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

[Sleeprider]

I use an auto bilevel mode with PS between 1 and 4.

Deepbreathing covered ramp, and I completely agree. Ramp move the pressure from a minimum pressure to your therapy pressure over a period of time. The default is from minimum pressure of 4 over 45 minutes. If you use ramp, I'd suggest a minimum pressure of 6 over 5 minutes. Let's just say it's based on 10 years of experience. Ramp is a comfort feature, and by starting at artificailly low pressures, you may not get as good of a mask fit, and you may find yourself short on air. During Ramp you don't get therapy pressure, so I strongly recommend just turn it off and get used to the pressure.

[PaytonA]

PaytonA,

Interesting that constant pressures for EPAP and IPAP works better for you than the machine automatically adjusting to the best pressure based on the algorithms. Why is this the case? Is the pressure varying uncomfortable or noticeable?

What info do you rely on from using it in Auto mode that helps to tell you what pressure settings would be appropriate in S mode?

thanks,

Pat

For me it has been quite simple. My original titration in a sleep lab was for IPAP=20, EPAP=16. That is where I still am set. The last time that I went to auto I used the settings EPAP min=16, IPAP max-22 with PS=3. I stayed on that for about 3 days and raised my EPAP min. to 17 for about 4 days. My AHI had increased by about 1-1.5 AHI and did not improve with the rise in EPAP. Went back to original settings in S mode and My AHI dropped back to where it was. I did not get any more centrals in auto mode. The AHI increase was all obstructive apneas.

To answer some of your other questions, no the pressure changes did not bother me. Nothing about the auto mode bothered me. It was simply that my AHI is better controlled in S mode. Judging from my data while in auto mode, it appears as if some of my obstructive apneas occur with no precursors that would clue the machine to raise the pressure prior to an apnea which is the idea behind the newer auto algorithm.

Starting from scratch with no titration, I would set the min EPAP to 6 and leave the max IPAP at 20 and set my PS at 3 or 4. I would run like that for 4 or 5 days unless you run into some major problem. I would then review my data and reset my min EPAP to my lowest median value and set my max IPAP to my highest 95% value Then run like that and watch for more gradual changes changing one thing at a time.

I would only change your PS if it is bothering you.

Well those are my thoughts anyway. Let us know how you are doing as you go along.

Best Regards,

Payton

[jpatfarrell]

thanks for all the great info. Once I have my AirCurve I will use the recommendations and see how it goes. Should arrive next week.

Once I get some data I will post the results and see if you or anyone can advise me as to how to adjust the settings to improve my sleep.

thanks,

Pat

[jpatfarrell]

Just received the AirCurve 10 and P10 nasal cushion and used it for the last two nights.

I feel like I am getting better sleep but what I don't understand at the early stage is why SleepyHead is showing so many Clear Airway events (~47) with only 1.4 OA and 1.5 H. My sleep study did not show any CA's and had AHI about 15 or so.

I have only used a dental appliance before never a CPAP.

Would being new to CPAP/VPAP cause high or false CA's?

I also had a lot of leakage and mouth breathing (especially the first night, second night I used a chin strap), can this cause Clear Airway Events?

I am trying to understand all the data and charts on SH so I can make sense of the info and make changes to IPA EPA and PS if needed.

Any suggestions on how to stop mouth breathing without using a chin strap?

Would higher or lower IPAP/EPAP help with Clear Airway events?

Any input is appreciated.

thanks,

Pat

[jpatfarrell]

I received the AirCurve 10 and P10 Nasal Cushion this week and have used it for two days.

What I don't understand at the early stage is why SleepyHead is showing so many Clear Airway events. Friday was (~38/hr) with only ~1.4 OA and 1.7 H. Thursday night about the same.

My sleep study did not show any significant CA's and had OA and H combined of about 15 or so if I remember correctly.

Early this morning I woke up at about 5:30a and laid awake, still using the VPAP, watching the clock and monitoring my breathing for at least an hour before I fell back asleep.

The data show many Clear Away events during the time I was awake and I was definitely breathing normally.

I think I tend to have long, very deep and slow breaths. The periods without many Clear Airway events seems to correlate with times I had lower Inspiratory Time.

I can't seem to post the screenshot data image from SH. Keeps telling me that I cannot post a link or image.

Is there any settings on the AirCurve 10 that are causing false readings for the Clear Airway events that needs adjustments:

....such as "Trigger and/or Cycling". I don't understand what changes to these value will cause but they have something to do with breathing cycle.

"The device has adjustable trigger/cycle sensitivity to optimize the sensing level according to patient conditions. Under normal conditions, the device triggers (initiates IPAP) and cycles (terminates IPAP and changes to EPAP) as it senses the change in patient flow. Patient breath detection is enhanced by ResMed's VSync automatic leak management."

.....or TiControl

"TiControl’s Ti Max and Ti Min parameters play a significant role in maximizing synchronization by effectively intervening to limit or prolong the inspiratory time when required. This ensures synchronization even in the presence of significant mouth and/or mask leak."

I have only used a dental appliance in the past and it seems to be effective for the most part. I just can't get a the molds taken or a replacement here in Panama.

Would being new to CPAP/VPAP cause false Clear Airway events? I also had a some leakage and mouth breathing, can this cause Clear Airway Events?

I am trying to understand all the data and charts on SH so I can make sense of the info and make changes to settings if needed.

Appreciate any help/suggestions/recommendation in any/all settings.
Currently set to: 6min, 25max, PS=4, ramp off. Rest set to default.

thanks,

Pat

[Sleeprider]

Permissions are a bit restrictive for new users to prevent spam. You should be able to post links and attachments shortly, just post. This tutorial will work to enable you to post screenshots hosted off-site, and it allows for larger better images http://www.apneaboard.com/wiki/index.php...pnea_Board

CA is a common occurrence, and the ones occurring while you're awake are nothing to be concerned about. Sleep/wake junk is what a lot of us call it. It's going to take a few days for things to settle down before you get meaningful data. If you see a lot of CA events in clusters while you sleep, we might get more concerned. Right now the priority is to address OA and H events. It may require higher EPAP pressure. It will be easier to interpret once you're able to post some data.

[jpatfarrell]

Hey Sleeprider,

thanks for the reply.

---

Hopefully I will be able to upload data with a few more post

thanks

Pat

[jpatfarrell]

I think I can post my SH screenshot with the next post. If so, please let me know what you think especially.

[jpatfarrell]

Here is the Screenshot from SH. Note the large amount of Clear Airway Events scattered throughout the night. Note especially that they still occurred between 5:30a and 6:30a while I was awake, watching the clock and monitoring my breathing. Also notice that when there were no or very few CA's is when my INSP rate was shorter.

Please look at my questions in the post above asking about settings to change to eliminate false readings if these are due to my long breaths.

Also any other comments about pressures, etc are appreciated.

[img][/img]

thanks,

Pat

[Sleeprider]

Is your normal respiration rate really less than 10 per minute? Combined with your tidal volume, which isn't that large, you really aren't ventilating very well. Before we draw any conclusions, could you zoom in on one of the event clusters so we can see the respiratory wave form? The graphs that are most useful are:
1 events
2 flow rate (wave form)
3 pressure
4 leaks.

You can drag the charts to that order before zooming in and taking the screen shot.