New BiPAP/ASV user

Hello. I'm newly diagnosed with mixed apnea and have just had my first night on my prescribed BiPAP/ASV machine. I like what you all have built on these forums.

During my first night at about 20 minutes into treatment, I had "pins and needles" (paresthesia?) in my fingers, hands, arms and chest. My DME suggests that it might be a pinched nerve due to my mask's straps. But I suspect that I was having a panic attack and hyperventilating.

I think that I'm having trouble trusting the machine. My breathing sometimes gets out of sync with the in/out pressures of the machine - I end up trying to breathe out while the machine is trying to get me to breath in. Or I'll pause breathing for a moment while I wet my lips or swallow saliva - the ASV feature suddenly kicks in and I'm having to take a breath I wasn't ready for.


Any tips on bonding with the machine and learning to trust it? I've read that I should spend some awake time with the mask/pressure on to get used to it. I had done that last night, but it seems that I need more practice.

i have been switching from cpap to bipap and finally to bipap ASV about three weeks ago. I never had a good nights sleep with cpap or bipap. My first night and every one since with ASV have been the best sleep I can ever remember having even before the head injury induced centrals. That said, I had almost three years of changing masks and fighting machines not suited to me before I got my ASV machine. According to each mask I tried I would sometimes adjust the headgear three or four times a night for a week or more before I realized I had the best fit for that particular combination. The fact that you got through your first night with what sounds like minimum shock seems like your going to do good. Play with your fit, get used to the concept mentally and physically and don't be afraid to try another mask type. I never thought I would get acclimated to xpap therapy but my previous doctors just would not put the effort into getting me dialed into the correct machine. Now I look forward to masking up and usually don't roll over or even wiggle till the alarm goes off in the morning. Good luck.

Greetings! And welcome to the forum.

You will learn that I caution it takes time to adjust to ASV therapy. Typically it can take two to three months.

One way to learn to get along with the unit is to listen to TV while wearing the mask. Our or while reading.

Another way to work with the unit is to turn it off and then back on. This will reset what the unit expects from you.

Later today I'll post more information. But in the meantime I hope that helps.

Ghune,

Welcome to the forum.

Can you please take the time to verify your equipment choice. The machine that is currently showing in your signature is the S9 VPAP™ Auto BiLevel Machine, which is the Resmed Auto bilevel machine that does NOT have any ASV settings. But your post refers to the ASV algorithm kicking in when you momentarily stop breathing long enough to lick your lips.

I suspect that you are actually using the S9 VPAP Adapt SV Bilevel Machine, which is not available on the pull down list in the user panel because CPAP.com (our host) does not sell this machine right now. So you'll need to just add the the correct machine name to the "Additional Comments" section of the Edit Equipment panel in the User Control panel. In the long run it will create less confusion if the equipment in your signature accurately reflects the ASV machine you are using.

Welcome.

I was new to ASV in October. I know what you mean about sometimes not being ready to receive the breath that the machine is trying to give to you. That might just be an acclamation issue. I find that the ASV actually tries to follow my breathing pattern and breathe with me. Yes, if i pause for too long, it will give me a breath. You will learn to subconsciously breathe with it.

Please, give your machine time, and be patient. Iam only 2 months into ASV, and my experience is getting better.

Hang in there.
I am about 5 weeks into ASV and I took to it pretty quickly. I have had instances where the machine gets stubborn about when I should be breathing. I tend to breathe it down. Think Clint Eastwood. I kind of breath heavier and more purposefully than I normally would and within a minute the machine basically says OK you win, and it settles in to my pace and I relax and go to sleep.

Ghune wrote:I think that I'm having trouble trusting the machine.

Hi,

Here is what is kind of funny about humans…while we have very regular patterns for breathing when we are sleeping, our breathing is all over the place when we are awake. The more we think about it, the more irregular our breathing becomes. So, while this is a real pain in the butt when you are trying to fall asleep, once you actually get to sleep, it will smooth out and you will breathe just like clockwork. That is, however, the trick…trying to get to sleep with this thing trying to outsmart your awake breathing that isn't fitting into any good pattern. My machine wants me to breathe a little shallower and a little faster than what I would prefer. While I have found ways to trick it, I find that the path of least resistance is to let it do its thing. That does take a little getting used to, but it becomes second nature pretty quickly.

-john-

I think the auto setting pushes my breathing too hard and I feel foggy now on max IPAP 18cm epap 6-9cm. I think the BPM 8 might be a better setting for me but what do you set Ti on which I assume is time for inspiration? does anyone use low BPM settings?

sickwithapnea17 wrote:I think the auto setting pushes my breathing too hard and I feel foggy now on max IPAP 18cm epap 6-9cm. I think the BPM 8 might be a better setting for me but what do you set Ti on which I assume is time for inspiration? does anyone use low BPM settings?

John
Please ignore sickwithapnea's response....... she tries to interject comments in threads when others won't give her the responses she wants.

Ghune, and others reading this post should know that most people find the AUTO mode for Breaths Per Minute is the best balance between enforcing regular breathing and just allowing you to breathe on your own. The auto mode tends to follow your breathing pattern, but does not allow you to stop breathing.

Also, a caution for others reading this post. If you have any type off heart problems do NOT change the breathing settings, as that can lead to serious heart problems.

Learn from SWA, who refuses to learn from others including his/her doctor, yet always complains about not feeling well.

JohnBFisher wrote:
Also, a caution for others reading this post. If you have any type off heart problems do NOT change the breathing settings, as that can lead to serious heart problems.

Learn from SWA, who refuses to learn from others including his/her doctor, yet always complains about not feeling well.

I am interested in the science behind this. Why would changing setting effect any heart problems? Would someone with heart issues want to be on auto mode or not?

For what it's worth, I don't have any heart conditions that i am aware of, other than palpitations which aren't "problems"

icipher wrote:

JohnBFisher wrote:
Also, a caution for others reading this post. If you have any type off heart problems do NOT change the breathing settings, as that can lead to serious heart problems.

Learn from SWA, who refuses to learn from others including his/her doctor, yet always complains about not feeling well.

I am interested in the science behind this. Why would changing setting effect any heart problems? Would someone with heart issues want to be on auto mode or not?

For what it's worth, I don't have any heart conditions that i am aware of, other than palpitations which aren't "problems"

It's not so much science as common sense. Though in the past I did read some articles to this effect, I can not lay my hands on them now. Here's the issue. With an ASV unit you can not only change the Breaths Per Minute, but you can change the time the unit will allow for inspiration and expiration. If incorrectly set, this can result in insufficient inspiration time, or too deep (or shallow) an expiration. The result is that it can decrease the blood oxygen levels or unduly increase the CO2 levels. For someone with a healthy cardiovascular system, this is stressful enough. It will at best leave you feeling horrible the next day. But if you have a compromised heart, this can lead to further heart complications. As the body reacts to a poor setting, it can actually increase fluid retention, which would make things worse for a patient with congestive heart failure.

Please understand that there is no doubt that an ASV unit has been proven to be the most effective option for such patients. However, such patients should follow the advice from their medical team in regards to the breathing rates set on the units.

Of course, not all DMEs know how to set the ASV units. Mine was improperly set up when I first received it. I had to change it to follow the settings prescribed by my doctor.

Mr. Ghune, I have used Auto SV since 2010. I also have suffered with the feeling of hyperventilation with my machine. I found a mask called Mirage Liberty by Resmed that has separate nasal cannula and mouth area, without anything going over the top of my nose. The nasal cannula's come up from the top lip area and they stay put. I have daytime apnea's and get that hyperventilation feeling and have even gone to the ER thinking it's a heart attack. I take an antianxiety melt if this happens day or night and it helps a lot. As for your neck, does it feel hyperextended, like you've been looking at the ceiling all day. This could be your bodies (learned way) of trying to keep your airways moving. My neck always feels like this. I get cranial/sacral release from a PT for it. I also have a small therapy ball(grapefruit sized) that I put under my occipital area at night for a while to give the neck a good stretch. I am having a problem with moisture and looking into a new ASV machine. Good luck with your sleep.

welcome i myself use asv and have found it to be life saving

To expand on what JohnB said about fiddling with your settings,
When the ASV machine kicks into ventilator mode, it depends on external air pressure and the natural relaxation of your chest to cause exhalation. In my case with my settings, ventilator mode means the pressure change between inhale and exhale switches from EPAP 17-IPAP 19 to EPAP 10-IPAP 24 and it can sometimes do that between breaths.

So,if you get the EPAP pressure too close to the IPAP pressure, your lungs won't exchange air properly and you will start to increase the blood CO2 level and develope acidosis. That's bad news.

That difference in pressure is one of the reasons some people have difficulty adjusting to ASV machines.
In ventilator mode the machine kicks in and says BREATH NOW and if you are even partially awake it feels like you are the balloon at a kids birthday party and the machine is the Helium cylinder.