CPAPtalk.com

-SWS wrote:
<snip>

Because if I was a newcomer contemplating ASV pressure experiments, and I read banned's implied advice, I'd probably assume that highly-experienced banned just gave me the ASV-experimentation "go ahead" based on low risk assessment. And when highly-experience dsm lends credence to banned's ASV risk assessment, I'd assume that dsm has also garnered numerically sufficient ASV outcomes to endorse that implied low-risk assessment of banned's.

Again, not to offend either of you two. Risk assessment is always a worthy topic of discussion---and especially among the scant few ASV users we have.

<snip>

SWS
I am always very mindful of the reality that in these early days of growing ASV use, that the early adopters are more than likely special cases. It is essential to refer people to their RTs. If someone comes here & asks for suggestions in how they might vary the adjustments it makes sense to try to determine if they understand wht they are doing. I also tend to think that we have a lot of very smart people who come to cpaptalk & am certain the majority wouldn`t like being treated as dummies. But, caution is the safe approach in providing advice.

With Banned`s quip about the current machine hitting a brickwall, I laughed to myself as it was sooo Banned a remark. I personally believe I can set up a Bipap Auto to almost mimic a Vpap Adapt SV except for the speed of response. But the Bipap AutoSV has so many parameters one can play with which gives it a broad range of target users. I like both machines for different reasons. I do enjoy Banned`s lack of political correctness

DSM

dsm wrote:



Banned it is very expensive but also has a fantastic software program that provides what looks like the best data I have ever seen that can come off cpap.

The humidifier is essential as well.

The challenge will be finding where to buy it. A company here in Aust who are Weinmann agents offered to import one for me but there wasn`t ny way I could justify the price.

It doesn't look like this product is FDA approved for use in America.
Give me the short version of how you think EEPA, EPAP, and IPAP works on the Weinmann.
I don't use a humidifier. Does the Weinmann not work without a humidifier?
What is the US dollar equivalent price for what you were quoted?

Banned

Banned

I`ll email you a detailed document on how the SOMNOvent CR works. Plus, will do a summary of the key points. I`ll
add cost details but am not able to do this for a couple of days (holidaying)

DSM

Just for Banned...





ROAD TRIP!!!!

-SWS wrote:
ROAD TRIP!!!!

CPAP SALVATION SHOW!!!!

Where's Moe?

DSM and others have touted the many settings possible on the BiPapAutoSV. I would find it instructive (and believe many others would too) if someone could provide a list of those possible setting parameters and what each of those setting parameters is designed to accomplish through the machine.
Buffy - I chose not to walk in the rain this morning, but am still keeping the log current for you.

CROWPAT wrote:Buffy - I chose not to walk in the rain this morning...

I know what you mean!

Fluffy also has a

List of Weather-Related Phenomena That Necessitate Cancellation of Morning Routine

Untreated, road-covering glare ice (mostly because she don't want to F/U $22,000 worth of surgery);
Air-to-ground lightning (contrary to popular belief, it's not "ground-to-air");



...seems like there was one other thing...

Scruffy

CROWPAT wrote:DSM and others have touted the many settings possible on the BiPapAutoSV. I would find it instructive (and believe many others would too) if someone could provide a list of those possible setting parameters and what each of those setting parameters is designed to accomplish through the machine.

I'll start off by simply associating which setting parameters go with which SDB treatment objectives:

Respironics wrote:"BiPAP autoSV treats the obstructive component of SDB with a clinician adjustable CPAP or BiPAP pressure"

The EPAP and IPAP min settings are used for the above objective.

Respironics wrote:"BiPAP autoSV treats the central component of SDB with a timed backup rate (automatic or fixed)"

The BPM setting is used for the above objective. However, T(i) or inspiratory time is used in tandem with BPM when using a fixed backup rate.

Respironics wrote: "BiPAP autoSV treats the Periodic Breathing by: Normalizing ventilation by AUTOmatically adjusting Servo Ventilation (pressure support)"

The IPAP max setting is used as the upper limit for the above objective. The algorithm will then automatically fluctuate pressure support (via dynamic IPAP peak) between the IPAP max upper limit and the IPAP min lower limit.


DSM and others can comment and fill in yet more details. But I think the above settings are the most important based on the BiPAP autoSV's treatment objectives identified by Respironics. Hope that's a good albeit highly basic starting point as an answer to your question, CROWPAT.

CROWPAT wrote:I only eat dinner normally.

CROWPAT wrote:No evidence at all of GERD being a problem for me.

Based on your height, age, current weight and physical activity, your daily caloric expenditure is about 3200 calories:

Calorie Expenditure

or the equivalent of about 6 Big Macs (5 if you don't vigorously exercise)(but since you've been steadily gaining weight, it's probably 6). It may not be reasonable to consume that much food in a single sitting at night and then expect good quality sleep.

I would offer that those poor eating behaviors (too much food, all at one time, prior to bedtime) are not only a major cause of your overall feeling of well-being (or lack thereof) but a likely cause of sleep disruption as well.

Although you may not have noticeable signs of GERD, GERD can still be there but be "silent".

I would therefore suggest that you also start maintaining a food log and take my suggestion of 4 small meals per day.

Muffy

Silent GERD

http://www.medscape.com/viewarticle/516189

http://www.sciencedaily.com/releases/20 ... 080008.htm

___________________

Silent gastroesophageal reflux disease

Excerpt:
Silent gastroesophageal reflux disease (GERD) is a very common phenomenon that involves the incidental finding of erosive esophagitis, Barrett's esophagus, and the evolution of esophageal adenocarcinoma in asymptomatic patients. The reasons for having advanced GERD without clearly identifiable symptoms are poorly understood, primarily due to lack of recognition of this important phenomenon. The clinical implications of silent GERD are vast and should provide the impetus for further research into this group of patients. Recent studies have suggested that sleep disturbances and poor quality of sleep could be the needed clues to identify individuals with silent GERD.

_______________

http://www.sciencedaily.com/releases/20 ... 080008.htm

"These are patients without significant heartburn symptoms, who are experiencing acid reflux during sleep," explained William C. Orr, Ph.D. of Lynn Health Science Institute in Oklahoma City, OK. "'Silent reflux' may be the cause of sleep disturbances in patients with unexplained sleep disorders."

"All patients with sleep apnea should be evaluated for gastroesophageal reflux," said J. Barry O'Connor, M.D., of Duke University Medical Center, one of the investigators.

Short Story

Overeating. Overeating can trigger heartburn. That’s because the stomach remains distended when there are large quantities of food in it. There is a muscle located between your esophagus and your stomach. Your esophagus is a tube that lets food pass from your mouth to your stomach, and the muscle between it and your stomach is called the lower esophageal sphincter or LES. The more your stomach stays distended, the more likely the LES won't close properly. When it doesn’t close, It can’t prevent food and stomach juices from rising back up into the esophagus.

Eating habits. Eating too rapidly can be a heartburn trigger. So can eating while lying down or eating too close to bedtime. It helps to not eat during the two or three hours before you go to bed.

Long Story

All The Things That Happen Down There

In addition, the increased gastric basal pressure and frequent overeating may increase the incidence of TLESRs, one of the most important LES mechanisms for reflux.

But

The increased gastric capacity in obese patients can be an etiologic factor in the development of obesity or simply a result of an adaptive response to overeating.

So the Good News, Bad News is

We believe that patients with obesity have accelerated gastric emptying, and there has been some evidence suggesting that enhanced gastric emptying is related to overeating and obesity.

Muffy

-SWS wrote:

Muffy wrote:Here's a challenge for -SWS. In that pile of data you have accumulated, find ANYTHING that says a pressure < 10cmH2O is DEFINITELY ineffective.

You mean that well-known statistical 10cmH2O threshold in epidemiology? That very same 10cmH2O threshold beyond which significant numbers of SDB patients begin to manifest central problems?

That same well-known 10cmH2O statistical threshold beyond which unnecessarily pressure-aggressive titrations can actually create more SDB problems than solve?

CROWPAT, I bet I threw that word "statistical" in there just enough times to pique your interest in Muffy's possibility of a pressure-aggressive titration being a plausible explanation for some of your sleep issues. Muffy, I'll go back and see if I can find a shred of evidence contrary to that hypothesis.

Muffy, I see nothing in CROWPAT's sleep study reports that say: "a pressure < 10cmH2O is DEFINITELY ineffective."

I see the following clinical sequence that lead CROWPAT's doctors to a reasonable assumption that BiPAP autoSV should be tried:

1) an initial PSG that failed to yield adequate sleep and PSG data, followed by
2) a series of portable-equipment home studies in an attempt to acquire best pressure for what was initially assumed obstructive apnea, followed by
3) more in-lab PSG work that eventually resulted in a BiPAP autoSV titration to address SDB having presented obstructive and central components.

I personally didn't view the doctors' steps and assumptions along the way to be unreasonable in any way. And I was actually impressed by their willingness to accommodate CROWPAT, who I suspect to be yet another challenging patient/physiology to titrate. But I agree with Muffy that a careful PSG examination of fixed-pressure under 10cmH2O was never performed for what I think are understandable circumstances.

CROWPAT, thoroughly exploring your physiologic response to fixed pressures below 10cmH2O might turn out to be VERY worthwhile. But I think that one has to be performed during an attended multichannel PSG instead of an unattended home experiment. Unfortunately, we don't know how much physiological or cardiovascular stress you might incur between your latest 11 cmH2O results and say 7cmH2O: http://www.afsashoot.com/Images/111111day1.JPG

What do you think of me trying 10/10/20/Auto to try the 10 pressure but still let the machine go on up if it needs to?

CROWPAT wrote:What do you think of me trying 10/10/20/Auto to try the 10 pressure but still let the machine go on up if it needs to?

I'm good with that.

Larry

-SWS wrote:... viewtopic.php?f=1&t=46945&p=427430&#p427430
And while John mentioned that his PSG team did not spot any CompSAS events during his sleep study, there seem to be some disease-unique pathogenic factors that still manage to bring John to some pathophysiological commonality with CompSAS/CSDB. ...

There was one mixed apnea. But the factor that seems to be the biggest issue is the central apneas (waking and sleeping). I asked my sleep specialist why an ASV unit instead of the S/T unit. He indicated he felt (based on testing and the constellation of symptoms) my problem was more a problem of dysregulation of my breathing and sleep than it was one of just the central apneas. I often experience shallower and shallower breathing until it leads to a full apnea. It is not just a sudden and full central apnea. So, he feared (and appears to have been correct) that the timed response of an S/T unit would only address one half of my problem. I needed both the servo ventilation as well as the timed response. Thus, an ASV unit was his primary choice after the BiPAP titration study clearly demonstrated problems with central apneas and sleep onset issues.

He also prescribed ropinirole (Requip) to tackle the Restless Legs Syndrome. Additionally, he prescribed Lunesta to help me adjust to use of the ASV unit. [ Ambien does nothing for me. Sonata wears off too quickly (within two hours). Lunesta lasts longer, but costs much more. ] Fortunately falling asleep with the ASV unit is less of a problem than either of us expected.