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SWS,

"Perhaps the tiredness issue simply has to do with the extra neuromuscular workload that heightened airway impedance imposes throughout an entire night of sleep. I remember reading literature claiming that COPD patients can sleep poorly and be fatigued during the day because of heightened neuromuscular WOB during flareups. "

This is an interesting line - will see what I can dig up

Thanks

DSM

Just found the article mentioning muscle fatigue associated with work of breathing (WOB) and even Paco2 issues related to COPD:

http://www.rtmagazine.com/issues/articl ... -12_08.asp

Hyperinflation in patients with COPD increases the work of breathing.3 For this reason, it was suggested that there might be some benefit to be gained by resting the patient’s chronically fatigued muscles (using nocturnal NPPV).4-6 It was further theorized that this period of rest of 4 to 6 hours per day would permit recovery of muscle, increase muscle strength, reduce the length of periods of muscle fatigue, and improve gas exchange, as well as pulmonary function values.

Bear in mind the article is specific to COPD, and most points would not necessarily apply to CSDB pathophysiology. Also, COPD patients rely on the accessory pulmonary muscles in the chest to facilitate labored breathing, whereas non-COPD patients tend not to rely very much on those accessory muscles.

Regardless, I'm thinking James' atypically constant airway narrowing may very well impose added WOB. And perhaps that increased WOB would even impose added use of the accessory muscles to facilitate that constant state of high-resistance breathing. If so, that would be a potentially fatiguing physiologic sleep or wake scenario for James. The same BiLevel parameters that reduce WOB for COPD patients can hypothetically reduce WOB for James' constantly narrow airway. And that is conceivably beneficial---in addition to the autoSV machine also addressing his ordinary CSDB mix of events.



[on edit: I originally had the wrong part of the article quoted]

Some random thoughts ...

Am thinking about why this risetime adjustment may be helpful & several of matters come to mind ...

1) The WOB (Work of Breathing) that SWS has highlighted would seem to be one factor
##2 corrected meaning
2) Am wondering why speeding up risetime which should deliver more air, often shows Av Peak Flow drop & Tidal Volume drop while av BPM stays the same ?
- I am taking this to mean that respiration is somehow more effective (efficient) & thus the apparent drop in volume
3) Why increase in risetime usually also means a lighter level of sleeping - I associate heavier sleeping with CO2 retention but this thinking may well be wrong

One other factor that is coming into focus is that on cpap & when I exercised regularly I was constantly getting leg cramps in the calves. Used to occur regularly. Since going onto this Bipap AutoSV, the cramps have all but gone away. And almost as a proof, with recent exercise there have been no cramps.

Use of wine or alcohol. I used to wonder if the cramps could be attributed to a glass or two of wine in the evening that may have caused some dehydration. Taking magnesium tablets certainly eased the probability. But, am thinking the Bipap AutoSV itself seems to have almost eliminated the occurrence of cramps and that drinking wine / taking magnesium tabs, is not the culprit.

I have read plenty of data lately associating cramps with O2/CO2 imbalance. So am wondering if the type of cpap therapy can be a significant contributor / cure - depending on issues like risetime ?

DSM

#2 corrected meaning + typo

James,

My theory re risetime doesn't seem to be holding up in that having set risetime to 2 - have had 3 nights where it wasn't having the desired effect (waking up feeling 'ready to go').

After a w/e away - lots of exercise (1hr 15 mins walk each morn + swimming) have had 3 nights back home sleeping like a log on the Bipap Auto SV - so much so that I was not getting up early to do my morning walk although I did so eavery day for the prior 2 weeks. I was sure speeding risetime on the Bipap AutoSV would help. but after 3 nights & just sleeping 'too' heavily (like a log) - I dragged out the 'big guns' and swapped to the Vpap Adapt SV & sure enough felt like I had light sleep but got up at 5:30 & resumed exercise.

It is an odd thing to be able to say that I love the deep & seemingly restful sleep from the Bipap AutoSV & don't always enjoy the 'light & restless' sleep from the Vpap Adapt SV, but I nearly always get up early with the Vpap Adapt SV & usually have a good day (unless I had bad leaks). So, in effect I prefer the Bipap AutoSV, but seem to at particular times, lose the beneficial effect & need to switch to the Vpap Adapt SV, which I don't enjoy as much, to get back on track, then after a few days go back to the preferred Bipap Auto SV. Seems odd but it seems to work.

It seems to me that there is some dividing line between
> deep & seemingly restful sleep that then turns into wanting to sleep in the middle of the day versus
> light & restless sleep but feeling ok during the subsequent day

I just can't seem to come up with a predictable reason why this happens. I have heard many others make similar comments. I have been wondering if this phenomenon is CO2 related but not being able to make predictive changes means there is nothing clear to go by.

Anyway, how has your sleep been since you changed risetime to be faster ?

DSM

Hey DSM,

If you were to choose between the Respironics BiPAP Auto Sv or ResMed Adapt SV, which machine would you ask your wife to make sure you were on if you were facing long-term dementia or end-of-life?

Banned

Banned wrote:Hey DSM,

If you were to choose between the Respironics BiPAP Auto Sv or ResMed Adapt SV, which machine would you ask your wife to make sure you were on if you were facing long-term dementia or end-of-life?

Banned

Banned,

The only way I am going to be able to answer that is to use the Vpap Adapt SV for the same period as the Bipap Auto SV (9 months) and compare the consistency of daily wakefulness esp after 9 months of use.

That is a long haul way to figure out if there is a difference-in-machine effect coming into play here or a useage-over-time effect. I have in the past wondered if some of us get used to a particular machine & over time see it lose its effectiveness.

This happened with CPAP (aaprox 3 months), it happened with Auto (just a short time longer), it happened with bilevel (but after approx 9 months), now am seeing it with the Bipap Auto SV (after approx 9 mths).

The thing about it is I like the Bipap Auto SV, I feel comfortable with it, I feel I sleep well with it BUT, at about the 7 month period of use noticed the odd daytime drowsiness but just brushed those off as irrelevant odd days. The way to describe the days times when this effect happens is feeling 'leaden' or 'sluggish' - no energy - would prefer to be napping.

But change the machine to the Vpap Adapt SV, & feel like I have a not as good nights sleep, but wake up feeling fine, get up early, no 'heaviness', no 'sluggishness'.

There is the possibility that changing machines triggers some reaction. This all began when I went away last weekend & switched to my travel machine (Resmed Vantage set with EPR=3). Was feeling sluggish on both the sat & sun but persevered. Came back Sunday reverted to the trusty Bipap Auto SV & have had 2 more days in a row with a great night's sleep but not wanting to get up & exercise & feeling sluggish & heavy (plus napping) in the day. That then triggers concern as to what has gone wrong.

I sort of expect that after getting back on track with the Vpap Adapt SV, when I revert back to the Bipap Auto SV all will be well again until something triggers another bout of daytime sleepiness & I drag out the Vpap Adapt SV to get back on the rails.

The good thing about this odd process is that I feel I have a way to sort it out. I would be very concerned if I didn't have a process for getting back on track. Just wish the predictability of the why, when & what was more granular & less broad brush.

DSM

#2

I guess my dilemma is
> I love using the Bipap Auto SV & like the deep sleep I associate with it
> I dislike using the Vpap Adapt SV due to feeling sleep is too shallow but it leaves me ok in the day
usually after about 3 days I get irritated with the Vpap Adapt SV & go back to the Bipap Auto SV.
I may just try to hang on with it a few nights longer.

D

#3
Come to think of it - the last bad bout with the Bipap Auto SV was triggered after a massive leak that took me days to get tamed - back then I switched to the Vpap Adapt SV for 3 days & then back to the Bipap Auto SV. If I think about the bad periods, something always triggered them & I can recall the actual night - another was when we went from winter to summer & in one night had an unseasonable change to hot weather that persisted, that was the 1st bad patch I can recall. Used the Vpap Adapt SV back then & after a night or so reverted to Bipap Auto SV. Danged if I can figure out why this might happen.

#4
I believe I can illustrate what I mean about the Bipap Auto SV data being excellent but being leaden & drowsy in that day.
http://www.internetage.ws/cpapdata/dsm- ... -vgood.pdf

The above chart was my most recent on the Bipapn Auto SV & may rate as one of the best nights I have ever recorded off it - but I fell asleep at work in the early afternoon & was feeling that heavy & sluggish feeling I mentioned.

The data just couldn't get mach better - so why would it produce a 'slow' day ?

James,

Hope all is going well - ?

DSM

dsm wrote: The thing about it is I like the Bipap Auto SV, I feel comfortable with it, I feel I sleep well with it BUT, at about the 7 month period of use noticed the odd daytime drowsiness but just brushed those off as irrelevant odd days. The way to describe the days times when this effect happens is feeling 'leaden' or 'sluggish' - no energy - would prefer to be napping.

But change the machine to the Vpap Adapt SV, & feel like I have a not as good nights sleep, but wake up feeling fine, get up early, no 'heaviness', no 'sluggishness'.

I sort of expect that after getting back on track with the Vpap Adapt SV, when I revert back to the Bipap Auto SV all will be well again until something triggers another bout of daytime sleepiness & I drag out the Vpap Adapt SV to get back on the rails.

The good thing about this odd process is that I feel I have a way to sort it out. I would be very concerned if I didn't have a process for getting back on track. Just wish the predictability of the why, when & what was more granular & less broad brush.

I guess my dilemma is
> I love using the Bipap Auto SV & like the deep sleep I associate with it
> I dislike using the Vpap Adapt SV due to feeling sleep is too shallow but it leaves me ok in the day
usually after about 3 days I get irritated with the Vpap Adapt SV & go back to the Bipap Auto SV.
I may just try to hang on with it a few nights longer.

DSM,

Then, suffice it to say, you return periodically to the ResMed Adapt SV to recover from the sometimes deleterious bouts of Respironics BiPAP Auto SV therapy?

Even though I admit to a feeling of sometimes sleeping lightly on the RedMed Adapt SV, I have never experienced a particularly poor following day.

Banned

Banned,

I tend to agree based on the short periods I have stuck with Vpap Adapt SV.

Last night I did an SpO2 reading to see if it appears different between the machines but it looks identical to what
I get off the Bipap Auto SV. On the night before last I felt as if I was 'arm wrestling' with the Vpap Adapt SV
during the night. By this I mean it seems to force me to breath a particular way & even if I feel I am trying to
work with it I feel it often seems to keep forcing me to follow some pattern.

I usually last 3 nights then go back. But last night was the best night on it yet but still woke at 3 am feeling awake
& felt that sleep was light until I got up ay 5:30 & went walking.

I plan to try to stay with it for as long as I can. Interestingly the data from it shows less pressure increases than
what I am used to on the Bipap Auto SV. That may not mean much at the moment but I did notice a difference in
that aspect.

DSM

Just loaded a few nights data from the Vpap Adapt SV. Here is the night before last where I commented about 'arm wrestling' with the machine.

http://www.internetage.ws/cpapdata/dsm- ... 1dec08.pdf

The 1st thing I see is the extraordinary Tidal Volume - all over the place !!!. But the MV looks ok ???. Respiratory rate is very steady (compared to other nights). Pressure support looks modest (compared to the Bipap Auto SV).

DSM

Continuing nights data will be here
http://www.internetage.ws/cpapdata/dsm-vpap-adaptsv/

dsm wrote: On the night before last I felt as if I was 'arm wrestling' with the Vpap Adapt SV
during the night. By this I mean it seems to force me to breath a particular way & even if I feel I am trying to
work with it I feel it often seems to keep forcing me to follow some pattern.

I had the same experience on occasion with the 'original' VPAP Adapt SV. I'm assuming the backup rate algorithm would sample breathing and try and keep very tight control on subsequent breathes.

One of the first things I noticed about the 'Enhanced' APAP Adapt SV was this phenomenon is no longer apparent. ReMed must have cleaned up the algorithm for the backup rate as it no longer "forces (you) to follow the same pattern" . Inspiration and Expiration is a very smooth saw-tooth wave and appears now, to allow for some variance of breathing.

However, the backup rate is still ready to backup a breath if you don't take it.

dsm wrote:Just loaded a few nights data from the Vpap Adapt SV. Here is the night before last where I commented about 'arm wrestling' with the machine.

http://www.internetage.ws/cpapdata/dsm- ... 1dec08.pdf

The 1st thing I see is the extraordinary Tidal Volume - all over the place !!!. But the MV looks ok ???. Respiratory rate is very steady (compared to other nights). Pressure support looks modest (compared to the Bipap Auto SV).

I also see occasional nights with wild Tidal Volume swings such as yours on the 'Enhanced' Adapt SV, also with a steady respiratory rate. But no more 'arm wrestling' with the 'Enhanced' machine.

Banned

Banned,

Thanks for that info - helps enormously when observations are backed up by others very similar experiences.

DSM

(now to go sweet talk Resmed for a free upgrade - perhaps if I volunteer as a regular guinea pig )

PS (I know, the old unit is not upgradeable according to all reports)

#2

Hmmmm, anyone want a cheap Vpap Adapt SV - only 67 hrs - ex demo model - looks genuine & a real bargain (but it is the original model - else I'd have snagged it )
http://www.cpapauction.com/auction-list ... ifier.html

dsm wrote:James,
Hope all is going well - ?

Sorry for the slow response. I made a quick trip to Ohio to get setup for nasal surgery in January (Not willing to wait here in Canada until July) http://www.clevelandnasalsinus.com/

I've been finding a bit of a problem using the SV in that I find I don't sleep as deeply on it as I did on the Auto (even though I feel better apnea wise) After about 4 or 5 days I find I have to switch to BiPAP mode for a night or two or I get very tired out. Kinda sounds similar to your problem on the Adapt SV?

jskinner wrote:

dsm wrote:James,
Hope all is going well - ?

Sorry for the slow response. I made a quick trip to Ohio to get setup for nasal surgery in January (Not willing to wait here in Canada until July) http://www.clevelandnasalsinus.com/

I've been finding a bit of a problem using the SV in that I find I don't sleep as deeply on it as I did on the Auto (even though I feel better apnea wise) After about 4 or 5 days I find I have to switch to BiPAP mode for a night or two or I get very tired out. Kinda sounds similar to your problem on the Adapt SV?

James,

I have been finding that on my Bipap Auto SV, I get into tired bouts but usually it seems after something has happened such as a change in the weather, going away for a weekend & using my S8 Vantage etc:

I am now on the Vpap Adapt SV & have survived a week on it & will stay on it and gather its data. I haven't had the tired bouts on it - yet - so am going to hang in with it. It takes more getting used to than the Bipap Auto SV.

On the Bipap Auto SV I really enjoy the long deep sleeps but, then I get those periods of tiredness & often when I am getting the best data from the Bipap Auto SV - that is what confounds me about using it.

In many respects, there is not a really big difference between the two machines but that difference does appear to make a difference. The Vpap Adapt SV tracks peak volume & sustains a tight bpm rate around 15. The Bipap Auto SV tracks av peak flow & is more flexible on letting bpm rate meander a bit.

If I take a stab at what might be having some effect for me it is the Vpap Adapt SV tracking to 15 bpm. Maybe I can set 15 bpm on the Bipap Auto SV & see if that makes a difference. I can't believe the av peak flow vs peak volume is going to cause the issues I am seeing.

DSM