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Cheyne Stokes Respiration ?
#71
RE: Cheyne Stokes Respiration ?
Mal777, could you do me a favor and to approximately the same screenshot and show mask pressure instead of pressure? I bet we will see IPAP never gets off the ground. We need more pressure support for the extreme flow limitation shown in your statistics and inspiration/expiration times, and a CPAP and even bilevel wont' do it unless we can also treat CA events that will happen with higher PS.
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#72
RE: Cheyne Stokes Respiration ?
Here it is thanks


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#73
RE: Cheyne Stokes Respiration ?
Post the zoomed view so we can see flow rate and mask pressure response.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#74
RE: Cheyne Stokes Respiration ?
Thanks Sleeprider


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#75
RE: Cheyne Stokes Respiration ?
As you can see, the mask pressure is as chaotic as the respiratory flow rate. It does not provide the pressure support needed to either overcome flow limitation or respiratory instability. ASV targets minute vent and will usually re-establish the breath rate and volume in this case. The ST-A is also a candidate as it actually applies pressure support to maintain alveolar minute vent, and is designed to deal with obstructive issues. We don't know why you have this instability, but it is likely that if we use more pressure support, you may have more CA events or lose respiratory drive. ASV treats centrals and at least in the cases I have seen, stabilizes chaotic respiration like this. The problem with your CPAP and even the VPAP S and Vauto, s that it relies on your spontaneous effort and follows that. All of those machines are similar in how they react to this breathing pattern, although the VPAP machines can be set to hold IPAP a minimum time and not cycle to EPAP so easily. The ASV and ST-A have higher priority and will, as needed, maintain the volume and rate rather than follow respiration.

Have you tried EPR at 3? Did it result in higher CA?
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#76
RE: Cheyne Stokes Respiration ?
I have EPR at 3 all the time. I’ve tried it at 2 and I feel like I will suffocate. It’s hard enough at 3. 
In earlier posts you and others didn’t think centrals were a minor problem as they appear usually just before I sleep (sleep junk) in fact when I used to use ramp for 39 minutes they were very few as apparently events don’t show while in ramp
My biggest concern is to find a machine that will even out my breathing which is so erratic and also stop future periodic breathing   It appears ASV ticks these boxes
At my recent bi level sleep study they tried  the ST the technician told me. I had trouble breathing with it. It would give me a breath then stop half way. Also they don’t have easy breathe so I think may be hard to tolerate . Do you know if this is so?
I never new how complex sleep apnea can be ?
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#77
RE: Cheyne Stokes Respiration ?
I meant to say centrals aren’t a major problem ?
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#78
RE: Cheyne Stokes Respiration ?
Ticontrol on a vauto machine appears like it might be helping another member with similar breathing.

With your current machine everything is based off of your own breathing. When your breathing reverses flow direction the machine prematurely drops pressure. Ticontrol on the bilevel machine ensures pressure continues to build for a minimum amount if time, Timin, which helps support taking one full breath. It appears like it might help this sort of breathing.
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#79
RE: Cheyne Stokes Respiration ?
Do you have a link to the post please ?
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#80
RE: Cheyne Stokes Respiration ?
Ti Control can make IPAP stay on a minimum time so that the machine does not cycle to EPAP, and can cut off IPAP after a maximum period of time to force cycling. In addition these machines have trigger and cycle sensitivity. In your case, we would set trigger sensitivity to very high and TiMin at 1.0 to ensure the machine detects your weak inspiratory effort and hold IPAP for at least 1-second. We would also set TiMax to 2.0 and cycle sensitivity to low, which would ignore those lapses in inspiratory effort until you were "ready" to exhale. It could work, however like your Airsense 10, the pressure support in VPAP Vauto and S is proportional to inspiratory flow rate. If your breathing is weak, so is the pressure support. On the other hand, a true ventilator like the ASV will increase pressure support as your inspiratory flow weakens, or disappears, and the pressure support will be maintained until the tidal volume target is met. In other words, the Vauto may work, the Vauto will work. If you have access to try the Vauto without a purchase commitment, it would not take long to see if it stabilizes respiration.

Although your EPR is set to 3, you can see your median pressure support is only 2.0 cm (you may want to check your settings because this sure looks like EPR at 2). This may be a reflection of the extent of your weak or mixed inspiratory effort. The machine is not reaching its intended difference between IPAP and EPAP because it is following the inspiratory flow rate. I think the Vauto will do the same. I could be wrong, and it fixes everything, but like the Autoset, the Vauto is proportional to your flow and spontaneously triggers and cycles in the same manner based on your lead. Since you have such a tentative inspiratory lead, the odds it will work are lower, but it should be better than CPAP.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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