ASV users: the everything ASV thread.

[4betterO2]

I'm concerned about what my O2 levels are during the night; I bought a CMS50D+ oximeter online but can't get my PC to recognize it, and their tech support is lacking. I saw a thread on the CMS50D+ the other day, from 2011 I believe, but lost the info, wondering if posting to it can still be done so long after?
The software install file I received is SpO2Setup_Gen_1.5.exe, 5,389 KB, 7/25/2012, and I'm running XP SP3 normally, (but if someone has a solution for Win7, I run that also, on my small netbook).
How do you plug the CMS50D+ to the PC, do you have to turn it on and put it in any special mode, or just pick it up "dormant" and plug it in like you do a flashdrive?
Actually this topic belongs here too, because I would like to use the CMS50D+ with my ASV machine.
Apparently some are sold with an oximeter, just like some are sold with a heated tube on the humidifer, and some not.
Is that possible with the PR Advanced ASV model 950p?(not sure what the "p" means and whether it matters)
How do you hook it up? I don't remember seeing anything about that in the manual, though the oximeter is mentioned in some ways.

[4betterO2]

Big news, upon my request my DME is changing my inspiration time to 3.0s, and she said it will give me that every time, every breath, whether patient-triggered or machine-triggered. I can't wait to try it. (She also said that it was set to 1.0s before, which is too low, she didn't know how that had happened.)
I'm wondering if this functionality is available only on this new model 950 of the ASV, as it is not how we thought how Ti works, and it may be a new setting, not the Ti. It makes this ASV machine work more like an ST if/when needed, if it works indeed the way she said. I can't wait to try this new setting, I like my inspiration to be slow and deep, nourishing and relaxing, kind of like yoga breathing, and I think this will give me much better oxygen exchange.
Lots of thanks for all the post replies that prepared me to discuss the subject with her!

[-SWS]

..my DME is changing my inspiration time to 3.0s, and she said it will give me that every time, every breath, whether patient-triggered or machine-triggered.

I suppose an easy way to validate what the DME said is to time IPAP delivery while awake. Gradually vary your spontaneous breaths and simply time IPAP delivery. Does IPAP delivery stay fixed at 3.0s or does IPAP delivery vary in duration with spontaneous breathing? Either way, the important thing is that your DME is helping you figure out settings that might not be quite as disruptive.

As a side note, you mentioned in another thread that you were originally diagnosed with OSA----and that you migrated to ASV to treat periodic breathing. Do you present any central apneas at all? The reason I ask is that if you are using ASV to treat OSA + periodic breathing (w/out CA), then you might fare better by turning backup rate off altogether. I would recommend that only as a last-resort experiment, should your machine's interrelated backup and Ti parameters continue to disrupt your sleep. And I would stress that I think an experiment like that requires buy-in from the doctor. Hopefully the settings your DME programmed will work like a charm!

P.S. The USB cable that came with your oximeter has a UART chip built into the cable connector. You must use that USB cable with the built-in UART. USB cables not having the built-in UART chip will not work. Also, I'd recommend going into Windows XP Device Manager---before and during plug-in---to watch for the type of hardware that gets equipped.

[StillAnotherGuess]

Big news, upon my request my DME is changing my inspiration time to 3.0s, and she said it will give me that every time, every breath, whether patient-triggered or machine-triggered.

Let us know how much fun you are having with a Ti of 3.0s. It sounds like an arbitrary and high Inspiration Time. Albeit, 1.0s was very inappropriate.

[StillAnotherGuess]

Ti is a comfort setting. You will feel if it is right when you relax and reach your Resting Respiration Rate. When you reach your resting respiration rate, and If you feel you are being blasted with too much Ti, then reduce Ti to 2.9sec. and so on. My guess is your resting Ti is somewhere between 2.5 and 2.8s. Conversely, if you feel you are not getting enough Ti at your resting respiration rate, then raise Ti in 1/10 increments, until you are comfortable.

When all else fails, do as SWS suggested, and switch to BR = Auto.

[4betterO2]

Ti is a comfort setting

well if it will do what I need, I'll be comfortable indeed, ...I'm dreaming of feeling towards my ASV therapy the same way people feel towards going to their oxygen bar, he he! But really, -- when the Ti is badly set, it is much more serious than just being uncomfortable...! It feels like waterboarding except with air instead of water. And I haven't had the opportunity to chart my SpO2 under the Ti of 1.0s, but I really suspect I have not been getting normal oxygen levels...

If you feel you are being blasted with too much Ti, then reduce Ti to 2.9sec. and so on

Believe me if I could do it myself, I would have done so!
But I'm under DME and Dr. care, and must let them do their work until my machine is paid, which will be after about 1 year of monthly co-payments, which are hard enough to do... the last thing I would want, is to damage my relationship with either, and in the end not find the machine covered by insurance. The cpap.com store sells it for 3,900, and my DME is billing insurance over $6,000. After it's paid up and it's mine, I'll be really glad to get into the clinical mode on it, etc...! (Though I haven't found the right Provider Manual yet, the one I found was for an older PR ASV which has quite different appearance and buttons. Does anyone have the needed link for the current ASV model DHS950?)
I'm hoping the proper settings will be found and implemented very soon of course, don't want to wait a year...

[4betterO2]

Let us know how much fun you are having with a Ti of 3.0s. It sounds like an arbitrary and high Inspiration Time. Albeit, 1.0s was very inappropriate.

I can't assess the effect of the Ti change yet as it was sent remotely. I've seen a delay as much as 3 days before, for my machine to receive or activate new settings, when the change had been sent on Friday. I'm wondering sometimes how the modem operates, does it sometimes work only in upload mode, other times only in download mode, or is it bi-directional at each connection.

[4betterO2]

As a side note, you mentioned in another thread that you were originally diagnosed with OSA----and that you migrated to ASV to treat periodic breathing. Do you present any central apneas at all? The reason I ask is that if you are using ASV to treat OSA + periodic breathing (w/out CA), then you might fare better by turning backup rate off altogether

Centrals showed when I was switched from CPAP to BiPAP. They were not severe, just enough to qualify for the ASV. Statistically, I have read that between 5-20% of CPAP users get this side-effect. My doctor mentioned periodic breathing, I'm not sure how the PR ASV separates periodic breathing from other centrals, does it? The ASV is treating them very well, down to 0%, and it is treating my OSA much better than the BiPAP did. I know I need the backup rate; sometimes my expiration is followed by inaction kind of, then the backup inspiration comes in.(That happens when I'm in the still-conscious but near-twilight of falling asleep at night, not in daytime of course).

[4betterO2]

I'd recommend going into Windows XP Device Manager---before and during plug-in---to watch for the type of hardware that gets equipped.

Yes I know it is a UART, the Silicon Labs CP210x USB to UART Bridge driver shows it as a COM port in Device Manager.
Well I googled the subject of PC connection for the CMS50D+ again, and I found the proper software version (1.0) for XP from pulseoxstore.com the other day, misplaced it, tried again today to download it and found the link now delivers a truncated file. But then I located the earlier file (he he).
[I don't see a files library area on the forum or I would upload it.
I tried to open a page in the CPAP wiki on the subject of oximetry in CPAP therapy, and I thought I would upload the file after that, but I got the message that
"You do not have permission to do that, for the following reason:
The action you have requested is limited to users in the group user."
what are group users and how do you get to be in such a group?]

Most importantly, I found instructions also on pulseoxstore.com, and got it working.
(I bought my CMS50D+ from China and it came with a small sheet with skimpy, somewhat missing or wrong instructions).
When you make a recording, wouldn't you turn it off when you are finished?
That's what I was doing before. But to get the software to find the CMS50D+, you must not do that!

So, for users who are new to the CMS50D+,
here are the steps to get your CMS50D+ data read on the PC:
__LEAVE IT ON "Record ON" even though you are taking the device off from your finger,
__load the SpO2 Review software, (the green SpO2 icon),
__ plug the device on the PC,
__open new session (click on the magnifying glass icon)
__see when the software says the device is connected,
__turn the CMS50D+ OFF
__then the software CAN LOAD THE DATA!

I wouldn't have guessed these steps, but they work... I'll post them on the CMS50D+ thread soon.

Now comes the real test: how to use the CMS50D+ with the PR ASV?

[4betterO2]

I'd like to upload my SpO2 images to get feedback... I feel stupid, but I don't see instructions on how to post images?
What are the file extensions and file size accepted?
How to proceed for the upload?

[-SWS]

The forum doesn't host images. So people use 3rd party image-hosting sites like photobucket, tinypic, etc.

[4betterO2]

The forum doesn't host images. So people use 3rd party image-hosting sites like photobucket, tinypic, etc.

Ok thanks - I saw the link syntax in the editing window.
Any suggestion as for the best site to use? I need a free one, and I prefer the least invasive, as for registering and privacy.

[4betterO2]

As a side note, below are contraindications listed for Respironics' current ASV model:

• Inability to maintain an open airway or adequately clear secretions
• At risk for aspiration of gastric contents
• Diagnosed with acute sinusitis or otitis media

(Sorry for any repetition, I did post part of this on patrissimo's own therapy thread, but I think it is of general interest for ASV users, and belongs here)
The quote above seems to point to problems caused by pressure shoots, which would get more powerful if there is increased nasal obstruction, such as during allergic reactions or illness. I thought the Resmed did shoots, not the PR ASV.
Does the PR ASV normally do pressure shoots? if so, do pressure shoots come as a pressure support action during patient-triggered breaths, or only during the backup actions?
Thanks for posting this quote, because I'm having a sinus problem right now, and this reminds me I should not use the machine.
Last night I received a pressure shoot I had never experienced before, it was terrible; an instant single hit... It made my mask scream, popped my ear loudly, and shot air all the way down into my stomach. Wondered if the machine was going crazy, was defective?...
So your answers as to when/why/should the machine shoot will be very important.
If the ASV shoots when sensing obstruction, it seems that putting max limits would properly protect the patient.
(so far I have no functional upper limit, it can go to 25 if it wants - so that should be an easy fix!).
But if the machine shoots only when/as a way of doing the backup, it's a bit more tricky as it could save someone's life if it is the only way to get the patient breathing again?
I did not experience shoots before, I have experienced very nice breaths that "came to me" from the machine from time to time, and felt like my normal breaths, just a tad bit more powerful , and thought that was how the backup functions on the PR ASV. ...Is it?

And to make sure, how does the Resmed handle its responses to finding obstruction, and to the threat of a missing breath?

[n0hardmask]

RE: my breathing rate using ADAPT is elevated
My normal rate is 16 or so; I've noticed it's being pushed up around 18 to 20 pretty regularly. I'll wakeup with the feeling I've been breathing real hard, even noticed a tender muscle just under breastbone recently.
Anyone else experienced the ASV pushing breathing like this? (I don't think it's the typical timing issue we newbies run into; but then I'm new to the ASV.) Thanks, Y'all

[Papit]

. . . (I bought my CMS50D+ from China and it came with a small sheet with skimpy, somewhat missing or wrong instructions).
When you make a recording, wouldn't you turn it off when you are finished?
That's what I was doing before. But to get the software to find the CMS50D+, you must not do that! . . .

Hi 4betterO2,
This is from an old post I did last April. Try it exactly as laid out. I've had reliable good results with it. Hope it helps.

--papit

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Inserting CMS-50 Pulse-Oximetry Graphs into SleepyHead

by Papit on Mon Apr 23, 2012 5:05 pm

Here's the operating procedure I use. I hope it helps new and regular CMS-50E/F Pulse-Oximeter users experience consistent ease of use and convenient access to their pulse-ox graphs both in the provided SpO2 Review software and in SleepyHead.

(Note: If you continue to have difficulty after using this procedure, go to 'Manuals/Downloads' at http://www.pulseoxstore.com/Manuals-Downloads.html to download and reinstall the latest software .)

CMS-50E/F Pulse Oximeter operating procedure
A. Record your Pulse-Ox data over night
1. Turn ON your Pulse-Oximeter after masking up at night.
2. Turn Record to ON.
3. Insert a finger into the sensor and sleep with it all night.
4. Turn Record OFF when you awaken in the morning.

B. 'Import’ your Xpap data to Sleepyhead
1. If you use SleepyHead software, remove the SD memory card from your xpap machine and insert it into the SD card reader on your computer.
2. Open SleepyHead and click ‘Import’ to upload the sleep session data from your SD card.
3. Click ‘My Computer’ on your desktop screen, right click on the drive containing the SD card, click ‘Eject’ and remove the card.
4. Return the SD card to your xpap machine and reinstall it.


C. Upload and view your Pulse-Ox data
1. Use the provided USB cable to connect the Pulse-Oximeter to your computer.
2. Open SpO2 Review software.
3. Click ‘Not Active’ button to open a New Session.
(Click ‘Cancel’ and repeat this Step if ‘New Session’ button on top line is not shown selected.)
4. Enter a file name (e.g., today’s date) and click OK. A message, "Device Connected: waiting for data…," should be displayed.
(If you see a message, "Can’t open COM 6", click OK, disconnect the USB cable from the Pulse-Ox, then reconnect it and go back to Step 3.)
5. If Record is ON, turn Record OFF on the Pulse-Ox.
6. Turn Upload ON on the Pulse-Ox.
7. Wait (up to a minute) while ‘Receiving data, Please wait….’is displayed.
8. View the Pulse-Ox graphs. Click ‘M’ on bottom line and set the Time scale by changing 'HH: 1’ to the number of whole hours you slept last night rounded up by one. Click OK.

D. View the Pulse-Ox Reports and Graphs in the SpO2 Review CMS-50 software
9. Click the Print Settings button in the lower far right, select a report (e.g.,'OxiMetry Report'), and click ‘Preview’. Print it for your file and/or for your doctor, or just view it. For easier viewing change ‘ % ‘ to 100% or higher (right-most button at top of screen).
10. Press and hold Power off to turn OFF the Pulse-Ox (“Bye Bye!”).
11. Recharge Pulse-Oximeter.

D. View the Pulse Oximetry Reports and Graphs Time-aligned in SleepyHead software
1. Open SleepyHead and click the 'Oximetry' tab at the top. Click the ‘Open .spo/R File’ button in the lower right. Select the sleep file you want to view and click ‘Open’. You should see your red pulse and blue oximetry charts vs. clock time.
2. Click the Save button just left of ‘Open .spo/R File’ button and confirm ‘Yes’ that you want to save the data. (Disregard the ‘No Oximetry Data’ screen.)
3. Click ‘Data’ on the top main menu line, then click ‘Rebuild Oximetry Indices’.
4. Exit out, then restart SleepyHead and click the 'Daily' tab to view the graphs, now including pulse and oximetry, all aligned to the same time scale.
5. Click the 'Daily' button in the SleepyHead Navigation bar on the right. The dates that appear in red on the calendar will display time aligned pulse-oximetry data and graphs. Click on a red date to see the pulse-ox charts for your sleep on that date along with the standard SleepyHead graphs.

(All the steps above need to have previously been performed to see a date's pulse-ox graphs and data in SleepyHead. If the clock time setting on the Pulse-Ox and on your xpap machine do not match closely enough, you will see a notice that the pulse-ox data cannot be linked with SleepyHead. Re-sychronize the current time on the Pulse-Ox so its time setting and that on the xpap machine are the same or very close. Note that fractured sleep sessions are listed in the lower left and each can be toggled ON and OFF.)
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