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+--- Thread: Help, can't figure out my low pressure issue AutoSV/Advanced BiPap! (/Thread-Help-can-t-figure-out-my-low-pressure-issue-AutoSV-Advanced-BiPap)
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Help, can't figure out my low pressure issue AutoSV/Advanced BiPap! - Granman - 08-19-2012
Need help. I have been on my machine for 6 months now and successfully adjusted to it. I use a Philips-Respironics system one Auto SV Advanced Bipap machine and wear a full face ResMed Mirage Quattro Mask. The pressures vary with this machine, but I average pressures are 10 and 15. I average about 7 1/2 hours a night successfully without waking up at night and feel rested...that is until a week and a half ago and I can not figure it out. I have been waking up over the past 10 days with low pressure settings. The pressure within the mask at first feels fine, like it should. However, I am waking up feeling less pressure in the mask than I should. However, my machine is not registering any leaks. Just the normal 2-3% I usually have. I have done some troubleshooting, but still no answers. Here is what I have done:
1) I swapped out my machine temporarily for a rental of a similar type, older model, to see if I would have the same issue...I am.
2) I replaced the seal, and make sure the seal and my face are cleaned and shaven every night. The seal seams fine and very sealed but not too tight.
3) I took my mask apart and cleaned all of the parts and made sure everything was in place. I even took all of the seals out and replaced them on the machine.
4) replaced the proper tubing and checked the machine for size to make sure they matched.
I have done all of this, but I am still having the same problems. The machine was tested and it is putting out the right amount of pressure, and there are no leaks within the machine. The biggest thing I notice is that the pressure within the mask does not feel consistent, and lower at times, and fine at others. I can turn over, and it feels like the pressure is barely there...however, I have continually checked for leaks and the seal is tight...I am in need of help...do the masks/valves go bad or need replaced? This happened right out of the blue. I had been sleeping perfectly since 5 months ago. All night for 7-10 hours straight at times. I just dont get it...nothing has changed as far as sleeping positions, etc. I did loose about 12 pounds over the past 2 months. I dont think that would cause this thought. I wear a large mask. The basic problem is I am waking up, feeling way less pressure at night, although the machine reads as though it is the right amount of pressure, as does the rental. I have CHF, and was feeling better lately and getting my heart strength back...now I am really struggling. I am 35, married with 2 kids and work full-time. I really need to try and get this solved so I can get my therapy back in line so it doesnt stress my heart so bad when I sleep. My AHI levels have been between 1.5 and 2.9 since I became adjusted 5 months back. Please HELP! Thanks.
Gran
RE: Help, can't figure out my low pressure issue AutoSV/Advanced BiPap! - PaulaO2 - 08-19-2012
If I am understanding you correctly, I have a simple, great answer: You've gotten used to the machine and the air.
There's a lot of mornings where I have to put my hand in front of the exhaust port to believe it is actually on. Yet, many mornings I notice it more.
But, just in case I misunderstood, are you not sleeping well? Or do you just wake up and notice you don't feel the air?
RE: Help, can't figure out my low pressure issue AutoSV/Advanced BiPap! - trish6hundred - 08-19-2012
Hi Granman, WELCOME! to the forum.! I'm sorry you are having such a rough time. I don't know the answer to all of your questions but usually, (if I'm not mistaken,) you should replace your mask every 6 months. CONGRATULATIONS! on your weight loss, Keep up the great work, I know it's very difficult. Losing weight can affect the way things fit, so maybe you might talk to your Dr. or DME about a different mask.
Best of luck to you and hang in there, someone will be along with more suggestions for you, so keep checkin' back in to this forum.
RE: Help, can't figure out my low pressure issue AutoSV/Advanced BiPap! - Granman - 08-19-2012
Paula, thanks for your reply. Actually I was already used to it. The problem is that 10 days ago I started to not sleep well because the pressure is not what it should be in the mask...it is all over the place. I made changes to try and diagnosis it as stated in the previous post, but something isn't right. At times the pressure is right and great, and other times it is lower than what it should be. I have been getting some low pressure alerts too, and waking up 2-3 times a night. Prior to this I had 1 month of adjusting to the machine, wanted to throw it out, but stuck with it, and for the last 5 months I have slept 7+ hours a night with it. It is just within the past 10 days that the lower/changing pressures have developed, and I cant seem to pin point anything...I just cant seem to sleep now...it is killing me...the lower & unstable pressures just is not enough. I thought the loss of 12 pounds may have slimmed down my face to te point of a smaller mask with a tighter fit might help, but not sure. Any thoughts?
(08-19-2012, 05:10 PM)PaulaO2 Wrote: If I am understanding you correctly, I have a simple, great answer: You've gotten used to the machine and the air.
There's a lot of mornings where I have to put my hand in front of the exhaust port to believe it is actually on. Yet, many mornings I notice it more.
But, just in case I misunderstood, are you not sleeping well? Or do you just wake up and notice you don't feel the air?
RE: Help, can't figure out my low pressure issue AutoSV/Advanced BiPap! - vsheline - 08-19-2012
(08-19-2012, 04:06 PM)Granman Wrote: I average about 7 1/2 hours a night successfully without waking up at night and feel rested...that is until a week and a half ago and I can not figure it out.
[clip]
I did loose about 12 pounds over the past 2 months. I dont think that would cause this though.
[clip]
I have CHF, and was feeling better lately and getting my heart strength back [clip] ... now I am really struggling.
Hi Gran,
Perhaps you need a new Titration study to recheck your therapy parameters, like the Pressure Support parameter.
If you are now suddenly feeling worse (which you have not quite said, but you may have meant it by "was feeling better [clip] [but] now I am really struggling") then perhaps your weight loss has mostly eliminated the Obstruction Apneas which cause the machine to keep the pressure as high as in the past. So the EPAP pressure stays at (or drifts back to?) its minimum, and for some reason this degrades your breathing during Clear Airway events?
With a lower EPAP, maybe your Pressure Support needs to be higher to fully ventillate you during the Clear Airway events? Although it does not make sense to me that a person, when starting from a lower EPAP, would need a greater pressure differential (Pressure Support is difference between EPAP and IPAP) to handle the Clear Airway events - who knows, maybe you are unusual in that regard? Or, maybe it is some other parameter which needs to be tweeked?
If you are suddenly feeling worse then I would think you need to see your doctor as soon as is feasible. But, again, this is not clear from your post, which instead says "The basic problem is I am waking up, feeling way less pressure at night", and that is not the same as saying the basic problem is you are feeling worse. If you are feeling worse I hope the doctor can help.
Take care,
--- Vaughn
RE: Help, can't figure out my low pressure issue AutoSV/Advanced BiPap! - vsheline - 08-19-2012
(08-19-2012, 05:24 PM)Granman Wrote: The problem is that 10 days ago I started to not sleep well because the pressure is not what it should be in the mask...it is all over the place. [clip] I have been getting some low pressure alerts too, and waking up 2-3 times a night. [clip] I just cant seem to sleep now...it is killing me...the lower & unstable pressures just is not enough.
Oh, I see. Obviously something changed, and maybe the machine's algorithms have reacted by lowering the pressure too much. Maybe now when rare obstructive events occur it takes too long for the machine to raise the pressure, starting from a lower pressure.
Perhaps the doctor simply needs to raise the minimum EPAP pressure to re-establish the higher EPAP pressures typically used earlier by the machine? Good luck.
Take care,
--- Vaughn
RE: Help, can't figure out my low pressure issue AutoSV/Advanced BiPap! - Granman - 08-19-2012
Thanks for the response. The problem is that I am not sleeping well now, and waking up from lack of consistent pressure throughout the night. The low pressure alerts are going off on the machine. I swapped out the machine, got a new seal, and new tubing, plus checked all of the filters and other seals. The air coming from the machine is testing fine, but the pressure from within the mask is unstable, but shows no leaks on my info...I turn on my side sometimes and it seems as though I dont have air, roll on my back and I have the full blast...My face has thinned out some, but I am still a decent sized guy...I would not think that loosing 12-16 lbs. would have made that much of a difference...it seems like it is a mask fit issue sometimes...I am on a large mask, and wondering if going to a medium would be more snug, and fit my face better? I just want to sleep normal again on my machine. I had been doing so well...Does that make more sense?
(08-19-2012, 07:23 PM)vsheline Wrote:(08-19-2012, 04:06 PM)Granman Wrote: I average about 7 1/2 hours a night successfully without waking up at night and feel rested...that is until a week and a half ago and I can not figure it out.
[clip]
I did loose about 12 pounds over the past 2 months. I dont think that would cause this though.
[clip]
I have CHF, and was feeling better lately and getting my heart strength back [clip] ... now I am really struggling.
Hi Gran,
Perhaps you need a new Titration study to recheck your therapy parameters, like the Pressure Support parameter.
If you are now suddenly feeling worse (which you have not quite said, but you may have meant it by "was feeling better [clip] [but] now I am really struggling") then perhaps your weight loss has mostly eliminated the Obstruction Apneas which cause the machine to keep the pressure as high as in the past. So the EPAP pressure stays at (or drifts back to?) its minimum, and for some reason this degrades your breathing during Clear Airway events?
With a lower EPAP, maybe your Pressure Support needs to be higher to fully ventillate you during the Clear Airway events? Although it does not make sense to me that a person, when starting from a lower EPAP, would need a greater pressure differential (Pressure Support is difference between EPAP and IPAP) to handle the Clear Airway events - who knows, maybe you are unusual in that regard? Or, maybe it is some other parameter which needs to be tweeked?
If you are suddenly feeling worse then I would think you need to see your doctor as soon as is feasible. But, again, this is not clear from your post, which instead says "The basic problem is I am waking up, feeling way less pressure at night", and that is not the same as saying the basic problem is you are feeling worse. If you are feeling worse I hope the doctor can help.
Take care,
--- Vaughn
RE: Help, can't figure out my low pressure issue AutoSV/Advanced BiPap! - vsheline - 08-19-2012
(08-19-2012, 07:45 PM)Granman Wrote: the pressure from within the mask is unstable, but shows no leaks on my info...Well, if you have not *felt* many leaks (you haven't mentioned feeling leaks), and if by "shows no leaks on my info" you mean the downloaded data from the machine shows little sign of leaks, then I would think you may be mistaken that leaks have much to do with the problem.
(08-19-2012, 07:45 PM)Granman Wrote: I turn on my side sometimes and it seems as though I dont have air, roll on my back and I have the full blast...When you are on your back obstructive events will be more frequent, so the machine will keep the EPAP pressure higher to avoid the OSA. And when you are on your side obstructive events may disappear, so the machine lets the EPAP pressure very, very slowly drift back to its minimum setting, which may be too low for you now.
(08-19-2012, 07:45 PM)Granman Wrote: I would not think that loosing 12-16 lbs. would have made that much of a difference...it seems like it is a mask fit issue sometimes...The weight loss is a very good achievement in itself and is probably very important for your long term health, for which congratulations are in order. At the same time, my best guess is your improved weight reduces the incidence of obstructive events enough that perhaps the machine's minimum EPAP parameter now needs to be adjusted upwards. (Perhaps the minimum EPAP parameter was actually too low for you before, too, but the EPAPmin being too low was being prevented from coming into play very often because of a higher frequency of obstructive events before you successfully reduced your weight.) Good luck to you and your doctor in getting this problem (whatever it is) worked out.
Take care,
--- Vaughn
RE: Help, can't figure out my low pressure issue AutoSV/Advanced BiPap! - PaulaO2 - 08-19-2012
No, I don't think 12lbs would have changed it that much. And I'm not sure it would have changed your face that much either. But like the other guy said, if the machine says no leaks and the mask doesn't feel like it is leaking, then it isn't leaking. I don't think the next size down mask would make a difference.
Just running through ideas here....
Have you checked the hose? Is it intact and not kinked? Could something be in there that is intermittently blocking the air?
Are you using that machine because you have central apnea or because you need the extra breathing help?
Have you been to see the doc? It might be time to discuss this with him/her especially if your main diagnosis is central apnea.
RE: Help, can't figure out my low pressure issue AutoSV/Advanced BiPap! - Sleepster - 08-19-2012
You say you swapped out machines but have you tried, as Trish suggested, a new mask? Masks are replaced every three months according to Medicare protocal. Many insurance companies follow this schedule, but not all. Other countries have different replacement schedules, too.
Full face masks have anti-asphixiation valves, so maybe someting like that has failed in your mask.
The other thing I can think of is stress. Has there been a significant event in your life that's stressing you out?