EERS Experiment Data (sherwoga)

[slowriter]

Seeking your input for tonight to know whether or not to increase Ti Max further or change the trigger sensitivity to High or Very High.  Also, can I just ignore Ti Min for the time being?

I'd ignore Ti Min, keep Ti Max stable (unless you want to experiment while awake as I suggested and you conclude from that otherwise), and raise trigger.

As for high vs very high (I use the latter), that's another thing best to experiment while awake with, I think. If very high feels wrong, for example, you can just do high.

Note: I'm not worrying about your experimental validity in these suggestions obviously; just trying to optimize the therapy.

[sherwoga]

All the Ti Max does is specify the max time for the machine to stay in IPAP before it switches to EPAP.

If it's a bit short, it will at times switch before you're ready; when you're still breathing in.

The spont cycle % is telling you how often that doesn't happen; that you are driving that switch.

Therefore, if it's below 100, it suggests you can extend it a bit.

Again: you can experiment yourself while awake. Set it back to 2.0, for example, and take a deep breath, and notice what happens.

In the end, I think these tweaks are really about comfort though.

I don't really know any downside for it being too long; maybe sleeprider can clarify.

Thank you.  Too bad your first four sentences aren't in the manual.  Makes a lot more sense than that blasted chart.  

Regarding the experiment while awake you propose: I did spend just 5 minutes or so when I got all hooked up last night exploring the three Report Screens in the Clinician Mode, but I did not make any changes.  I have had difficulties corrupting a nights data when I've tried experimenting with the machine itself.  So I am somewhat loathe to follow through.  Give me some time: maybe, I'll get there.

[sherwoga]

Seeking your input for tonight to know whether or not to increase Ti Max further or change the trigger sensitivity to High or Very High.  Also, can I just ignore Ti Min for the time being?

I'd ignore Ti Min, keep Ti Max stable (unless you want to experiment while awake as I suggested and you conclude from that otherwise), and raise trigger.

As for high vs very high (I use the latter), that's another thing best to experiment while awake with, I think. If very high feels wrong, for example, you can just do high.

Note: I'm not worrying about your experimental validity in these suggestions obviously; just trying to optimize the therapy.

I'll take this advise.  I may even set it up with Very High Sensitivity, get hooked up and start the pump, view the report screens, and then make a quick decision on the fly to stay at very high versus high based on comfort.  I don't think I will see anything on the screens that I would recognize as "useful" in that decision at this point.  I don't think I understand the screens that well yet.  Regardless this has been very useful.

[slowriter]

I may even set it up with Very High Sensitivity, get hooked up and start the pump, view the report screens, and then make a quick decision on the fly to stay at very high versus high based on comfort.

[sherwoga]

Did you drink 6 beer the first time you drank alcohol just because someone else you knew drinks 6 beer? You want pressure, PS and EERS to be minimum required. You should start out low and work your way up, instead you started at the maximum settings you should require and some of your results are questionable because of it...  

Regarding some of your questions.

I'd like to see what the flow rates look like during those apneas (flow rate and mask pressure), I don't trust the event flags.

I assume the machine is reporting I:E. Value should be around 2:1 for E:I. It is easy to calculate in OSCAR(don't trust the reported E&I times though), find some breaths and measure time for expiration(negative flow rate) and inspiration(positive flow rate). You need to look at examples from your different breath wave forms as the value will vary through the night.

I don't drink alcohol!

Yes, the machine reports I:E.  

Yesterday, I examined flow patterns on the flow rate chart trying to measure times.  My efforts were unsuccessful.  Then this AM it dawned on me the I and E might be better measured from the pressure graph.  I decided to examine the mask pressure chart.  I believe after this investigation that an appropriate way to measure I and E is illustrated in this capture.  At least the numbers I get now make some sense.  

   

[Geer1]

You should get roughly the same times measuring flow rate.

Sounds like you figured out Timax. As for slowriter's regarding too large a Timax the answer would be no IF you don't need help enticing the exhalation phase. These bilevel machines are primarily meant for people with more serious breathing issues that aren't capable of ideal spontaneous breathing and that is what these features are meant to address.

As for adjusting Timin, that strange breathing would be the main thing that you might want to consider changing Timin for. If it seems like it is helping but only lasting half the inhalation period lengthening it a bit could help. Just don't want to make it too long that it screws up with exhalation.

How has that strange breathing been on vauto? Still noticing it? Maybe better, maybe worse? There is another member with the same issue so would like to know if it might be helping.

[sherwoga]

You should get roughly the same times measuring flow rate.

Sounds like you figured out Timax. As for slowriter's regarding too large a Timax the answer would be no IF you don't need help enticing the exhalation phase. These bilevel machines are primarily meant for people with more serious breathing issues that aren't capable of ideal spontaneous breathing and that is what these features are meant to address.

As for adjusting Timin, that strange breathing would be the main thing that you might want to consider changing Timin for. If it seems like it is helping but only lasting half the inhalation period lengthening it a bit could help. Just don't want to make it too long that it screws up with exhalation.

How has that strange breathing been on vauto? Still noticing it? Maybe better, maybe worse? There is another member with the same issue so would like to know if it might be helping.

I've used the VAuto 3 nights now and haven't seen the exaggerated cardiogenic oscillations even once.  If I zoom in, I can see some small oscillations.  

Still as PS of 5.4 and using 12 inches of EERS  (haven't changed either).  

Last night I did change the trigger sensitivity to very high.  Left Ti Max at 2.4.  Spont cycle fell back down from 97.5 to 95.5 and E:I was again at 1:1.8.  I think I will increase Ti Max tonight another increment to 2.6.  For now leaving the Ti Min alone at 0.3 s.

[slowriter]

Any change in AHI/CA?

[sherwoga]

Any change in AHI/CA?

Here is that data in tabular form with changes to Trigger Sensitivity and Ti Max.  Short answer: yes but very small and desirable decreases coincident with unwanted increase in hypopneas.  Also, had one significant period of flow limitations near the end of the night last night.  Flow Limit median and max were 0.06 and 0.54, respectively.  RR trace still very stable and low relative to Autoset.  No cardiogenic oscillations.

   

[slowriter]

Good.

Looks like you could start bumping your min EPAP a bit?

One strategy to titrate with the vuto is to adjust min EPAP and PS so that you smooth out pressure swings (I don't see your pressure graph), and of course eliminate the OAs.