1st Night Bi-Pap, high pressures = terrible

[Brando80]

I appreciate those inputs, that helped.  The reason my minute ventilation got screwed up was that in the learning mode I was taking big breaths so it kept those settings. Ironically it wasn’t as uncomfortable as 22/17. Obviously I take full responsibility for that. 

The pulm Dr I saw today was great, presented her with my info and they recommended an ASV so we’re gonna try that. 

Going forward I’m going to go back to ivaps close to the settings from Wednesday night as they were the most comfortable. My question is that if I pick a low target minute ventilation will it try and prevent me from going over that? So instead of trying to nail a number can I undershoot it and then take whatever I need over it? Or does it shoot for that target high and low?  We’ll see, I could just go back to ST also but I’ll try this first, it’s a lot more intelligent mode. 

Again I appreciate everything.
Brando

[Geer1]

That is something I was wondering about and hesitated on recommending as I do not know how iVAPS works in that regard.

With ASV it targets 90% of your previous minute ventilation and provides pressure support to maintain this current target. This allows the machine to fluctuate with your breathing requirements which does vary a bit in different stages of sleep etc. The minute vent is determined by your effort and the machine just works to supplement any bad breaths/apneas.

That is not possible on iVAPS which is one reason I would be hesitant to use it. Either you set a realistic target and the machine provides ventilation at times or you set a low target and run the risk of it under treating your apnea as you are handcuffing its pressure support/algorithm by doing so(breathing has to drop below that low target before machine will try to help you).

Your doctor is on board with the ASV, how long will it take to swap machines? Seems like you should be able to get that to happen sooner than later if the decision has already been made.

[Brando80]

I did an experiment and turned the minute ventilation way down to 3L/min, it didn't restrict breathing so I think it's just a floor that it tries to meet and if you go over it allows you to pull whatever you want. but if you fall below it it brings you up. So I'm just going to put it a 7L/min and try again tonight and see what the AHI's are. Thats pretty close to what it was on Wednesday night when I had the most comfort and felt the best. The Dr said their regular nurse was out today so they would call Monday. I'm working 13hr shifts the next 4 days so just trying to be conservative and get some sleep. They also want to do an echo of my heart since ASV isn't good if you have heart failure which I don't suspect to have anything, also getting an MRI brain just to make sure there's no underlying etiology for the centrals although we don't expect anything. Thanks again, fingers crossed.

I've been so busy with this machine thing I haven't time to look around at other topics yet. Hopefully with lower pressures I can try a nasal mask again. I'll look around and see what people prefer.

Brando

[Sleeprider]

Brando, thanks for bringing the results of your experimental trials with vent rate to the forum. You can be assured these insights will be passed along to others as we start to see more of these machines in use. I would be concerned that a Va of 3 L/min would not be supportive enough of someone with restrictive respiratory conditions that merit the use of this machine, but it's useful to know that it does not interfere with spontaneous respiratory rates. The 7.0 L/min sounds like a more appropriate target even for your CA events and chronic hypopnea. Please keep us informed.

[Sleeprider]

Brando, would you be interested in helping with the new OSCAR beta release? The new version in testing now should read your therapy mode and other data on your ST-A more accurately. If you'd be willing to try the new version and evaluate for bugs or QA issues, please send a PM to Bonjour and request admission to the Beta Test Group. The new beta version is available for download from that location and should improve your experience with OSCAR. Equally important, we don't have a lot of ST-A users, and your input would be appreciated.

[Brando80]

Absolutely, I’m working a lot over the next few days but I’ll get to it.

[SarcasticDave94]

Brando80,

Continued best of luck in succeeding when dealing with the Ducks and DMEs.

[Brando80]

Wow how the world has changed in a couple months. I finally got my ASV, took another study and a few calls to the DME company. I've worn it for about a week. Last night went about 7 hours without interruption, much more comfortable. I finally gave up on the iVAPS / ST after trying multiple settings. I'd wear it 3-4 hrs then pull it off in my sleep. 

My AHI started at 11, then 8 first 2 days and has been between 4 and 6 the last 5 days. 

My prescriptions for the ASV 

EPAP MIN 8
MAX EPAP 20
MIN 2CM MAX 17 CM
MAX 25 CM

 I'f anyone is interested I'd love to post some data from OSCAR but other than screen shooting multiple views is there an easier way?
Can't thank you enough for the help, I feel like I'm finally getting some treatment and am optimistic. Only issue is that I developed either contact dermatitis or some sort of folliculitis from having overtightened the straps around the back of my head. Working on getting that cleared up. 

Best, Brando

[SarcasticDave94]

I think it's possible to go by the suggested view of OSCAR in my signature that maybe even one chart should show how you're doing via the numbers. The other half of the story, and likely the more important aspect, is how you are feeling.

Preliminarily, it looks like those setting numbers are a bit skewed from what ResMed would have suggested in a titration, the building block to get yourself dialed in. Specifically, the EPAP range is 8-20 and I can't quite sort out what PS should be. This all is my opinion, it just seems like these settings need a bit of adjusting to gain you comfort and more effective therapy. The 8-20 sounds so close to the wide open junk the docs dump on people with a CPAP.

It's your choice of course, but I'd try an OSCAR chart and consider a redo on those settings.

[Sleeprider]

Glad you stopped back. In February, I think we already called what would work http://www.apneaboard.com/forums/Thread-...#pid332843  Predicting EPAP between 5-9 and  the use of ASV was alreay the obvious choice. Glad you finally got yours.  What do you think was the biggest obstacle getting the right therapy?  It's always painful to watch someone that needs ASV struggle with ST treatment which I have NEVER seen to be the right choice.