[Equipment] Machine with fixed EPAP/IPAP

[richb]

All Hypopnea and periodic breathing at low pressure and nearly all Centrals at higher pressure. I am currently on a ResMed S9 ST machine. My current settings are EPAP 11 IPAP 15 and a backup rate of 8. The backup rate of 8 BPM is at the same pressure as the normal settings. Last night I had an AHI of 9 and felt terrible when I got up this AM. I looked at my waveform and found erratic breathing for most of the night. ( The machine doesn't score a Hypopnea when it is providing backup breaths). I only had about 1 hour of smooth waveform indicating some level of sleep. I am trying to get an ASV machine but am worried that might not work either. I have an appointment with a new sleep center in a month.

Hi richb,

During your centrals the ST machine is initiating IPAP for you, but with IPAP only 4 higher than EPAP the machine will not be able to keep you adequately ventilated.

I suggest decreasing EPAP by 1 (to 10) for a week. If the obstructive apneas stay low, I suggest lowering EPAP again, to 9 for a week. If you can manage to sleep only on your side(s) you may be able to keep lowering EPAP each week until you see an increase in your obstructive events and know you've backed off EPAP too much.

Each time you decrease EPAP (keeping IPAP unchanged) the Pressure Support (PS is the difference between EPAP and IPAP) will increase, better allowing the machine to keep you adequately ventilated during central events.

If you find you can't lower EPAP to achieve a higher PS, I recommend increasing IPAP 1 cmH2O per week, in order to increase PS.

When the PS gets as high as 8 the machine may be able to keep you adequately ventilated during central events.

When I stop breathing my ASV machine increases the PS to around 8 or 9 or 10, which a big enough difference between EPAP and IPAP to do for me all the work of breathing.

If the CA Index (number of central apneas per hour) is at least 5 and larger than your OA Index then I think you will qualify for an ASV machine.

If you do get an ASV machine, I would suggest the PRS1 BiPAP autoSV Advanced with heated tube. This machine is versatile and can be operated like an ASVAuto, ASV, BiPAP ST, BiPAP Auto, fixed BiPAP, APAP or CPAP machine. (Very much unlike the ResMed AurCurve 10 ASV which can only be operated in a particularly dumb (no CA versus OA detection!) version of basic CPAP therapy mode, or in ASV modes which are restrictive and require the difference between Min PS and Max PS be at least 5.)

In my view, ResMed has shamefully disserved their ASV customers by not including central apnea detection when in CPAP mode and by not including any of the other less expensive therapy modes other than their restrictive versions of ASV therapy. (But it's all so simple to set up and automatic.... no thanks!)

Take care,
--- Vaughn

Thanks for the recommendation. I have an appt next Tues with the sleep doc. I have shown my wave patterns to the DME. They are recommending an ASV machine. I will try to get the PRS1. I had to stop using the S9 st machine because it was sending my respiration rate to 40 bpm.

[PaytonA]

Sorry - brain fart!

[richb]

All Hypopnea and periodic breathing at low pressure and nearly all Centrals at higher pressure. I am currently on a ResMed S9 ST machine. My current settings are EPAP 11 IPAP 15 and a backup rate of 8. The backup rate of 8 BPM is at the same pressure as the normal settings. Last night I had an AHI of 9 and felt terrible when I got up this AM. I looked at my waveform and found erratic breathing for most of the night. ( The machine doesn't score a Hypopnea when it is providing backup breaths). I only had about 1 hour of smooth waveform indicating some level of sleep. I am trying to get an ASV machine but am worried that might not work either. I have an appointment with a new sleep center in a month.

Hi richb,

During your centrals the ST machine is initiating IPAP for you, but with IPAP only 4 higher than EPAP the machine will not be able to keep you adequately ventilated.

I suggest decreasing EPAP by 1 (to 10) for a week. If the obstructive apneas stay low, I suggest lowering EPAP again, to 9 for a week. If you can manage to sleep only on your side(s) you may be able to keep lowering EPAP each week until you see an increase in your obstructive events and know you've backed off EPAP too much.

Each time you decrease EPAP (keeping IPAP unchanged) the Pressure Support (PS is the difference between EPAP and IPAP) will increase, better allowing the machine to keep you adequately ventilated during central events.

If you find you can't lower EPAP to achieve a higher PS, I recommend increasing IPAP 1 cmH2O per week, in order to increase PS.

When the PS gets as high as 8 the machine may be able to keep you adequately ventilated during central events.

When I stop breathing my ASV machine increases the PS to around 8 or 9 or 10, which a big enough difference between EPAP and IPAP to do for me all the work of breathing.

If the CA Index (number of central apneas per hour) is at least 5 and larger than your OA Index then I think you will qualify for an ASV machine.

If you do get an ASV machine, I would suggest the PRS1 BiPAP autoSV Advanced with heated tube. This machine is versatile and can be operated like an ASVAuto, ASV, BiPAP ST, BiPAP Auto, fixed BiPAP, APAP or CPAP machine. (Very much unlike the ResMed AurCurve 10 ASV which can only be operated in a particularly dumb (no CA versus OA detection!) version of basic CPAP therapy mode, or in ASV modes which are restrictive and require the difference between Min PS and Max PS be at least 5.)

In my view, ResMed has shamefully disserved their ASV customers by not including central apnea detection when in CPAP mode and by not including any of the other less expensive therapy modes other than their restrictive versions of ASV therapy. (But it's all so simple to set up and automatic.... no thanks!)

Take care,
--- Vaughn

Thanks for the recommendation. I have an appt next Tues with the sleep doc. I have shown my wave patterns to the DME. They are recommending an ASV machine. I will try to get the PRS1. I had to stop using the S9 st machine because it was sending my respiration rate to 40 bpm.

Saw the sleep Doc today. He is giving up on me. It seems he doesn't do complicated. The Doc couldn't figure out what was going on from my SH graphs. I have an appt. in early Oct with the Sleep center at the local University Hospital. The DME provider had recommended an ASV machine and the Doc agreed that I probably do as well. He also said I need a titration on the ASV machine and thought that the new Doc should do it. I thought ASV was auto titrating!

Rich

[storywizard]

Rich wrote:
Saw the sleep Doc today. He is giving up on me. It seems he doesn't do complicated. The Doc couldn't figure out what was going on from my SH graphs. I have an appt. in early Oct with the Sleep center at the local University Hospital. The DME provider had recommended an ASV machine and the Doc agreed that I probably do as well. He also said I need a titration on the ASV machine and thought that the new Doc should do it. I thought ASV was auto titrating!

Hi there...

from my experience with two titration studies in the last 2 months, and 4 months worth of data on ASV I would say its hard to really trust either the titration studies, or the machine data totally. I would go for the titration, look at your data, and access how you feel...then hope that the doc you see will be skillful enough, and care enough to help you, if not then there is this board and your own feelings on how you feel on the therapy ...I sincerely wish you the best of luck, sometimes its hard being complicated...

Storywizard

[richb]

Rich wrote:
Saw the sleep Doc today. He is giving up on me. It seems he doesn't do complicated. The Doc couldn't figure out what was going on from my SH graphs. I have an appt. in early Oct with the Sleep center at the local University Hospital. The DME provider had recommended an ASV machine and the Doc agreed that I probably do as well. He also said I need a titration on the ASV machine and thought that the new Doc should do it. I thought ASV was auto titrating!

Hi there...

from my experience with two titration studies in the last 2 months, and 4 months worth of data on ASV I would say its hard to really trust either the titration studies, or the machine data totally. I would go for the titration, look at your data, and access how you feel...then hope that the doc you see will be skillful enough, and care enough to help you, if not then there is this board and your own feelings on how you feel on the therapy ...I sincerely wish you the best of luck, sometimes its hard being complicated...
Storywizard

I am afraid that I may have to go through a new sleep study and then a new titration. I have already had one PSG and two titrations. None of the titrations were on an ASV machine. I didn't sleep very well during any of the studies. No REM sleep observed during my 2nd titration. My new appointment is less than a month away.

[vsheline]

I am afraid that I may have to go through a new sleep study and then a new titration. I have already had one PSG and two titrations. None of the titrations were on an ASV machine. I didn't sleep very well during any of the studies. No REM sleep observed during my 2nd titration. My new appointment is less than a month away.

In my view another PSG may be a waste of time and money. Before your appointment, send or drop off with the new doc the full reports from the PSG and the titrations and let him/her know you will be asking for an ASV titration. (You should have or should obtain copies of the full reports for all your overnight studies, including all data. You have a right to copies of these for your own records.)

Before approving coverage for an ASV machine insurance companies usually insist on an ASV Titration to verify ASV therapy is successful in treating your complex sleep apnea.

Also, an ASV Titration may produce helpful info and guidance for what settings to use.

ASV (like APAP) can be auto titrating but, in my view, both work best when the lower end of the range for EPAP is not much lower than whatever EPAP you need to prevent your obstructive events, and for the Max Pressure Support setting to be around 10 (cmH2O), or maybe 8 or lower to start and later increase to 9 or higher as you get used to ASV therapy.

Good luck,
--- Vaughn