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cpap and apap not effictive
Nice to see this worked out for you with a bilevel.  Those are good results.  Hypopnea is usually addressed through an increase in pressure support.  So that might be something to try, a little at a time.  I have not played with trigger levels on my machine, but did make changes to Ti settings.  Hopefully that information can help someone else.   The biggest thing that has changed overall i that you now have a normal inspiration / expiration ratio where your exhale is longer than inhale.  Have you noticed?

I see this pattern in people that have short exp time relative to insp, that they produce a lot of AHI, and it seems not to respond logically to pressure.  So to compare, your curent insp / exp time is 1.44/2.46.  In your first graph on page 1 of this thread, it is 3.5/1.6.  Pretty big difference!

[Image: attachment.php?aid=2901]

and ended here
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Ed, in thinking about this, I think you may have stumbled on something really important. Even on the previous page where you had your new Aircurve, you were getting miserable results and still had the inverse I:E ratio discussed above. https://onedrive.live.com/?authkey=%21AC...83&o=OneUp

Could you summarize the trigger and Ti settings you changed. I have wondered for a long time how to help people with this issue, and you are one of the first I know of to document a change like this.
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I agree that we need to take a good look at those ratios and the trigger and TI settings.  Very interesting findings.  Thanks Ed.

Rich
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Ed set his trigger and cycle sensitivities to very high. I am not sure what he set Ti min and max to. I could guess but I will wait for Ed to tell us. It would also be interesting to hear his logic for adjusting them to where he has them. Great job, Ed,

Best Regards,

PaytonA
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I hadn't noticed the difference in ratio, but yes that is a big change!

For settings I have:

TImin 1.3
TImax 3.2
Trigger very high
Cycle very high

I tried a little bit with different trigger values, even just testing awake to feel the differences and it was pretty clear that for me having both on high sensitivity was best.

For the TImin my theory was that since the triggers needed to be high part of the issue may have been my shallow/weaker transitions so that with the other machines they were not sensing my changes and just pushing air (hence the aerophasia).

I tracked my TI values in my sleep report and it seemed to be best to set TImin to just slightly below my average.

My numbers last night were:

Vt 480
RR1.5
MV 7.3
Ti 1.4
I:E 1:1.7
Spont Cyc 64%

I'm still not clear on what spont Cyc is looking at?  but before I made the changes to TImin/max and sensitivity my values had been upwards of 97-98%

For I:E I've been pretty consistent now.

I feel like the big part of my centrals and especially the aerophasia was more to do with timing than pressure.  Running at 9cm before was really filling me up a LOT and now it is much, much less (but still present).

I'm going to leave my settings as is for a few weeks but eventually I may try some more tests with TImin/max to see if I can find an even better value re: aerophasia.

I would once again like to thank all of you for your help and encouragement.  I was ready to give up and now I feel like I'm actually getting some real benefits from treatment!
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Spont cyc. I have not seen that in Sleepyhead but in ResScan Spontaneously Cycled Breaths indicates the percentage of breaths that the patient initiated him or her self. That is versus breaths that the machine helps to initiate.

Best Regards,

PaytonA
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