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[Pressure] Help needed with new VPAP and new to forum
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justMongo Offline

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Post: #31
RE: Help needed with new VPAP and new to forum
(03-01-2015 11:46 AM)PaytonA Wrote:  jpatfarrell,

I use the S9 VPAP Auto which is the prior version of the Aircurve 10 Auto. Previous to that I used the S8 VPAP Auto. Anyway what I have seen for PS setting is 4-6 cm/H2O. I think that 4 may be the most common and that is what I use. The Ti min and Ti max can generally be left at their default values of Ti max= 2.0 and Ti min= 0.3 which is where mine are (had to go double check that). At the very least, I think that is a good starting point.

If the Aircurve has an "Easy Breathe" setting, I would turn it on. I use it on my S9 and the transitions from EPAP to IPAP and vice versa are almost undetectable

Best Regards,

PaytonA

I use the same machine as Payton; and agree with what he said above.
My PS=5. Most DMEs just default Ti min and max. I pushed out Ti min to 0.6 seconds to reduce a double trigger I was getting. Easybreathe gray's out the rise time setting; and the rise fall of the pressure waveform is smooth like an exponential rise and decay. Without easybreathe I found the switch to/from IPAP to/from EPAP sort of slams.

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.
03-14-2015 09:58 PM
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justMongo Offline

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Posts: 3,851
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

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Sex: Male
Location: Калифорния

Post: #32
RE: Help needed with new VPAP and new to forum
(03-14-2015 06:56 PM)jpatfarrell Wrote:  Hi PaytonA,
Thanks for the info. I do have ResScan on my computer and just uploaded the data.

It shows 76% for % Spontaneous Cycled Breaths.

Is it the percent of breaths that are spontaneously terminated by the patient (termination of IPAP and changing to EPAP)?

If correct this tells me that 24% of my breaths were terminated by the VPAP....correct?

What affect does this have? I am guessing it is not good to be that low.

If this is not good, what do I change. TiMax, TiMin, Trigger and/or Cycle. Or something else?

I have increased the TiMax to 3.0.

Do you still recommend changing the TiMin to 0.7 and also changing the Cycle to HIGH or VERY HIGH?

Should I leave the Trigger at Medium?

Your help is greatly appreciated.

Pat

I wouldn't fiddle with Ti min Ti max or the sensitivities until you have copious data to understand your situation.

The average person spends 1/3 of a cycle in inspiration and 2/3 in expiration. So, the I:E ratio is typically 1:2

Running Ti Max at 3 seconds is for people with a slow respiration rate.
At I:E of 1:2 and 3 seconds for I, then 6 seconds are for E; and the BPM is 60/9= 6.7 BPM.

Likely you are breathing around 15 BPM.

Ti max at 3 seconds will not hurt as you should cycle faster than that. Still I would leave it at default for now.

Most of us run in the 98 to 100% Spontaneous Cycled Breaths.
I would not be concerned at this time. Gather data and examine your breathing patterns. Then think about how Ti min and Ti max might interact with your particular pattern.

There is physiology, science and math involved -- if you are like me -- that's your meat and potatoes!

best regards, Mongo

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.
03-14-2015 10:13 PM
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DeepBreathing Offline
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Post: #33
RE: Help needed with new VPAP and new to forum
Perhaps we should go back to basics on this. Pat wasn't prescribed a bilevel machine, he chose that in the hope that it would cover all eventualities. Instead of getting ever more caught up in the intricacies of timed breaths etc, maybe it would be better to try and set the machine as a straight CPAP and work from there? Get the machine dumbed down as far as possible so that all the breathing rate support stuff isn't causing more problems than it's solving. Once stabilised in that regime, we could see whether there is any need to invoke the more advanced features of the machine.

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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.
03-14-2015 11:13 PM
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justMongo Offline

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Machine: ResMed VPAP Auto (S9)
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Post: #34
RE: Help needed with new VPAP and new to forum
(03-14-2015 11:13 PM)DeepBreathing Wrote:  Perhaps we should go back to basics on this. Pat wasn't prescribed a bilevel machine, he chose that in the hope that it would cover all eventualities. Instead of getting ever more caught up in the intricacies of timed breaths etc, maybe it would be better to try and set the machine as a straight CPAP and work from there? Get the machine dumbed down as far as possible so that all the breathing rate support stuff isn't causing more problems than it's solving. Once stabilised in that regime, we could see whether there is any need to invoke the more advanced features of the machine.

If it's like my S9, then it has straight fixed pressure CPAP, Fixed Pressure S mode bilevel, and bilevel auto. One could set it to auto; and set PS very close to zero; then one would have essentially an Autoset machine.

Those would be the choices; and the most dumbed down would be straight CPAP.

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.
03-14-2015 11:20 PM
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PaytonA Offline
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Post: #35
RE: Help needed with new VPAP and new to forum
(03-14-2015 06:56 PM)jpatfarrell Wrote:  Hi PaytonA,
Thanks for the info. I do have ResScan on my computer and just uploaded the data.

It shows 76% for % Spontaneous Cycled Breaths.

Is it the percent of breaths that are spontaneously terminated by the patient (termination of IPAP and changing to EPAP)?

If correct this tells me that 24% of my breaths were terminated by the VPAP....correct?

What affect does this have? I am guessing it is not good to be that low.

If this is not good, what do I change. TiMax, TiMin, Trigger and/or Cycle. Or something else?

I have increased the TiMax to 3.0.

Do you still recommend changing the TiMin to 0.7 and also changing the Cycle to HIGH or VERY HIGH?

Should I leave the Trigger at Medium?

Your help is greatly appreciated.

Pat

For right now I would go ahead with the Ti Max at 3.0. It might help and will not hurt anything. I also think that for right now I would leave TiMin at 0.3. I would not change Trigger or Cycle right now. Let's ride with it for a while.

Sleeprider might be right. Simplification might be the best thing to try next. Keep us apprised on how this is going.

Best Regards,

PaytonA
03-14-2015 11:21 PM
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justMongo Offline

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Machine: ResMed VPAP Auto (S9)
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CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
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Post: #36
RE: Help needed with new VPAP and new to forum
Re-reading jpatfarrell's 1st and 2nd post, jpatfarrell seems to have a good handle on how the VPAP works.
Whereas most people would have gotten the A10 version of the Autoset, jpatfarrell choose the VPAP Auto.

So, why not use the VPAP auto like an Autoset to titrate the needed pressure.
Setting PS=1 would be like setting EPR to 1. Default all timing a sensitivity parameters as it doesn't matter when it switches from IPAP to EPAP when PS is set low. Set IPAP max to 20; and EPAP min to 6 -- and let it run. You have essentially an Autoset with EPR = 1.
Then after watching the data, jpatfarrell can narrow the pressure window as most people do with an auto machine.

And, jpatfarrell, keep the intake filter clear -- I hear the mosquitoes in Panama can clog a jet engine intake.

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.
03-15-2015 09:33 AM
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jpatfarrell Offline

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Post: #37
RE: Help needed with new VPAP and new to forum
Thanks JustMongo, Maybe this is the way to get it right.

What is a normal/typical Tidal Volume for a healthy adult male that weights about 200 lbs while sleeping?

Still researching.

thanks,

Pat
03-15-2015 12:25 PM
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jpatfarrell Offline

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Machine: ResMed AirCurve 10 VPAP Auto with HumidAir Humidifier
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Post: #38
RE: Help needed with new VPAP and new to forum
(03-15-2015 12:25 PM)jpatfarrell Wrote:  What is a normal/typical Tidal Volume for a healthy adult male that weights about 200 lbs while sleeping?

Google says normal tidal volume is 500ml for a healthy adult male. Don't know if this is awake or sleeping or if it makes a difference.

Mine is 540ml med, 980ml 95% and 1600ml Max. I do know that i have always had a very large lung volume and can take really deep breaths.

Just curious and still researching.

thanks,

Pat
03-15-2015 01:54 PM
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justMongo Offline

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Machine: ResMed VPAP Auto (S9)
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Post: #39
RE: Help needed with new VPAP and new to forum
Sleeping, about 500ml is the norm. I run right near 500 ml.
There is a parameter, minute volume -- it's simply TV x BPM.
So, at TV=500ml (0.5 liter), and say 15 BPM, the minute volume is 0.5 x 15 = 7.5 liters

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.
03-15-2015 02:30 PM
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Sleeprider Online
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Post: #40
RE: Help needed with new VPAP and new to forum
I think you're well within the normal range. Mine is typically in the low 600s and I know I'm in the upper percentiles when testing for vital capacity.

When I mentioned it in an earlier post, it was mainly because you had pointed out you have a very slow inspiration time. Your respiratory rate bears this out, but it's not because you have a particularly unusual tidal volume.

Your slow inspiration rate is messing with the AirCurve brain, and causing it to cut off your respiration. What we've been knocking around here is dumbing down your machine and making it a CPAP. Set your pressure, or a high and low range for pressure, remove the pressure support (difference between IPAP/EPAP) and even any EPR.

I'm not sure what settings you have available, but to mimic an APAP you should set your minimum pressure to 8.0 and maximum pressure to 13.0 turn off pressure support and EPR. For CPAP mode set constant pressure to 11.0. This is based on the graphs you posted earlier that shows you control OA at pressures above 10. The objective here is to take pressure swings from inhale/exhale off the table as they appear to cause you to have abundant CA events.

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03-15-2015 02:38 PM
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