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+--- Thread: New Here - Could use some help (/Thread-New-Here-Could-use-some-help)
RE: New Here - Could use some help - SarcasticDave94 - 02-15-2021
As you're already aware, mask and mouth leaks are your enemy here.
I'd say it's time to consider a different mask either brand make/model or different type. I forgot which you're using but your left panel info says nasal Dreamwear. Mouth leaks are addressed either by maintaining tongue seal, or by chin strap, tape, maybe even a collar. Or by going full face mask type. If you go full face, I can say my Fisher & Paykel Vitera is excellent. I've had a Respironics Amara View and ResMed F20. Neither were leak free and I moved on to F&P.
It may be perceived to be ResMed PAP is the issue but it's likely due to ResMed goes after events by pressure change and your Respironics didn't so much. Which means your mask and mouth seals aren't passing the test of higher pressures. And to me that says the seal needs work.
RE: New Here - Could use some help - Sleeprider - 02-15-2021
You might be a candidate for a full face mask. This has been a problem with both machines, and it's not apparently going away. Your pressure is lower with the Vauto and these leaks are going no where.
RE: New Here - Could use some help - tsitalon1 - 02-15-2021
Thanks guys, I will try surgical tape tonight as a test to see what happens.
As far as full fask masks, do they work well with a medium sized beard?
Also I would prefer a mask that allows the hose to connect like the Dreamware masks (on top of head) to prevent getting tangled up.
RE: New Here - Could use some help - SarcasticDave94 - 02-15-2021
Some will work better than others. Unfortunate like almost everything Apnea you'd have to try it to see the results. Again I'd try Fisher & Paykel. I'm very pleased with that brand. I've got both Simplus and Vitera, with Vitera being my go-to. It works with physical sleep posture changes. I side sleep but do change to back sleeping occasional. The Vitera handles it without breaking seal.
RE: New Here - Could use some help - Sleeprider - 02-15-2021
If you can get Gideon to drop in on this thread, he has one of the most impressive beards imaginable, and he used to use a full-face mask. He has gone to the Airfit P10.
RE: New Here - Could use some help - tsitalon1 - 02-16-2021
I ended up aborting my XPAP last night, it was my first night with my mouth taped.
It felt like my body would hold it's breath and then I would wake up hearing the pressure leak, this happened multiple times. I never felt this feeling before, so after multiple times, I ripped the tape off and shut off the machine.
Also, any idea why the vAuto went to full pressure almost immediately even without having any "events" to cause the pressure jump?
I'm going back to my Philips tonight, because even though the vAuto has once produced better AHI numbers, the Phillips seems to have provided me with better rest much more consistently. I know that the vAuto has to be the better machine, but I'm having a really hard time getting it dialed in I guess. I know the inconsistent leaks, don't help, but again the Philips "felt" better. I will not give up on the vAuto just yet though.
I have a full-face dreamware mask that should be here tomorrow, interested to see how that goes.
RE: New Here - Could use some help - tsitalon1 - 02-16-2021
SleepRider, I have a question regarding Ti Min/Max, if I'm reading this chart correctly, since my median Resp Rate is about 14, my Ti min/max should be 1.0/1.3.
Can you help me understand why we went with 0.3/2.0?
Also how does this effect actual feel to the patient?
RE: New Here - Could use some help - SarcasticDave94 - 02-16-2021
Here's info from the ResMed ST-A clinical manual on Ti controls. It should apply to VAuto but the ST-A is a different class, so VAuto isn't mentioned.
TiControl - Inspiratory time control S, ST and iVAPS modes only Unique to ResMed bilevel devices, TiControl limits on the time the device spends in IPAP. The minimum and maximum time limits are set at either side of the patient's ideal spontaneous inspiratory time, providing a 'window of opportunity' for the patient to spontaneously cycle to EPAP. The minimum time limit is set via the Ti Min parameter and the maximum time limit is set via the TiMax parameter.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. The following table is a guide to selecting the Ti Max and Ti Min values that best correspond to the patient's respiratory rate and inspiration and expiration ratio, depending on the respiratory conditions.
Just after that is the I:E chart you showed. That chart is a guide, not an "it must be this" but a reference. Literally just to guide for you to get numbers in, that you then have to edit for your personal requirements.
RE: New Here - Could use some help - Sleeprider - 02-16-2021
0.3 to 2.0 are default settings and seem to match your respiration pretty well. Increasing Ti Min is done mostly when an individual fails to maintain inspiration after it has started, and a shorter Ti Max is often set when a person has COPD or needs more time reserved for expiration, so the short time cycles the patient to expiration sooner. You seem to have no problems with spontaneous respiration with appropriate timing, so the default settings mostly just stay out of the way of that.
RE: New Here - Could use some help - tsitalon1 - 02-16-2021
Thank you, that's what I'm trying to do, it seems we started fairly far away from "recommended" or "reference" numbers.
Don't misunderstand, not complaining, just trying to understand why we did that. I really want to keep this ResMed machine, so I'm trying my hardest to like it.
Maybe Sleeprider has found in his years of experience that the recommended starting points are crap and his settings are better, IDK, just trying to comprehend, that is all.