Question for the ASV people here…

I downloaded data from first night with adapt. Is there a reason the FL graph no longer shows up?

Bright Choice wrote:

JohnBFisher wrote:A mask liner helps a LOT with the Quattro FX and an ASV machine. Most masks work fine as long as the pressure range remains fairly constant. That's something the ASV does NOT do. The wild swings in pressure cause the mask to leak, which wakes me up. The mask liner helps the mask work better (at least in my case).

Pad-A-Cheek and REMzzzs both make mask liners.

Thanks! I had forgotten that I have a padacheekfor the Q FX. I will use it tonight.

Any idea what causes the "bursts"? My mouth was closed, no leaks, I was very conscious about keeping my tongue in place to seal the back of my throat but these burps of air kept me from sleeping soundly.

Those burst of air in the mouth are your mouth trying to open. That's why I wear a FFM now. It doesn't matter if it does open with the FFM, but since I've been wearing it I haven't awakened once with a dry mouth so I guess I'm doing better with the ASV than I was on CPAP and Bipap. I had those "burst" of air with both of those. Now the burst of air comes from the ASV machine and not me.

Good luck with the new machine. I'm still waking up 2 to 5 times a night on this thing, but I feel more rested in the morning than I was feeling before.

Going back to NM on the 23rd for my next study.


JeffH

ignorant1 wrote:Mr. Bill: Interesting information. Indeed, most primary central apneas are a hypocapnic issue, but in my case the centrals are iatrogenic, i.e., induced due to pressure intolerance on xPAP. The new Resmed S9 based ASV unit does not have a rise-time adjustment in any of the clinical menus. I’ve looked at everything to see if it’s buried in there, but to no avail.

JohnB: Being a longtime hosehead, I’ve already adapted very well to the ASV rhythm; and indeed the machine will adapt to provide a slower respiration rate while asleep. During the first two nights, there were times where I experimented with trying to manually control my breathing at a lower pace, but fighting against the machine was fruitless. I learned to just trust the machine and not try to regulate it. It really is just a matter of the machine wanting an immediate inhalation at the end of exhalation, with no pause in between. (as noted by Mr. Bill above.) You are correct in noting how flexible & adaptive our bodies can be, but I also think that it would hypothetically be best if the machine would emulate each persons natural rhythm more effectively. Maybe the next generation of software will do that? Who knows…

My RT called Respironics and the tech support person told her that the machine wants no less than 3 seconds between finishing the exhalation and beginning an inhalation. We pausers really mess up the machine. With the PR machine, increasing the setting on the rise time slows down the amount of time somewhat (interesting to find out, since after I told the tech doing my sleep study that I felt like the machine was trying to make my hyperventilate she turned the rise time setting DOWN).

Bons wrote:With the PR machine, increasing the setting on the rise time slows down the amount of time somewhat (interesting to find out, since after I told the tech doing my sleep study that I felt like the machine was trying to make my hyperventilate she turned the rise time setting DOWN).

I don't know what the rise time is. I don't think I have used that. The instruction manual for the BiPAP autoSV Advnaced says: The Rise Time Setting screen is only displayed if Bi-Flex setting is disabled and the Masimum Pressure Support is greater than zero.

When I first got my machine, I was having the problem of the machine wanting me to breathe faster. I adjusted the Bi-Flex setting and that helped a lot. I still have the problem JohnBFisher described with the machine getting some weird ideas about how fast I should be breathing while I am getting my mask adjusted. Turning the machine off and then back on fixes that.

Deborah

Things are getting a bit mixed up here, as "rise time" adjustment is applicable to the Respironics ASV machines, but not the newer Resmed ASV units.

Getting to BrightChoice's question:

The data provided by the the S9 VPAP Adapt is very different from that provided by the S9 Autoset that you are used to. For one thing, there is no flow limitation graph.

It seems that Resmed has taken a somewhat arrogant approach by assuming that all flow limitations are being resolved, and therefore there is no need for a flow limitation graph. However, you can look at the patient flow graph to see how your inhalation & exhalation flow curves look. This will give you an indication of flow limitation(s), pressure intolerance, etc., etc.

Also, you will notice that the "Pressure, (high rate)" trace typically runs inversely to the patient flow trace. I believe this is indicative of the machine trying to regulate patient flow, i.e., increasing "pressure support" in response to reductions of patient flow (flow reduction), and/or flow curve patterns indicative of flow limitation (flattening, etc.). Conversely, it will then back off pressure support when patient flow returns to a more normal volume & pattern.

Hope this helped...

JeffH wrote: Good luck with the new machine. I'm still waking up 2 to 5 times a night on this thing, but I feel more rested in the morning than I was feeling before.

Going back to NM on the 23rd for my next study.
JeffH

Only 2 nights on adapt so far. Feeling headachy, brain fog and tired. I am hoping it is just the adaptation. Slept good last night - awake x 2. Humidifier ran dry - it uses up more water than with the autoset.

Good luck in NM! I'll be eager to hear how it goes.

ignorant1 wrote:It seems that Resmed has taken a somewhat arrogant approach by assuming that all flow limitations are being resolved, and therefore there is no need for a flow limitation graph. However, you can look at the patient flow graph to see how your inhalation & exhalation flow curves look. This will give you an indication of flow limitation(s), pressure intolerance, etc., etc.

Also, you will notice that the "Pressure, (high rate)" trace typically runs inversely to the patient flow trace. I believe this is indicative of the machine trying to regulate patient flow, i.e., increasing "pressure support" in response to reductions of patient flow (flow reduction), and/or flow curve patterns indicative of flow limitation (flattening, etc.). Conversely, it will then back off pressure support when patient flow returns to a more normal volume & pattern.

Hope this helped...

I need to spend some time looking at the reports. It is a bit over my head right now - I'm in a bit of a brain fog...

Thanks!

Bright Choice wrote:

JeffH wrote: Good luck with the new machine. I'm still waking up 2 to 5 times a night on this thing, but I feel more rested in the morning than I was feeling before.

Going back to NM on the 23rd for my next study.
JeffH

Only 2 nights on adapt so far. Feeling headachy, brain fog and tired. I am hoping it is just the adaptation. Slept good last night - awake x 2. Humidifier ran dry - it uses up more water than with the autoset.

Good luck in NM! I'll be eager to hear how it goes.

I felt like that at first too, so maybe that's normal? That machine is a different beast for sure. I like it and feel better in the mornings than I did on other therapies, but it takes some getting used to. Be glad you don't have 12 years of "habit" to break....LOL.

Hang in there.

JeffH

JohnBFisher wrote:A mask liner helps a LOT with the Quattro FX and an ASV machine. Most masks work fine as long as the pressure range remains fairly constant. That's something the ASV does NOT do. The wild swings in pressure cause the mask to leak, which wakes me up. The mask liner helps the mask work better (at least in my case).

Pad-A-Cheek and REMzzzs both make mask liners.

One way to avoid a mask's response to abrupt pressure change is to use a mask that does not depend on the inside air pressure for sealing.

Re-edit: I am still looking for such a mask and suspect that none exist. Or, that my post is stupid. This is b/c if you have just foam pressing on your face then the head gear straps would need to be extra tight, and you would feel the pressure changes even more. What about this:

http://www.cpapxchange.com/cpap-masks-b ... 7AodHWQgKQ

avi123 wrote: One way to avoid a mask's response to abrupt pressure change is to use a mask that does not depend on the inside air pressure for sealing.

Suggestions, please?

My doc and sleep lab say the quattro is the "Cadillac" of masks. They pretty much insisted on it for ASV titration. I have not gotten mine yet so can't give personal experience but quattro fx is not working well, nor is swift fx much to my disappointment. But, I don't know if it relies on an air cushion...

I find the use of a mask liner helps solve the problem of the air being used to form the cushion. I've used Quattro and Quattro FX full face masks with little problem. But the mask liner was key to making them work consistently with my ASV unit.

I'm not crazy about any FF mask I've tried. That's why I go with taping my mouth in order to use nasal pillows that let me sleep comfortably.

I did try a regular Quattro (not the FX) and did not like the Quattro as well as I liked ResMed's older full face mask...the Ultra Mirage FF in "Small Shallow" size. That one worked ok for me, but was just bulkier for trying to lay the side of my face on the bed pillow like I can with nasal pillows masks.

Bright Choice wrote:I need to spend some time looking at the reports. It is a bit over my head right now - I'm in a bit of a brain fog...

Thanks!

Reports...that reminds me. Were you able to get the full reports of your sleep study and titration? Posting the sleep study reports (the diagnostic and the titration) here on the forum might help people make suggestions for things to ask the sleep doctor when you have followups.

rested gal wrote:

Bright Choice wrote:I need to spend some time looking at the reports. It is a bit over my head right now - I'm in a bit of a brain fog...

Thanks!

Reports...that reminds me. Were you able to get the full reports of your sleep study and titration? Posting the sleep study reports (the diagnostic and the titration) here on the forum might help people make suggestions for things to ask the sleep doctor when you have followups.

I also don't remember Bright Choice ever posting any study reports of her case. Just text book data.

Starting all the way back to here:

viewtopic.php?f=1&t=63712&p=595125#p595125

What happened to this:

"I downloaded data from first night with adapt. Is there a reason the FL graph no longer shows up? "

If FL is Flow and you use a ResScan, then you do a Customized reprot from Navigation and add the Flow graph (move it from left to right).