Respironics auto sv bipap settings

I have been using the respironics auto sv for almost 2 months. It has been a challenged.I am not convince that my sleep doctor understands the machine. My settings now are: Max:25 epap min:6, epap max:15, Ps min:0, ps max: 10,and the breath rate on auto. My first settings: epap min: 4 and ps max:15, and other settings the same.I have been sleeping a little better and i no longer have headaches but i still am not feeling rested. Sitll feeling sleepy after a few hours of being up. Since using the machine i may have had 3 days where i felt good.the machine wakes me up with high pressures and its hard to get back to sleep. Are my settings ok ?

Did you get a copy of your sleep study?

Do you know at which pressure it showed that obstructive apneas, hypopneas, and flow limitation were treated completely?

How severe (frequency) and for how long did you have CSA events and/or Cheyne-Stokes events?

The numbers look like your obstructives were being handled at a relativly low pressure but that increasing from 4 to 6 is trying to get them completely handled.

The other numbers look like the machine is set to wide open to handle the rest.
In your case, the pressure swing going from OSA levels to CSA levels might be as much as 15 cm H2O which can be daunting. As JohnBFisher points out, adjusting to this new type of treatment can be difficult.

Hang in there, things can get better.

Boop wrote:... I have been using the respironics auto sv for almost 2 months. ... I have been sleeping a little better and i no longer have headaches but i still am not feeling rested. Still feeling sleepy after a few hours of being up. Since using the machine i may have had 3 days where i felt good.the machine wakes me up with high pressures and its hard to get back to sleep. Are my settings OK ? ...

Yes. It takes time for our bodies to adjust to ASV therapy (the machine you have uses Adaptive Servo-Ventialation or ASV therapy). The fact that you are sleeping a little better, that you have had a few times when you feel well all indicate that you are on the right track.

Think of it this way. It took years for you to reach the point you did where you knew you needed to see a doctor about your sleep. Don't be surprised if it takes months to sleep better with this new (to you) therapy.

That you awaken with the higher pressure at night just indicates the machine was doing its job. You had stopped sleeping (or were breathing very shallowly). Your machine detected the decreased flow and increased the pressure to assist your respiration. It helps break the cycle of constant central apneas. For every time you awaken with the higher pressure you probably have ten or more times when you slept through the higher pressure.

If the mask leaks at that higher pressure, you might want to consider a mask liner to help quiet the leaks. It does not fix them, but it helps. And it certainly decreases the noise of the leak, which often helps you sleep through the higher pressure.

So, hang in there. Read and learn. This is one medical situation where the more involved you are, the greater your chance of attaining good sleep.

If you get a copy of EncoreBasic, you can look at your waveform data a see how the machine is reacting to your central type apneas. Watching how fast it tries to correct your breathing issues can be a great encouragement to keeping on.

Pugsy can help with the software.

Cheers

I agree that it's important you get the software necessary to download and evaluate your data. If you can get the data and post it here, we can help you interpret it. As JDS said, Pugsy should be able to help you get the correct software. You're going to need a SD card reader which you can get for less than $15 from Best Buy.

Boop wrote:I have been using the respironics auto sv for almost 2 months.

I am going to assume the PR System One Auto ASV...either model 950 or 960 and not the older model Legacy series.
If you click on the link to my machine in my profile and the general look is like mine..then you have one of the System One models.

If 950 model (3 digit number on the bottom of the blower unit with maybe DS or REF in front) then you can use EncoreBasic.

A card reader is only needed if your computer doesn't have a slot for the SD card.

If 960 model the only software that will work is a specific version of Encore Pro.
I need to know computer specs to know which version of Pro to point you to.

If you have one of the older models prior to the System One series of machines...we get to have a totally different discussion. It's unlikely that you would have been given that model since it was discontinued last year but it wouldn't be impossible.

EncoreGuide link this will show you examples of what you will see if you have a System One machine.
http://www.healthcare.philips.com/pwc_h ... _Guide.pdf

Boop wrote:the machine wakes me up with high pressures and its hard to get back to sleep.

Press the "ramp" button. That'll make it settle down for a few minutes, which makes it easier to fall back asleep. (I'm assuming they haven't disabled the ramp.)

Are my settings ok ?

How do you feel when it first starts? If you feel smothered, you might look into increasing PSmin to something more comfortable.

JDS74 wrote: The other numbers look like the machine is set to wide open to handle the rest.
In your case, the pressure swing going from OSA levels to CSA levels might be as much as 15 cm H2O which can be daunting.

I agree, that's a big pressure change that can lead to all kinds of weird reactions. I'm no expert but I don't like to see a machine, especially an ASV, set wide open by a sleep doctor. That's kinda lazy IMO. Heck, what was your $2000 sleep study was for, if not to determine your window of optimum treatment?

Maybe I should put a shingle that sez: ASV sleep study evaluations: fifty buck, cheap. Then just set everybody 'wide open'.

The pressure swing in an ASV machine is in ventilator mode.
What is going on is you aren't making any effort to breathe.

The machine inflates your lungs and then drops the pressure to let natural muscle tone exhale for you when you don't do it yourself. There needs to be a significant pressure swing to ensure ample air exchange to keep the O2 level up and the CO2 level down. If the pressure difference is small, the air exchange is not so great and you suffer the equivalent of an extended hypopnea. In my case, I had one sequence that went on for more than 80 minutes - that's a pretty long time to not breathe and survive.

This is very different from what happens in a bi-level machine where the pressures switch back and forth for patient comfort while keeping the airway open. Your muscles do the breathing, the machine is only keeping the airway open.

Sir NoddinOff wrote:... I'm no expert but I don't like to see a machine, especially an ASV, set wide open by a sleep doctor. That's kinda lazy IMO. Heck, what was your $2000 sleep study was for, if not to determine your window of optimum treatment? ...

And if you can tolerate that wide open setting, then that will be the MOST EFFECTIVE setting. The ASV *REQUIRES* the widest possible range to be effective. Without it, it can not help sustain respiration. It's not laziness. Of course, some people with complex sleep apnea (as is your case, if I remember correctly) can not tolerate the wide open spread. My issue is neurological, so I'm not trying to avoid pressure induced apneas. And for me that's good. Because SOMETIMES my body simply FAILS to work well. And when that happens, like below, I really WANT it to run wide open!!




Yup. That's over 20 (*TWENTY*) minutes of not breathing well. I *LOVE* it when my machine runs flat out. It means I stand a chance of sleeping - even when I would have been unable to sleep a wink without my ASV unit.

JohnBFisher wrote:

Sir NoddinOff wrote:... I'm no expert but I don't like to see a machine, especially an ASV, set wide open by a sleep doctor. That's kinda lazy IMO. Heck, what was your $2000 sleep study was for, if not to determine your window of optimum treatment? ...

And if you can tolerate that wide open setting, then that will be the MOST EFFECTIVE setting. The ASV *REQUIRES* the widest possible range to be effective. Without it, it can not help sustain respiration. It's not laziness. Of course, some people with complex sleep apnea (as is your case, if I remember correctly) can not tolerate the wide open spread. My issue is neurological, so I'm not trying to avoid pressure induced apneas. And for me that's good. Because SOMETIMES my body simply FAILS to work well. And when that happens, like below, I really WANT it to run wide open!!

Yup. That's over 20 (*TWENTY*) minutes of not breathing well. I *LOVE* it when my machine runs flat out. It means I stand a chance of sleeping - even when I would have been unable to sleep a wink without my ASV unit.

John, I’m happy to report that my current AHI on ASV is below 0.2 virtually every night, which of course includes centrals. Alas, there are always other problems to address. I guess one of my major concerns with the 'wide open' concept is that mask leaks can shipwreck my whole sleep process. I know they do if my upper pressure (PSmax) gets above 19cmH20. - notably, my overall 95% IPAP is always about 17cmH20 anyway.

Also a separate issue: If I set my PSmin too low, ie. 3-4cmH20, then I get a weird strangled catch in my larynx at the beginning of inspiration, which is an ugly arousal factor too. For lack of a better term, I seem to like a little 'pre-loaded pressure' on the start of inspiration and this greatly helps round off my flow line, especially during REM stages, or so I’ve observed in Sleepyhead. I've also noted that my diaphragm regulates better, and that it feels better (more refreshed?) in the morning. I start getting the benefits of this pre-loaded pressure effect at 5-6 PSmin. After all, I heard that PSmin is really a comfort setting that allows one to exhale against a low pressure. I'll trade that comfort for no rattling catch at the beginning of my inhale cycle any day. Obviously I'm not suggesting my method is right for everybody. So, it's still early days in this experiment with a sample group of one, namely me.

Thanks for the previous reply and a differing point of view, John. Interesting comments on the neurology vs centrals issue. It's always good to learn new stuff from you.

JohnBFisher wrote:

Sir NoddinOff wrote:... I'm no expert but I don't like to see a machine, especially an ASV, set wide open by a sleep doctor. That's kinda lazy IMO. Heck, what was your $2000 sleep study was for, if not to determine your window of optimum treatment? ...

And if you can tolerate that wide open setting, then that will be the MOST EFFECTIVE setting. The ASV *REQUIRES* the widest possible range to be effective. Without it, it can not help sustain respiration. It's not laziness. Of course, some people with complex sleep apnea (as is your case, if I remember correctly) can not tolerate the wide open spread. My issue is neurological, so I'm not trying to avoid pressure induced apneas. And for me that's good. Because SOMETIMES my body simply FAILS to work well. And when that happens, like below, I really WANT it to run wide open!!




Yup. That's over 20 (*TWENTY*) minutes of not breathing well. I *LOVE* it when my machine runs flat out. It means I stand a chance of sleeping - even when I would have been unable to sleep a wink without my ASV unit.

John, during that period, with restless sleep, did you sleep well anyway? Do you notice of when the machine is "working"?

Lazer1234 wrote:... John, during that period, with restless sleep, did you sleep well anyway? Do you notice of when the machine is "working"? ...

Did I sleep well? Nope. Sometimes my symptoms flair and I have very poor sleep. This was one example. And it's little wonder.

Did I notice the machine working? Sort of. Anymore, I hardly notice the increased pressure. But I noticed it some at the time. I could tell that I was simply not breathing. So, yes. I noted the machine was working for me. But it was not disturbing. Rather, I was grateful to know that even if my body was not working the unit was trying very hard to breathe for me. Thus, I find the higher pressure pretty reassuring.

But no. Those events always lead to poor sleep.

JohnBFisher wrote:

Lazer1234 wrote:... John, during that period, with restless sleep, did you sleep well anyway? Do you notice of when the machine is "working"? ...

Did I sleep well? Nope. Sometimes my symptoms flair and I have very poor sleep. This was one example. And it's little wonder.

Did I notice the machine working? Sort of. Anymore, I hardly notice the increased pressure. But I noticed it some at the time. I could tell that I was simply not breathing. So, yes. I noted the machine was working for me. But it was not disturbing. Rather, I was grateful to know that even if my body was not working the unit was trying very hard to breathe for me. Thus, I find the higher pressure pretty reassuring.

But no. Those events always lead to poor sleep.

John, do you mind me asking what your PB number was for that night?

icipher wrote:John, do you mind me asking what your PB number was for that night?

Nope. I don't mind. I do not remember the exact number. But it's never been much over 1%. Periodic Breathing is (fortunately) not one of my problems.