Am I on the right track? Not feeling it yet.

[PaytonA]

I would think that increasing EPAP during CAs would not be the best thing the machine could do. The hypopneas may be central in nature which would make the previous statement applicable.

Best regards,

PaytonA

[Sleeprider]

I would think that increasing EPAP during CAs would not be the best thing the machine could do. The hypopneas may be central in nature which would make the previous statement applicable.

Best regards,

PaytonA

Not sure if I mis-stated in my previous post, but an significant increase of IPAP of 8 - 10 cm additional pressure is what we'd expect to see during CA, and even in hypopnea to encourage greater ventilation.  If somehow I said EPAP was increased that was a brain fart.

[PaytonA]

Gee, I am known to have some of those.

Best Regards,

PaytonA

[vsheline]

The mask pressure shows me exactly what I need to know, but similar data is available on the pressure chart.  What we see is that mask pressure increases on a breath by breath basis at the minimum pressure support setting, and it does that even when it should be increasing pressure to help increase inspiratory volume during hypopnea and CA events.   The machine should be using up to your maximum PS to treat inadequate or non-respiration.  It never gets above 14 cm, even during a central event.  That is a malfunction.

Try to get a Resmed Aircurve 10 ASV...Much better machine for what you need.

 If you have clinician's manual check the modes section. It looks like DME has it set to a variable Epap only. Should be autosv or something like that.
Could be wrong and if so I agree it is broken.

Hi benseidler,

The Therapy Mode appears to be ASV with Variable EPAP, which is the desired mode, all right. (An earlier ASV mode did not automatically adjust EPAP.) The posted data shows EPAP and PS are automatically adjusting, but as Sleeprider has explained, the machine is certainly not acting as needed. Verifying that the therapy mode is set correctly by checking on the machine itself is a good idea, to be completely sure that SleepyHead is not misreporting the therapy mode.

I agree the machine is not working, in the sense it's not treating your CAs and hypopneas in the way you need it to.

If the machine is not malfunctioning electrically (meaning, if nothing is wrong with its sensors and another PRS1 autoSV Advanced machine would behave similarly) then I think the PR ASV algorithm (which tries to maintain Peak Flow rather than Minute Volume) is not well suited to your breathing style. By "breathing style" I mean how slowly or quickly or shallowly or deeply or weakly or forcefully we tend to inhale or exhale, as exhibited in different sections of the Flow waveform.

The ResMed ASV algorithm works to maintain Minute Volume (MV is the estimated total volume of air breathed in one minute) which is a method which does not directly depend on Peak Flow. I think the ResMed algorithm would work well with any breathing style.

In your case, I agree it would likely be best to push for a switch to a ResMed ASV machine, one which is also able to automatically adjust EPAP.

S9 ASV Adapt machines made earlier than November 2012 did not have the capability to adjust EPAP, but S9 ASV machines manufactured in November 2012 and later (and the new AirCurve 10 ASV) do.

Take care,
--- Vaughn