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Help with s-9 Vpap in S mode
#21
RE: Help with s-9 Vpap in S mode
(07-12-2020, 01:36 PM)Crimson Nape Wrote: If you haven't set the "Trigger" to Very High, I suggest that you do.

What is the purpose of the trigger setting exactly?
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#22
RE: Help with s-9 Vpap in S mode
There are two sensitivity settings, Trigger and Cycle. Trigger is the sensitivity for switching from EPAP to IPAP, so we use higher trigger sensitivity to help individuals that can benefit from a transition that requires less inspiratory flow such as in central events or weak inspiratory flow. Cycle is the switch from IPAP to EPAP, and we will increase cycle sensitivity for individuals that need more expiration time, such as COPD. We have observed lower CA event rates by increasing trigger sensitivity to high or very high.

The minimum inspiratory time can also be increased from the default 0.3 seconds to 0.8 seconds for those individuals that may have weak inspiratory effort that seems to quit too soon. By changing to 0.8, IPAP will not cycle to EPAP for at least 0.8 seconds, sustaining the inhale. There are good explanations of the Ti min, Ti max and trigger/cycle sensitivity in the clinical manual available from the forum. https://www.apneaboard.com/adjust-cpap-p...tup-manual
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#23
RE: Help with s-9 Vpap in S mode
I have another question what exactly is a CA apnea? Is it when I don’t initiate a breath? Those seemed to have increased while my obstructive last night decreased.
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#24
RE: Help with s-9 Vpap in S mode
CA is a central apnea or clear airway and can happen for many reasons or none at all. It is a minimum 10 second pause in breathing where the airway is open, and that means no spontaneous effort to breathe. When the frequency is low, a CA can come from something as innocuous as holding your breath during a movement, a change in sleep stage or just a breath omission. When we see more CA events, it is sometimes because ventilation has reduced CO2 in the blood stream and reduced respiratory drive. There is no need to change any settings or do anything in response to CA. There is no respiratory effort during CA events, and short duration events are usually not as disruptive to sleep as obstructive events which can cause more oxygen desaturation.
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#25
RE: Help with s-9 Vpap in S mode
Another night in the books. Lots more questions for you guys.

1. Changed the ti max/min suit my breathing rate I think it is now 3.3 max -.3 min. Only changed Ti Max Back down a little bit.
2. Upped the pressure again because my obstructive's are not as controlled as I would like. was 8/4. now is 9/5. 
3. Lots of clear airways again. Not worrying with those.
4. Should I up the pressure again tonight? To  10/6 or leave it alone for a few days?
5. I am feeling much more rested and my resting hr is dropping.
6. Let me know if any one wants a closer picture of flow rates or an event.


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#26
RE: Help with s-9 Vpap in S mode
(07-10-2020, 08:49 AM)Sleeprider Wrote: Your settings are EPAP 3.0 and IPAP 7.0.  I agree with Jaswilliams you need higher pressure to deal with the OA events.  Increase EPAP and IPAP by 1-cm until the events are controlled the next changes are 4/8 then 5/9.  I have rarely seen such low pressure work with obstructive apnea.

My "hunch" was assuming your pressure and pressure support were higher and resulted in CA events, so i was way off, but that's why we want to see some data first.  Assuming works about as well as your current low pressure.

I have done these changes and then some. Thanks for the tip of 1cm increases. I have been upping each epap and ipap before I go to bed each night. Last night was by far my best night 2.97 AHI at pressure 10/6 ps 4. My AHI is slowly trending downward thanks to you all's help. The question I have today is should I leave it alone for a few days or up it to 11/7 tonight? To me at least the slow increase in pressure has been easier to handle then just putting from 7/3-10/6 thats just me though.

Oh and ti max wasnt 3.3 it is something more like 2.2 or 2.3 or somewhere in that range.

Attached are two of the events I experienced last night.


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#27
RE: Help with s-9 Vpap in S mode
Where the majority of apnea are obstructive, continue increasing EPAP and IPAP maintaining PS the same.  To show you that this stuff actually has some basis:

[Image: attachment.php?aid=4203]

[Image: attachment.php?aid=9715]
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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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#28
RE: Help with s-9 Vpap in S mode
I have read that article somewhere before probably on here. But just by the way I’m feeling I can tell you it’s working. Slowly but surely I’ll get to the right pressure. Rome wasn’t built in one day...so no need to massively change pressures all at once slowly let the body acclimate to the increased pressure.
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#29
RE: Help with s-9 Vpap in S mode
Hello everyone again. Obstructive's still on the decline. The question is do I still need to keep increasing pressure? I am attaching a flow rate chart from last night. Thanks in advance. Im thinking yes as my obstructive events are not controlled as I would like. And the flow chart I think indicates more pressure is needed.


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#30
RE: Help with s-9 Vpap in S mode
You may benefit from another slight increase in pressure. I think you'd need to watch event counts on both OA and CA. Right now, CA is about 1 point higher, but you've got overall AHI under 4. I'd rely more on how I felt at this point. And I'd not recalled what the CA were determined to be such as treatment emergent, and if so labeled, then they should be on the decline soon enough. I'd think that you could try another increase and if the events go up and/or it feels worse, dial it back to this.
Dave

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