Night 8, it's already Love - Hate. So glad I found you guys!

[FE350]

Thanks for explaining that Fred.  So you think I might try to raise the pap pressure to 13?  12 even?  What about the length of the IPAP cycle, It feels like it is too short, sometimes, and cuts me off.  I say "sometimes", because usually, when I first start the machine, the breathing cycles feel like they are longer.  Am I imagining this?

[FE350]

That's what I got out of that chart Fred. Thanks. SO now what, 13? This thing called SP5?

[Gideon]

First, I do not believe this is the correct machine for you.  I believe an ASV is what you should try.

Take the IPAP to 13 so your PS will be 6.  This is an experiment to see what happens.

[thibaulthib]

Hi FE350,

Thanks for your comments and screenshots, it is extremely helpful!

Based on the attached screenshots (AHI 24.95)
- Your median Respiratory rate is 13.60. You are also mentionning your machine is saying it is 12 resp/minute. So let's keep 12 as your respiratory rate. When using ST mode, Resmed recommends to set the Backup rate to 2-4 below the normal respiratory rate. You said your backup rate was set to 6, this is way too low, meaning your machine will only trigger 6 breaths per minute if you don't breathe by yourself. What we need to do, is to increase the backup rate to 10. This will have a very positive effect on your mask pressure moving from EPAP to IPAP (to trigger an inhalation) more frequently. By doing so, you are likely to breathe within a frequency below 10s, which is what we are looking for! 


Conclusion: Tonight, please do the following:
- Set your backup rate to 10, this may lower the occurence of apneas because each breath will be closer from one another
- Set your trigger settings to "high" instead of "medium"
- Keep your EPAP to 7 and set your IPAP to 12. This will give you a pressure support of 5, likely to lower your hypopneas

Don't worry, these are very minor changes, and be reassured you will not die, I would even say the opposite!

Thibault

[FE350]

Thanks Thibault.  I can't thank you enough.  Wish me luck@!

[thibaulthib]

No worries, keep us posted tomorrow!

[Sleeprider]

Conclusion: Tonight, please do the following:
- Set your backup rate to 10, this may lower the occurence of apneas because each breath will be closer from one another
- Set your trigger settings to "high" instead of "medium"
- Keep your EPAP to 7 and set your IPAP to 12. This will give you a pressure support of 5, likely to lower your hypopneas

Don't worry, these are very minor changes, and be reassured you will not die, I would even say the opposite!

Thibault

I agree with the suggested settings by Thibault, and I know how he derived them.  In addition, please post your current Ti min, Ti Max and rise time if available.  Your description of inhale being cutoff makes me think you need a longer Ti Max.

You need to be on ASV because you have central apnea, not restrictive lung disease or hypoventilation which is what the ST is intended to treat.  I am going to link the Resmed Titration Protocol, and I want you to read and understand what the intended therapeutic uses of the VPAP ST and ASV are.  This resource also describes the setting changes recommended for different types of events.  You should share this with your doctor so he can understand that his choice of therapy is either wrong or not optimal.  I suggest that you should probably be under the care of someone that actially understands central and complex apnea,and the use of ASV therapy.  https://www.resmed.com/us/dam/documents/...er_eng.pdf 

Note the chart on page 5.  
ASV Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes.  It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB) 

ST Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate.  It treats COPD, NMD, OHS and other respiratory conditions.

This is described in detail pn pages 28 and 38.  You will quickly see, the machine you were given is the wrong one for your condition.  I need you to assume the role of student, so you can learn enough to train your doctor.  The alternative is to get a doctor with existing knowledge in this field.  Please do not continue to try and make a hammer do the job of a screwdriver, you are using the wrong tool!

[FE350]

Hey Thibault and Gang!

Are you ready for this???!!  I made the changes you suggested and look at my results!  I'm over the moon about it!  I woke up in the night, with a bit of asthma.  Stopped the machine to get a puff and relax a bit, then restarted the machine.  In my last 3 hours of sleep I had only one CA an hour and 2 hypopnea, for a total of 3 events an hour!  Party, at my place!!  Haha!  Thanks all!

Note: I adjusted the sensitivity to high, changed the IPAP to 12, changed the backup rate to 10, all as you had suggested, but quickly dropped the backup rate to 9, then 7, as I felt I was just being forced to breath too quickly.  After the asthma rest, I dropped the IPAP to 11.6.  It seemed like a lot less air was being forced at me, and I was more comfortable at that setting.  I'm thinking that tonight I may switch the IPAP a tad higher, to 11.8, and the backup rate to 8.  Maybe a faster respiratory rate will help me to get into and keep some rhythm?  Your thoughts??

[Gideon]

I'll add that I am 150% behind the direction that Sleeprider is taking you.  Please follow his direction.  FWIW working with timing was the next thing I was going to look at.  BUT you NEED an ASV.  Everything else is trying to maximize the use of the wrong tool, and make the round peg fit the square hole.

[FE350]

Just seeing this, thank you Sleeprider, your guidance is greatly appreciated.  I'm on the road today, home tonight late.  I will print out that guideline and see if I can't learn from it.

Is there a resource of knowledgeable docs?  I'm in the greater Los Angeles area, surely there are a couple of great docs in the region??