UARS Suggestions (CPAP triggers centrals) Need help with ASV settings

[Peach25]

Hey there Sleeprider, indeed; increasing the PS min will contribute to a better response to events . However, imho, I would keep it within around 4-6cm range, so it’s not too intrusive during times of hyperventilation..does that make sense..?
The software Philips used (I speak of the time when I was working with their machines) to track was actually quite up-to-speed, however the issue seemed to be the increments to get to peak response were smaller than others (including the response increments of ResMed tracking), so it gave the end result of acting ‘slower’ than other algorithms…for some states of tissue health and particular personal preferences, this is preferred, however for other states of tissue health and personal preferences, a bigger incremental change is preferred. For instance, the smaller incremental changes in Philips algorithms is something I prefer, having tissue damage, as it allows my tissues to adjust to change without effectively compromising the therapeutic outcome (I’m still having gasses exchanged effectively as evidenced by pulse oximetry)….meaning I don’t wake up uncomfortable due to too-quick changes in response (something that becomes more important at higher pressures, ie: AVAPS above 30cm).
Back in the day, I would split machine trials prior to purchase between both ResMed and Philips so patients could feel the different therapeutic responses in their algorithms, and choose which one worked for their comfort levels (tweaking the settings to compensate for each manufacturers nuances as much as I could to suit the patients feedback).

It would be a pleasure to lend a hand with any AVAPS queries; if I don’t catch them as they are posted, please do feel free to send them my way and I’ll do my best to help out!

[Peach25]

Just to clarify, above where I’ve mentioned to  keep between 4-6 at the most, I’m referring to the PS Min pressure…I just thought I’d try to make that clearer - I hope it’s worked

[ophiuchus]

Fiddled a bit by turning off BPM out of...Stupid curiosity and desperation. Obviously that didn't work out.

The idea behind making the EPAP and IPAP more distinctive makes sense to me and I'll definitely give that a try. My major issue is either I sleep through an excess of timed breaths that fragments my sleep or I get on the cusp of sleep and the pressure influx from timed breaths keeps me right out of falling asleep. I definitely have issues with my breaths becoming shallower and shallower the closer I get to actually falling unconscious and I think the machines sees and tries to fix that which gets really uncomfortable. 

My settings are still in flux honestly, I've been fiddling with them whenever I feel up enough to give the device a try again. Lack of quality sleep does a real number on my mental state and using the machine tends to make my bad sleep even worse.

Max Pressure: 25
EPAP min: 8 (tended to see the least OSA events at 7.5-8.5 on CPAP before centrals start to take over)
EPAP max: 13
PS min: 1.5
PS max: 11
BPM: Auto -or- 12
Bi-Flex: 3 (tried 2 as well)

As for trying Resmed, I'm definitely open to it but I'm still in provider limbo. I may try to get rid of my CPAP as I can't use it and see what I can find out of pocket.

[Peach25]

Sounds like it’s hard, and I’m very sorry it’s messing with your mental state. If you’re feeling like a change, I have some suggestions…
EPAP 8
IPAP min 12
IPAP max 20
Ps min 4
Ps max 12
Turn off biflex and use rise time of 2 to 2.5 - see which is more comfortable 
Change the system one resistance to X2 (this alters the setting for calculating dead air space in the mask, and at this reduced set volume setting, it feels gentler in delivery)
Breath rate 12
Put a ramp on for 20mins starting at 6cm (if you have events starting prior to the end of the ramp time, the machine will override the ramp and provide therapy accordingly)
And please do get back with how you get on

[ophiuchus]

Gave those settings a try last night!

My eye hasn't been twitching at all today which is usually a good sign, but to be honest I feel the same fogginess/tiredness and the data is still showing a ton of those timed breaths -more than I think is probably regular. Captured a couple of sections where timed breaths take over and a good part of the night where I didn't have any breathing issues.

[Peach25]

The data output seems to have improved a lot, and from an outsider perspective this is really great news. The matter of still feeling foggy and tiredness is something to address in terms of tweaking settings, and persistence…then, let’s see what happens - how does that sound..? 
In terms of the timed breaths, if there are periods that your body isn’t effectively ventilating itself for some reason or other, the machine should be doing a back up ‘breath’ for you, for as long and as much as necessary - that’s what’s so great about advanced type machines; they treat these kinds of ‘advanced’ problems
For instance, my machine takes over breathing for me each and every night, the entire time I’m asleep, as I have a spontaneous breath rate of less than 10% (and that’s recording when I’m turning over, or at the start/end of therapy when I’m awake). Otherwise, when I look at my own data, I have a 0% patient breaths outcome for hours at a time when I’m asleep - the back up rate/volume is what keeps me breathing throughout the night. 
Would you mind increasing EPAP Max to 22, and the PS Min to 6..? 
Then, would you be happy to try that for a few nights to see how it goes..? 
Keep the silicone cushion of your mask really clean so it adheres to your face really well for as long as possible overnight, let it inflate against your face by lifting it gently when you start the pressure, then let it settle on your face - this places air inside the curved section and sits the edge against your face, so it’s like a tyre inflated against a rim, giving it flexibility when you move at night, and while the EPAP/IPAP is cycling (try not to overtighten it - all of the above regarding mask helps it not to disturb you). 
Ok, let’s see how it goes - please do post how it’s going when you are ready.

[ophiuchus]

Thank you so much for the input -I'll give it a try and potentially up my EPAP slightly since there were some Hypopneas. Should I be leaving the Ti setting (the one that populates on a manual BPM) at the default 1 in your opinion?