This VPAP Adapt is beyond me, sorry to say.

[PhyllisBalboa]

Hello, all. This is my first post, after reading threads here for a couple of months. I’ve tried to educate myself so that won’t be an idiot about all this, but alas, no such luck. Now I’m having trouble and need some help. Hopefully help in very plain terms, as I’m not getting how all this works.

So I have a VPAP Adapt, running in ASV mode, not ASV auto, whatever that might mean. I was put on it 3 months ago due to calculated centrals of 90/hr. They couldn’t get me to sleep enough in my second sleep study, thus the calculated part. My diagnosis is complex sleep apnea, with an RX of 8 cm at default settings (max ps of 15, min ps of 3).

Now to my situation: I lived in Oregon all my life except these last 6 years living in Arizona. So naturally I got sicker than anything living in the desert. Lots of health issues that I’ll save for another time. After going from doctor to doctor, I finally got to the real issue with the sleep problem, and have regained my health to a great extent after being on this machine for only the summer. But I lost my health' insurance just a week after getting the machine, so have not had any help with it since getting it. I stayed in Arizona throughout the summer, mostly struggling with pain from swallowing air, but with AHIs consistently below 5, and at the end, below 2. My air swallowing got better, and I had energy galore, as if I was 20 years younger. My sleep was deep, and I quit having such vivid dreams and nightmares.

Then 3 weeks ago I moved to Montreal, Quebec, where it’s wet and cool like I’m used to. But now I’m back to swallowing air like mad, and had to stop using the machine for a few nights this week. I’m worried my lungs are too full of air. My chest hurts and feels odd, and I have to wake up many times to walk around to get the air out. Even during my 40 minute ramp I swallow air and have to get up. And I know I don’t have my mouth open during the ramp, since I’m awake.

I don’t have a doctor here, but will try to get one. Medical services are iffy for me since I’m not Canadian. This machine seems complicated to tweak. I feel like my pressure goes too high. My sleephead graphs show spiking galore, but maybe that’s normal. My official sleep report stated that pressures were difficult to determine for me. I have the clinical setup for my machine, thanks to this forum. Should I adjust something? I’m lowering the ramp to 10 minutes. I’m thinking of lowering my epap from 8 to 7, starting epap from 6.6 to 6. Maybe my expiration pressure doesn’t let me breathe out enough? And my graphs show spikes of pressure going above 20 many times, which is often when I have to get up and walk around. Can I limit that until things get better? Maybe that pressure is inflating my lungs too much and sending all the extra down into my stomach.

Anyway, thanks for any help you might be able to offer. I’ve gone round and round trying to figure this out, and am now being forced to skip nights using it for fear I’ll collapse a lung or something. I don’t want to give up using the machine until I'm able to get a doctor. And who knows how good that doctor will be. This energy increase alone is worth it, if I could just stop all this air going down my throat.

[trish6hundred]

Hi PhyllisBalboa,
WELCOME! to the forum.!
I'm sorry you are having such a rough time with CPAP therapy right now.
I'm not familiar enough with the type of machine you are using, but, I know there are a few ASV users who can help you, so hang in there, don't give up, someone will be able to help you soon.
Best of luck to you with CPAP therapy and mastering your ASV machine.

[archangle]

Welcome to the board.

There's a youtube video in the links in my signature line that might help with the air swallowing.

Good luck.

[vsheline]

But now I’m back to swallowing air like mad, and had to stop using the machine for a few nights this week. I’m worried my lungs are too full of air. My chest hurts and feels odd, and I have to wake up many times to walk around to get the air out. Even during my 40 minute ramp I swallow air and have to get up. And I know I don’t have my mouth open during the ramp, since I’m awake.
... I’m thinking of lowering my epap from 8 to 7, starting epap from 6.6 to 6. Maybe my expiration pressure doesn’t let me breathe out enough? And my graphs show spikes of pressure going above 20 many times, which is often when I have to get up and walk around. Can I limit that until things get better?

Hi PhyllisBalboa, welcome to the forum

When you walk around to get the air out, I take it you mean that burping removes air from your stomach? This is called aerophagia and is a common problem. Sometimes it helps to move our head a little, perhaps moving our chin slightly closer to our chest, if this helps us swallow less air.

Pressure Support is the boost in air pressure that occurs while we are inhaling. PS does for us some of the work of breathing.

The higher the "Max PS" is set, the higher the machine will be able to raise PS when it thinks it needs to, in order to keep us breathing.

When we are in the middle of a central event (not making any effort to breathe), the machine raises Pressure Support (PS) to help us breathe in and breathe out, until we again start breathing on our own.

According to ResMed website, a Max PS (Max Pressure Support) setting of 10 is usually adequate to allow the machine to raise PS enough to do for us all the work of breathing, if we have normal lungs.

Your Max PS is 15, which is very high and is probably unnecessarily high for you. If your doctors have never told you that your lungs are diseased or impaired, then I suggest you consider lowering the Max PS to 10. If that does not help enough, I would suggest you consider lowering the Max PS to 9 or 8, but not lower.

For now, I suggest keeping EPAP unchanged at the prescribed level of 8, and Min PS at its present level of 3.

It is normal for us to have spikes in the PS while swallowing, so I try to time my swallows to occur between breaths.

I also recommend downloading ResScan software (see link on page 1 of the main ResScan thread, http://www.apneaboard.com/forums/Thread-...397#pid397) and installing it.

ResScan works on Windows XP and on Windows 7 and (I think) on Windows 8 but maybe Windows 8.1 sometimes causes problems for the SD card by writing to it when we don't want the computer to do that.

Take care,
--- Vaughn


Added:

By the way, if changed to ASVauto mode the machine would automatically raise EPAP to be as high as it thinks the EPAP needs to go, in order to better prevent obstructive events from happening. I suggest keeping the machine in ASV mode for now, not ASVauto mode. I also suggest trying to sleep on your side, because usually sleeping flat on our back makes obstructive sleep apnea worse, meaning EPAP tends to need to be higher when we sleep on our back.

[PhyllisBalboa]

Welcome to the board.

There's a youtube video in the links in my signature line that might help with the air swallowing.

Good luck.

Thanks so much for the link. I will be viewing it tomorrow.

[PhyllisBalboa]

When you walk around to get the air out, I take it you mean that burping removes air from your stomach?
Well, from both ends I'm afraid. I must have missed the biology class that explained how that all works. I always thought air went to the lungs. Now I find it goes from the nose to parts that should be off limits.

Your Max PS is 15, which is very high and is probably unnecessarily high for you. If your doctors have never told you that your lungs are diseased or impaired, then I suggest you consider lowering the Max PS to 10. If that does not help enough, I would suggest you consider lowering the Max PS to 9 or 8, but not lower.
Just what I needed to know and do. Thanks so much!

For now, I suggest keeping EPAP unchanged at the prescribed level of 8, and Min PS at its present level of 3.
Will do.

ResScan works on Windows…
I only have a Mac I'm afraid.

I suggest keeping the machine in ASV mode for now, not ASVauto mode.
Will do that as well.

I also suggest trying to sleep on your side, because usually sleeping flat on our back makes obstructive sleep apnea worse, meaning EPAP tends to need to be higher when we sleep on our back.
Yes, I only sleep on my side as it is.Don't have any obstructives these days with the vpap.

Vaughn, thanks so much for this. I will give all this a try. Your explanations were plain and to the point, which is exactly what I need.

[vsheline]

ResScan works on Windows

I only have a Mac I'm afraid.

If you can get any old junk Windows XP computer that you can pick up for a few dollars at a garage sale, it could be used to run ResScan. ResScan does not need a new or fast or powerful computer to run on. Any old junker would work okay and maybe would be better than a new Windows 8.1 computer. Just something to keep in mind if you ever want to double check anything from SleepyHead.

[PhyllisBalboa]

If you can get any old junk Windows XP computer that you can pick up for a few dollars at a garage sale, it could be used to run ResScan. ResScan does not need a new or fast or powerful computer to run on. Any old junker would work okay and maybe would be better than a new Windows 8.1 computer. Just something to keep in mind if you ever want to double check anything from SleepyHead.

Well, now that you mention it, I have 3 older windows computers laying around. Thanks for nudging my memory.

[PhyllisBalboa]

Update: still in trouble with pressures. Can someone help?

After receiving great advice here, I've carefully made small adjustments over many days trying to solve this swallowing air issue. While it's not nearly as bad as before, it is still causing me to stop therapy after 4 hours of use most nights because of the pain and discomfort. I'm desperate to get back to full use of my machine, because it made a huge difference for me when it worked.

Here's what I've done so far: stopped the ramp completely; lowered max ps from 15 to 8.2; raised min ps from 3 to 3.2; lowered epap from 8 to 7.4; fiddled with pillows enough to fix leaking.

My sleep report mentioned 8 as the best pressure for me, but my machine regularly hits over 15 (90% IPAP=15.6), even when I'm awake and breathing normally. I feel like this is way too high, but I don't know how to keep it down with the settings available for my vpap. With the high pressure my cheeks are puffing out and air is forced down my throat. My mouth is staying shut, and I have plenty of air, and haven't had any obstructive events since starting therapy. My AHI is regularly under 1, usually .3, almost always hypopneas.

So why am I getting blasted all the time, enough so that my abdomen is distended and hard, and my chest hurts, and I have to get up and walk around several times during the night? My trouble is mostly centrals, and I don't think I need these powerful pushes to keep breathing. Does anyone know how I can make this machine behave nicely? I hope I wasn't given the wrong machine because I'm in insurance limbo now.

[retired_guy]

Here's what I've done so far: stopped the ramp completely; lowered max ps from 15 to 8.2; raised min ps from 3 to 3.2; lowered epap from 8 to 7.4; fiddled with pillows enough to fix leaking.

My sleep report mentioned 8 as the best pressure for me, but my machine regularly hits over 15 (90% IPAP=15.6), even when I'm awake and breathing normally. I feel like this is way too high, but I don't know how to keep it down with the settings available for my vpap. With the high pressure my cheeks are puffing out and air is forced down my throat. My mouth is staying shut, and I have plenty of air, and haven't had any obstructive events since starting therapy. My AHI is regularly under 1, usually .3, almost always hypopneas.

So why am I getting blasted all the time, enough so that my abdomen is distended and hard, and my chest hurts, and I have to get up and walk around several times during the night? My trouble is mostly centrals, and I don't think I need these powerful pushes to keep breathing. Does anyone know how I can make this machine behave nicely? I hope I wasn't given the wrong machine because I'm in insurance limbo now.

Phyllis it would seem to me that if your epap is set on 7.4 and your ps is set to 3.2, you would need your max to be at least 10.6. You may not go to max, but if I understand this machine that's what it needs to see. If the max is set below the epap + ps, what will the machine do? I don't know.

But mostly, I'm wondering if you wouldn't do just fine setting the machine at a straight cpap mode for awhile with a pressure of 8 or 9. Your results look as if you're being nicely controlled in spite of too much air in you mouth etc. I don't usually favor cpap mode over all the fancy stuff we can do, but sometimes it just looks like that's what would make the most sense.

As to the mouth filling up and all of that? You can develop a very good air-lock in your mouth. What has to happen is you learn to keep your tongue against the roof of your mouth when you sleep, and your jaw forward. The tongue will not stay in place when you fall asleep if your jaw is allowed to relax and drop back. That's where a chinstrap comes into play. It's just used in a gentle way to encourage the jaw to stay forward. You don't want to force anything, because Mrs. Jaw will get cranky if it thinks you're being rude. So a chinstrap not so much loosely, but gently applied. The idea is you can still open your mouth if you wish, but it's probably a little more comfortable to not do that. Then the jaw stays forward, the tongue stays planted, the air stays where it belongs, the machine doesn't have to go nutz trying to replace all that air you're swallowing, God is in His heaven and all is right with the world. Peace in our lifetime: Sleep for Phyllis.