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Looking for some thoughts on VPAP use
#1
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
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
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
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#4
(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
(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
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
(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
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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