Replies to This Discussion

Permalink Reply by Mike on July 10, 2009 at 7:51pm

at first glance (and I'm no pro, let alone a pro at ASV units for those with central apnea), i get concerned that your Average AHI, or times you stop breathing/have apnea-hypopnea in a given hour, is 23.1 -- an AHI above 5 is considered unhealthy, and one of 23.1 is pretty darn high. You're already at a pretty high pressure setting for the IPAP (inhalation) pressure (22 cm H2O) -- I wonder whether your doctor thinks it might be wise to raise your pressure upon exhalation. Maybe that would bring the AHI down.

Also, the leak seems high.

Those are thoughts off the top of my head, but i'm hoping that someone with experience with ASV machines can chime in.

• ▶ Reply

Permalink Reply by RockRpsgt on July 11, 2009 at 2:07am

His back up rate is probably to low. they need to look back at his previous sleep studies to get an idea of what his average breaths per minute was and adjust accordingly. 10 is very low in my opinion. The average person has 15-20 breaths per minute. Someone with complex apnea might have even more due to the high co2 levels. That's just my opinion though. Without knowing what the interpreting tech saw it is very hard to know for sure.

I had a pt a while back. We followed all ASV protocols to no avail. Finally when we were about to give up I counted every breath he had taken that night during each 30 second epoch. The average was 22 breaths per minute. I changed his back up rate to 22 and he was fixed. I got lucky but it might be what this pt needs.

Also this pt has to know that this therapy may not work. complex apnea is just that way

• ▶ Reply

Permalink Reply by RockRpsgt on July 11, 2009 at 2:17am

That IPAP of 22 is the IPAP max Mike. ASV works a little different than normal PAP. You have an IPAP max and an IPAP min. as well as EPAP and a back up rate. The max is a floating rate, up to it's fixed peak, like on an auto system. IPAP min and EPAP are always the same like a CPAP. If a pt has any flow limitaion the IPAP max will go up and down accordingly as an auto would. It can go as high as 30cmwp unless the range is set lower. The back up rate controls breaths per minute and helps to assist in breathing to fight the central apneas. If his events are indeed CSA in origen raisng the EPAP will not do him any good. It might even make him worse as it could flush more co2 out of his lungs and increase his CSA.
Mike said:

at first glance (and I'm no pro, let alone a pro at ASV units for those with central apnea), i get concerned that your Average AHI, or times you stop breathing/have apnea-hypopnea in a given hour, is 23.1 -- an AHI above 5 is considered unhealthy, and one of 23.1 is pretty darn high. You're already at a pretty high pressure setting for the IPAP (inhalation) pressure (22 cm H2O) -- I wonder whether your doctor thinks it might be wise to raise your pressure upon exhalation. Maybe that would bring the AHI down.

Also, the leak seems high.

Those are thoughts off the top of my head, but i'm hoping that someone with experience with ASV machines can chime in.

• ▶ Reply

Permalink Reply by Mike on July 11, 2009 at 10:24am

i shouldn't even try to help anyone with ASV until I learn more about it. Thanks for chiming in, Rock!

Rock Hinkle said:

That IPAP of 22 is the IPAP max Mike. ASV works a little different than normal PAP. You have an IPAP max and an IPAP min. as well as EPAP and a back up rate. The max is a floating rate, up to it's fixed peak, like on an auto system. IPAP min and EPAP are always the same like a CPAP. If a pt has any flow limitaion the IPAP max will go up and down accordingly as an auto would. It can go as high as 30cmwp unless the range is set lower. The back up rate controls breaths per minute and helps to assist in breathing to fight the central apneas. If his events are indeed CSA in origen raisng the EPAP will not do him any good. It might even make him worse as it could flush more co2 out of his lungs and increase his CSA.
Mike said:

at first glance (and I'm no pro, let alone a pro at ASV units for those with central apnea), i get concerned that your Average AHI, or times you stop breathing/have apnea-hypopnea in a given hour, is 23.1 -- an AHI above 5 is considered unhealthy, and one of 23.1 is pretty darn high. You're already at a pretty high pressure setting for the IPAP (inhalation) pressure (22 cm H2O) -- I wonder whether your doctor thinks it might be wise to raise your pressure upon exhalation. Maybe that would bring the AHI down.

Also, the leak seems high.

Those are thoughts off the top of my head, but i'm hoping that someone with experience with ASV machines can chime in.

• ▶ Reply

Permalink Reply by RockRpsgt on July 11, 2009 at 1:17pm

I do still think that an increase in the back up rate might help this person.

Rock Hinkle said:

His back up rate is probably to low. they need to look back at his previous sleep studies to get an idea of what his average breaths per minute was and adjust accordingly. 10 is very low in my opinion. The average person has 15-20 breaths per minute. Someone with complex apnea might have even more due to the high co2 levels. That's just my opinion though. Without knowing what the interpreting tech saw it is very hard to know for sure.

I had a pt a while back. We followed all ASV protocols to no avail. Finally when we were about to give up I counted every breath he had taken that night during each 30 second epoch. The average was 22 breaths per minute. I changed his back up rate to 22 and he was fixed. I got lucky but it might be what this pt needs.

Also this pt has to know that this therapy may not work. complex apnea is just that way

• ▶ Reply

Permalink Reply by Ron Sowell on July 13, 2009 at 10:14am

thanks to all for your thoughts and advice. I am going to doctor Wednesday and it will be interesting to see what transpires. I agree that I need to leave it to the professionals. I just hope I have the experienced RRT and neuro. Will let you guys know what I find out! Thanks - Ron

j n k said:

I am willing to comment on ideas for simple obstructive patients to tweak their own therapy. But anyone on SV, in my opinion, needs a trusted team made up of (1) an RRT experienced with SV plus (2) either a pulmo doc or a neuro doc (if not a cardio doc, depending) for any meaningful assessment of the effectiveness of that treatment. I don't condsider central-apnea-treatment machines to be patient-tweakable, myself. So I have no comment.

• ▶ Reply

Permalink Reply by Mike on July 14, 2009 at 10:41pm

Good luck tomorrow, Ron. If you do get a doctor who knows his stuff, be sure to pick his brain about each and every aspect of your ASV treatment/ results. Then tell all of us what you learn. we clearly could use some more education on this front.

Ron Sowell said:

thanks to all for your thoughts and advice. I am going to doctor Wednesday and it will be interesting to see what transpires. I agree that I need to leave it to the professionals. I just hope I have the experienced RRT and neuro. Will let you guys know what I find out! Thanks - Ron

j n k said:

I am willing to comment on ideas for simple obstructive patients to tweak their own therapy. But anyone on SV, in my opinion, needs a trusted team made up of (1) an RRT experienced with SV plus (2) either a pulmo doc or a neuro doc (if not a cardio doc, depending) for any meaningful assessment of the effectiveness of that treatment. I don't condsider central-apnea-treatment machines to be patient-tweakable, myself. So I have no comment.

• ▶ Reply

▶ Reply to Discussion