S9 VPAP ST-A OSCAR Data Question

[SarcasticDave94]

Ah yes, do the adjustment, but tell us how and if it's helping after you use it. With OSCAR of course.

I'm not trying to be negative about using your only choices. It just makes it a bit more difficult for you.

Again don't edit the timing stuff.

[gadgetmaniah]

Ok, thanks. I'll report back tomorrow.

[gadgetmaniah]

Ok so increasing the IPAP and EPAP seems to have done the trick. I only had a couple of UAs today. My sleep was interesting though - some good things and some bad.

The bad: I woke up a few times which disrupted my sleep. I wonder why, but it might be because of air leaking into my eyes. I also had very strange dreams. 

The good: I feel the sleep was better today, even though I only managed to sleep about 5 hours. 

OSCAR Data: One thing I noticed in my data is that there were a lot less UF 2s (User Flag 2s). Typically I have many of those. So I guess this indicates something good. I have defined UF 2 in the settings as 50% flow limitation accompanied by a 5 second stop in breathing. 

Flow rate shape: I noticed that my flow rate inhalation curves look more pointy. Could that be because of the short rise time of 150 ms? Note that for my previous sleep - the data of which I posted in my first post in this thread - the rise time was actually 500 ms. However, I set it to the default 150 ms before last night's sleep. I did read online that shorter rise times are better if you're looking to reduce flow limitations. The only issue is that it feels a bit uncomfortable because, at 150 ms, it's like a sudden rush of air when you inhale. Perhaps I could increase it a bit to something like 250 ms.

   

Also, there were a few places in the flow rate graph where I could see evidence of flow limitation and arousals. For example:

   

By the way, is there no way to see the flow limitation data for this machine? The clinician menu does state that the machine offer FL data. Maybe I would need to install ResScan?

Here's the overview for the sleep:

   

[gadgetmaniah]

Ok so increasing the IPAP and EPAP seems to have done the trick. I only had a couple of UAs today. My sleep was interesting though - some good things and some bad.

The bad: I woke up a few times which disrupted my sleep. I wonder why, but it might be because of air leaking into my eyes. I also had very strange dreams. 

The good: I feel the sleep was better today, even though I only managed to sleep about 5 hours. 

OSCAR Data: One thing I noticed in my data is that there were a lot less UF 2s (User Flag 2s). Typically I have many of those. So I guess this indicates something good. I have defined UF 2 in the settings as 50% flow limitation accompanied by a 5 second stop in breathing. 

Flow rate shape: I noticed that my flow rate inhalation curves look more pointy. Could that be because of the short rise time of 150 ms? Note that for my previous sleep - the data of which I posted in my first post in this thread - the rise time was actually 500 ms. However, I set it to the default 150 ms before last night's sleep. I did read online that shorter rise times are better if you're looking to reduce flow limitations. The only issue is that it feels a bit uncomfortable because, at 150 ms, it's like a sudden rush of air when you inhale. Perhaps I could increase it a bit to something like 250 ms.



Also, there were a few places in the flow rate graph where I could see evidence of flow limitation and arousals. For example:



By the way, is there no way to see the flow limitation data for this machine? The clinician menu does state that the machine offer FL data. Maybe I would need to install ResScan?

Here's the overview for the sleep:

A few more pictures

[Sleeprider]

Could you please post the mask pressure graph with the flow rate. It looks like IPAP pressure is being delivered abruptly and for a short time. I think we can use the timing controls to improve on that.

[gadgetmaniah]

Here you go. Let me know if you need a different type of screenshot. Thanks!

[gadgetmaniah]

So should I try increasing my Ti Min and Rise Time settings? I was trying different settings right now and looked at my flow rate curves on OSCAR and it seems like I have more normally shaped flow rate curves if I have the Rise Time at 500 ms and Ti Min at 0.8 s. Would these settings be alright to keep keeping in mind flow limitations (because I read that to tackle FL short rise times are recommended)?

[gadgetmaniah]

Ok so I tried the settings last night and my sleep was just ok, not that great. Still woke up feeling sleep deprived. However, it is a bit better than on the Resmed Airsense 10 Autoset on which I had been waking up very fatigued. 

I set the Rise Time to 450 ms and Trigger to Very High and Cycle to Very Low. I also changed the Ti Min to 0.6. I did manage to sleep for a longer duration this time, maybe because these settings made breathing more comfortable. However, zooming into the flow rate, I do see more flow limitation than with my previous settings. I also think my sleep was a bit better when I had the Rise Time to 150 ms. So, I think I'm going to revert the Rise Time setting to 150 ms and set the Trigger to High, and change the Cycle to Medium.

I'm unsure of what to set my Ti Min to but reading through some other threads I think maybe setting it to 1 would be a good option. There's almost a 1:2 ratio in inhale:exhale even though on the Autoset my inhale and exhale times used to be almost equal. My inhale time on average would be more than 2 seconds but on this machine it's around 1.4 seconds and my exhale is much longer. Not sure if that is relevant though. My tidal volume is also significantly lower at 240 whereas on the Autoset it would always be above 300.

[TassieDevil Tamar]

Hi,  
I have just started using the Lumis 150 VPAP ST and had some awful nights before I educated myself and I now don't feel like it's overinflating my lungs.

I am using the Lumis due to a neuromuscular condition I have causing Respiratory muscle weakness, greatly decreased MIP and MEP and SNIPS on Resp Function testing. The weakness can fluctuate a bit as it's caused by a Mitochondrial problem [Mutation in MFN2 --> causing CMT2a..]
(and I had Sleep apnoeas of 30 when supine, and 15 when sleeping on my side....)

It was set to ST to begin with, 12/6. Awful. The breaths were too sudden, tiring and not conducive to falling asleep. After 3 hours I was still awake.. Changed to Ivaps but took a while to get sorted...  

Now using iVaps, but had to tweak a few settings after reading online and watching videos about Non invasive ventilators.
To begin with the Rise Time was too small, and the volumes set were too high for me... 
In particular was the knowledge that 6-8mls/kg of your Ideal Body Weight was a good idea of the range for my Tidal Volume (and Minute Volumes).. I altered the settings to bring that into line with these measurements. as they are greyed out on Ivaps with Epap auto....

Now I am getting almost 0 apnoeas, and much decreased Hypopneas.

I have to leave and go out very shortly, but I will copy the settings I am now using if it helps you out.....

the settings I now have on my iVAPS are as follows...

iVAPS
Height 175cm
Target Pt Rate 11
Target Va 4.1L/min
  (greyed out. MV. 5.4L/min
                     Vt.  492ml
                     Vt/kg  7.1ml/kg IBW)
Auto EPAP.  on
Min EPAP. 4
Max EPAP 15.0
Min PS. 4.0
Max. PS. 11.0
Ti Max 3.5 sec
Ti Min 0.6 sec
Rise Time 600ms.  (MUCH more comfortable)
Trigger. Med
Cycle    Med
Mask.  Full Face. (F30i Airfit, really comfy sits under my nose with a pillowedge, covers mouth as I can mouthbreathe)
Comfort. Ramp Time 25 mins
Tube Temp 27'C
Climate Control Auto

Anyway, good luck, I hope this helps you out....

[gadgetmaniah]

Thanks for this; I appreciate it! However, I'm not using my machine on iVAPS mode actually. I'm using it on regular 'S' mode. Still, your advice about comfort settings is useful. I did try increasing my minimum rise time to 500 ms and it felt much more comfortable, but right now it seems that I have lower flow limitation if I have my rise time is low. So, I'm still experimenting with the settings to see what suits me best. 

Last night I had an alright sleep - not too bad but not too good. I can see that I had some unclassified apnea which look like obstructives, so I'm thinking that I should try raising the EPAP and IPAP by 1 cm. Other than I can see the typical short arousals in my sleep but I guess there isn't much you can do about them and they're probably not a concern as long as they're not respiratory related arousals. The good thing is that, other than the UAs and mini arousals, my flow rate seems good and I don't see the irregularities in the inhale portion like I would on the Resmed Autoset. So it seems like the pressure support is helping. I subjectively feel better too and I hope the improvement continues.

Some images below of last night's sleep. I guess for tonight I'll keep EPAP at 7 and IPAP at 12. I've set the rise time to 250 ms for now and Ti Min is at 0.6. Trigger is high and Cycle is medium. One problem though I anticipate with a higher IPAP is air leaking into my eyes, and I have been having a lot of problem with dry eyes and pain due to this recently.