bipap auto ASV help newbie

Hey everyone,

So, I am new to the site but have been reading everything on here for months.. Maybe everyone can help me set up a brand new PR System One REMstar 60 Series BiPAP Auto SV Advanced... I will be receiving my new machine sometime this week..

I little background: I am retired military 20 years, I was diagnosed with sleep apnea in 2010 after 2 different sleep studies... I was given a Bipap Brick S8 and the DR told me it would take care of everything "after you get used to it" well after 4 years of it not working and learning everything I could, I read my own sleep study, went to the VA doctor and didn't leave his office until I had a paper prescription for this machine.. I am attaching my sleep study so everyone can see it and help me set this new machine up, also to have a single thread for setting up and documenting everything I go through..
It takes about 3 to 8 months to see a sleep doctor in the VA, so I will be reading and doing everything myself with your help and tutoring. My setting for my old S8 were 5.6 EPAP and 9.8 IPAP, anything over a 10 IPAP I would get air in my stomach.. I would almost always ( 5 days a week) wake up about 2 hours after falling asleep gasping for air.. It has not bothered me at all wearing the mask or getting use to using the machine, I am so tired by 2100 that I fall asleep within 10 minutes from laying down.. I do not use the ramp feature.. After waking up gasping, I would take the mask off and go back to sleep, after months of nothing seeming to work I gave up... Until now... I am taking charge of getting better and making this work....

Thank you all for any help you can offer.

Cowboy

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Might want to add "ASV" after the Bipap Auto part of your subject title to get the attention of ASV users who can maybe help with ideas on setting up the machine since you have to DIY it until next doctor visit at the VA.

Thanks Pugsy...

I am not much help with initial setup on the ASV machines despite my using the ResMed S9 Adapt SV right now.
All I did was use the defaults and got lucky.

I received my machine yesterday.. wow, what a difference.....

It took me about an hour or so to get used to it.. the pressure would go up just as I was falling asleep and wake me up... This machine picks up everything, man what a difference... I only woke up 3 times last night... I am attaching screenshots of the whole night and 1 zoomed in on about 30 minutes... seems like a perfect storm, I still woke up right after it happened...

Here is the first of many questions: What is the best information to post from sleepyhead? I need to set up how the graph's look and what information displays.

Screenshot 2014-06-06 05.58.04 by cowboycasey, on Flickr
Screenshot 2014-06-06 06.03.45 by cowboycasey, on Flickr

I feel better today, but my AHI index went up.. Most of it looks like right after I fell asleep.... I did not wake up once, YAY...

Q1: What are the green bands in SH, is that something being flagged? (screenshot 2 and 3 on flow rate)
Q2: On the flow rate, there are a bunch of dots above the lines?
Q3: I see numbers above everyone else's lines/flags and mine just have H or CA with no number next to it, is the something I have to change or is it just my machine...

Thanks to everyone...

Screenshot 2014-06-07 09.03.54 by cowboycasey, on Flickr
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Cowboy Casey wrote:I feel better today, but my AHI index went up.. Most of it looks like right after I fell asleep.... I did not wake up once, YAY...

Q1: What are the green bands in SH, is that something being flagged? (screenshot 2 and 3 on flow rate)
Q2: On the flow rate, there are a bunch of dots above the lines?
Q3: I see numbers above everyone else's lines/flags and mine just have H or CA with no number next to it, is the something I have to change or is it just my machine...

yay for newer tech working better!

I don't have the 960p model (autoSV), but I have used a 560p (auto) and so are familiar with some of the prs1 behavior on sleepyhead.
1) those correspond to the 'periodic breathing' or 'pb' marks in the event flags section, that's where you're breathing heavy and then light then heavy in cycles, not quite CSR but approaching it.

2) dots are 'pressure pulses', it's the PR way of checking whether you stopped breathing because your airway is blocked, or because you just stopped breathing (obstructive vs central), the resmed units use a vibration of the airstream, respironics uses those pulses (thanks pugsy, I got this from one of your posts, I'd been wondering what those pressure pulses were) (you can see the 'pressure pulse' in the events tab just above the big AHI on the left there)

3) that's just how sleepyhead shows 'em on the chart.

next question?

keep at it, enjoy the new rest.

It looks like most of your events are early on, then you finally start getting good sleep after an hour or so. Do you suffer from sleep onset insomnia? Things to look at are your medications, stress, caffeine, cough meds, before bed snacks (sugar), aches and pains and so forth. You did touch on aerophagia, what's going on with that I see you got your 960p to work with Sleepyhead v 9.5... congrats.

Thank you for letting me kmow..

Q1: CSR, I think I will watch that and see if it gets better or worse, or stays the same and go from there...

Q2: well that makes sense, The machine is doing its job..

Cowboy

Sir NoddinOff wrote:It looks like most of your events are early on, then you finally start getting good sleep after an hour or so. Do you suffer from sleep onset insomnia? Things to look at are your medications, stress, caffeine, cough meds, before bed snacks (sugar), aches and pains and so forth. You did touch on aerophagia, what's going on with that I see you got your 960p to work with Sleepyhead v 9.5... congrats.

Sir NoddinOff. ( I love your screen name )

With my old S8 anything over 10 IPAP I had aerophagia, my script/sleep study says I need to be at 11 but my old machine just didn't know what was happening and hit me with 11, I think I was having centrals and it would fill my stomach with air, it was bad... I had a little the first night with this machine but not bad, last night was nothing and that was great...

After 20 years of being in the Army, I suffer from allot of things, the list:

I am 90% disabled
I am on pain management ( Tramadol ) 1 to 2 a day as needed.. for the past 3 months I have made myself only take 1 a day between noon and 4 PM if needed.
I have chronic psoriasis and psoriatic arthritis from the psoriasis eating at all my joints and skin.
https://www.rheumatology.org/Practice/C ... Arthritis/
I have lower and upper back problems and see a chiropractor on a monthly basis.
I give myself an embrel shot once a week for the psoriasis
I quite smoking 3 packs a day in Dec 2009, we went to vaping and that has been awesome, no more hacking, coughing and not being able to breath.. The #1 best thing we have done for ourselves..

Being in the Army, you get use to not sleeping, I have stayed awake for 4 days during the first gulf war.. It is normal to stay awake 30 hours at least 2 to 3 times a month for CQ/Staff Duty/ guard duty, you name it.. In the field you can stay up 48 hours, get 4 hours sleep and go another 24 to 48 hours..You are taught to not sleep soundly because not knowing what happens around you can kill you.. I can instantly be awake from the sound of the door clicking when my wife closes it. 20 year habits are hard to break but I am trying.. We have a white noise machine in the room along with the ceiling fan to cut noise down or at least mask it.

So that is about it, some major obstacles but I am trying to over come them and take control.. I believe not getting sleep is the root cause of allot of my problems..

Cowboy

If you remove the AHI graph and include the leak graph that will help us.
I use the same machine, but I have not yet grasped the nuances of the settings. I have simply kept the prescribed settings.
It seems yo might want to tryinching up the max IPAP a bit and see if that helps.

I think some good multi vitamins and fish oil might help the psoriasis. Send me a PM if you like.

bwexler wrote:If you remove the AHI graph and include the leak graph that will help us.
I use the same machine, but I have not yet grasped the nuances of the settings. I have simply kept the prescribed settings.
It seems yo might want to tryinching up the max IPAP a bit and see if that helps.

I think some good multi vitamins and fish oil might help the psoriasis. Send me a PM if you like.

I am thinking about going up to 12 on my IPAP but I think i am going to wait a few weeks and let my body get use this this pressure... I am already getting use to it but what I am not sure about is: Is the extra pressure going to 11 escaping as leaks so maybe I am only receiving around 10 IPAP?? I may use my old trusty gel mask tonight, it does not leak 1 bit, this new mask is much more comfortable but with that comfort comes leaks...

I am getting use to how this machine works.... YAY, the fact that it is working is the most awesome thing... I want to thank every one who has posted on this site, both asking questions and every one who is giving answers.. Without that, I would have never known that ASV would help with detecting more complex sleep apnea's.. I would have never known to get a paper script from my local doctor, he is not my sleep doctor, matter of fact, I have not seen a sleep doctor for 4 years since my sleep study.. I did see a sleep nurse, she gave me tubing and filters, LOL....

So, last night's data: My AHI went down Allot and I slept for 8 hours, amazing.... Not sure if I just had a good night or what.. I didn't change anything.. I did zoom in to where I woke up, I am not sure if the machine missed a central or if it was just me waking up, it did not flag it so i am not sure... I added my leak rate and I may change to my gel mask tonight to see what that does...

Screenshot 2014-06-08 08.48.14 by cowboycasey, on Flickr
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Screenshot 2014-06-08 08.49.56 by cowboycasey, on Flickr

Cowboy Casey wrote: So, last night's data: My AHI went down Allot and I slept for 8 hours, amazing.... Not sure if I just had a good night or what.. I didn't change anything.. I did zoom in to where I woke up, I am not sure if the machine missed a central or if it was just me waking up, it did not flag it so i am not sure... I added my leak rate and I may change to my gel mask tonight to see what that does...

we all have good nights and ... (if we're lucky) less good nights

remember, while you may not have changed things, the machine is always changing things... but, it is working in your best interests.

generally you should disregard anything that happens both near the beginning and the end of the sleep periods, because you're transitioning from one state to the other, and you'll typically see a lot of weird breathing squiggles on the flow chart... and that can confuse the machine, which *assumes* you'll be asleep while using it.

Cowboy Casey wrote:

bwexler wrote:If you remove the AHI graph and include the leak graph that will help us.
I use the same machine, but I have not yet grasped the nuances of the settings. I have simply kept the prescribed settings.
It seems yo might want to tryinching up the max IPAP a bit and see if that helps.

I think some good multi vitamins and fish oil might help the psoriasis. Send me a PM if you like.

I am thinking about going up to 12 on my IPAP but I think i am going to wait a few weeks and let my body get use this this pressure... I am already getting use to it but what I am not sure about is: Is the extra pressure going to 11 escaping as leaks so maybe I am only receiving around 10 IPAP?? I may use my old trusty gel mask tonight, it does not leak 1 bit, this new mask is much more comfortable but with that comfort comes leaks...

Assuming your leaks are below large leak the machine should be able to account for leaks and maintain prescribed pressure. How you feel should determine how bad leaks are. If you feel good and are regularly below large leak things are probably fine.