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RE: In anticipation of my BIPAP Re: New Thread
RE: Plmnb - the journey continues now with ST-A.
I don't remember seeing these flow limitation periods every night on Vauto. Please look at your data and try to confirm or deny if these moments of bad flow limited breathing are happening more or less often now that you are using ST-A.
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RE: Plmnb - the journey continues now with ST-A.
I'll be happy to look Geer1, but how do I do that when the ST-A does not report FLOW LIMIT graphs?  Do I just look for the worst FLOW RATE waves?

Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: Plmnb - the journey continues now with ST-A.
At 2:00 your charts showed significant pressure support changes as the machine applied pressure to ensure target ventilation rates are met. This was a time of relatively low respiration rate, variable but low inspiratory time. The respiration rate graph has several flat plateaus that show the ventilator is pacing the respiration rate. In your zoomed chart, we see irregular respiration until 02:00:10 where the machine begins to pace your respiratory rate and increase pressure support. You can see the minute vent response to the pacing and pressure support.

At 03:00 the overall chart suggested very little machine intervention in term of pressure support, and your respiration rate, timing and flow all looked normal. Your zoomed image confirms this was a very good period of respiration with inspiration time not approaching the TiMax limit.

At 06:00 your overall chart showed inspiration time bouncing off the TiMax limit, flow rate looks a little ragged but pressure support is quiet. Your zoomed chart confirms a lower respiration rate with longer inspiration times. At 05:49L45 we see where the machine cycles but you give inspiration a bit of extra effort causing a peak in flow. This is likey a moment where you thought the machine was cutting you off too soon. /While we can extend your time of inspiration, you have shown that even with a TiMax of 2.5 you will try to suck in air (hyperinflation) until the machine finally cycles.

Look at your clincal manual to see recommedations on setting TiMin and TiMax.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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RE: Plmnb - the journey continues now with ST-A.
Thanks Sleeprider.  Will do!

I'll let you know if I have any questions about trying to understand the manual.  Probably later tonight.  I'm doing my taxes now, oh joy!  Then off to work.  I think I have had 6 cups of coffee...yikes.

Have a great day.

Plmnb
Phoebe
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: Plmnb - the journey continues now with ST-A.
(02-22-2020, 08:32 AM)Plmnb Wrote: I start to take a breath in, continue to breathe in, but then the machine appears to want me to breathe out sooner than I am ready to do.  Usually it almost feels like a double bump of out.  Does that make any sense to anyone?

Hi Plmnb,

On bilevel machines the start of exhale is called “cycle” and lowering the “cycle sensitivity” (for example changing the cycle sensitivity setting from Medium to Low) will delay how early the machine ends IPAP and cycles back to EPAP. Sounds to me like you might want to try that. 

Also, you might find it more comfortable to increase the Risetime setting. Personally, I like Risetime set somewhere between 600 and 750 milliseconds because to me it feels smoother, more like the ResMed EasyBreathe waveform.
The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies.  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.
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RE: Plmnb - the journey continues now with ST-A.
Oh wow!  Thanks vsheline.

I just was checking the board for new messages and found yours as I was about to leave work.  Thank you so much for taking the time to post your comments.  I will try to adjust my machine accordingly so that maybe, just maybe I'll be able to have a smoother transition into sleep and not wake up with my not realizing I threw it on the floor.

Best Wishes,
Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: Plmnb - the journey continues now with ST-A.
(02-22-2020, 11:13 AM)Plmnb Wrote: Here are zooms sleeprider of the three time periods you mention.


Hi Plmnb,

At 2:00:45 the IPAP has just about max’ed out at 30 cmH2O, and at 2:01:45 the Flow is ratty/squiggly as if pushing air gurglingly past an obstruction. Likewise at 6:00:14 there is complete obstruction preventing IPAP from producing Flow. 

I agree with the earlier suggestion to try raising EPAP from 12 to perhaps 13 or 14. 

Take care,
— Vaughn
The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies.  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.
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RE: Plmnb - the journey continues now with ST-A.
Hi Vsheline.

So do I adjust only the one setting and not the others? Or should I just keep the settings to how they appear now after all of tonight's tweaks:

Target Pt Rate............14
Target Vt....................5.1L/Min
EPAP..........................13 (Was 12)
Min PS........................5.0
Max PS.......................17
Ti Max........................2.0s
Ti Min.........................1.0s
Rise Time....................600 (Was 300)
Trigger........................Med
Cycle..........................Low (Was Med)

I'm very curious what this set of settings will yield, as this set has not been tried in this combination yet.  Especially the Rise Time, which was on 300 and now we have doubled it.

Eager to hear.  Dancing

Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: Plmnb - the journey continues now with ST-A.
(02-22-2020, 11:18 PM)Plmnb Wrote: Hi Vsheline.

So do I adjust only the one setting and not the others? Or should I just keep the settings to how they appear now after all of tonight's tweaks

Often it’s best to make only one change at a time and leave things alone for week or longer between changes, but I suggest all these small changes may be done together if you would like. 

Especially, I think adjusting the Risetime and Cycle primarily for comfort can be done at any time, although in principle much later a person may find some reason to compromise on comfort based on very gradual variations to optimize overall results.
The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies.  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.
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RE: Plmnb - the journey continues now with ST-A.
Glad to see vsheline in the thread. He has been with the forum a long time, and I've always respected his input. The fact he is an experienced user of ST-A is something I can't offer. My tendency is not to post when I'm in agreement, but I thought you should know his suggestions are solid in my opinion.
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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