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Plmnb - the journey continues now with ST-A.
#51
RE: Plmnb - the journey continues now with ST-A.
Geer1,

I was just getting ready to post the video for the time period including 1:45 when I looked at the video for that approximate time frame.  At approximately 1:25 my mask was over my mouth and nose.  However, by approximately 1:32, the mask was on top of my head.  So I really don't think you need this time period of 1:45.  About 1/2 way through 2:16 I am seen with my mask again over my mouth and nose.

Do you want me to zoom in around then or other time frame?

And what EXACTLY setting wise am I going to change for tonight? (Already set the Ti min to 1.0s). 

Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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#52
RE: Plmnb - the journey continues now with ST-A.
Target pt rate 14, and adjust Va down until it results in a target MV of 6. My guess is that is a Va around 5.

My guess is you removed the mask because breathing was uncomfortable due to the machine maintaining too high of ventilation. Your ventilation was noticeably higher than when you were on Vauto.
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#53
RE: Plmnb - the journey continues now with ST-A.
Just made all remaining setting changes...with me luck!

Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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#54
RE: Plmnb - the journey continues now with ST-A.
I was away last evening and will catch up today. I think things are going pretty well here, and until we have more than one session in, I don't have much to add. See ya later!
Sleeprider
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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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#55
RE: Plmnb - the journey continues now with ST-A.
Coffee Morning all.

Well, second night of iVAPS under my belt.  Not sure what to make of the charts/graphs.  I had a very lengthy large leak, approximately 2 hours and 40 minutes.  I THINK part of the issue here is my new headgear.  The velcro failed on my previous headgear, which was the general size that comes with the kits.  I kept having to pull the straps further and tighter and ultimately the velcro on one strap failed to hold anymore.  So when I ordered a new one, I ordered the small.  It might be a tad too small.  If I can figure out how to make the strap hold I will try the original one tonight. (I tried adding a new piece of velcro, but it didn't work).  Any suggestions would be appreciated on what to do about this.  I know the mask is supposed to "float" on your face, but that just won't work for me, I have tried and tried with various masks to get the floaty result, but the leaks are much worse.  The tighter the better it seems for me.

At any rate, here are the results from last night.  I combined two not so great periods into one image.  Corresponding video shows some "jerky"? breathing for the disturbances in FLOW RATE wave patterns in graph showing the period about 1:44:10 and also in graph for 5:14:50 - 5:18:20. 

The LARGE LEAK period shows basically starting around 2:31:00/2:32 and it goes to 04:09 ish.  In my video I become restless around time stamp 2:32, start fiddling with the mask, and then stop, leaving mask on.  Then I again become somewhat restless at time stamps 4:02 and 4:10, still have mask on.  I am laying down, "asleep" until time stamp 5:00/5:01 have a deep inhalation, become restless, sit up, then appear to be performing my "yoga" position, but ultimately remove the mask and stop the machine at about 5:00:05.

I don the mask again about 10 minutes later, at approximately 5:10:24 for another session. 

Need any more info or clarification, please don't hesitate to ask.  Bigwink

   

   

   
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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#56
RE: Plmnb - the journey continues now with ST-A.
To me, the flow limitation appearance may be related to maximizing your respiratory volume which is the ultimate limit of how much air you can manage before the lungs are so packed with air, they don't expand more. Hope that makes sense. Your minute vent is way too high, and you need to back off on the Va target until that drops back to a normal level near 6 L/min. It's that simple. You are trying to force too much air into a small container, and it is overflowing. Drop back the Va target rate.

The longer TiMin worked. Your close-up shows well synced breaths. Although they are flat on top, this may be your normal. You are certainly not under ventilated, and in this zoomed image, your PS is actually less than 6.0 cm and is much lower than the pressure you used on Vauto. I think it is a good thing that the machine is cycling to EPAP at 1.8 seconds or so, and avoids those long protracted car crusher flow limits.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#57
RE: Plmnb - the journey continues now with ST-A.
(02-18-2020, 05:35 PM)Geer1 Wrote: Target pt rate 14, and adjust Va down until it results in a target MV of 6. My guess is that is a Va around 5.

Sleeprider,

I made the adjustments to the machine last night that had been suggested.  So what should I set things for for tonight?  I already under reported my height to get the one tweak to be set.  Do I try again with all the above quoted setting categories or back to one at a time?  One increment of measure at a time? 

EDIT: Those nasty "car compactors" did rear their ugly heads.  Should I figure I may always have them?

Regards,
Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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#58
RE: Plmnb - the journey continues now with ST-A.
Minute vent was reported at 9.0 last night with 95% at over 11 L/min. That suggests you are over-ventilated and we want the machine to back-off.  I have some random thoughts I'm going to put down here for consideration by others that are following along. These are thoughts, not suggestions for changing therapy:

It appears that Phoebe has very fast rise to peak inspiration before inspiratory capacity is reached and flow rated flatten out or drop. While this appears as flow limitation, it may simply be too much air.  We know that statistically, she is over-ventilated. Phoebe does not appear to have a normal cycle to expiration at times. The iVAPS  has helped to normalize I:E times and she has started to cycle in sync to the machine.  This has in turn curtailed the worst looking flow limitations. I suspect the "car compactor" flow limitations are not out of a need for more air, but an abnormally long inspiration time that exceeds vital capacity before cycling to exhale.

The ST-A has some tools that we could implement to work with the conditions I hypothesized above.  
1. We could slow down the rise from EPAP to IPAP from 300 ms to 400 ms.
2. We can shorten Ti Max

These actions would theoretically slow the inspiratory rise time and conserve expiration time.  I'm in new territory here, and would lke to get other's thoughts.

The question on the extreme flow limitations and whether they may always be present.  I dunno Dont-know We don't know why they occur, but I am arriving at a theory that they may not be flow limitation related to traditional upper airway restriction we normally encounter, and instead is derived from an "air hunger" that causes you to hyperinflate or ventilate your lungs. You continue to try to inhale long after the lungs are filed with air. If that is the case, the solution becomes, ensuring you get the lung-ful of air you crave, but cut-off the inspiration time forcing you to cycle.  Just a thought.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#59
RE: Plmnb - the journey continues now with ST-A.
Please start including the minute volume and leak rate graphs. It is clear that your tidal volume and therefore minute volume numbers were both influenced by that large leak and the inclusion of these graphs will help us estimate the true ventilation.

I'd like for you to lower target pt rate down to 13. The machine still appears to be supporting your respiration rate when set at 14.

Assuming your target MV on the machine is 6 the only reason I can see that yours was so high is because of leaks influencing numbers, backup rate and Timax speeding up your respiration rate and possibly the square wave shapes due to fast rise time and possibly PS being too high in conjunction with that square wave shape. 

I am also wondering if EPAP should be increased, I believe before it had been decided that 14 was best? I understand wanting to dial it back for use with iVAPS but perhaps she needs the pressure to help hold things in place?

When you look at your videos try to find out when those periods of flow limitation are starting and whether your body, chin moves etc. The cause of these limitations wont be found on OSCAR, you need to resort to video, ENT findings etc.
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#60
RE: Plmnb - the journey continues now with ST-A.
Thank you Geer1 & Sleeprider.  I will make the adjustment.  Maybe even for a nap today.  I'd like to target in at least a little more before tonight.

Since I'm off work, this afternoon will be a good time to really try to comb through the video.  One problem with my video system is I unknowingly purchased a system that only records in increments of approximately one minute at a time.  Some times there is a second or so lost between clips.  It is motion activated supposedly, but still records what seems like "continuously", maybe because of the ceiling fan or my breathing movements.  It is set to high sensitivity.

I will start posting charts with the graphs requested.

Until later on.

Regards,
Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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