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Anyone else experience this?
#1
So what I am experiencing has to do when I exhale. It seems I am not done exhaling before the machine wants me to start inhaling. Anyone else experience this?

I have the ResMed Aircurve 10 VAuto and it has been set on the VAuto setting for the last six weeks. Originally was set on a constant pressure of 5 to 9 for the first six weeks of therapy, but had some really high AHI numbers (as high as 46) so the doc put me on the VAuto setting. Here are my current settings;

Min EPAP: 4.0 cmH2O
Max IPAP: 25.0 cmH2O
Pressure Support: 4.0 cmH2O

So I will freely admit I am not too sure what those numbers represent other than min and max pressure (if anyone else knows I'm all ears). So since I have been on the VAuto setting my AHI numbers have come down and I am averaging around 11 (still high though). Does what I am experiencing have anything to do with my current settings? If so is it the lower number that I should raise or lower? Thanks
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#2
Hi wxmcpo,

EPAP = Exhalation pressure
IPAP = Inhalation pressure

Pressure support (PS) = Difference between EPAP and IPAP pressures. In your case, there will always be a 4cm difference between your IPAP and EPAP pressures.

With the PS of 4, the lowest your IPAP pressure can go is 8 because your Min EPAP pressure is 4. And the highest the EPAP pressure can go is 21 because your Max IPAP pressure is 25.

The issue you're describing (the too-fast transition from EPAP to IPAP pressure) does not sound like it's due to your pressure settings. Instead it sounds like you may want to look at the triggering and cycling settings in the clinical menu. These settings have to do with the machine's sensitivity to your own breathing rhythm. You can read about these in the clinician manual, starting on page 8.

I don't know your history to date so I can't comment on your high AHI. If for example most of that AHI is made up of centrals, then increasing pressures would not be appropriate. I'm sure you'll get some feedback from folks who know more about your history and have seen some of your data.
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#3
I did a little research last night and found the transition is actually none of those numbers, but the TiMax and TiMin. Mine was set at 2.0 and 0.3 meaning the max transition time between exhaling and inhaling cycles would be 2 seconds and the min it would be is .3 seconds. I upped the max to 3 seconds and my AHI was down to 5.2. Now I have had lower AHI numbers than that when the TiMax was 2.0 so I'm not claiming the change helped me in anyway, at least not yet. I will give it some more time and see where my AHI numbers go from here. Hopefully they continue to go down.
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#4
I think that you may have misconstrued the Ti max and Ti min. The Ti max setting gives you a maximum of x seconds after you started inhale to start your exhale. If you do not start your exhale in that time period, the machine will switch to its exhale pressure anyway.

kaiasgram is right. What you probably need to adjust is the trigger sensitivity, if anything.

Does your machine have the Easy Breathe feature and is it set on or off?

Best Regards,

PaytonA
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#5
(07-13-2015, 12:56 PM)PaytonA Wrote: I think that you may have misconstrued the Ti max and Ti min. The Ti max setting gives you a maximum of x seconds after you started inhale to start your exhale. If you do not start your exhale in that time period, the machine will switch to its exhale pressure anyway.

kaiasgram is right. What you probably need to adjust is the trigger sensitivity, if anything.

Does your machine have the Easy Breathe feature and is it set on or off?

Best Regards,

PaytonA

It does have the Easy Breathe feature, but not in the current VAuto setting. When it is set to a constant EPAP and IPAP I can set it on or off (it was set to on when my pressure was set at a constant 5/9).

Most nights my IPAP is falls in between 8 & 9 with it being between 10 & 12 for the 95th percentile. My EPAP typically is around 4.5 to 5 with it being between 7 & 8 for the 95th percentile.

So if I were to adjust the pressure settings and put it back at a constant pressure would it be 7 to 12 or the 5 to 9? If I set the pressure constant I can turn the Easy Breathe feature back on, just not sure what to set the pressure setting at. I know I also have to adjust the pressure support because right now it's only set to 4 so I would have to raise that up to 5 or maybe even 6 is my thinking. Is that correct?

Thanks in advance

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#6
The first thing that I would do, if you are still having the problem that you described, is to raise your min EPAP to 5. The second thing that I would do is to reduce the trigger sensitivity by one step. If trigger sensitivity is currently set to medium, which is the factory setting, I would set it to low. Try that for a while and see how it works out.

Do not worry about the Easy Breathe, I forgot that it is only available in the S mode.

The Pressure Support setting of 4 is the factory setting and I would leave it there for now. Pressure Support is not available in straight BiPAP mode since you set both the EPAP and IPAP separately and that does not change on its own.

Best Regards,

PaytonA
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#7
Please be courteous and change your avatar. It is too similar to that of vsheline's- it threw me off.
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#8
(07-14-2015, 01:38 PM)tedburnsIII Wrote: Please be courteous and change your avatar. It is too similar to that of vsheline's- it threw me off.

It's one of the stock avatars. There are more members than stock avatars, so other members inevitably will use them.
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#9
(07-14-2015, 10:24 AM)PaytonA Wrote: The first thing that I would do, if you are still having the problem that you described, is to raise your min EPAP to 5. The second thing that I would do is to reduce the trigger sensitivity by one step. If trigger sensitivity is currently set to medium, which is the factory setting, I would set it to low. Try that for a while and see how it works out.

Do not worry about the Easy Breathe, I forgot that it is only available in the S mode.

The Pressure Support setting of 4 is the factory setting and I would leave it there for now. Pressure Support is not available in straight BiPAP mode since you set both the EPAP and IPAP separately and that does not change on its own.

Best Regards,

PaytonA

I raised TiMax to 3 and EPAP to 5 last night and my AHI shot up 29.2 (was 5.2 the night before when my TiMax was 3.0 and EPAP was left at 4). So I am thinking about lowering TiMax to 2.5 and putting EPAP back at 4 and seeing what that does for me. I know I need more than one night to gauge where I'm at, but not sure after a jump from 5.2 to 29.2 if I shouldn't be changing something.


(07-14-2015, 01:38 PM)tedburnsIII Wrote: Please be courteous and change your avatar. It is too similar to that of vsheline's- it threw me off.

How's the new one? Not meaning to copy someone else, just as mentioned I used a stock avatar before now.

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#10
hey. what did you do? my avatar was changed as well. change me back, please.



jkjk

UPDATE: BACK BY POPULAR DEMAND.

QAL
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