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% SPONT C and %SPONT T - question?
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vsheline Offline

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Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #11
RE: % SPONT C and %SPONT T - question?
Hi Peter_C,

In the Important Threads section of the listing of forum threads, in the thread on how to adjust your pressure, I think there would be links to instructions on how to download the User Guide and the Clinician Guide for your machine.

The Clinician Guide gives a table showing recommended settings for TiMin and TiMax depending on the measured ratio between inhalation time versus exhalation time.

The User Guide for your machine shows your machine uses the proprietary smart card which was used on ResMed S8 series machines (not modern SD card used on S9 series), so the special proprietary card reader would be needed to read the data. The smart card data would record at least summary data. Might include waveform data for plots of what the Pressure and Leak and events were throughout the night. My old S8 AutoSet II would record summary data plus waveform data of the Pressure and Leak and events, but not sure whether the S8 Auto 25 would do the same. I think the summary data would include nightly statistics of median, 95 percentile and max values for several things, like for Pressure, Leak, % Spontaneous Tigger, % Spontaneous Cycle and the measured ratio between inhalation time versus exhalation time used for setting the TiMin and TiMax.

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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 10-20-2013 01:57 PM by vsheline.)
10-20-2013 11:17 AM
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Peter_C Offline

Advisory Members

Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #12
RE: % SPONT C and %SPONT T - question?
I called Resmed and was told that unless my 'DME' happened to have one in stock, that there was no way to get the 'smart card' any longer, or unless I could find one used.

I guess I am wondering/worried about the spont t and spont c always reading zero? Should I care if my AI and AHI are much better than without PAP care? Am I worried about something I really shouldn't care about?

I've played with my Ti MAX setting, and found that I am more comfortable at 4.0 than at a lower number (seems like I take long breaths). It's only been one night, but changing the TRIGGER and CYCLE from MED to LOW seemed to make everything 'smoother' (for lack of a better word) - we'll see what another few nights does.

Overall I am very pleased with my therapy, and am not fighting my mask at all. I do wonder about the LEAK rate? Is this an acceptable number? I have no leaks that I can find, other than the exhaust port of course.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-20-2013 11:40 AM
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vsheline Offline

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #13
RE: % SPONT C and %SPONT T - question?
(10-20-2013 11:17 AM)Peter_C Wrote:  Prior to last night, the 'trigger' and cycle' were on their default settings of 'MED'. I then changed them before going to sleep last night to 'LOW" (both of them).

Settings:
MODE: VAUTO
Max IPAP: 25
Min EPAP: 7
Press SUP: 6
Ti Max: 4.0s
Ti Min: 0.3s
EXHALATION: MED
SMARTSTART: ON
Mask: STANDARD
Leak Alert: OFF
TRIGGER: Low
CYCLE: Low
Tube Length: 3m
MaxSettle: off

Data from last night (10/19/2013)
USEAGE: 9:48hrs

Item | DAY | WEEK |
LEAK: 0.46L/s 0.48L/s
VT: 420-860 360-780
Resp Rate: 10-15 10-15
MV: 5.2-10.3 5.0-9.6
PRESS: 13.4 13.2
AHI: 19.6 11.2
AI: 4.4 2.3
%SPONT T: 0% 0%
%SPONT C: 0% 0%

I noticed no real change, other than having one of those nights where you don't even notice the air flow in your mask.

Hi Peter_C,

Your setting for Ti Max (4 seconds) is allowing maximum time for the machine to wait for you to end inhalation on your own, which should maximize % Spontaneous Cycle. Yet your machine reports % Spont C is zero.

The new setting for Cycle sensitivity (Low) would have made the machine less sensitive in detecting the end of inhalation, and would be expected to delay the start of EPAP and lower the % Spontaneous Cycle. But because your machine reported % Spont C was zero before the change, the change could not make it drop any lower.

The new setting for Trigger sensitivity (Low) would have made the machine less sensitive in detecting the start of inhalation, and would be expected to delay the start of IPAP and lower the % Spontaneous Trigger. But because your machine reported % Spont T was zero before the change, the change could not make it drop any lower.

But you also wrote:
I've played with my Ti MAX setting, and found that I am more comfortable at 4.0 than at a lower number (seems like I take long breaths). It's only been one night, but changing the TRIGGER and CYCLE from MED to LOW seemed to make everything 'smoother' (for lack of a better word)....

If your % Spont T and % Spont C were really, actually and truly zero both before and after the changes in Trigger sensitivity and Cycle sensitivity, then I think it would be impossible for these changes to have made any difference in how treatment behaved or felt.

The sensitivity settings only affect how the machine reacts when you initiate the transitions. If 0% of the transitions from EPAP to IPAP and back to EPAP were initiated "spontaneously" (by you), these sensitivity changes could have made no difference at all. That the changes in these settings make the treatment feel different than before makes me think the reported % Spont T and % Spont C of zero may be bogus, invalid and untrue.

Changing Trigger sensitivity to High or Very High would make the machine more sensitive in detecting the start of inhalation, and would be expected to speed up the start of IPAP and raise the % Spontaneous Trigger. It would also tend to increase Respiration Rate and tidal volume (Vt).

Likewise, changing Cycle sensitivity to High or Very High would make the machine more sensitive in detecting the end of inhalation, and would be expected to speed up the start of EPAP and raise the % Spontaneous Cycle. It would also tend to increase Respiration Rate.

By the way, if we are changing the Trigger and/or Cycle sensitivity to High or Very High (and especially if using a machine which does not distinguish and report Central Apneas versus Obstructive Apneas) we need to go slowly (making changes no more often than weekly) and we need to cautiously keep an eye on AHI, because for a few people (for a minority, I think) setting the Trigger and/or Cycle sensitivity to High or Very High may tend to increase their tendency to have central apneas.

Also, if you happen to be among those who are susceptible to having central apnea, your fairly high setting of 6 for Pressure Support may tend to increase the number of Central Apneas and/or episodes of Periodic Breathing (PB), which is when the depth/volume of breathing gradually increases (producing too much ventilation) followed by a slow decrease in depth of breathing until there is too little ventilation and the cycle repeats. In PB, the cycle of gradually increasing breathing followed by gradually decreasing breathing tends to repeat with a period of a minute or so.

At the extreme, Periodic Breathing turns into Cheyne-Stokes Respiration (CSR), in which central apneas replace the periods of shallow breathing. CSR, if lasting for long periods, can raise the CAI (average number of central apneas per hour) enough to warrant treatment with an ASV machine.

On the other hand, if the problem is very low Respiration Rate, then increasing the Pressure Support may be helpful to increase tidal volume and possibly Respiration Rate. (Just keep an eye on the
AHI in case higher PS or higher Trigger/Cycle sensitivity give rise to more central events.)

Increasing the PS tends to increase ventilation (increase "tidal" volume and Minute Ventilation) and tends to reduce obstructive events and Flow Limitation and can make sleep more restful, unless we are one of the people (a minority) who have a strong tendency toward central apnea.

Regarding Exhalation rate setting: This can be set to SLOW/MED/FAST.
Clinical Guide says to adjust this setting for patient comfort. SLOW causes a smoother but slower transition from IPAP to EPAP. FAST causes a faster but sharper transition from IPAP to EPAP. In those who are susceptible to central apnea, the FAST setting may increase the number of central events.

Take care,
--- Vaughn

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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 10-20-2013 05:04 PM by vsheline.)
10-20-2013 04:58 PM
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Peter_C Offline

Advisory Members

Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #14
RE: % SPONT C and %SPONT T - question?
Lots of great info for me to consider. I guess I am first wondering if I should even try modding any of the settings since I have ZERO knowledge about me and possible CA events. I do not remember my sleep doc ever talking to me about these type of events, only about my very severe OSA.

I guess I am a don't fix it if it ain't broke kind of a guy - but on the other hand, I am always for better sleep! Prior to PAP I used to never dream (as it turns out, because I never entered REM sleep), the last couple of months I've stopped dreaming (or at least that I know of, or can remember) - which is why I am wondering if some setting changes might be a good idea? Of course, with no medical, a new study or seeing my sleep doc is not a good choice at the moment.

So I am sort of asking for opinions on what someone would do if they were in my shoes? Due to the meds I take, sleeping itself is not really an issue, quality of sleep however, can be at times.

In the above post, I infer that raising my PS thereby increasing my VT and/or my RR would be a good thing? Since I do not know if a RR of 10-15 is considered high, low or what (same for VT) I don't know if it makes sense as a goal to raise them. I haven't found any material that gives info on what 'good numbers' are...

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-20-2013 08:55 PM
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vsheline Offline

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #15
RE: % SPONT C and %SPONT T - question?
(10-20-2013 08:55 PM)Peter_C Wrote:  I guess I am first wondering if I should even try modding any of the settings since I have ZERO knowledge about me and possible CA events. I do not remember my sleep doc ever talking to me about these type of events, only about my very severe OSA.

I guess I am a don't fix it if it ain't broke kind of a guy - but on the other hand, I am always for better sleep! Prior to PAP I used to never dream (as it turns out, because I never entered REM sleep), the last couple of months I've stopped dreaming (or at least that I know of, or can remember) - which is why I am wondering if some setting changes might be a good idea? Of course, with no medical, a new study or seeing my sleep doc is not a good choice at the moment.

So I am sort of asking for opinions on what someone would do if they were in my shoes? Due to the meds I take, sleeping itself is not really an issue, quality of sleep however, can be at times.

In the above post, I infer that raising my PS thereby increasing my VT and/or my RR would be a good thing? Since I do not know if a RR of 10-15 is considered high, low or what (same for VT) I don't know if it makes sense as a goal to raise them. I haven't found any material that gives info on what 'good numbers' are...

Knowledge can be paralyzing sometimes, because we become aware that an adjustment might help or hurt. That paralysis can be a good thing, though, because it might inhibit us from unwittingly making things worse. But gradually, cautiously, we learn how to make things better.

A "good" Vt (tidal volume, the air volume exhaled or inhaled per breath) or Vm (minute volume or minute vent, which is the recent Vt times the recent Respiration Rate) depends on the person.

In my case, I often have arousals if my Vt drops much lower than 550 mL/minute, but I suppose others may have no problems with a Vt of 450 or lower. By reviewing weekly my Flow, Vt, RR, SpO2, pulse rate and High Rate Pressure waveforms, I have learned what seems to make most of my arousals occur. It is usually either the Vt drifts too low, or the occasional need to swallow.

I think somewhere between 10 and 12 breaths per minute is considered a normal (but low end) Respiration Rate, appropriate for deep sleep. A median RR around 15 breaths per minute is considered nominal, typical. During REM sleep, I think RR may occasionally be a lot higher.

However, I think the RR number reported by your machine may be the nightly median (50 percentile) respiration rate, rather than the minimum. The minimum may be zero during apneas, of course, but even disregarding periods of apnea the minimum while breathing may be much lower than the median.

Medications often cause Central Apneas, especially pain medications. Maybe sleep aids, too. And some types of sleep aids can prevent REM and/or prevent deep restorative sleep. I suggest researching your medications, by googling the med name and "sleep" or "REM" or "apnea" or "side effects". You may learn a lot of important information, important for you to know.

Take care,
--- Vaughn

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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 10-21-2013 04:04 AM by vsheline.)
10-21-2013 02:53 AM
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Peter_C Offline

Advisory Members

Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #16
RE: % SPONT C and %SPONT T - question?
Sidenote: For grins and giggles, I changed both the 'cycle', and 'trigger' to 'high' last night. No change whatsoever to either spont t or spont c. - None of my other numbers had any real change either. I almost wonder if the spont t and spont c are 'broke' or not in use, or something?

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-21-2013 11:58 AM
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Peter_C Offline

Advisory Members

Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #17
RE: % SPONT C and %SPONT T - question?
UPDATE: Last night I put on a new hose, and mask and my leak data was still 0.46L/s. Spont T and Spont C still report 0%.

I even raised both my EPAP and PS 1 each, and the leak rate did not change, so I am going to call these numbers 'normal'.

The interesting point, is my AHI was only 6.6, and AI was only 0.6 - so I plan to keep these higher pressure settings for a while and watch.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-22-2013 12:09 PM
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Peter_C Offline

Advisory Members

Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #18
RE: % SPONT C and %SPONT T - question?
Bump??

No ideas on both the 'SPONT C, and SPONT T" always being 'ZERO'??

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-26-2013 08:13 PM
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vsheline Offline

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #19
RE: % SPONT C and %SPONT T - question?
(10-26-2013 08:13 PM)Peter_C Wrote:  No ideas on both the 'SPONT C, and SPONT T" always being 'ZERO'??

Hi Peter,

I suggest the following experiment: temporarily set both sensitivities (Trigger and Cycle) to Very High and, when awake, see what that feels like for a few minutes. Stop the machine and check whether the %SPONT numbers are zero. Then change both sensitivity settings temporarily to Very Low and see what that feels like for a few minutes. Stop the machine and check whether the %SPONT numbers are zero.

If you could definitely feel a difference between the two sets of settings, this would mean the machine is reacting differently (quickly versus slowly) to your spontaneous breathing.

If the sensitivity changes are making the machine react differently when it senses the transitions between inhale versus exhale, then it is sensing your spontaneous trasitions, and if the %SPONT numbers were always zero, then the zero values are invalid, disabled, whatever.

By the way, if the vents in your non-ResMed nasal mask are larger than the vents in ResMed nasal masks, the extra air being vented will be misinterpreted as "leak".

Take care.

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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 10-27-2013 04:42 AM by vsheline.)
10-27-2013 04:35 AM
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Peter_C Offline

Advisory Members

Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #20
RE: % SPONT C and %SPONT T - question?
(10-27-2013 04:35 AM)vsheline Wrote:  
(10-26-2013 08:13 PM)Peter_C Wrote:  No ideas on both the 'SPONT C, and SPONT T" always being 'ZERO'??

Hi Peter,

I suggest the following experiment: temporarily set both sensitivities (Trigger and Cycle) to Very High and, when awake, see what that feels like for a few minutes. Stop the machine and check whether the %SPONT numbers are zero. Then change both sensitivity settings temporarily to Very Low and see what that feels like for a few minutes. Stop the machine and check whether the %SPONT numbers are zero.

If you could definitely feel a difference between the two sets of settings, this would mean the machine is reacting differently (quickly versus slowly) to your spontaneous breathing.

If the sensitivity changes are making the machine react differently when it senses the transitions between inhale versus exhale, then it is sensing your spontaneous trasitions, and if the %SPONT numbers were always zero, then the zero values are invalid, disabled, whatever.

By the way, if the vents in your non-ResMed nasal mask are larger than the vents in ResMed nasal masks, the extra air being vented will be misinterpreted as "leak".

Take care.

I did the test, and gave it plenty of time on each setting, with no change at all to either the SPONT C or the SPONT T. So guess I will ignore those two...

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-27-2013 08:01 PM
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