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Just got new BiPAP machine, need help with treatment/optimization
#1
Just got new BiPAP machine, need help with treatment/optimization
Hello,


Today I bought a new ResMed VAuto on craiglist, thanks for the advice. The reason I bought this was because of flow limitations and aerophagia with the AutoSet. I used the full face mask because the aerophagia wasn't as bad but now that I can control the exhale pressure I would like to use the nasal pillows. From my 3 days of use with the nasal pillows on AutoSet aerophagia occurred with min pressure 10 epr 3 and the average  95% pressure was 12. What pressure should I start at (I don't know the pressure gap works on the vauto). Also, my average AHI did go down with the full face mask on the AutoSet, but I still felt tired after 2 months and had flow limitation throughout. Thanks for your help.
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#2
RE: Just got new BiPAP machine, need help with treatment/optimization
You will need to modify your thought process a little when stepping up to the AirCurve from the AirSense. The AirSense subtracts the EPR value from the pressure set to achieve the EPAP pressure. Whereas, the AirCurve adds the PS (Pressure Support) to the EPAP pressure to obtain the IPAP pressure. Let's say you had your AirSense set to 10 to 15 and an EPR of 3. This would give you an EPAP range of 7 to 12. To set the exact same pressures on the AirCurve you would set the EPAP to 7, the IPAP max 15, and the PS to 3. However, you spoke of still having flow limitations at those pressures. With that in mind, I would start with the EPAP at 7, the IPAP Max to 16, and a PS set to 4. See how you feel with those settings and if they are providing the therapy you need.
.
Crimson Nape
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#3
RE: Just got new BiPAP machine, need help with treatment/optimization
Thanks for the response. I'll follow your suggestions and post Oscar data tomorrow. The explanation made sense as well thanks a lot!
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#4
RE: Just got new BiPAP machine, need help with treatment/optimization
Also, what is Ti max, Ti min, trigger, and cycle? What should they be set to?
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#5
RE: Just got new BiPAP machine, need help with treatment/optimization
Unless there's a need to adjust, run these timing settings as default.
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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#6
RE: Just got new BiPAP machine, need help with treatment/optimization
blancobonzo - Small steps grasshopper...  
  • Ti Max is the maximum time in seconds that the AC10 will maintain the IPAP pressure before dropping to the EPAP pressure,  You can increase (lengthen the time) this parameter without any downside effect.  It can allow you to take a long, slow inhale without the pressure suddenly dropping.

  • Ti Min again is in seconds and is the minimum time before the AC10 will allow the user to drop to the EPAP pressure. Generally you never touch this one.

  • Trigger is the sensitivity setting for the AC10 to determine when breath direction changes to an inhale.  This can be set to be more sensitive if CAs become a problem.

  • Cycle is the sensitivity setting, as your inhale drops off, to allow it to go to EPAP pressure. This setting is rarely changed.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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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#7
RE: Just got new BiPAP machine, need help with treatment/optimization
Here's last night's oscar data. Aerophagia seems to be better on BiPap with nasal mask as I didn't have any bloating at all, but event woke me up earlier today. I have no idea what happened at around 4:30. (Power outage?) Also, the flow limitation seems to have all but disappeared (on the flow limit graph) but I'm still having hypopneas and apneas, as well as a lot of central apneas. There's also some flattening on what I think is inhalation. I had a lot of centrals/Clear Airways on the AutoSet as well for 2 months which is the period after which treatment emergent CA typically recedes right? Also, the CA's seem to be preceded by massive changes in flow rate like in the second attachment. Is there any advice/adjustments to be made to the pressure and other settings? Thanks for your help and advice.


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#8
RE: Just got new BiPAP machine, need help with treatment/optimization
Especially since you bought a used unit on Craigslist, nothing wrong with that but you have no idea what settings were altered. Perform a Factory Reset to place all settings in their default values in case some unexpected setting was changed and forgotten. Then reset your settings
It may not make a difference, but it has on the past.
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#9
RE: Just got new BiPAP machine, need help with treatment/optimization
It was unused with 0 run hours and the humidification tank and tubing were sealed. I also performed a factory reset before adjusting the settings last night. I didn't alter anything except the pressure support and min epap settings.
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#10
RE: Just got new BiPAP machine, need help with treatment/optimization
Everything looks pretty good to me on your settings and results. Setting trigger sensitivity to high will likely reduce the CA events. Your pressure is almost not changing through the night and flow limitation is nil, so I expect if we can address the CA events with trigger sensitivity you should pretty much be optimized and good to go.
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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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