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Looking for some thoughts on VPAP use
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ckingzzzs Offline

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Posts: 57
Joined: Aug 2015

Machine: resmed aircurve 10 VAUTO
Mask Type: Nasal pillows
Mask Make & Model: swift fx nasal pillows
Humidifier: resmed aircurve10 vauto
CPAP Pressure: min epap 7, max ipap 20, PS 4
CPAP Software: ResScan SleepyHead

Other Comments: CPAP user June-Dec 2015, VPAP starting Jan 2016 and struggling with proper adjustments

Sex: Male
Location: maine

Post: #1
Looking for some thoughts on VPAP use
I am not sure which numbers I should change to help decide if the VPAP is working for me. I provide a range of dates showing different adjustments I have tried.

For 2/17 to 3/6 I had 9 of 18 AHI readings of less then 5. Resmed VPAP set at Max Ipap=20, min epap 7, PS=3.0, timax=2.5 and tmin=.5 (medium Ipap shows 10.7 with a max of 12.7, and medium epap shows 7.8 with a max of 9.8)


For 3/7 to 4/9 I had 6 of 34 AHI readings of less then 5. VPAP set at Max Ipap=20, min epap 7, PS=2.2, timax=2.7 and tmin=.5 (medium Ipap shows 10.5 with a max of 13, and medium epap shows 8.3 with a max of 10.9)

Not sure what adjustments I should try to better my situation. Median leaks show 0, and 95% around 16. Even using a chin strap I am not seeing much better.

I changed machines from a Resmed CPAP to a Resmed VPAP. In using the CPAP for 6 months, I had approx 9 days out of 172, that gave central readings of less than 5, while on the VPAP, I have had 27 days out of 52, that gave central readings of less than 5. So it would appear that my centrals got a little better, but still a crappy AHI overall. I was getting too many centrals with the CPAP and the centrals do seem to have improved using the VPAP.

I welcome any constructive thoughts on this.
04-10-2016 01:24 PM
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palerider Offline

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Posts: 440
Joined: Nov 2014

Machine: s9 vpap auto
Mask Type: Nasal pillows
Mask Make & Model: p10
Humidifier: none
CPAP Pressure: 18/13+
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Dallas(ish)

Post: #2
RE: Looking for some thoughts on VPAP use
don't change the trigger, cycle, and Ti settings away from default, until you figure out exactly what they do.
04-10-2016 02:29 PM
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PaytonA Online
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Posts: 3,000
Joined: Dec 2013

Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Orange County,California

Post: #3
RE: Looking for some thoughts on VPAP use
I agree wholeheartedly with palerider. Changing trigger, cycle,and Ti is generally not necessary and I have not heard of those variables affecting centrals unless there is a recognizable timing problem. In fact, with the first machine I had, the RT who set it up for me used really weird settings for Ti min and Ti max. When I finally realized what was going on to cause a problem, I set them back to the default. Problem solved.

Without seeing more data, I do not feel that I can suggest any adjustments that might be helpful. Keep in mind the fact that bilevel machines are not designed to prevent centrals. Sometimes you may be able to find a middle ground that will result in not too many OAs or CAs. You may really need to go with a different machine like an ASV.

Out of curiosity, how long have you been PAPing?

Best Regards,

PaytonA
(This post was last modified: 04-10-2016 02:59 PM by PaytonA.)
04-10-2016 02:58 PM
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palerider Offline

Preferred Members-

Posts: 440
Joined: Nov 2014

Machine: s9 vpap auto
Mask Type: Nasal pillows
Mask Make & Model: p10
Humidifier: none
CPAP Pressure: 18/13+
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Dallas(ish)

Post: #4
RE: Looking for some thoughts on VPAP use
(04-10-2016 02:58 PM)PaytonA Wrote:  I agree wholeheartedly with palerider. Changing trigger, cycle,and Ti is generally not necessary

after figuring out what they do, and examining my nightly flow carefully, as well as inspiration time, I tweaked my trigger and TiMax, and got lower AHIs as a result, but again, that's only *after* thoroughly understanding what those settings do.

(I was seeing partial inhales before an apnea where the machine wasn't responding by going to ipap.... and I was bumping up against the TiMax setting on inspiration times quite a bit, seemed my sleeping self wanted longer than 2 second inhalations.)
04-10-2016 03:41 PM
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ckingzzzs Offline

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Posts: 57
Joined: Aug 2015

Machine: resmed aircurve 10 VAUTO
Mask Type: Nasal pillows
Mask Make & Model: swift fx nasal pillows
Humidifier: resmed aircurve10 vauto
CPAP Pressure: min epap 7, max ipap 20, PS 4
CPAP Software: ResScan SleepyHead

Other Comments: CPAP user June-Dec 2015, VPAP starting Jan 2016 and struggling with proper adjustments

Sex: Male
Location: maine

Post: #5
RE: Looking for some thoughts on VPAP use
(04-10-2016 02:58 PM)PaytonA Wrote:  I agree wholeheartedly with palerider. Changing trigger, cycle,and Ti is generally not necessary and I have not heard of those variables affecting centrals unless there is a recognizable timing problem. In fact, with the first machine I had, the RT who set it up for me used really weird settings for Ti min and Ti max. When I finally realized what was going on to cause a problem, I set them back to the default. Problem solved.

Without seeing more data, I do not feel that I can suggest any adjustments that might be helpful. Keep in mind the fact that bilevel machines are not designed to prevent centrals. Sometimes you may be able to find a middle ground that will result in not too many OAs or CAs. You may really need to go with a different machine like an ASV.

Out of curiosity, how long have you been PAPing?

Best Regards,

PaytonA

I have been paping since May of last year 2015. It is coming up on a year now and still not where I should be.
04-10-2016 09:28 PM
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JSL747 Offline

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Posts: 22
Joined: Feb 2016

Machine: ResMed S9 VPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 17/12 PS1
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Female
Location: Oregon

Post: #6
RE: Looking for some thoughts on VPAP use
You could post some screen shots of your SH data. You might get more help that way. Really do need to see the data...
04-12-2016 11:17 PM
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Sleepster Offline
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Posts: 4,988
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #7
RE: Looking for some thoughts on VPAP use
(04-10-2016 01:24 PM)ckingzzzs Wrote:  I am not sure which numbers I should change to help decide if the VPAP is working for me. I provide a range of dates showing different adjustments I have tried.

For 2/17 to 3/6 I had 9 of 18 AHI readings of less then 5. Resmed VPAP set at Max Ipap=20, min epap 7, PS=3.0, timax=2.5 and tmin=.5 (medium Ipap shows 10.7 with a max of 12.7, and medium epap shows 7.8 with a max of 9.8)


For 3/7 to 4/9 I had 6 of 34 AHI readings of less then 5. VPAP set at Max Ipap=20, min epap 7, PS=2.2, timax=2.7 and tmin=.5 (medium Ipap shows 10.5 with a max of 13, and medium epap shows 8.3 with a max of 10.9)

Not sure what adjustments I should try to better my situation. Median leaks show 0, and 95% around 16. Even using a chin strap I am not seeing much better.

I changed machines from a Resmed CPAP to a Resmed VPAP. In using the CPAP for 6 months, I had approx 9 days out of 172, that gave central readings of less than 5, while on the VPAP, I have had 27 days out of 52, that gave central readings of less than 5. So it would appear that my centrals got a little better, but still a crappy AHI overall. I was getting too many centrals with the CPAP and the centrals do seem to have improved using the VPAP.

I welcome any constructive thoughts on this.

It seems you need a higher PS and a lower maxIPAP. I would try 4 and 14, respectively. I agree that you should leave the trigger, cycle, and Ti max settings on the factory defaults until you get the other stuff tweaked.

I'd also try a full face mask to see if it will bring down the leak rate.

Sleepster
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www.ApneaBoard.com


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.
04-13-2016 07:17 PM
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ckingzzzs Offline

Preferred Members

Posts: 57
Joined: Aug 2015

Machine: resmed aircurve 10 VAUTO
Mask Type: Nasal pillows
Mask Make & Model: swift fx nasal pillows
Humidifier: resmed aircurve10 vauto
CPAP Pressure: min epap 7, max ipap 20, PS 4
CPAP Software: ResScan SleepyHead

Other Comments: CPAP user June-Dec 2015, VPAP starting Jan 2016 and struggling with proper adjustments

Sex: Male
Location: maine

Post: #8
RE: Looking for some thoughts on VPAP use
Sleepster,

For the past several months I have tried a PS of 2.2, 2.6, 3.4, and 4.0, with a min epap of 6.8 and a max IPAP of 14.

No matter what I do to the PS changes, I keep getting centrals of 4.6 to 5.5.

My AHI average 6 to 7.5

Thus, it appears that changing my PS values does little if anything to changes in centrals.

50% of the month my centrals are <5, and the other 50%>5, like 5 to 13

25% of the month my AHI is <5, and the other time the AHI is >7
07-18-2016 06:59 PM
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