bipap auto ASV help newbie

Hi,
I hope I will be able to help you with your machine settings and make your AHI lower and at least more consistent. I currently use the exact same machine at a similar pressure and have a similar mix of central and obstructive events.

Looking at your recent bad night June 9th when your AHI was 10.5 there were a large number of hypopneas between 22.30 and 0.30. The machine increased the EPAP, which had little effect suggesting they were central hypopneas and it was unable to treat any central events because the Maximum pressure limit appears to be set at 11.0 cm H2O. Central events can only be treated by rapidly altering the Pressure Support (PS) which equals the difference between the IPAP and the EPAP. In this case because of your settings the machine was unable to respond appropriately.

Looking at Sleepyhead my best guess at your current settings is Max Pressure 11 (? because of aerophagia), EPAP min 6.5, EPAP max 11, PS min 0.0, PS max 4.0. Is that about right?

Based on your data so far I would recommend changing to the following : Max Pressure 20, EPAP min 7.0, EPAP max 8.5, PS min 0.0, PS max 6.0. I would suggest trying these for a few days and seeing if your AHI lowers and stabilises. If you then repost your Sleepyhead data, we can see if any other adjustments are needed.

Hope this helps
Ian

Ian,

Thank you, my settings now are Max Pressure 11 (? because of aerophagia, correct), EPAP min 6.5, EPAP max 11, PS min 0.0, PS max 4.0. You sir are correct on all the above, I take it you were set almost the same...

so let me see if I understand this...

so basically by adjusting the PS max to 6.0 and the epap to range between 7 and 8.5 that will let the machine adjust but try to keep as close to 11...

So far anything over 10 IPAP is giving me aerophagia, but not as bad as my old S8... I am dealing with it to try and find the right settings... maybe my body will get use to the pressures and stop doing it.. one can hope

Thank you for the help

Cowboy

igdoc wrote:Hi,
I hope I will be able to help you with your machine settings and make your AHI lower and at least more consistent. I currently use the exact same machine at a similar pressure and have a similar mix of central and obstructive events.

Looking at your recent bad night June 9th when your AHI was 10.5 there were a large number of hypopneas between 22.30 and 0.30. The machine increased the EPAP, which had little effect suggesting they were central hypopneas and it was unable to treat any central events because the Maximum pressure limit appears to be set at 11.0 cm H2O. Central events can only be treated by rapidly altering the Pressure Support (PS) which equals the difference between the IPAP and the EPAP. In this case because of your settings the machine was unable to respond appropriately.

Looking at Sleepyhead my best guess at your current settings is Max Pressure 11 (? because of aerophagia), EPAP min 6.5, EPAP max 11, PS min 0.0, PS max 4.0. Is that about right?

Based on your data so far I would recommend changing to the following : Max Pressure 20, EPAP min 7.0, EPAP max 8.5, PS min 0.0, PS max 6.0. I would suggest trying these for a few days and seeing if your AHI lowers and stabilises. If you then repost your Sleepyhead data, we can see if any other adjustments are needed.

Hope this helps
Ian

You had a "good" night Sunday night and a not so good night Monday night when looking at just the software reports.
Makes me wonder why the big difference. Anything that you can think of that might have been a factor?
Did you sleep more soundly either night? If so, which one?
Sleep position change?
Anything change?
If you never had a "good" night that would be one thing but you did...so makes me wonder what was different between the 2 nights that might account for the need for different pressures on Monday night.

Looking back on your reports with this machine and I know you haven't been using it all that long....do the not so good nights out number the good nights or do you see any improvement trending maybe?

Casey,
Looking at your data so far, nearly all your events are hypopneas (which the machine cannot classify as central or obstructive) with a few central apneas and almost no obstructive apneas. Obstructive events are treated by the machine by raising the EPAP whereas central events/periodic breathing are treated by rapidly altering the pressure support (PS) on a breath by breath basis. In the case of hypopneas it tries both and monitors to see if it works. On your bad night, with your current settings, it was unable to successfully treat the hypopneas (which were almost certainly central) because it had no pressure support available.

If the pressure support (PS) max is set too low it will not successfully treat the majority of the central events and periodic breathing. A PS of 10 cm H2O is enough to induce a full breath in most people with healthy lungs. However a rapid change of 10 cm can wake people up and so I have suggested an increase from 4 to 6 in the first instance.

Narrowing the EPAP range to between 7 and 8.5 potentially reduces the machines ability to control obstructive events but your data so far suggests that obstructive events are not a problem. By lowering the EPAP max it will help to limit the aerophagia.

You will have to raise Max Pressure to allow the machine to work with these changes and anything above 14.5 will be fine as that is the highest pressure that can be reached on the settings I have suggested. Don't worry about this potentially high IPAP pressure as it may only be reached for a few seconds per night and it is persistently high pressure that causes the aerophagia.

Regards
Ian

Good Day everyone,

Well I feel much much better today, not in a fog, go figure..

Ian, That helped alot.. The one thing I left was EPAP Min at 6.5, 7 felt like it was hard to breath out... The machine pretty much kept my EPAP down at 6.5 all night, I see it went up to 8/8.5 a couple of times but nothing like the night before... I feel like I did better, my data looks like I did better so I think we are on to something here... My machine only flaged 2 as central but the hypopneas "look" really close to the same as my central's.. You were right about the PS, the first time it went to 6, I was almost asleep, my heart rate went up and startled me but I got used to it fast and went right to sleep...

Pugsy, The 1 thing that changed was my pain meds, I had been off of them for more than 2 days and it really messed with my sleep, its amazing how much your back, joints and body hurting can make that much of a bad night.. I am not sure if I was just moving around alot or what was happening... I can say that I have not changed any of my sleep habbits, I do exactly the same things going to sleep every night and it works for me.. I am going to get my sleep under control before I try to get of the pain meds, I think trying to do both at the same time is messing with me... What I am hoping is by getting sleep it will take care of everything else... STEP 1, sleep...

Pugsy, Ian, Is there anything that you see that you want a closer look at? If you give me a time on the SH chart I can zoom in for you and upload it...

Since I have used this machine, the one thing I notice the most from my old machine, I keep my mask on all night.. I believe the ASV is getting me the air I need when I need it so I dont take it off...

Thank you both for the help, and I hope that everyone else is benifiting from my experiance, I know I am..

Cowboy

Screenshot 2014-06-11 05.56.06 by cowboycasey, on Flickr
Screenshot 2014-06-11 05.56.54 by cowboycasey, on Flickr
Screenshot 2014-06-11 05.57.52 by cowboycasey, on Flickr
Screenshot 2014-06-11 05.58.50 by cowboycasey, on Flickr

Casey
Good to hear you had a better sleep. From last nights Sleepyhead the ASV is certainly reacting better to the events with the new settings.

The increase in the hypopneas later in the night are most likely due to 'REM rebound' where your body is trying to catch up with REM sleep after a period of relative sleep deprivation. The breathing pattern is inherently more irregular in REM sleep and the ASV can only partially compensate. If this is the case your AHI should reduce over the next few days.

Alternatively your hypopneas may be worsened by increased arousals due to coming off your pain meds. In this case your AHI should improve if you restart the meds.

I would leave the ASV settings as they are for a few days and see how you go. Was the aerophagia OK? In due course you may get a small improvement in AHI if you increase the PS to 7 but get used to 6 first!

Best wishes
Ian

Ian,

The aerophagia was better but still present, I am going to get something from the pharmacy to try and combat it, something I can take before I go to bed... I agree, I think im going to leave these setting and see how it goes for awhile.. My body is trying to REM rebound from 1998, it may take some time...

Thanks
Casey

igdoc wrote:Casey
Good to hear you had a better sleep. From last nights Sleepyhead the ASV is certainly reacting better to the events with the new settings.

The increase in the hypopneas later in the night are most likely due to 'REM rebound' where your body is trying to catch up with REM sleep after a period of relative sleep deprivation. The breathing pattern is inherently more irregular in REM sleep and the ASV can only partially compensate. If this is the case your AHI should reduce over the next few days.

Alternatively your hypopneas may be worsened by increased arousals due to coming off your pain meds. In this case your AHI should improve if you restart the meds.

I would leave the ASV settings as they are for a few days and see how you go. Was the aerophagia OK? In due course you may get a small improvement if you increase the PS to 7 but get used to 6 first!

Best wishes
Ian

Cowboy Casey wrote:The aerophagia was better but still present

The thing that's helped me the most (and a recent development) was finding a different way to hold my jaw. Due to a mouthguard (bruxism) I tended to have my lower jaw a bit forward. One night I tried moving my jaw back a bit, and the aerophagia diminished dramatically!

Also I stopped chugging water at the end of a meal and instead sip water over time, which helped with some reflux.

CPAP pillows, raising the bed, etc. all didn't really have much effect, but are definitely worth a try.

Ian, Pugsy,

I want to thank you both for helping me... I "tried to" help someone this morning and realized just how hard it is to recommend setting to someone just showing up here... You both helped me...


Thank you

Screenshot 2014-07-12 17.32.36 by cowboycasey, on Flickr

Casey
Glad we could help and it is good to get positive feedback. As you know Pugsy helps far more people on this forum than myself.

I have to admit to number jealousy. On settings very similar to yours, I have had an AHI <1 on only one occasion but I need to be satisfied with my mean AHI of 3.8 which is a heck of a lot better than my mean AHI of 28 (likely all central) scored on month 2 of CPAP.

From your other posts it sounds like you are sleeping better too, at long last! Wishing you continued success.
Ian