Doing worse on Bi-PAP than on Auto-PAP

[Bluebonnet_Gal]

JNK I didn't say that she should reset Ti Max on her machine. I was merely trying to restate what is says in the manual about Ti Max and what it does and how it can affect the machine's operation. A Ti Max setting of 3.0 is, according to the manual, for a person with an average BPM of 10 breaths per minute. BlueBonnet's numbers were above that. I was just trying to shed a little light on her orginally posted question. I tried to copy the information from the manual but the tables in the manual would not copy. The following is what did copy from the manual.
Norm




Setting Ti Max
The majority of patients on bilevel therapy experience mouth leaks, especially
during sleep. During mouth leak there may be poor synchronization between
patient and machine breaths, which reduces both the comfort and effectiveness
of therapy.
The VPAP Auto allows clinicians to specify a maximum IPAP time (ie the time the
device spends delivering the inspiratory pressure during a spontaneous breath).
Thus, if a patient develops mouth leak, the VPAP Auto automatically cycles to
EPAP after reaching the maximum time set by the clinician.
In the following graph, Panel A demonstrates poor synchrony between the
diaphragm EMG (EMGdi—which is indicative of inspiratory effort) and
inspiration, resulting in poor chest wall movement and ineffective therapy.
Panel B demonstrates improved synchrony when Ti Max is set to profile the
patient’s intrinsic inspiratory time, as demonstrated by EMGdi, chest wall
movement, and pressure profile synchronization.
TiControl
Patient Flow
Ti
Min
Ti
Max
Cycle
Window
Operating Information 7
Use the equation or table below to calculate a value for Ti Max. This will generally
ensure that Ti Max is set slightly longer that the patient’s inspiratory time.
Ti Max = (60 ÷ patient’s respiratory rate) ÷ 2
Setting Ti Min
The Ti Min parameter allows the clinician to set a minimum time the patient
spends in IPAP. It allows adjustment of the minimum inspiratory time parameter
ranging from 0.1secs to Ti Max. Ti Min is usually set to its default setting of 0.1
second.

Thanks for the interesting info. I was looking at this in the Clinician Manual. The graphs in the Clinician Manual make this very evident. I didn't put "two and two" together though until reading your post. Thanks for this valuable information.

At this point, I don't want to make changes to the machine. I first want to (hopefully) get my insurance company's approval on the machine and calculate how much it will cost me out of pocket. I can't afford to purchase one without going through insurance until May 1st at the earliest. I'm HOPING my DME and/or my ENT will be familiar enough with the device to recommend the best settings for me. At the very least, I need to get through letting my DME sent my ENT a report, then adjust the machine according to my ENT's specification.

Thanks for your help though guys! I can't wait to try some adjustments (and hopefully start feeling better again)!

[papdad]

BlueBonnet. I wish you all the luck in the world with your new machine. Both you and JNK are lucky in that yall both evidently have Doctors that are knowledgable and that are interested. I am having to learn pretty much on my own, with the help of this forum. I still think you will really like the Auto 25 when you get the bugs worked out -- I know I like mine.
Good luck, Norm

[cflame1]

A Respironics autobipap machine works differently. Those machies have a hardcoded minimum pressure support and a programmed maximum, so the gap varies overnight.

Where'd you get that from? It doesn't on my auto bipap.

[Slinky]

... A Ti Max setting of 3.0 is, according to the manual, for a person with an average BPM of 10 breaths per minute. ...
Setting Ti Max ... The VPAP Auto allows clinicians to specify a maximum IPAP time (ie the time the device spends delivering the inspiratory pressure during a spontaneous breath). Thus, if a patient develops mouth leak, the VPAP Auto automatically cycles to EPAP after reaching the maximum time set by the clinician. ...
Operating Information 7
Use the equation or table below to calculate a value for Ti Max. This will generally ensure that Ti Max is set slightly longer that the patient’s inspiratory time.
Ti Max = (60 ÷ patient’s respiratory rate) ÷ 2
Setting Ti Min
The Ti Min parameter allows the clinician to set a minimum time the patient
spends in IPAP. It allows adjustment of the minimum inspiratory time parameter
ranging from 0.1secs to Ti Max. Ti Min is usually set to its default setting of 0.1
second.

This is what I have been looking at. That "puff" I experience is AT THE END OF INHALATION, the beginning of exhalation. My inhalaltion is cut short by this "puff" of pressure. I'm not sure if it is an extra push of exhaled air.

The three weeks I behaved myself *snort* and stayed in Spontaneous mode at IPAP 10, EPAP 5, Pressure Support 4, Ti Max 4.0s, Ti Min 0.5s, Trigger, Cycle and Exhalation Sensitivies at Med and Rise Time 300 mS my Respiratory Rate was 17 Median, 21 for the 95th percentile and 27 for the Maximum.
My Leak rate during that same period was Median 4.2, 95th percentile 23.4 and Maximum 33.0
My reported Median, 95th percentile AND Maxium Pressure was 10, 10 and 10.

When I had had enough of that dang "puff" and HAD to get some decent sleep again I switched her back to good ole VPAP mode. Ahhhhhh. I also opted to combine the local titration IPAP 13, EPAP 8 with the Mayo titration of IPAP 10, EPAP 5 and set her at IPAP 13, EPAP 5 and did change the Pressure Support to 5, all the other settings I left the same.
Ahhhh, that d*mn "puff" gone again. I'm actually sleeping well and feeling rested. *happy sigh*
Now my Respiratory Rate was Median 14, 95th percentile 18 and Maxium 24
My Leak rate was Median 2.4, 95th percentile 24 and Maximum 33

But then I just "had" to diddle around w/trying out the Swift LT and then with the OptiLife cradle cushion so whilst I was working w/adjusting and fitting them just right I pretty much ignored that data as not consistent w/my normal use of my beloved Simplicity so didn't include their data with the above data.

[Bluebonnet_Gal]

I woke myself last night with a snore! That hasn't happened since I started xPAP theapy.

My numbers actually look BETTER this morning that they did yesterday, and I feel a little better than I did yesterday. But I was really surprised when I woke myself with a snore!

[Slinky]

Well, you are one up on me then. I haven't pulled that one - yet anyway.

Did you notice the difference in our graphs for the respiratory rhythm? Mind you, I have COPD, ours is NOT going to look alike. But I sure did appreciate seeing what the "normal" charts look like.

[jnk]

A Respironics autobipap machine works differently. Those machies have a hardcoded minimum pressure support and a programmed maximum, so the gap varies overnight.

Where'd you get that from? It doesn't on my auto bipap.

I think rested gal explains it a lot better than I did:

viewtopic.php?t=15666

Perhaps the simplist way to say it is that in Respironics autobilevels, you set the maximum pressure support; whereas, in ResMed autobilevels, you set the unvarying pressure support.

[Slinky]

I'm sorry. I would have sworn that I'd posted the URL to my VPAP Auto download for you to compare, BlueBonnet, but I don't see it here so .... here goes.

http://www.box.net/services/ipaper_by_s ... v41n5dpdqh

Its not the two nights back in Spontaneous mode. And boy! does the data for those two nights suck - big time! If there weren't so many pages for two nights I'd post them so you could see how lousy they were - every bit as lousy or worse than yours!!! We both DESPERATELY NEED an RT who know his fanny from a hole in the ground about the finer points of Resmed VPAP Auto therapy!!!!!!

[Bluebonnet_Gal]

http://www.box.net/services/ipaper_by_s ... v41n5dpdqh

Its not the two nights back in Spontaneous mode. And boy! does the data for those two nights suck - big time! If there weren't so many pages for two nights I'd post them so you could see how lousy they were - every bit as lousy or worse than yours!!!

I'm glad to know I'm not the ONLY one with some problems with leaks. And my DME said my leaks aren't too bad. He didn't even look at the detail graphs though, just the Stats.

We both DESPERATELY NEED an RT who know his fanny from a hole in the ground about the finer points of Resmed VPAP Auto therapy!!!!!!

You can say that again!!!

[Slinky]

Hey, for months, due to all the suggestions here regarding getting leaks under control I asked my local sleep doctor and DME supplier about my high leak rate and was always told that these newer CPAPs compensate quite nicely for leaks - and they do - but there is a limit as to just how much leak they can compensate for! AND too high a leak "can" cause a need for a higher pressure during titration. My local sleep techs never said a word to me about leaks. But Mayo sure did pick up on my leak rate w/o my ever questioning and had me on a chin strap before the night was over!!

Local titrations results: IPAP 13, EPAP 8. Mayo titration results: IPAP 10, EPAP 5. Neither one quite perfect, but between the IPAP 13 and EPAP 5 in auto mode I do pretty darn good. I usually share my poorer results hoping someone can pick up on whether its "just the COPD" or what "comfort options" need adjustment.

When I'm in auto mode w/my Simplicity I get lots of median 0 leaks reported. Didn't have as good luck w/the leaks and chin strap w/the Swift LT and the OptiLife cradle cushion - but - I was experimenting w/them. I've found it takes me 10 to 14 days before I can be sure a promising mask will or won't work for me. I've always needed some time to play with and experiment w/them that many nights. Of course,there are also those masks that yuo KNOW in less than 5 minutes just are NOT the mask for you and not worth putting any effort into improving the fit.