2/25 data(first night) and 3/4 data and 3/5 data

Here is the results of my bipap asv test. Not entirely happy with the results... but seems better than the last one. Hopefully I can get used to the treatment and improve over time. Still waiting for the Machine. The DME ordered this one http://1800cpap.com/resmed-s9-vpap-adapt.aspx (Its not listed on cpap.com) They were waiting on my pcp to write the script and he thought the sleep dr at my sleep clinic was writing it... So got that sorted out today. DME is now working this out with the insurance while waiting for the machine to get here.

4betterO2 wrote:First, your normal, usual respiratory rate must be determined, then a backup rate should be applied at -2 from the normal rate.

Well that would seem to be in conflict with the OP's current prescription, eh?

Beauty, eh?

mollete wrote:

4betterO2 wrote:First, your normal, usual respiratory rate must be determined, then a backup rate should be applied at -2 from the normal rate.

Well that would seem to be in conflict with the OP's current prescription...

Which, for anybody keeping track (or giving a FF) is 14, while

the NPSG wrote:(that the respiratory rate) commonly declined to 10 to 12 bpm while asleep,

Further, I would question the accuracy (or relevance)(or significance) of this comment:

NPSG interpretation wrote:The respiratory events were more common when the respiratory rate was 10 bpm.

If that was measured using signal averaging over x seconds (or minutes), the dynamics of the area of respiratory disturbance would not be accurately respresented, i.e., there would be an event, followed by period of hyperventilation, followed by a central event, etc., unless this was another case of opiate-induced CSA, where RR would be decreased throughout (of course, it would be something like 4, and not 10).

Nooblakahn wrote:Here is the results of my bipap asv test. Not entirely happy with the results...]

One thing bewilders me, the Rx recommendation does not add up.
It says max pressure is 25 (that's all the PR ASV can deliver, don't know as for the Resmed equivalent machine?)
but it also says,
max EPAP= 15
max PS= 15
doesn't this add to a max pressure of 30, not 25?
...sloppy work (?)

4betterO2 wrote: One thing bewilders me, the Rx recommendation does not add up.
It says max pressure is 25 (that's all the PR ASV can deliver, don't know as for the Resmed equivalent machine?)
but it also says,
max EPAP= 15
max PS= 15
doesn't this add to a max pressure of 30, not 25?
...sloppy work (?)

The prescription is acceptable: If EPAP ranges between 8cm and 10cm, then the entire PS range is allowed; but if EPAP ranges above 10cm, then the resultant IPAP should be capped at max pressure.

I appreciate the info.. but the last couple of posts here are way over my head. Still waiting on my machine. They got it Wednesday, but didn't submit stuff for the insurance auth on the Wednesday before as they were supposed to. I have an appointment set up for Monday but have no clue if they have my auth or not.. as the phones were conveniently down today at this place... So we will see what happens on Monday.

-SWS wrote: if EPAP ranges above 10cm, then the resultant IPAP should be capped at max pressure.

Thanks for the correction and reminder! In my case I'm really glad I got my max pressure reduced, I see it was the only way to get the needed limit on IPAP.

Nooblakahn wrote:I appreciate the info.. but the last couple of posts here are way over my head. Still waiting on my machine. They got it Wednesday, but didn't submit stuff for the insurance auth on the Wednesday before as they were supposed to. I have an appointment set up for Monday but have no clue if they have my auth or not.. as the phones were conveniently down today at this place... So we will see what happens on Monday.

Don't worry about all those settings initially. However, PLEASE be certain the person who works at the DME understands how to properly set the prescription. It's pretty common that they get it wrong. I haven't followed which unit you are getting, but the prescription is based on the Respironics unit. The Resmed unit would not be able to follow the recommended prescription.

When you get your unit, I will provide a PM to help you learn how to check your unit for the proper settings.

Plus, please be aware that it can take two to three months to become accustomed to using an ASV unit. In addition to leaking masks, the most common complaint is that you and the unit are not in synch when you fall asleep. I found that for those first few months I would occasionally have to turn off the unit and then start all over again. Fortunately, the mask was already in place. But by restarting the unit, it allows the algorithm to start from scratch. You and the unit have a better chance of working together.

Gradually over that first few weeks and months, you will find that you AHI value will drop. It appears (from what many of us have seen) that over the first few weeks the unit encourages you to breathe more consistently. The result is that you will have fewer events when you sleep. However, don't think you can do without the unit. That's a great way to wind up with a splitting headache from the lack of oxygen (been there, done that!).

Anyway, congratulations on your progress through the sleep medicine labyrinth. You made it and have the best solution currently possible for your condition. Hopefully you will be able to soon sleep much better and reclaim your life.

Best wishes!

-SWS wrote:

4betterO2 wrote: One thing bewilders me, the Rx recommendation does not add up.
It says max pressure is 25 (that's all the PR ASV can deliver, don't know as for the Resmed equivalent machine?)
but it also says,
max EPAP= 15
max PS= 15
doesn't this add to a max pressure of 30, not 25?
...sloppy work (?)

The prescription is acceptable: If EPAP ranges between 8cm and 10cm, then the entire PS range is allowed; but if EPAP ranges above 10cm, then the resultant IPAP should be capped at max pressure.

-SWS pardon me for correcting you a bit, but:

• EPAP (the exhalation pressure) can range from 8cm to 15cm H2O. This allows the unit to dynamically adjust the pressure to overcome obstructive sleep apneas. So, if the OP is on his back (when obstructive apneas are normally most severe), it can ramp up the pressure to overcome them. But if the OP is on his side the machine can scale back the pressure accordingly.
• IPAP is at a minimum 10cm H2O over the CURRENT EPAP pressure. So, if the current EPAP pressure is 8cm H2O, the current IPAP will be a minimum of 8cm + 10cm H2O .. or 18cm H2O.
• However, since the ASV unit uses IPAP to overcome central apneas, the current maximum IPAP can range in this case upto 15cm H2O over the current EPAP. Again, if the current EPAP is 8cm and the current pressure support is 15cm H2O, then the current maximum IPAP would be 8cm + 15cm H2O .. or 23cm H2O. If the current EPAP was 15cm then the current maximum IPAP would be 15cm + 15cm H2O .. or 25cm H2O (since the maximum pressure is 25cm H2O).

It's almost the same thing. But it's a bit more complicated, since both the lower and upper scale are moving targets. I created a graph that might help explain this (using different EPAPmin and max and PSmin and max values):

Hope that helps.

JohnBFisher wrote:

-SWS wrote:The prescription is acceptable: If EPAP ranges between 8cm and 10cm, then the entire PS range is allowed; but if EPAP ranges above 10cm, then the resultant IPAP should be capped at max pressure.

-SWS pardon me for correcting you a bit, but:

Well, you lost me on that correction, John. Below is the OP's Rx followed by a table of allowable EPAP ranges for the OP's Rx. You can also see the allowable IPAP range at each EPAP value.

Op's Rx wrote: Minimum EPAP 8cm, Maximum EPAP 15cm, Minimum Pressure Support 10, Maximum Pressure Support 15, Maximum Pressure 25cm, Backup rate 14 bpm, BiFlex of 3."

Ranges at OP's Rx:
==================
EPAP8: IPAP18->IPAP23 (full PS range allowed)
EPAP9: IPAP19->IPAP24 (full PS range allowed)
EPAP10: IPAP20->IPAP25 (full PS range allowed)
EPAP11: IPAP21->IPAP25 (PS range capped by max pressure setting)
EPAP12: IPAP22->IPAP25 (PS range capped by max pressure setting)
EPAP13: IPAP23->IPAP25 (PS range capped by max pressure setting)
EPAP14: IPAP24->IPAP25 (PS range capped by max pressure setting)
EPAP15: IPAP25->IPAP25 (PS range capped by max pressure setting)


Of course the delivered EPAP and IPAP pressures will increment/decrement in decimals rather than the whole numbers in the above example. But please explain to me what you are correcting, either in the table above or the description below:

-SWS wrote: If EPAP ranges between 8cm and 10cm, then the entire PS range is allowed; but if EPAP ranges above 10cm, then the resultant IPAP should be capped at max pressure.

Thanks.

Well... I already have the machine. Last night was one week of using it. I have a resperonics vpap adapt. The script as you said was wrong and they had to redo it. I haven't checked it to see if it is set right... but that explains why it had to be rewritten. It seems to be working.. I have been below one AHI for three or 4 out of these nights. I have been meaning to upload a few charts. Ill have to get that.

JohnBFisher wrote:

-SWS wrote: The prescription is acceptable: If EPAP ranges between 8cm and 10cm, then the entire PS range is allowed; but if EPAP ranges above 10cm, then the resultant IPAP should be capped at max pressure.

-SWS pardon me for correcting you a bit, but:

However, since the ASV unit uses IPAP to overcome central apneas, the current maximum IPAP can range in this case upto 15cm H2O over the current EPAP. Again, if the current EPAP is 8cm and the current pressure support is 15cm H2O, then the current maximum IPAP would be 8cm + 15cm H2O .. or 23cm H2O. If the current EPAP was 15cm then the current maximum IPAP would be 15cm + 15cm H2O .. or 25cm H2O (since the maximum pressure is 25cm H2O).

You guys should work together more often. You both said the same thing. Or close enough..

StillAnotherGuess/Banned wrote: You guys should work together more often. You both said the same thing. Or close enough..

Hey, don't blame me, Sir Banned... I said it, he expanded it with paraphrasing, and I'm still trying to understand what exactly was corrected. I suspect it might have to do with John's interpretation of how I used the term "capped".

Nooblakahn wrote:Well... I already have the machine. Last night was one week of using it. I have a resperonics vpap adapt. The script as you said was wrong and they had to redo it. I haven't checked it to see if it is set right... but that explains why it had to be rewritten. It seems to be working.. I have been below one AHI for three or 4 out of these nights. I have been meaning to upload a few charts. Ill have to get that.

That AHI is excellent.

How does your new Rx differ from the PSG-recommended Rx?

Nooblakahn wrote:Well... I already have the machine. Last night was one week of using it. I have a resperonics vpap adapt. The script as you said was wrong and they had to redo it. I haven't checked it to see if it is set right... but that explains why it had to be rewritten. It seems to be working.. I have been below one AHI for three or 4 out of these nights. I have been meaning to upload a few charts. Ill have to get that.

Glad they got the settings straightened out. It's a really common problem. They just don't deal with anywhere near as many ASV units as they do CPAP or BiPAP units.

-SWS, the correction is that the EPAP range is from 8cm to 15cm (not 10cm as you initially quoted) H2O. (Though I may have misread your first clarification post which read "If EPAP ranges between 8cm and 10cm" .. and does not in fact imply that the EPAP range was from 8 to 10 .. just that was used as an example).

Your second post clarifying the ranges shows that relationship. Sorry for my confusion .. It's a pretty normal state for me! ..

Nooblakahn, sounds as if you are off to a running start! .. One thing I would mention is that you will probably need to research with your DME how frequently they will replace the cushion on your mask. And/or the mask itself. You will find that the constant flexing of the mask will cause it to stiffen. This tends to lead to more leaks over time.

One thing that can help you sleep better - even if the mask does leak are mask liners. These liners are essentially cloth that sits between you and the mask. Here are three different brands. I've used the REMzzzs and Pad-A-Cheek. I use the REMzzzs for several nights, not just one night. Though over time, it picks up the oils from my skin, so becomes less effective. So, I try to change the mask liner on a weekly basis, rather than a daily basis. That seems to be a good compromise between the cost (which most insurance companies do not cover) and the effectiveness of the product.

REMzzzs: http://www.remzzzs.com/
Quietusliners: http://quietusliners.com/
Pad-A-Cheek: http://padacheek.com/PAC_Maskliners.html

Hope that helps.