BIPAP AUTO-SV SETTINGS HELP

CROWPAT wrote:Thanks for continuing to work with me. I tried both 13/13/13 and 14/14/14 last week with no measurable differences but only for s single night of each per Banned recommendation to try them. Will go with 13/13/13 for several nights to more data and get back to this thread.

Okay, good. If 13 cmH2O is not too disruptive then collect a few nights. We're going to focus on your subjective assessment of sleep and daytime symptoms at least as much as AHI and flow volumes. PB is very important as well.


As long as sleep and respiration stay reasonable, here is rationale for exploring a lower fixed pressure (emphasis mine in red):

[u]Recognition and Management of Complex Sleep-Disordered Breathing-[/u] by Geoffrey S Gilmartin; Robert W Daly; Robert J Thomas wrote: Avoiding Pressure Toxicity
Patients with complex disease are sensitive to positive airway pressure, and usually flow limitation cannot be eliminated without worsening periodic breathing or inducing central apneas. An immediate worsening with bilevel ventilation may be seen, consistent with an effect of induced hypocapnia on the peripheral chemoreceptors. One approach is 'permissive flow limitation' - allowing some obstruction to persist and thus avoiding the worsening of control dysfunction.

While collecting empirical data at any given point, you'll always have your subjective assessment "feelers" engaged for that unlikely "Eureka, that symptomatically feels much better by day or night" moment. This preliminary empirical data might help us establish a better base pressure or modality for your upcoming ASV experiments (assuming your doctor is still okay with those).

CROWPAT

I fully endorse SWS's suggestion re the fixed pressure and 13 is a good start. But, am inclined to believe that it will only be helpful in providing baseline statistics. I personally doubt that cpap alone will show improvement in your case.

I also believe you will see a significant difference in what the baseline works out to be if you set your self a target to reach 220 lbs in the next 6 months. I am sure that maintaining the exercise and achieving that weight loss are an important need to improving your sleep.

My instincts are that excess weight plus what I understand is that early morning (early sleep hours) decline in respiration are where the problem is. The early morning decline in respiration is (my guess) the basis of the daytime tiredness. Just how to fix it is probably going to come out of the suggested experiments from SWS. Naturally, seeing the charts off the machine will help greatly.

DSM

Pat

Do you feel you have what you want by way of steps to trial on your Bipap AutoSV ?

If not we could list the suggestions SWS has put forward & one of the best was working with your doctor on any trials.

Cheers

DSM

I used 13/13/13 last night and will do so for 2-3 more nights before changing anything more. Then, I will gathere data for 12 and 14 for the same number of nights. Last, I will post results for all to see and offer further recommendations.
Am I on target?

CROWPAT wrote:I used 13/13/13 last night and will do so for 2-3 more nights before changing anything more. Then, I will gathere data for 12 and 14 for the same number of nights. Last, I will post results for all to see and offer further recommendations.
Am I on target?

I would say so.

DSM

CROWPAT wrote:I used 13/13/13 last night and will do so for 2-3 more nights before changing anything more. Then, I will gathere data for 12 and 14 for the same number of nights. Last, I will post results for all to see and offer further recommendations.
Am I on target?

The fixed pressures sound right to me, CROWPAT.

After Bev's unwieldy ASV thread I decided never again to vie with avid online titration committees. And I think that approach has yielded more efficient ASV threads. So go ahead and put your graphs up for group suggestions. I'll primarily read along unless I think the group is lacking ideas or something is potentially dangerous... Good luck!

SWS

I am happy to step back having offered my thoughts re weight loss program. I agree the committee approach to tests & adjustments leads to confusion. In the past you have done an excellent job in suggesting adjustments on the SV machines to various users so pls do handle as you see it.

DSM

Well, I'm actually perfectly good with CROWPAT's suggestion for group input. In that respect, I'm a quintessential Jungian INTJ type. I don't have a burning desire to run any show unless there's an absolute need.

I think group input as CROWPAT suggested should work just fine... So everybody let's get those sleeves rolled up.

There is no question that my weight loss would be good for me, but I do not expect it to affect the settings much if at all. I had the same tiredness problems 30 or more pounds ago. Last night I had 15 PB events at 13/13/13. That is WAY high for me. AHI was 2 which is about normal, and patient triggered breaths were 100% (a bit higher than normal). Leak rate was almost straight lined at 40.2 with Large Quattro.

If SWS now has the lead that is who I will be looking to for advice.

CROWPAT wrote:There is no question that my weight loss would be good for me, but I do not expect it to affect the settings much if at all. I had the same tiredness problems 30 or more pounds ago. Last night I had 15 PB events at 13/13/13. That is WAY high for me. AHI was 2 which is about normal, and patient triggered breaths were 100% (a bit higher than normal). Leak rate was almost straight lined at 40.2 with Large Quattro.

If SWS now has the lead that is who I will be looking to for advice.

One bit of info that will put to rest one idea I had, pls see when in the night the PB events typically occur ?
If at any time then my 'early morning being a key factor' may need to be rethought.

Tks

DSM

I think the rethink is in order. In the last eight days there have been 0 in the first or last hour of sleep. I can look farther back if you want me to. Prior to starting this excercise, PB events averaged less than .25% per night for months of data. The few I had generally occured during hours 4 to 7 of sleep. Last night was an anomaly with one about 1/2 hour before waking and most occuring between 6 and 7 1/2 hours of sleep. I am not aware of any of them ever and sleep with the mask 100% of the night every night for 8-9 hours of sleep.

CROWPAT wrote:In the last eight days there have been 0 in the first or last hour of sleep.

That was one of the patterns I had looked for as well. Seemingly your PB is unrelated to sleep/wake transitions. My own philosophy is to at least attempt to suspend intermediate conclusions regarding either etiology or phenotype.

Thus the basis for wanting to cautiously explore pressure treatment/response patterns via more extensive CPAP, BiLevel, and SV parameter variation type tests... searching for efficacious patterns.


Thoughts anyone? Everyone?

-SWS wrote:Thoughts anyone? Everyone?

VPAP Adapt SV. It doesn't even record PB. But, machine switch maybe off-topic. Apologies to all, in advance.

Banned

Sir Banned- that sounds like a reasonable suggestion to me. People who have tried both SV machines sometimes claim very different results.

If I had one lying around, that's what I would try next if I were CROWPAT. If I had to purcha$e or rent one, then I'd be inclined to finish exploring the current machine before plunking any ca$h down.

So how does your subjective feel of those two machines compare, Banned? Similar to what dsm has described regarding a more tightly controlled feeling from the Resmed ASV algorithm?

-SWS wrote:So how does your subjective feel or comparison of those two machines compare, Banned? Similar to what dsm has described regarding a more tightly controlled feeling from the Resmed ASV algorithm?

It may or may not be significant that ResMed does not consider it relevant to score PB with the VPAP Adapt SV. I do not personnally know the rational for not scoring PB on the ResMed device.

It may or may not be significant that the two individuals on the board who own (and use) both SV machines prefer the therapy provided by the VPAP Adapt SV.

In a very subjective sense, the VPAP Adapt SV 'feels' more comfortable than the Auto. It gives what I characterize as a more natural breathe. No concern for Rise Time. No inadvertent EPAP/IPAP switching. Unlike the BiPAP Auto SV, the VPAP Adapt SV allows for .1 incremental steps when adjusting EEP (EPAP) and PS Min (IPAP Min). You can feel the difference between those .1 incremental steps in PS.

I got the BiPAP Auto SV because it could score PB. The BiPAP Auto SV consistently records slightly higher Tidal Volumes than the VPAP Adapt SV in all cases.

However, I have relegated the BiPAP Auto SV as my travel machine. I prefer that it has a slightly smaller and lighter profile than the ResMed Adapt SV (tethered to aircraft AC and in hotel rooms). The long length of the cord (with Power Brick) on the BiPAP Auto SV does not require carrying an additional extension cord.

I'm sure dsm has more to say about the comparison of both SV devices.

Banned