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Answer Question Pls
#11
[attachment=3263]
[attachment=3263 Wrote:Sleeprider pid='194855' dateline='1488904154'][attachment=3263][attachment=3263]You will probably cut about 75% of the events with these changes.  Once you have a bit more data, we can look if there is any more fine-tuning needed.  Also, once you have a week of these settings under your belt, leave a message with your doctor's office advising of the new settings of "Vauto at 15.0/7.0 over PS 4".  They can update your records.  

As you can see, we have the same machine, and I can guarantee that if I use PS 6, I would have just as many central events as you.  I think what happened is that you were issued an auto machine, and somehow the prescription got messed up.  Anyway, you have a great VPAP machine and it's going to give you very good results.  I think you will find these changes a lot more comfortable.   Just so you understand, the high pressure support caused too much CO2 to be blown off causing your respiratory drive to be messed up.  It's not that harmful, and easily fixed.  When we set bilevel pressure, we use the EPAP pressure to control OA (obstructive), and pressure support to reduce hypopnea and flow limitations, reduce breathing effort and increase ventilation volume.   Too much pressure support results in CA, and too little can cause an increase in hypopnea.  Your new settings will start at an EPAP of 7.0, but that can increase automatically if obstructed breathing is detected.  The highest it can go is 15/11.  Hope this is more clear.
 I'm getting ready to make the adjustments that you spoke of.  I got this note from the Dr today. Can you make heads or tails out ot it?

Thanks
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#12
[attachment=3264 Wrote:golfgame pid='195046' dateline='1489018032']            
(03-07-2017, 11:29 AM)Sleeprider Wrote: You will probably cut about 75% of the events with these changes.  Once you have a bit more data, we can look if there is any more fine-tuning needed.  Also, once you have a week of these settings under your belt, leave a message with your doctor's office advising of the new settings of "Vauto at 15.0/7.0 over PS 4".  They can update your records.  

As you can see, we have the same machine, and I can guarantee that if I use PS 6, I would have just as many central events as you.  I think what happened is that you were issued an auto machine, and somehow the prescription got messed up.  Anyway, you have a great VPAP machine and it's going to give you very good results.  I think you will find these changes a lot more comfortable.   Just so you understand, the high pressure support caused too much CO2 to be blown off causing your respiratory drive to be messed up.  It's not that harmful, and easily fixed.  When we set bilevel pressure, we use the EPAP pressure to control OA (obstructive), and pressure support to reduce hypopnea and flow limitations, reduce breathing effort and increase ventilation volume.   Too much pressure support results in CA, and too little can cause an increase in hypopnea.  Your new settings will start at an EPAP of 7.0, but that can increase automatically if obstructed breathing is detected.  The highest it can go is 15/11.  Hope this is more clear.
 I'm getting ready to make the adjustments that you spoke of.  I got this note from the Dr today. Can you make heads or tails out ot it?

Thanks
I think I neglected the file. Here it is.
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#13
Hi Golfgame.  I hate to disparage your doctor's ego, but he got it backwards.  In any titration protocol, the EPAP (expiratory pressure) is increased until obstructive apnea are resolved.  Most titrations use a default PS of 4, and I have done that in your case as well, but in your case that may still be a problem due to CA.  In any event, we would normally add pressure support (increase inspiratory pressures) in order to resolve hypopnea, flow limitation and RERA, however we would reduce pressure support in the event CA events are noted.  

While I doubt your doctor can produce a single written bilevel titration protocol that confirms his theory, I'll give you a link to the one recommended by Resmed. https://www.resmed.com/us/dam/documents/...lo_eng.pdf  I think you will find on all machines that EPAP is raised to resolve obstructive, and IPAP is use for ventilation and hypopnea.  The VPAP S titration protocol outline is on page 35.  I have used exactly that protocol for you, and if centrals remain present at PS = 4 cm, I will recommend reducing that pressure support to 2.0 or less.  Um, your doctor fails in the first part and got the second part right. 50% is a fail.

[Image: attachment.php?aid=3264]
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#14
More to the point, you have an auto bilevel, and we're going to let the auto algorithm do the work. I am still concerned PS at 4 is a bit high, but we can lower that as we go forward and see what happens. I'm certain the problem was the high pressure support you were prescribed. It was unnecessary pretty easily fixed.
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#15
(03-08-2017, 07:50 PM)Sleeprider Wrote: Hi Golfgame.  I hate to disparage your doctor's ego, but he got it backwards.  In any titration protocol, the EPAP (expiratory pressure) is increased until obstructive apnea are resolved.  Most titrations use a default PS of 4, and I have done that in your case as well, but in your case that may still be a problem due to CA.  In any event, we would normally add pressure support (increase inspiratory pressures) in order to resolve hypopnea, flow limitation and RERA, however we would reduce pressure support in the event CA events are noted.  

While I doubt your doctor can produce a single written bilevel titration protocol that confirms his theory, I'll give you a link to the one recommended by Resmed. https://www.resmed.com/us/dam/documents/...lo_eng.pdf  I think you will find on all machines that EPAP is raised to resolve obstructive, and IPAP is use for ventilation and hypopnea.  The VPAP S titration protocol outline is on page 35.  I have used exactly that protocol for you, and if centrals remain present at PS = 4 cm, I will recommend reducing that pressure support to 2.0 or less.  Um, your doctor fails in the first part and got the second part right.  50% is a fail.

[Image: attachment.php?aid=3264]
Thanks, I couldn't understand it because I could not read it all. I will go forward with your settings tonight and will report back in aday or so.

Thanks
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#16
(03-08-2017, 08:47 PM)golfgame Wrote:
(03-08-2017, 07:50 PM)Sleeprider Wrote: Hi Golfgame.  I hate to disparage your doctor's ego, but he got it backwards.  In any titration protocol, the EPAP (expiratory pressure) is increased until obstructive apnea are resolved.  Most titrations use a default PS of 4, and I have done that in your case as well, but in your case that may still be a problem due to CA.  In any event, we would normally add pressure support (increase inspiratory pressures) in order to resolve hypopnea, flow limitation and RERA, however we would reduce pressure support in the event CA events are noted.  

While I doubt your doctor can produce a single written bilevel titration protocol that confirms his theory, I'll give you a link to the one recommended by Resmed. https://www.resmed.com/us/dam/documents/...lo_eng.pdf  I think you will find on all machines that EPAP is raised to resolve obstructive, and IPAP is use for ventilation and hypopnea.  The VPAP S titration protocol outline is on page 35.  I have used exactly that protocol for you, and if centrals remain present at PS = 4 cm, I will recommend reducing that pressure support to 2.0 or less.  Um, your doctor fails in the first part and got the second part right.  50% is a fail.

[Image: attachment.php?aid=3264]
Thanks, I couldn't understand it because I could not read it all. I will go forward with your settings tonight and will report back in aday or so.

Thanks

Sleeprider, I opened the unit as instructed. I found the machine was already set to Vauto. The IPAP max was at 13, I changed it to 15, the PS was at 6.0, I changed it to 4.0.  So as I see it that is not much of a chnage. what say you?

Huhsign
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#17
Re-reading what he said, I'm the one that has to eat some crow. "Inspiratory pressure is set to eliminate hypopnea and expiratory pressure is set to eliminate apneas (obstructive)", is an absolutely correct statement. Based on that, your titration at 7 cm for OA should be correct, but it appears they over-shot the pressure support resulting in centrals.

My apologies, I just read it wrong. No changes to what we discussed before, and I'm pretty sure we're on the same page as your doctor who would likely reduce your pressure support for the centrals. Hopefully that does it.
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#18
(03-08-2017, 09:06 PM)Sleeprider Wrote: Re-reading what he said, I'm the one that has to eat some crow.  "Inspiratory pressure is set to eliminate hypopnea and expiratory pressure is set to eliminate apneas (obstructive)", is an absolutely correct statement.  Based on that, your titration at 7 cm for OA should be correct, but it appears they over-shot the pressure support resulting in centrals.  

My apologies, I just read it wrong.  No changes to what we discussed before, and I'm pretty sure we're on the same page as your doctor who would likely reduce your pressure support for the centrals.  Hopefully that does it.

OK, do I understand that the settings as they were are right and I should reset it to where it was?
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#19
Your pressure support is too high, and that causes the centrals. The settings we discussed before will help, so leave them in. I was just correcting my insulting comments in response to the doctor's note. We are all on the same page, but you need the settings we discussed. I'm sure he would agree.
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