Whoa! Wrong kind of VPAP? Confused.

I waited 2 weeks for this VPAP to arrive, (after a 6 week wait for the doctor appt) and the DME tells me this is the wrong kind of machine for me? If they're right, then the doctor got it wrong... there will be hell to pay...

If anyone can please advise me on this, I'd be very grateful.

The doctor was aware that I need 17cm of fixed pressure to treat my obstructive events. I have complex sleep apnea, meaning there is a certain level of centrals happening while on CPAP.

He prescribed a VPAP Adapt SV to treat both. Only, I find out today that the darn thing has a maximum pressure of 15cm? And they set it to run from 3cm to 15cm? I said I'll suffocate on 3cm - I gasp for air with 10cm! How is this machine going to maintain the control I have over my obstructive events, while treating my centrals?

Do I need a VPAP ST? Will that enable me to treat both?

This is SO frustrating. I have been struggling on CPAP for 8 months with little improvement. And shunted from pillar to post by sleep doctors and sleep techs. Help!!

Oh, I really think you need this machine!
Especially If your having Centrals, go to cpap.com & click on the machine you have & read up on it.
They might be trying to say you need a ST instead of a SV!!!
Goodluck...

For my 0.2c worth. I am not sure that ST machines (a Bilevel with Spontaneous + Timed modes) are
considered the optimal therapy for complex apnea. Am sure they can handle it, but SV machines appear
to be the better option as they have extra features.

The Vpap Auto SV is one option as is the Bipap AutoSV.

But without doubt if your epap requirement is 17 cms, I'd be thinking a Bipap AutoSV might be the 1st
machine I'd try. That is because it is highly tunable (can be made to run like an ST or an SV). The Vpap
Adapt SV would be my 1st choice if someone had Irregular Breathing vs having Complex Apnea. By
Irregular Breathing I am meaning distinct patterns of waxing & waning volume & rate that occur within
the tracking/averaging window (3 mins on a Vpap AutoSV).

Am sure some of our other experienced regulars can add more thinking on this.

DSM

dsm wrote: But without doubt if your epap requirement is 17 cms, I'd be thinking a Bipap AutoSV might be the 1st
machine I'd try. That is because it is highly tunable (can be made to run like an ST or an SV). The Vpap
Adapt SV would be my 1st choice if someone had Irregular Breathing vs having Complex Apnea. By
Irregular Breathing I am meaning distinct patterns of waxing & waning volume & rate that occur within
the tracking/averaging window (3 mins on a Vpap AutoSV).

Thanks dsm, I appreciate that advice. Are you referring to the Respironics Bipap AutoSV that goes to 30cm? I don't have Irregular Breathing - have had 5 sleep studies - the 4 that were able to find complex sleep apnea found it. Centrals throughout the night but also clustered at sleep onset.

I've decided to hold off using the VPAP for at least one night. I can't afford a 3rd bad night's sleep in a row (I have a cold and am under a lot of stress right now). I really need all the urgent advice I can get. I don't even know how to switch it on. And I'm worried about having inadequate pressure to breathe while awake. All they keep saying is that it's totally different to CPAP and don't change the settings!

Bump. Can anyone help?

The VPAP adapt SV shoots the pressure up in bursts when necessary -- the max. of 15 is only the highest it can be set at - but it bursts up higher from there.

Your DME is less knowledgeable than you doc in this case.
From Resmed titration protocol for VPAP Adapt SV

Note: For lab titration, start at default settings
ASV Mode default settings:
• EEP = 5 cm H2O (EEP = EPAP)
• Minimum Pressure Support (Min PS) = 3 cm H2O
• Maximum Pressure Support (Max PS) = 15 cm H2O

EEP• EEP = EPAP
• Increase to treat obstructive events
Minimum Pressure Support (Min PS)
• The minimum amount of pressure support
delivered to the patient until ventilation drops
below the target ventilation
Maximum Pressure Support (Max PS)
• The maximum pressure support that may be
delivered to the patient. The highest pressure
the device will deliver = 25 cm H2O
Pressure Support (PS)
• Difference between inspiratory and
expiratory pressure
Example: Inspiratory pressure = 12 cm H2O,
EEP = 5 cm H2O, PS = 7 cm H2O

All added emphasis mine.

Your DME apparently doesn't know how to set the machine -- and your doc should have had you titrated on it. The default setting is not the only setting the machine can be used at.

http://www.vpapadaptsv.com/product.html

PS is not the equivalent of IPAP. It is the pressure added on top of your EEP (EPAP - exhale pressure).

The VPAP Adapt SV will automatically limit to ensure that:
- MAX PS minus MIN PS is greater than or equal to 5 at all times
- EEP + MAX PS will not exceed 25 cm H2O
To satisfy these limits:
1. Setting EEP automatically adjusts MIN PS then MAX PS
2. Setting MIN PS automatically adjusts MAX PS

With an EEP of 10 and a PS Max of 15, you can get to a pressure of 25 -- if the machines thinks its necessary.
O.

I know that in another thread ( viewtopic/t44351/viewtopic.php?f=1&t=44 ... 47#p394628 ) you said:

. . . if I can get away without a titration study I'd like to. . . .

But I agree with ozij. If it was me, I'd want a titration.

Ozij & JNK are dead right. You really need to be titrated on the Vpap Adapt SV if that is what the doc insists on.

If you need 17 CMs to control your OSA that is one big lot of base pressure. The implication is your EEP or Epap setting needs to be 17 CMs or close. I don't think a Vpap Adapt SV can have EEP set that high which is why I made my comment that a Bipap Auto SV might be my 1st choice. The Bipap Auto SV can have Epap set that high if that is what the titration says is needed.

The Ipap or Pressure Support, is an added pressure the machine goes to on inhale. That is typically 3+ CMs above epap.

There are too many unknowns about that 17 CMs number you gave us, if that was a standard CPAP titration it means one thing but if they did a Bilevel titration it would mean another.

It is a great worry that you were handed the machine set up the way it was.

DSM

I know, it is a great worry, and I thank you all so much for your information and advice.

Having a titration is not a matter of preference for me - it would cost approx/est NZ$1450 at my local sleep clinic, who are the people who set up this machine. (With the exchange rate I think that equates to about US$2800 (without actually going to work it out). Now, based on the 8 months that I've been dealing with them and the crappy split night study I had in the first place, I don't trust them to do it right.

The nearest sleep clinic that I would trust is a one hour flight away. That's ok, I can do that (hey at least I save the hotel bill). But there's the cost of the study, and the lost earnings. And I still have to somehow find thousands of dollars to buy the VPAP. No insurance policy covers equipment here. I would love nothing more than a full, competent VPAP titration study. But if I can get away with achieving something at home with frequent data analysis over the next month, that would be best for me. NZ is not as strict with laws on this - you do need a specialist prescription to get a VPAP machine, but there is no restriction on selling any xPAP machine, and you can get an Autoset or CPAP without any prescription at all. 96% of New Zealanders with sleep apnea have not had any kind of sleep study. The number of accredited sleep specialists is not in the double figures. They probably all know of me by now That's fine. I want to sleep properly and save my life. I don't care who I annoy. They have annoyed me... and that is one hell of an understatement.

Note I am taking care not to identify them. I don't believe in being sued if I can possibly help it.

Back to the VPAP... I did call my blessed 3rd sleep doctor and he explained the VPAP settings and I was greatly reassured. Poor man had to explain it several times and was so patient with me. All this STRESS could have been avoided if the DME sleep tech explained it properly instead of scaring the bejesus out of me.

First off, (partly to reassure me) he said that people often don't need as high a baseline pressure on VPAP. Then as I understand it, I found out that my VPAP is set to 10cm PLUS 3cm which = 13cm. Not so bad, I thought it was set to 3cm like an Autoset. No wonder I had visions of suffocation. Now, once it detects a coming event, it should go higher to prevent it, up to 25cm if necessary. The relief in my mind was palpable. Look, if I'm slightly wrong on this, bear with me... at least I am willing to use the machine tonight, unlike last night.

He stressed that there are no guarantees it will work for me, and I accept that, I always have. I have always said I need to try it, and then see the data. So, as I have done so many times before, I am about to start another night with high hopes and low expectations, quietly confident that having tried so many things before, maybe this time this will work.

As soon as I have some data I will present it. If I need to tweak things, I am quite prepared to. I've checked the LCD menu and the memory has been cleared (it's had some hours of use). So, godwilling, I will have some data from that in the morning. I am not buying a cable and software just yet, and will take the machine to the DME for download. I plan to bring the files home... as pdfs i guess, or hard copy if nothing else. They've been co-operative in the past and emailed files to me from other downloads. They still can't see how VPAP will help me, given my high pressure need... so, aside from getting well, being able to prove them wrong is something I really hope I can do!

BlueSky72

Tēnā koe! - Kia Ora !

That lil GGson in my sig was born 4 months ago in Wanganui his mum born in Akl. I was over there last month from Sydney to see him.
They must be feeding him grow-plus & steroids

Where are you located ?

The Vpap Adapt SV is a great machine & from your updated desc the doc does seem to know what he wants & that is good. The settings are pretty close to what I run on mine. (I was using 10 + 3 for the past year, just tried a few variations recently).

I am sure you will be happy with it as the pressure it can deliver is more than most people need but it only raises the pressure if really needed such as to keep your tracked volume on target.

Do you have a PC with a serial port that takes a 9-pin serial plug ? - if yes then there are some things we can do to get some real data off your machine. The Vpap Adapt SV sells here in Oz for RRP 2,990 $AUD but typically can be got for about $2,500 (which is close to $3,000 NZ).

e noho rā

DSM

NZ is not as austere with laws on this - you do charge a specialist decree to get a VPAP machine, but there is no brake on affairs any xPAP machine, and you can get an Autoset or CPAP after any decree at all. 96% of New Zealanders with beddy-bye apnea accept not had any affectionate of beddy-bye study.



________________
Dental insurance plans

dsm wrote:BlueSky72

Tēnā koe! - Kia Ora !

That lil GGson in my sig was born 4 months ago in Wanganui his mum born in Akl. I was over there last month from Sydney to see him.
They must be feeding him grow-plus & steroids

Where are you located ?

The Vpap Adapt SV is a great machine & from your updated desc the doc does seem to know what he wants & that is good. The settings are pretty close to what I run on mine. (I was using 10 + 3 for the past year, just tried a few variations recently).

I am sure you will be happy with it as the pressure it can deliver is more than most people need but it only raises the pressure if really needed such as to keep your tracked volume on target.

Do you have a PC with a serial port that takes a 9-pin serial plug ? - if yes then there are some things we can do to get some real data off your machine. The Vpap Adapt SV sells here in Oz for RRP 2,990 $AUD but typically can be got for about $2,500 (which is close to $3,000 NZ).

e noho rā

DSM

Aww, DSM, you not only know how to greet me in Maori, but you know how to use macrons to boot! Awesome. (I have yet to master macrons, but I'll get there).

Your GGson is so cute. It would be great to catch up next time you're here. I'm a little reluctant to say where I am, as that is about the same as naming the health professionals that I have a grievance against. But if anyone is in NZ and needs to know who to avoid, I am happy to talk privately - I don't think I can be sued for that. We have strange laws here - if a midwife neglects to adequately monitor fetal distress and the baby dies, her name does not get released to the public, even after conviction. Many of us are opposed to this law.

I'm prepared to buy a PC with a 9-pin serial port - would be worth the cost to get the data with the frequency and control I want. Thank you so much. I've seen this model of VPAP at cpapaustralia.com for AU$3995 I think... sounds like Aus is the way to go for me. I have a friend in Queensland who could help with logistics if needed. I use a humidifier too, so that's an added cost to count in.

I am one of the first kiwis to use a VPAP Adapt SV for Complex SA (based on my sleep dr's handful of patients on it, and him being one of a handful of sleep drs).

Ok, now for the first night's result! AHI 3.4 with 5 hours use. Now, for less than 5 hours sleep, I feel better than if I'd had 8 hours with an AHI of 7.0. And my chest doesn't hurt, I have no burping, and my mouth is not dry. Average pressure was 11.4 - I know an average is meaningless with ASV. I will be curious to see if we hit 25 at any point. I used hardly any water from the humidifier. I feel strangely alert, like I normally do after a good 4-5 hours of being awake. This is much better than I expected to feel this soon. Fingers crossed for tonight. My goal of AHI <1.0 feels achievable with tweaking.

It took a bit of getting used to - the pulsating nature of the airflow - but I was tired enough to sleep after about an hour of it. I'm sure tonight will be quicker.

I am feeling hopeful, and grateful.

BlueSky72

You have got off to a great start. The Vpap Adapt SV is intolerant of leaks & the way it drives its pressure tends to exploit any weakness in the mask seals. I use a F/F mask and *must* wash it every day to keep the seals grease free. Leave that cleaning for a couple of nights & the mask is likely to burp all night.

I would be surprised if your machine ever gets to 25 CMs but mine will go to 18-20 about 6 times a night.

Now for the guessing game. If in the Nth Is what is the nearest volcano to where you live. Else, if in Sth Is what is the nearest lake - Just name one or the other & I will be pretty sure where you are

By the way, if at the bottom of the Sth Is, any nightly rumbles may not be from your tummy

Cheers

DSM

But let me guess a Volcano => Ruapehu