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Paper_Nanny, isn't this the guide for titrating your ASV?

OutaSync wrote:Fantastic! Are you feeling better today?

I am feeling much better today. I felt like I had energy! And like I wasn't too groggy and tired to do anything other than slog my way through the bare necessities of the day. Wow! A girl could get used to feeling this way!! Still waiting to hear back from the RT at the Sleep Doctor's office. But, I am not in such a hurry to hear back from them now.

I talked to the RT at my DME place today. She said it is commendable that I am taking such an active role in my treatment. (And yes, that was after I had told her I had changed the settings on my machine! )

Some good and happy news in that regard. I will be getting one of the new BiPAP autoSV Advanced—System One machines very soon. Those are the machines that record waveform data, so I will be able to be even more active in my treatment.

Of course, the waveform data has nothing to do with why I am getting the new machine. I am "really" getting the new machine because I need more humidity settings than what I have now and I also need a lighter, quieter machine.

Hoping I feel as good tomorrow as I do today.

Deborah

avi123 wrote:Paper_Nanny, isn't this the guide for titrating your ASV?

Looks like it just might be, but it also looks like it only covers the initial set up, not what to do after my machine was set up AND suddenly no longer adequately controlling hypopneas AND consitently giving me queer looking results for patient triggered breaths. Oh, well. I think I am headed in the right direction at this point...

Deborah

Paper_Nanny wrote:Looks like it just might be, but it also looks like it only covers the initial set up, not what to do after my machine was set up AND suddenly no longer adequately controlling hypopneas AND consitently giving me queer looking results for patient triggered breaths. Oh, well. I think I am headed in the right direction at this point...

I think you are too. That is indeed the titration protocol guide for our model of ASVs, but it really is meant as a guideline for the in-lab technicians and isn't of much use when trying to figure out how to tweak your settings at home -- other than being another source of reference information about how EPAP and PS should be changed in response to certain types of events. There seem to be a whole bunch of us (you, me, and JIMCHI to name a few) who suffer from this problem of residual hypopneas, and because of the many possible causes and origins of hypopneas, there's not a one-size-fits-all approach to solving them. You certainly seem to be on the right track with yours, though!

BrianinTN wrote:

Paper_Nanny wrote:Looks like it just might be, but it also looks like it only covers the initial set up, not what to do after my machine was set up AND suddenly no longer adequately controlling hypopneas AND consitently giving me queer looking results for patient triggered breaths. Oh, well. I think I am headed in the right direction at this point...

I think you are too. That is indeed the titration protocol guide for our model of ASVs, but it really is meant as a guideline for the in-lab technicians and isn't of much use when trying to figure out how to tweak your settings at home -- other than being another source of reference information about how EPAP and PS should be changed in response to certain types of events. There seem to be a whole bunch of us (you, me, and JIMCHI to name a few) who suffer from this problem of residual hypopneas, and because of the many possible causes and origins of hypopneas, there's not a one-size-fits-all approach to solving them. You certainly seem to be on the right track with yours, though!

And it was your sharing of your own experience that did tipped Deborah in the right direction, Brian.
What a relief to see that correct Patien Triggered Breathing percentage - and to see what an impact it has on your day, Deborah!!!

What an ignorant fool that PA is!

Now that you are feeling better, Set PS Min = 2.

Paper_Nanny wrote:I am feeling much better today. I felt like I had energy! And like I wasn't too groggy and tired to do anything other than slog my way through the bare necessities of the day. Wow! A girl could get used to feeling this way!!

I've been following your saga, Deborah, and was so glad to see your good news.

What a dramatic change in the Patient Triggered Breaths and in the way you feel. Way to go, Deborah!

StillAnotherGuess wrote:Now that you are feeling better, Set PS Min = 2.

I am not yet well versed enough in all this to know what that will do. Could you explain? The PS Min= 0 right now.

If I do make further changes, I will probably wait a few more days to make sure things have settled down now at the new EPAP level. My AHI was back up a little last night. Probably not something to be horribly concerned with, but I don't want to change too many things at once, just in case. I hope to have time later to post graphs from the last couple nights.

Deborah

Your last numbers looked good. You're feeling better. I wouldn't touch PS at this point.

To answer your question: PS is the difference between IPAP and EPAP. When you set a min PS, you're basically guaranteeing that your IPAP will be no lower than min EPAP plus min PS. An increase in IPAP can address central apneas and some hypopneas. It also can make things more comfortable for some people -- those who prefer a bilevel gap, such as our own Mr. Bill. On the flip side, increasing min PS can potentially exacerbate problems and/or make things less comfortable for some. As the titration protocol indicates, establishing the proper EPAP is the first place to go. PS can be adjusted after that. Remember that an ASV *will* adjust your IPAP by itself, too.

Paper_Nanny wrote:

StillAnotherGuess wrote:Now that you are feeling better, Set PS Min = 2.

I am not yet well versed enough in all this to know what that will do. Could you explain? The PS Min= 0 right now.

Your concern is self initiatted breathing low. And you show signs of residual hypopneas. Setting PS Min = 2 will further mitigate both occurrances.

del

I just got done talking to the RT at the sleep lab. I had called her last week, sent some graphs to her, and asked her to talk to Mister Sleep Doctor about my high AHI as well as my low percent patient triggered breaths. I will call him MSD for the rest of this post.

She said it was fortunate for me that they had an expert in at the lab last night and he looked over my data, also. The expert is someone from Respironics. I got the impression the RT wasn't sure what he did for respironics. Sales only? RT? I don't think she knew. Consequently, I don't know. But I got his input, anyway! And for the rest of the post, I shall refer to him as MRR, for Mister Respironics Rep.

With regards to the low percent patient triggered breaths, she said it is not something to worry about. According to the RT, MSD initially said the PTB SHOULD be low. The graphs look like he would have expected them to look. MRR disagreed, saying no, the PTB should NOT be low, but it is okay that they are.

And that is a perfect example of why I hate having a go- between in my communications with my medical care providers. I would have asked MSD: Why would you expect the PTB to be low? and I would have asked MRR: Why are the low PTB's not something to be concerned with, given that it is not supposed to look like it does?

MRRs advice was to switch me from my BiPAP ASV to a straight BiPAP, set at 5/15. I will admit that I had trouble really listening after that, because I kept loudly thinking, "No!! You can't take away my fancy toy! I don't want the regular BiPAP!"

I don't know what would be different with a regular BiPAP. Why it would work better. I also asked the RT why going to a regular BiPAP would makes sense, considering that during the titration study, I started with that and was switched to the ASV. She said during the initial study, the number of central events was so low that they don't really warrant treatment. But, my understanding is that during REM sleep, the number of central events wasn't so low. My read on the report is that during REM sleep, my central event index was 14.3. The total index on central events is only low because I wasn't in REM sleep very long.

She didn't address that when I brought it up. Again, I hate this go- between stuff. I think she was disregarding the question because she hadn't brought that up with MSD, and had no answer to give me.

Anyway... I did tell her I had lowered my EPAP Min and that seemed to be helping. She sounded surprised. I am going to call her toward the end of next week and let her know how things are going.

Couple other questions... Is it not possible to set the ASV to function like a straight BiPAP?

I asked RT if it would be good for me to keep the ASV because if the ms progresses, I would need that anyway. She said if the ms progresses, I would need an AVAPS. I have minimal understanding of what that is, but based on what she said, I am guessing that an AVAPS would help only if my muscle tone was preventing me from breathing sufficiently. It wouldn't help if the involvement was strictly neurological brain malfunction. Is this understanding correct?

Lots of information for me to process. My head feels too full and muddled up now. Or maybe it isn't a lot to process and what I am feeling is only the fear of losing my cool sophisticated BiPAP ASV.

Deborah

avi123 wrote:Trying to read Paper_Nanny's sleep study posted above.

Apparently it needs more work to make it legible.

Zooming (@ View) to 200% it becomes more legible.

Not much more legible, though. Do I need to make the original bigger? Or is it something else that needs to be fixed? I'll try to re-post it later. Right now, I have to go pick Husband up from work. I hate when Real Life interferes with my computer life!

Deborah

You can make your ASV act (pretty much) just like a standard BiPAP. You'd set your min PS and your max PS to the same value, set your max pressure to your desired IPAP pressure, and turn your backup rate off. (If you wanted it to behave like a BiPAP S/T rather than a standard BiPAP, you'd set a backup rate.) But I can't think of any reason why you'd want to do this, and I can think of many reasons why you wouldn't. One of the wonderful things about the ASV is precisely that it can adjust to changing circumstances, both within a night and over time. I'll quote an email from my RPSGT friend :

I foresee docs switching to ASV for many patients in the way that some currently prescribe ACPAP for all (auto ranging CPAP). ASV is clever since the unit runs a moving window of what appears to be stable breathing and tries to normalize current breathing against that moving average. It can also succeed with lower pressures because it's only ramping things up as needed.

As for lowering your EPAP working, I'm not sure why she's surprised. You (so far) appear not to need as high of an EPAP to control your obstructive apneas the majority of the time, and if your hypopneas are central in nature, that also would be consistent with your AHI lowering when you lowered your EPAP. Keeping the floor on your EPAP low most of the time and letting it ramp up just a little bit as needed seems to work well for you.

As for the legibility of your report: bigger might help, but more important would be scanning it at a higher resolution or DPI, if you see that option.

Deborah, the text in your PSG report is fuzzy (not in focus). You can try to edit while in My Album in Photobucket, but I doubt it if you could bring them to focus.
It's there from either photoing or scanning the originals. If yes then enlarging somewhat could also help. I could delete my version whenever you say so.

Ask the MRR also why those machines don't suppress all Hypopneas the way they claim in their literature.