tics are residual events, assume it didn't take care of any of those tics on the therapy flag graph. Sure its an improvement over what you had, but still a lot of unstable breathing there.

Maybe this machine will help retrain your breathing over a course of weeks where it will settle down with very little change. Machine is doing its job, I just think it could do a better job at it. Would be interesting to see what happens when IPAP Min is increased say to 12, that is 2 cm pressure support, same you would get with a Bipap Auto at a minimum. I don't have a lot of confidence in what they came up with in your lab report, sounded to me like they wanted you on fixed 20/10 instead of 20/10/10, your avg. so far is 20/13/10 on avg.

If you are positive the lowest AHI on your old machine was 10 cm, then leave EPAP=10, my first move would be to move IPAP Min to 12 cm adding 2 cm minimum Pressure Support and see what happens. That may be enough to improve and lower HI things a bit.

It is not so much you are getting use to the machine, it is more like the machine is re-training your breathing, that will take
some time.