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Permalink Reply by Mary Z on February 18, 2012 at 12:11pm

Marcia, I am not sure the machine is working correctly, but my symptoms bear out the readings.  Also the readings have never been questioned, or the functioning of the machine, by the doc.

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Permalink Reply by MZH on February 18, 2012 at 12:57pm

I've read that IPAP (inhalation pressure) controls hypopneas and EPAP (exhalation pressure) controls apneas. Does your machine have a separate setting for EPAP?

How do feel now that you're on CPAP? Better, the same or worse? That's pretty telling as to how you're doing. :)

Mary, did the doc say why your O2 stays good when your AHI is high? I'm very curious about that one.

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Permalink Reply by Terry Vella on February 18, 2012 at 3:23pm

snoozebabe, are there any other factors that could increase you AHI's i.e. weather, when you eat, what you eat etc, I find mine change daily, mainly I think due to the weather. When it's hot they seem to go up more than when it's cooler. Maybe I moving around more when I'm asleep and the mask moves more and gives me an inaccurate figure, I just think there are so many variables it is difficult to tell. My sleep Dr says it more how you feel than the actual figures and as long as they are around 5 everything is OK. Last night mine was 3.2 but the night before 6. I do think you should try Mary z suggestion and get your pressures back to the prescribed setting and go from there. Keep us updated.

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Permalink Reply by Mary Z on February 18, 2012 at 7:11pm

Never heard that about EPAP/apnea, IPAP/hypopnea.  I use straight CPAP  with no change for exhalation.  Well, actually today while I wait for the ASV process I changed the machine back to my last prescription of 4/8 Bilevel. I have not been successful at self titration. No clue as to why I don't desat, but my sats have been checked at home and of course in the lab.  I don't know the results of my study from Feb 1 yet.

CPAP, Bilevel, AUTO have made no difference  in how I feel.  The day after ASV I felt pretty good. 
Marcia Herman said:

I've read that IPAP (inhalation pressure) controls hypopneas and EPAP (exhalation pressure) controls apneas. Does your machine have a separate setting for EPAP?

How do feel now that you're on CPAP? Better, the same or worse? That's pretty telling as to how you're doing. :)

Mary, did the doc say why your O2 stays good when your AHI is high? I'm very curious about that one.

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Permalink Reply by MZH on February 18, 2012 at 7:54pm

That's really mysterious, Mary, but I'm glad the ASV is working for you. I never dreamed that one could have apnea without significant desats!

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Permalink Reply by snoozebabe on February 19, 2012 at 8:12am

What is ASV?

Mary Z said:

snoozebabe, it may mean the exact opposite.  You may need a lower pressure. What is your prescribed pressure?

I changed docs when he put my pressure to 27/30 (yes, they do make a machine that goes that high) and going up and up had not improved my AHI.  Another doc, another sleep study, a new prescription 4/8.  That still didn't work so I experimented with the AUTO mode- the higher the pressure went the higher my AHI went.  This was over a four year period of trying and trying to get my AHI down. I would go back to my recommended range and start titrating again.  I found it to be easier to titrate in CPAP mode making small changes once a week.  Good luck.  Great on the leaks and commitment.

I have ended up needing ASV (don't have it, yet).  As I said, it was a four year process.

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Permalink Reply by Mary Z on February 19, 2012 at 10:08am

Adaptive Servo Ventilation, and I hope it will work for me at home. Evidently it did in the lab.

I wish I could give a good explanation of how it works.  It's a different animal than our usual 'PAP's.  For one thing if can prescribe a target number of breaths, I believe they usually set it two lower than either your average or minimum respiratory rate.  If you don't take a breath in the right time frame the machine initiates a breath.  You can also specify a flow volume- don't know if I'm saying this right, but if your tidal volume (the amount of air you breathe on any one breath, or minute volume- by minute)  doesn't reach target it gives you more air..  If anyone can explain it better please chime in.  I'll do a quick google and see if I can find a better explanation.  It's used with people with certain medical conditions and central or complex apnea.  I meet the criteria because of my high AHI and remaining symptoms.  It's called non invasive  ventilation.  This machine will practically breathe for you.  Only Respironics and ResMed make the machines at present and they can run $6,000 with humidifier.  It's fairly new in home use as it's so expensive and the algorythms each company uses are very complicated.  As I have watched what machines people use in the three years I have been on the forum only this year have I seen it prescribed a little more often.

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Permalink Reply by Mary Z on February 19, 2012 at 10:10am

This is from ResMed.

VPAP Adapt SV™ is an adaptive servo-ventilator designed specifically to treat central sleep apnea (CSA) in all its forms, including complex and mixed sleep apnea.

The right support at the right time—adapting breath-by-breath     Unlike conventional SDB therapies such as CPAP, adaptive-servo ventilation:

• Treats complex sleep apnea syndrome and central sleep apnea
• Normalizes breathing, completely suppressing CSA and/or Cheyne-Stokes respiration (CSR)2,3
• Improves sleep architecture2 (the amount of time the patient spends in slow-wave and REM sleep increases)

Peer-reviewed literature shows that adaptive-servo ventilation:

• Enhances quality of life for patients with CSA3,4

Support when it's needed   The adaptive-servo ventilation algorithm:

• Adapts to the patient’s ventilatory needs on a breath-by-breath basis
• Automatically calculates a target ventilation (90% of the patient's recent average ventilation)
• Adjusts the pressure support to achieve it

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