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Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
#61
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
(06-11-2018, 06:33 PM)sleeplover69 Wrote: AirCurve 10 VAuto to try out, but only for a week.

Whats a good starting point for pressure settings and are there other settings to tweak as well? I'm thinking of trying 5/10/5 EPAP/IPAP/PS, but my supplier wrote down suggested settings of 8/16/4 EPAP/IPAP/PS so I'm confused by those numbers. I am outside right now so I'll have to go home tonight to double check if I'm remembering correctly.

Hi sleeplover69,

The "auto" in Vauto refers to self-adjusting EPAP.  So there will be settings for Min EPAP, Max IPAP, and Pressure Support.

The supplier is suggesting settings of 8/16/4.  In Vauto therapy mode this would signify Min EPAP = 8, Max IPAP = 16, PS =4.  These are reasonable settings (under the assumption that the machine will not increase EPAP higher than needed), but would be similar to a fantasy AutoSet set for Min Pressure (IPAP) of 12, Max Pressure (IPAP) of 16, and EPR of 4.  I say "fantasy AutoSet" because a real AutoSet cannot be set for EPR higher than 3.

If you set Min EPAP to 5, Max IPAP to 10 and PS to 5, as sleeprider pointed out this would not allow the EPAP to adjust. It would be similar to "S" therapy mode with fixed EPAP and fixed IPAP.  I suppose you are interested in trying PS=5 to see if it eliminates your possible UARS.  These settings would be similar to a fantasy AutoSet set for Min Pressure (IPAP) of 10, Max Pressure (IPAP) of 10, and EPR of 5.

I agree with the suggestion of Min EPAP of 5, Max IPAP of 14, but I suggest starting with PS of 4 the first night, to not make too big of a change at once, and to follow the suggestion of the supplier who suggested starting with PS of 4.  

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#62
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
By the way, the VAuto therapy mode allows adjustment of the Min and Max inspiration time.  As starting points, I suggest TiMin around 0.8 seconds and TiMax around 2 seconds.  If the TiMin is too low it would allow your inhalation time to be cut too short sometimes, and if TiMax is too short (in VAuto mode) it might not allow you to finish inhaling as long as you like.

The VAuto mode also allows adjustment of Trigger Sensitivity; the more sensitive the earlier the machine will follow your lead and change from EPAP to IPAP when you begin to inhale.  A Trigger Sensitivity setting of Very High may jump the gun and trigger into IPAP earlier than you really want, and a Trigger Sensitivity setting of Very Low may trigger into IPAP way too late.

The VAuto mode also allows adjustment of Cycle Sensitivity; the more sensitive the earlier the machine will follow your lead and change from IPAP to EPAP when you stop inhaling.  A Cycle Sensitivity setting of Very High may jump the gun and cycle back into EPAP earlier than you really want, before you have finished inhaling, and a Cycle Sensitivity setting of Very Low may cycle back into EPAP way too late, too long after you are already trying to exhale.

When I was using a ResMed VAuto machine, I found it most comfortable when the Trigger Sensitivity was set to Very High, causing PS to begin right away after I started inhaling, helping me to inhale.  And I liked it when the Cycle Sensitivity was set to Very Low, allowing IPAP to last until I was completely finished with inhaling.

But I did find that the higher the Trigger sensitivity and the lower the Cycle sensitivity, the more central apneas I would have.

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#63
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
I'm trying to approximate 8-12 + EPR 3 on the Autoset but increase inspiratory pressure without increasing min EPAP of 5.

With my above settings on the Autoset, don't I have min EPAP 5, min IPAP 8, max IPAP 12? If so then I don't think the supplier understands that 8/16/4 would give me too high of a min EPAP which was causing ratty breathing in the first place. He didn't bother to look at my sleepyhead data this visit at all so I'm going to disregard his settings.

Looking at my last few reports with 8-12 EPR 3 on the Autoset, should I try 5/13/4 EPAPmin/IPAPmax/PS or am I really confused?

Let's pretend I never mentioned what the supplier suggested given his disconnect and go from the sleepyhead data that I've so far posted in this thread. Lol sorry, my bad
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#64
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Also that is very informative about the other settings on the VAuto and is exactly the kind of detailed response I was hoping for. Thank you again, Vaughn.
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#65
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
(06-11-2018, 10:32 PM)sleeplover69 Wrote: ... too high of a min EPAP which was causing ratty breathing in the first place.

Quote:Looking at my last few reports with 8-12 EPR 3 on the Autoset, should I try 5/13/4 EPAPmin/IPAPmax/PS?

Yes, settings of EPAP Min = 5, IPAP Max = 13, PS = 4 would give you the same range for EPAP as before, which I think is very reasonable.

Regarding ratty breathing patterns, I am not sure that it should be attributed to the EPAP being too high.  Personally, I would have assumed that ratty/wiggly Flow waveforms would be associated with partial obstruction, which I would have thought would be be helped by higher EPAP.  But I'm not sure.

By the way, we often have small wiggles in our Flow waveform at the same frequency as the heart rate, which is normal. I think the strongly ratty/wiggly Flow waveforms are likely caused by variation in obstruction, perhaps quickly varying Flow Limitation.

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#66
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
EPAP and rattiness - Hmm, I thought my graphs were more consistently sinusoidal as I increased expiratory pressure relief. I think it was Sleeprider at post #43 who pointed it out to me a few that I was struggling to inhale after expiratory breathes when EPR was set at 1 or 0, or maybe he was just talking about needing increased pressure support. I have another example of such shaky breaths when I cranked up min pressure to 10.

Noted on breath wave form correlating with heart rate, which may also be disconcerting given some of the irregular looking wave forms of mine.

One more thing, does this look like the S9 Autoset has very low 'trigger sensitivity' or is sleepyhead not matching up the mask pressure graph with the flow rate graph? And I wonder if the VAuto is somehow, on default, more responsive than the S9 Autoset in this aspect:

[Image: EERA3fl.png]
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#67
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
I would guess the S9 AutoSet may have "medium" Trigger sensitivity.

Looking at the green vertical line at 12:23:01.5 the EPAP pressure ends and the Mask Pressure begins to rise toward IPAP starting around 0.4 seconds after inhalation begins, but I think the pressure usually starts increasing toward IPAP slightly earlier, around 0.2 +/- 0.1 seconds after inhalation starts.
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#68
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Thanks again, Vaughn. This kind of info and comparison would seem quite difficult to find out on my own. I wonder how significant the impact of all these settings would have on overall sleep quality and reduction in disturbances as even a minor change in comfort settings can be the difference between raining out and sleeping soundly throughout the night. I think I'll try starting out with 'high' trigger and maybe leave cycle on default at pressure settings of 5/13/4 for tonight.

Thank you as well, Sleeprider.
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#69
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Aircurve 10 Vauto Bilevel Day 1 - 5/13/4 EPAP/IPAP/PS - Cycle sensitivity "High"

What a terrible night. I probably slept a total of 6 very broken hours. Night was broken up to four segments with shorter awakenings happening in the first and third periods. Kept tweaking the settings until I settled on 'high' cycle sensitivity with everything else on default settings. For some reason, 'med' cycle sensitivity felt stressful on the lungs.

The hose had a strong shampoo smell and some personal funk to it so it was pretty hard to stay asleep for the first two hours. It was gross. Also I started waking up every time with phlegm and I've been constantly clearing my throat. Either it's LPR or from eating hose funk or a combination of both, ugh. The funk has disappeared now, I think. I should probably get tested for LPR before it gets worse?

During the second major break, I awoke gasping really hard for air with the flow rate looking almost like a long OA but it wasn't flagged or anything. I was afraid to go back to sleep with the machine for a while.

For the third segment, I tried 'med' cycle sensitivity again anyway and had a few brief awakenings and ended up with some aerophagia. Then I turned it back to 'high' and went back to sleep for the final leg of the night.

[Image: qf96Hcw.png]

[Image: KjIMB0E.png]

Random wave form from first segment

[Image: 4agInBq.png]

Shortly before first break. I don't know what happened, maybe it's thinking about that hose funk.

[Image: muAgmZx.png]

More wave forms

[Image: SJqnjfg.png]

At times it looks alright, but not for very long stretches of time

[Image: x5iFUJW.png]

How long can you have a stretch of good breaths before it starts to look weird?

[Image: sk9ZGxN.png]

So this is where I woke up hard gasping for air. Looks almost like an OA but it's unflagged. No idea what happened and I was afraid to go back to bed for a little while.

[Image: EJ4nLhl.png]

Close-up of that flat line. I:E ratio goes to 100 after those 4 little bumps

[Image: J32yTLJ.png]

3rd segment with cycle sensitivity back to 'med.' Tidal volume was a little higher but I had brief awakenings and woke up with some aerophagia.

[Image: IJFAdCm.png]

These lead to the largest arousal-looking breaths of the run. Maybe try 5 PS tonight? At 4 PS, I had some aerophagia with cycle sens to 'medium.'

[Image: uPRxJTX.png]
[Image: R6oFW9j.png]

Last leg of the night with setting cycle sensitivity back to "high," it felt more comfortable as I felt I exhaled a bit faster than the machine could change back to EPAP even if these clusters of breaths look a little weaker.

Well, that concludes the first night with the bilevel. Should I try again tonight with 5/13/4? Any suggestions about tweaking any settings?
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#70
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Nothing is going to resolve that huge central at 10:05:40 but a backup rate. I don't see anything else that is obvious in terms of settings. I would clean the equipment with products you are comfortable with.
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