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ChrisT wrote:I just discovered this thread. I should have posted here first although I can see that at least one of you caught my original question posted in desperation last night. I have been on the older version of BIPAP autoSV Advanced only two nights (the one that uses the smart card) and have been unable to sleep due to feeling like I can't get enough air. BP went up as well. I finally took the humdifier and one way valve off and bypassed them completely. Suddenly I had air and the higher pressures I was used to. I didn't feel like I had to work for each breath after that but that was at 5 am . Has anyone else using this model had problems with the valves or the humidifier? I find it hard to believe the humidifier would be the problem as everyone who used it would be complaining so I am suspecting the one way valve which was put in correctly by the way...is the culprit. I was already scheduled to get the system one on Monday so I only have to get through two more nights. The air warmed up when I put the hose under the covers but I lost much sleep and had too high BP before that.

Just wondering if the valve has been an issue for others. ChrisT

Hi Chris, I haven't had that problem. I do know the machine starts off at a high pressure which for some can make it feel difficult to breathe, but this can be relieved through the ramp setting. The pressures start to reduce after about 15 minutes or so as it adjusts to your breathing. How long did this go on?

I found a new valve in the bag an tried it. That seemed to fix the problem. This in the light of day. I was also able to observe pressures and I think when I was working harder against a sticky valve I just didn't generate higher ones. ChrisT

Good morning! As some of you know. I may be going to a Resmed S9 Vpap Adapt soon. I was looking at a comparison chart of the Resmed Vpap devices. I noted that the Adapt is not so good on obstructive and Hypopnea. All of my events displayed are unknown or hypopnes. Im wondering how well this might work for me. Im wondering if someone might have a brief explanation of ASV function or could point me to a source I might read. Ive only found white papers that are to complex, at least for me! Read my chart this am, Ahi 13.7,with 7.5 unknown and 6.2 Hypopnea. Detail pane looks like CSR every day. I slept so poorly PSG night, hope they pick it up! Still working on mask leaks. RT sent a Quattro Fx home to try. I have leaks, but planning to order a mask liner. I made a hose hanger supported from a elastic band, which is working really well. That has helped my nasal mask! My wife helped me with that ! God bless her! Dan

LittleRedTruck wrote:Good morning! As some of you know. I may be going to a Resmed S9 Vpap Adapt soon. I was looking at a comparison chart of the Resmed Vpap devices. I noted that the Adapt is not so good on obstructive and Hypopnea. All of my events displayed are unknown or hypopnes. Im wondering how well this might work for me. Im wondering if someone might have a brief explanation of ASV function or could point me to a source I might read. Ive only found white papers that are to complex, at least for me! Read my chart this am, Ahi 13.7,with 7.5 unknown and 6.2 Hypopnea. Detail pane looks like CSR every day. I slept so poorly PSG night, hope they pick it up! Still working on mask leaks. RT sent a Quattro Fx home to try. I have leaks, but planning to order a mask liner. I made a hose hanger supported from a elastic band, which is working really well. That has helped my nasal mask! My wife helped me with that ! God bless her! Dan

First, the (Pad-a-cheek) mask liner for the Quattro FX fixed all of my leak problems. I hope it does for you, too. With the high pressures of the ASV unit, you have to keep your mouth closed or use a FFM (with leaks under control) in order for the therapy to work well. Otherwise, the timed breaths will escape out your mouth (or out of the leaks) and do you no good with your centrals/CSR. I would bet your unknowns are centrals and the machine is having trouble identifying them as such because of leaks.

-A

LittleRedTruck wrote:... I may be going to a Resmed S9 Vpap Adapt soon. I was looking at a comparison chart of the Resmed Vpap devices. I noted that the Adapt is not so good on obstructive and Hypopnea. All of my events displayed are unknown or hypopnes. I'm wondering how well this might work for me. ...

Well, I have severe obstructive sleep apnea. And I use the older Resmed VPAP Adapt SV Enhanced unit. I end up with an AHI of 0 to 2 most nights. It should work fine for you.

LittleRedTruck wrote:... I'm wondering if someone might have a brief explanation of ASV function or could point me to a source I might read. ...

Well, let me take a swing at that. Central Sleep Apnea (CSA) and Cheyne Stokes Respiration (CSR) (a type of periodic breathing) result from an undershoot / overshoot cycle in our breathing.

With CSA and CSR, for some reason the body does not properly expel the CO2. Breathing slows down, gets shallow (that is the waning - decreasing - side of the Cheyne Stokes respiration) and sometimes it stops (that is a central sleep apnea). That is the undershoot side of the cycle. It's actually the CO2 in our blood stream that drives respiration. When CO2 builds up in our blood, our bodies are driven to breathe to exchange the CO2 for some fresh O2.

Eventually, our bodies figure out that the CO2 has hit a critical level and we resume breathing. This can often result in a slight arousal (we go from a deeper level of sleep to a lighter level of sleep). Thus it robs us of the deep sleep we need. When the body does resume normal breathing, it is often a bit frantic to blow off the CO2. We breathe faster (hyperventilate) and more deeply than normal (that's the waxing side of the Cheyne Stokes respiration). Unfortunately, our bodies tend to overshoot.

They overshoot and blow off too much CO2. As a result, it sets the body up for a repeat of the undershoot side of the cycle. Thus you experience the waxing and waning of breathing for someone with Cheyne Stokes respiration and repeat occurrences of Central Sleep Apnea.

Researchers recognized this undershoot/overshoot cycle and wondered if they could break the cycle. That is by maintaining respiration during the undershoot side of the cycle, would it avoid the body's drive to overshoot. So, they decided that if a xPAP device also included the ability to act as a respirator for a while, it might help break the cycle. Thus during the undershoot side of the cycle, the ASV act as a small ventilator and provides Adaptive Servo-Ventilation.

But to maintain your breathing, the machine has to REALLY ramp up the pressure. If you think you are fighting with leaks now, I can guarantee you will need those mask liners when you get your ASV unit. A pressure of 20 to 30cm H2O is a STRONG windstorm.

But you know what? IT WOKRS!!

LittleRedTruck wrote:... Read my chart this am, AHI 13.7, with 7.5 unknown and 6.2 Hypopnea. Detail pane looks like CSR every day. ...

Unknown sounds as if it might be central apneas on your unit. If there is a lot of CSR present, then you will be glad, since the ASV machines were specifically designed to address CSR.

LittleRedTruck wrote:... I slept so poorly PSG night, hope they pick it up! ...

If there is any significant presence of CSR, they will have picked it up and noted it. If they tested you on an ASV unit, then you are already a candidate and will see benefit with an ASV unit.

LittleRedTruck wrote:... Still working on mask leaks. RT sent a Quattro Fx home to try. I have leaks, but planning to order a mask liner. ...

With an ASV unit, it is very helpful to have a mask liner. The wild swings in pressure cause just about any mask (and certainly all the masks that I have used) to leak. That pulse essentially pushes the mask away from the face, causing those annoying face farts. With a mask liner, I awaken only a few times during the night. Without it I would awaken twenty times or more. No fun.

LittleRedTruck wrote:... I made a hose hanger supported from a elastic band, which is working really well. That has helped my nasal mask! My wife helped me with that ! God bless her! Dan ...

Sounds like you have the most important accessory. A supportive and loving wife!

Here's hoping that helped. And here's hoping you will love your new unit. I am a new person because of my ASV. I do not think I would have lived a lot longer had I not been prescribed an ASV unit. I was DESPERATE for sleep when I got one almost two years ago.

John, your the man !!!! That was a awesome explanation, I do understand it. Yes my PSG Wed nite was a ASV study. So, I suspect I know where Im headed ! I have 2 granddaughters in the bedroom where I have my computer, for the weekend, so printer disconnected and removed for now. Will print it as soon as things are put bacck together. I just ordered the Quattro Fx liner and strap from Padacheek, so hope I can tame the beast when he bites me. Always so grateful for members of this group! I know Ill need your support with ASV . Dan

LittleRedTruck wrote:John, your the man !!!! That was a awesome explanation, I do understand it. Yes my PSG Wed nite was a ASV study. So, I suspect I know where Im headed ! I have 2 granddaughters in the bedroom where I have my computer, for the weekend, so printer disconnected and removed for now. Will print it as soon as things are put bacck together. I just ordered the Quattro Fx liner and strap from Padacheek, so hope I can tame the beast when he bites me. Always so grateful for members of this group! I know Ill need your support with ASV . Dan

This site is so amazing! A problem can be solved before it even appears! It's magic!!

I am bummed that the antileak strap hasn't been quite right for me. It slips off of the back of my head and I still need to use a chin strap so I am back to the "ace" solution. The antileak strap may work better for you because the Q FX headgear goes over the top of your head and Karen has placed some velcro on the back which might be able to attach to the headgear - or cling to your hair. I'm using the Mirage Quattro (I have become a very reluctant fan of this mask) and the headgear is more on the back of my head so the velcro can't cling to it. More experimenting may be in order but leaks have been zero with my current config so maybe I shouldn't fuss too much. I could not tame the Q FX with the adapt. I'll be eager to hear how you do.

I am using Remzzz which I really like. At first I thought they would not be a good solution because of the expense, but I find that I can use them many times over. A week at least, if not more. I use two at a time and it really cuts the leaks - plus they include a piece which goes under the forehead piece on the M Quattro. Better yet, I found that Medicare will provide them for me so no out of pocket expense.

Have I mentioned the "Hozer" hose management system? Oh my that is great!! I didn't think I needed a hose management system because I do not turn much at night but it is wonderful. Even if I turn only once or twice I don't have to check to see where the hose is and then rearrange it. Very well engineered and well made. I think it helps diminish leaks too. I wouldn't be without it. Took it on one overnight trip and almost didn't pack it, but I was so glad to have it. It is really perfect! And no, I don't get a commission from them.

Good luck!

Bright,
I adapted my antileak strap by adding another velcro strip and loop to make it more snug. I've also found that weaving it through my headgear kept it in place.

Bons wrote:Bright,
I adapted my antileak strap by adding another velcro strip and loop to make it more snug. I've also found that weaving it through my headgear kept it in place.

Where did you add the loop? It looks like the your headgear goes just a tad bit higher on the back of the head than the M Quattro headgear. It appears that the alignment would be better. I'll do some experimenting.

Thanks.

JohnBFisher wrote:With an ASV unit, it is very helpful to have a mask liner. The wild swings in pressure cause just about any mask (and certainly all the masks that I have used) to leak. That pulse essentially pushes the mask away from the face, causing those annoying face farts. With a mask liner, I awaken only a few times during the night. Without it I would awaken twenty times or more. No fun.

I guess I've been quite lucky, I use the Quattro FX and have not had any leak problems. In fact, that's just about the only problem I don't have in trying to get my breathing in line. Other issues, but leaks are not one of them.

My second night with EPAP=4, minPS=4.

Second morning waking up with a slight headache.

While I still feel better than pre-ASV, I'm still not 'there' yet and have a long way to go.

ameriken wrote:My second night with EPAP=4, minPS=4.

Second morning waking up with a slight headache.

While I still feel better than pre-ASV, I'm still not 'there' yet and have a long way to go.

Ken,

Try PSmin of 3 tonight.

Antonio

Here's last nite, PSmin=3, EPAP=4. No headache this morning or hungover feeling, so I feel good in that regard. Still feel a little tired, like I can sleep another hour. Overall mood is better.

I do remember being woken up a few times before 5 am with the high pressure blowing through the seals with a high pitched squeal. That's where my PTB bottomed out. I'm surprised by the OA, I usually don't have any of those.

No matter what I try, something is missing: it's the feeling that I am well rested and ready to take on the challenges of the day. Just haven't gotten that back yet.

July 16- 17:

ameriken wrote:Here's last nite, PSmin=3, EPAP=4. No headache this morning or hungover feeling, so I feel good in that regard. Still feel a little tired, like I can sleep another hour. Overall mood is better.

I do remember being woken up a few times before 5 am with the high pressure blowing through the seals with a high pitched squeal. That's where my PTB bottomed out. I'm surprised by the OA, I usually don't have any of those.

No matter what I try, something is missing: it's the feeling that I am well rested and ready to take on the challenges of the day. Just haven't gotten that back yet.

Ken,

I would never worry about a single event, like your OA. We all have them, and one or two for the night is no big deal. If you start having a cluster of them or your OAI (or CAI) trends upwards, then that would be cause for concern and further investigation. Glad you are feeling better. I always feel a little tired at first wake and feel like I can sleep another hour or so, but that usually goes away after some food. I think I am still adjusting to better sleep (paying off my sleep debt), myself. Notice your average PS is decreasing as you decrease PSmin. That tells me you are going in the right direction with decreasing PSmin. You can keep it at 3 for a few more days to see if it gets better. If your hypops still are elevated, I'd go down to a PSmin of 2 (which is my current setting).

Here's my data from last night:



I'd like to get your PTB looking a little more like mine, with large areas of 100% PTB. I think that will happen once we take care of your central hypopnea, which reducing your PSmin should do.

-A

I guess I'm not doing to bad then. Must be the sleep debt thing as well.

I'd love to get my PTB like yours. I'll give this a little more time and see how it does over the next few days. At some point I may go back to my original settings for a few days as well and see how they compare. I see the sleep Doc on Aug 22 at the VA and I don't have enough data saved at the orignal setting...I'd like to have a good comparison when I go talk with him.

Thanks again for following along, I appreciate it.