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Looking for some thoughts on VPAP use
#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.


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#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.
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#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

Admin Note:
PaytonA passed away in September 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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#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.)
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#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.

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#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...
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#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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#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
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