No Answers Yet For Problems With ASV

Any suggestions on how to tweak the settings on my machine to lower my AHI? Sleep doctor is gone for several weeks and I feel horrid!! My AHI was initially fairly low after beginning treatment- usually around 4- 5. The past couple weeks it has gone up. I still have some nights with a 4 or 5, but many more nights in the 6- 9 range.

I have both OSA and CSA. According to the graphs, I also seem to have some issues with initiating my own breathing. That could the result of having multiple sclerosis. I have a history of symptoms indicating damage to the brain stem. Could be that I now have damage to the areas which are in control of my breathing. I can't have MRI's because I have a pacemaker, so no one really knows what's going on in my brain at this point. CT scans confirm that at least I still have a brain!

The current settings on my BiPAP ASV are:
BPM= Auto
Pres Max= 25
EPAP Max= 15
EPAP Min= 9
PS Max= 15
PS Min= 0

The EPAP min was 8, but I bumped it up to 9 at the suggestion of Beeping Beauty, later in this thread.

Here are graphs from the past couple nights.





Thanks for the assistance.

Deborah

edit to change subject line and add additional information in first post.
07-03 Edit to change subject line

Your Hypops seem a bit high. I think it's EPAP that handles the hypops. So maybe epap @8 is too low? Maybe PS@15 is too much? Write down ALL settings before changing even one.

Maybe sleep position? Do you keep a sleep journal? Why not?

Deborah, I can't see what the 90% pressure is for the the EPAP. Can you tell me?

GumbyCT wrote:Your Hypops seem a bit high. I think it's EPAP that handles the hypops. So maybe epap @8 is too low?

One the System One BiPAP Auto, it's the IPAP that increases to deal with hypops.

But Paper_nanny's machine is not a System One or a Series-M BiPAP though, it's the much more sophisticated AutoSV (auto servo-ventilator?) machine from Resprionics and I haven't the foggiest idea of what its algorithms for increasing the pressure settings and the PS setting are.

ozij wrote:Deborah, I can't see what the 90% pressure is for the the EPAP. Can you tell me?

On my computer's screen it appears the 90% EPAP is 9cm the first night and either 8 or 9cm the second night. Average PS is 2 the first night and 3 the second night.

Only thing I can think of to try might be to increase the min PS setting so that the IPAP starts out a bit higher and stays a bit higher (relative to the EPAP) all night long without unnecessarily increasing the EPAP since the OA's and VS's both appear to be under control.

ozij wrote:Deborah, I can't see what the 90% pressure is for the the EPAP. Can you tell me?

On 06/05 90% EPAP= 9 and on 06/06, %90 EPAP= 8.

GumbyCT wrote:Write down ALL settings before changing even one.

A good reminder... And if I forget, I can always come back and look at my posting here.

GumbyCT wrote:Maybe sleep position? Do you keep a sleep journal? Why not?

Sleep position is not a factor as I stay in the same position all night. Almost always on the right side, sometimes on the left.

As for the sleep journal, I do keep one but I don't know how useful the information would be to anyone. I'm not sure I am keeping track of the right variables. Do you have suggestions on what to keep track of?

Paper_Nanny wrote: Sleep position is not a factor as I stay in the same position all night. Almost always on the right side, sometimes on the left.

Paper_Nanny wrote:I'm not sure I am keeping track of the right variables. Do you have suggestions on what to keep track of?

Start with right or left?

Paper_Nanny wrote:A good reminder... And if I forget, I can always come back and look at my posting here.

I don't know anything about an SV but I do believe my bipap has more menu items than listed above. The thing is sometimes 1 setting also affects another. The journal is a good place to write it, tho I keep a separate sheet with that info so I don't have go searching.

I made up an excel spreadsheet with blanks to pencil in things for those times I can't sleep and get the urge to wing the dials around.

GumbyCT wrote:

Paper_Nanny wrote: Sleep position is not a factor as I stay in the same position all night. Almost always on the right side, sometimes on the left.

Paper_Nanny wrote:I'm not sure I am keeping track of the right variables. Do you have suggestions on what to keep track of?

Start with right or left?

As far as sleep position, if I go to sleep on my right side, I stay on my right side until I wake up. If I go to sleep on my left side, I stay on my left side until I wake up. I almost always sleep through the entire night. Once in awhile, I get up to potty during the night. Sometimes, I wake up when Husband's alarm goes off in the morning.

As far as sleep journal variables, I'm not sure if I am keeping track of the relevant variables.

Paper_Nanny wrote:As far as sleep journal variables, I'm not sure if I am keeping track of the relevant variables.

Hi, Deborah.

FWIW, when I kept a sleep journal, I noted things like bedtime, wake time, how many times I woke in the night (and why - bathroom, mask leak, external noise, cat fight on my bed , etc.), how I felt in the morning and how I felt later in the day or evening (yawning but staying awake, sleepy, needing a nap, or feeling okay and/or energized), whether or not I dreamed during the night, etc. When I was experimenting with pressure settings, I made note of those, too. Journaling makes it easier to see trends and/or potential problems.

Paper_Nanny wrote:Any suggestions on how to tweak the settings on my machine to lower my AHI? Sleep doctor is gone for several weeks; I have felt so horrid since my numbers started going up, I don't think I can wait until he gets back!

Current settings:
BPM= Auto
Pres Max= 25
EPAP Max= 15
EPAP Min= 8
PS Max= 15
PS Min= 0

Re: your data, I can appreciate the position you're in, waiting for the sleep doc to see about all those hypops you're still having. As I said in your other thread, it seems to me that raising EPAP a bit might help; but that's just logic on my part, and I have no idea if that's actually the prudent thing to do in your case. I'm no expert, and you have other medical issues that are impacting your therapy needs.

BTW, I thought your sleep doc was due back on Tuesday.

BleepingBeauty wrote:As I said in your other thread, it seems to me that raising EPAP a bit might help; but that's just logic on my part, and I have no idea if that's actually the prudent thing to do in your case. I'm no expert, and you have other medical issues that are impacting your therapy needs.

Yes, well, prudence... It is such an icky word that I long ago decided prudence itself must be an icky thing. Something best avoided, or taken only when absolutely necessary with no way to avoid it.

Seriously, though, if I am wrong in my adjustments, it seems like the consequences are fairly minimal and only short term. Unless I am missing a big piece of this picture... And I do realize that any advice I receive here is being offered on an non-expert basis. I accept complete and total responsibility for my lack of prudence.

BleepingBeauty wrote:BTW, I thought your sleep doc was due back on Tuesday.

Yeah, that's what I thought, but based on the e-mail I got from the RT, I get the impression he is only going to be in on Tuesday to take care of any urgent situations requiring his attention. It wasn't clear to me whether or not he would be in any other days this upcoming week. And then he will be gone again for another few weeks. Based on the information I sent her, she will be deciding if my situation is urgent enough to demand his attention on Tuesday. Of course I think it is and I think it is very bad manners of him to take time off when it is not convenient for me to have him gone.

Good suggestions on the sleep log. Thanks.

Deborah

Paper_Nanny wrote:

BleepingBeauty wrote:As I said in your other thread, it seems to me that raising EPAP a bit might help; but that's just logic on my part, and I have no idea if that's actually the prudent thing to do in your case. I'm no expert, and you have other medical issues that are impacting your therapy needs.

Yes, well, prudence... It is such an icky word that I long ago decided prudence itself must be an icky thing. Something best avoided, or taken only when absolutely necessary with no way to avoid it.

P_N wrote:Seriously, though, if I am wrong in my adjustments, it seems like the consequences are fairly minimal and only short term. Unless I am missing a big piece of this picture... And I do realize that any advice I receive here is being offered on an non-expert basis. I accept complete and total responsibility for my lack of prudence.

Strictly from a therapy standpoint, no, I don't see any serious danger in making a small change in your treatment.

P_N wrote:

BleepingBeauty wrote:BTW, I thought your sleep doc was due back on Tuesday.

Yeah, that's what I thought, but based on the e-mail I got from the RT, I get the impression he is only going to be in on Tuesday to take care of any urgent situations requiring his attention. It wasn't clear to me whether or not he would be in any other days this upcoming week. And then he will be gone again for another few weeks. Based on the information I sent her, she will be deciding if my situation is urgent enough to demand his attention on Tuesday. Of course I think it is and I think it is very bad manners of him to take time off when it is not convenient for me to have him gone.

Good suggestions on the sleep log. Thanks.

Deborah

Bad manners, indeed. The noive o' some people!

Ok. Well, I'll tell you what I'd do if I was in your shoes. No way would I opt to feel like crap for another two months (or however long it takes for someone else to deem it urgent enough to do something about it; been there, done that, got the t-shirt). I'd raise the EPAP just 1cm and see how that goes for a few nights. If the numbers improved and I felt better during the day, I'd leave the settings alone and see how things went for awhile (at least a week).

I know you know this, but here it is: Take my advice for what it's worth (which is exactly what you paid for it). I'd put much more stock in anything that ozij, -SWS, rested gal, JohnBFisher, or a few others around here might suggest for you.

BleepingBeauty wrote:Ok. Well, I'll tell you what I'd do if I was in your shoes. No way would I opt to feel like crap for another two months (or however long it takes for someone else to deem it urgent enough to do something about it; been there, done that, got the t-shirt).

My thought exactly.

BleepingBeauty wrote:I'd raise the EPAP just 1cm and see how that goes for a few nights. If the numbers improved and I felt better during the day, I'd leave the settings alone and see how things went for awhile (at least a week).

Just changed it from 8 to 9 and now I am really impatient to go to bed and see if it does anything! I am glad the RT at the DME was prudent enough to give me the Provider Manual for my machine. Or was that imprudent of her?? Which ever it was, it sure did make changing those numbers a heck of a lot easier!

BleepingBeauty wrote:I'd put much more stock in anything that ozij, -SWS, rested gal, JohnBFisher, or a few others around here might suggest for you.

If any of them respond with suggestions that contradict yours, I will keep that in mind. And, for what it's worth, I do think your suggestions are worth more than I pay for them.

Deborah

Paper_Nanny wrote:Just changed it from 8 to 9 and now I am really impatient to go to bed and see if it does anything!

I know how that is. I couldn't wait for bedtime the day I got my ASV. Hope it goes well!

I am glad the RT at the DME was prudent enough to give me the Provider Manual for my machine. Or was that imprudent of her?? Which ever it was, it sure did make changing those numbers a heck of a lot easier!

Whatever it was on her part, it was a bonus for you. (But someone here could have told you how to get into the settings and/or pointed you to the manual.)

P_N wrote:

BleepingBeauty wrote:I'd put much more stock in anything that ozij, -SWS, rested gal, JohnBFisher, or a few others around here might suggest for you.

If any of them respond with suggestions that contradict yours, I will keep that in mind. And, for what it's worth, I do think your suggestions are worth more than I pay for them.

Deborah

Fair enough. So now you're impatient to go to sleep, and I'm anxious to hear how it goes. Have a good night, Deborah!

Sorry to come in so late on this - the sun sets and rises on a different schedule over here...

The thing we don't know is if your Hypop's come from EPAP being too low, or IPAP being too slow, or they're a way the machine reads some of your "non-self initiated" breaths. We only know you're feeling terrible. If it were me, I wouldn't wait either for the doctor to come back. But before going it alone, I would try - very hard - to have myself considered a "can't wait till you return from vacation" case.

I haven't figured out yet why you PS is so low on the average, and what it means; the fact that for at least one night, EPAP didb't buge from 8 for 90% of the time does show you're near what you need there.

Did your sleep study show you have obstructive sleep apnea too, or are they only using the ASV to deal with the problem's you have initiating breathing spontaneously?

An RT is usually forbidden to change pressure unless being instructed to do so by a doctor - I hope you can make the changes with both RT and doctor in the picture --

Please post some more data. I hope last night was better.
O.

ozij wrote:Did your sleep study show you have obstructive sleep apnea too, or are they only using the ASV to deal with the problem's you have initiating breathing spontaneously?

Yes, my actual diagnosis is OSA. I did have some centrals during my initial study, but not enough for diagnosis. During the titration study, the centrals got worse on CPAP, which is how I ended up with the BiPAP ASV. There was no mention during either study of a problem with initiating breathing spontaneously.

ozij wrote:An RT is usually forbidden to change pressure unless being instructed to do so by a doctor - I hope you can make the changes with both RT and doctor in the picture --

Yes, that was my understanding is that RT's can't do the orders themselves.

ozij wrote:Please post some more data. I hope last night was better.

Last night was not better. It was actually worse. I had a sense during the beginning of the night that I was sleeping really lightly, no deep sleep. Got up to go potty halfway through the night. Interesting the need to get up coincided with a whole mess of hypopneas right close together. Also cleaned off mask when I got up because it seemed like it was leaking a lot. Graph doesn't back up that perception. Second half of the night, I recall dreaming a lot, but again, it was really light sleep. I don't feel particularly rested this morning. Urgh...

Here is data from last night. Is there other data you want to see, also?

Deborah