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Question about Trigger setting - Elgeeone - 12-29-2021
Hi, still unable to upload OSCAR for better information but I have questions.
I was following posts about trigger sensitivity, and thought I’d try going up from medium to high and see if there were any changes from my previous AHI’s ranging from 2.5-4.5. 3 nights, AHI was about 2.5 on high, so I tried the highest setting. Still 2.5. Took it down to just below medium and the last 3 nights have all been 1.5-1.8. Not sure if I should go lower to test.
My main issue, including seen on my very recent in lab study shows continual arousals, alpha intrusions and no delta/deep wave periods. This corresponds with my overnight trackers. And the way I felt. Dr. Quack had no suggestions. Period, other than a straight bilevel titration without ASV despite my neuromuscular issues. I’ve been on bilevel 20 years.
I am wondering if by lowering my trigger sensitivity, I have eliminated most of the intrusions and arousals. I am sleeping 6.5 hours now with up to 2.5 hours of “deep” sleep according to my trackers. I was getting zero for months. Most importantly? I feel so much better.
Have I made a change that is as beneficial as I think?
What say you all? (Other than showing OSCAR which I am unable to do)?
RE: Question about Trigger setting - Crimson Nape - 12-29-2021
Please look at the links in my signature under the heading, "Useful Links -or- When All Else Fails", for help in understanding OSCAR and posting images here.
- Red
RE: Question about Trigger setting - Sleeprider - 12-29-2021
Trigger sensitivity affects the transition from EPAP to IPAP. The most common use for higher trigger sensitivity is the presence of minor random central apnea. Higher trigger sensitivity can promote the transition to IPAP and stimulate a breath to occur. Lower sensitivity may be used where the natural respiratory cycle includes a longer period of expiration with flow at or near zero near as the transition to inhale approaches. Lower trigger sensitivity can prevent the trigger to IPAP until expiration completes. A closer examination of your flow rate should show your normal respiratory cycle morphology. This setting is about fine-tuning the machine response to an individual's needs and comfort, so my recommendation is to experiment with it and choose the setting that feels best or most natural to you.
RE: Question about Trigger setting - Elgeeone - 12-29-2021
Thank you very much. Your description fits my breathing cycle perfectly. I take very long exhales. That was my first issue with a very old respironics straight cpap w c-flex that my excellent dr thought might work. (he suspected I would fail it, but, insurance…) It did not work because it triggered a new breath before I finished the previous one. C-flex failed for me.
I was doing better with my S7, S8 and S9 bilevels. I will now try lowering trigger again, as I think you are absolutely correct!
Thanks again for all that this board does.
RE: Question about Trigger setting - Sleeprider - 12-29-2021
Philips C-Flex does not maintain pressure relief throughout expiration and returns to CPAP pressure before exhale is complete. The theory is that end expiratory pressure should be maintained to prevent obstruction. For someone like yourself that is sensitive to a pressure increase before inspiration begins, this would be very disruptive and uncomfortable.
RE: Question about Trigger setting - Elgeeone - 12-29-2021
Thank you Sleeprider. You described my experience perfectly. My doc explained after I failed the cpap, that he was putting me on a Resmed, literally drew out the wave design of “easy breathe” vs Phillips square wave therapy and showed me how much better the therapy would be for me. He just had to play the insurance game first. With little tweaking, he was absolutely correct and my AHI was about 1. If only he hadn’t retired.
RE: Question about Trigger setting - SarcasticDave94 - 12-29-2021
FWIW, here's ResMed's quick description of Trigger and Cycle. I've just copy/pasted that segment, but the webpage link is where it comes from.
https://www.resmed.com/en-us/healthcare-professional/products-and-support/innovation-technology/
Triggering, cycling and TiControl (inspiratory time control)
Under normal conditions, the device triggers (initiates IPAP) and cycles (terminates IPAP and changes to EPAP) as it senses the change in patient flow. Patient breath detection is enhanced by ResMed’s automatic leak management. In addition, the device has adjustable trigger/cycle sensitivity to optimize the sensing level according to patient conditions.
Unique to ResMed bilevel devices, TiControl lets you set minimum (Ti Min) and maximum (Ti Max) limits on the time the device spends in IPAP. These time limits are set at either side of the patient’s ideal spontaneous inspiratory time, providing a window of opportunity for them to spontaneously cycle to EPAP.
RE: Question about Trigger setting - Elgeeone - 12-29-2021
Thank you very much Dave. You all have given me details and information that the quacks in central FL haven’t a clue about. I formally fired 3 “sleep quacks” last year. That actually felt good. The 4th quack finally sent me the study report but refused to issue an rx for anything other than a straight cpap so I could show him that I failed it. Thank goodness for Supplier #2
RE: Question about Trigger setting - Geer1 - 12-29-2021
I doubt you have eliminated alpha intrusions but it does sound like you improved your sleep breathing by syncing the machine to your spontaneous effort. Without seeing data it is hard to know what all was going on before, it might have just been out of sync minorly or it is possible you have cardiogenic oscillations or something similar that was prematurely triggering pressure increases when using a higher trigger sensitivity.
Not sure what your neuromuscular issue is but it is worth noting that alpha wave intrusion is related to fibromyalgia.
RE: Question about Trigger setting - cathyf - 12-29-2021
(12-29-2021, 03:01 PM)Geer1 Wrote: ...it is possible you have cardiogenic oscillations or something similar that was prematurely triggering pressure increases when using a higher trigger sensitivity...
That's what I saw -- I have lots of sleep breathing that looks like short inhale, even shorter exhale, pretty long pause. During those pauses there are lots of cardiogenic oscillations. (This is where the heart beats against the lungs and makes them vibrate. It only shows up in the signal during the between-breaths.) When the trigger sensitivity is too high, every little wiggle gets seen as a separate breath, and the machine bounces the pressure all over the place.