Manuals and loads of questions

[thebestdog]

You guys are giving some great advice, and I was wondering if there is a resource you could refer me to in order not to be asking you loads of questions every day as I have many which I think could be sorted out by reading and experimenting with the settings on the machine. 

I am having some success at that but it's slow work. 

I'm using a pulse oximeter to measure to track any changes I made. 
I've switched from a Resmed Airsense 10 which i used for six year with little success - but I did notice that setting the ipap to 14 and having an epap of 11cm was the best I could manage and I was getting 1.5 hours sleep maybe three times a night- but I always wake up after that magic 90 minute mark and then have trouble getting back to sleep. 

This is why I bought a Dreamstation bilevel avaps 30. I'm not sure if it's the right machine for me but it says it treats centreal apnea which is what I am now suspecting i have.

I got the machine for a good price as it was reconditioned and I could never have afforded the full price.

From what I am reading on here I need to set a min epap of about 11 and let the ipap vary to suit my needs. I don't think there is a way to let the ipap vary- am i wrong there, and is that something I might need? Any suggestions on that would be appreciated

So far I am seeing improvements on the pulse oximeter. Could you refer me to any docs that I can read so that I can get a better idea of how to set this machine up? Also are there any threads here that you can refer me to for examples of people who have gone through this process?

When I look at my oscar data I see that the flow begins to decrease slowly over a period of about 30 minutes and tidal vol drops from 440ml to about 330, that's usually when I wake up. Should I be setting a target tidal volume with timed breathes, or just timed breathes. There seems to be so many options. 

I didn't mean to ask so many question in one post but if you have any suggestions I would be grateful

Thanks in advance.

[Jay51]

3 things:  

1.  Click on the "Cpap Setup Manuals" tab on the top of the page for the manual for your machine (instructions on how to receive it).  
2.  Type in the "search" tab at the top of the page, "Dreamstation bilevel avaps 30".  I did this and got a few threads to look at. 
3.  I used to have the Philips Evo ventilator.  It had avaps as well.  In regards to your question about setting a tidal volume number and rate during sleep, I would say yes, try it.  Here is why: I had the same problem you did.  When I fell asleep my tidal volume and respiratory rate sank.  By setting both a tidal volume number (you can experiment - you said it is about 440 or so normally).  You can even try a larger slightly larger and smaller tidal volume number based on both comfort and therapy.  You can set a back up rate as well if yours drops a lot when you fall asleep.  Maybe start with 12.  If that seems to high, lower it.  If that is ok, you can try increasing it a little bit at a time until you get to the point where it starts getting uncomfortable.  Then back off a little bit, and you have found your own personal setting for tidal volume and respiratory rate (back up rate specific number).  
It was a lot of trial and error on my avaps to get it just right.  Lots of different variables usually take time.  These 2 are the basic settings for avaps.  You can try to "tweak" other comfort settings later if you want to as well.

[thebestdog]

Thanks Jay- It's really helpful to know someone else has tried this and I'm on the right path. I am setting the target volume to 400 and the timed breaths to 12 tonight. They are on the low side compared to what I see in my stats,  I am hoping I wont notice small changes and can slowly increment them over weeks as I get used to them. 

Thanks for the search tips. I'm going to try that now.

I've been reading that the avaps might not be my best choice as it is are for more complex respiratory disorders such as copd, which i don't have because i got tested for it. I guess I could have breathing issues that I was not diagnosed with. I have 30 days to get my money back on the machine if it doesn't work out I was thinking of going for the philips bilevel asv.

[Jay51]

There are 2 main differences between avaps and asv (I have an s9 adapt asv also).  

1.  The ASV is for central apnea treatment (no copd, neuromuscular diseases, etc.).  It has a "dynamic" back up rate.  Every minute or 3 minutes it calculates a specific respiratory back up rate based on your own breathing during that time.  If your was 15, then it would use 15.  If, though, yours dropped significantly during sleep to say, 9, then the asv's back up rate would get lower and lower and lower over time until it got down to 9.  

2.  my avaps had both a static back up rate ( you could enter an actual numerical digit for it) and a dynamic back up rate like the ASV's.  Only the avaps, though, has an assured tidal volume feature.  With avaps, it will ensure every single breath you take the entire night is at least, "x" in number (whatever numerical digit you enter - say 440 like you plan on using).  

ASV doesn't have this feature.  It recalculates your tidal volume projection based on your previous couple of minutes of actual breathing - so it can get lower and lower and lower as well just like back up rate over time if you own personal tidal volume gets lower.

[thebestdog]

Thanks Jay- I get your point. If your breathing slows down over a period of say 30 mins which mine does, then the avs back up will also slow down which is not what I want. 

I like the sound of what you are sayin for option two with AVAPS: set the tidal volume and frequency, the machine will try to deliver by changing the pressure and hopefully you will get adequate minute ventilation. I've been looking at my stats and calculating the difference between the min and the median with the idea of setting it somewhere in between.

I've been looking at those numbers for years on the Resmed- but there were limited options. All I could do was set the starting pressure and put on EPR 3. This resulted in huge pressure increases as my breathing slowed down, I was getting huge tidal volumes and a pain in the stomach from all that air. My pressure was going to 17 in and 14 out.

I'll let you know if things improve over the next few weeks but I am reassured here that I am at least going about things in a logical way.

John