Re: Experimenting with VPAP pursuing UARS suspect

[tan]

After achieving some degree of success suppressing flow limitations with an S9 Autoset in CPAP mode, 13cm, EPR 3, I decided to give it a try with VPAP. Contrary to what others say that a similar setup of BiLevel IPAP=13, EPAP=10 should be easier, I found it much harder to breathe even when awake. So tweaked settings for a few minutes ending up doing IPAP=16, EPAP=6 and went to sleep. This is what I've got in the morning - any suggestions on self-titration with VPAP:




One of the events:

[palerider]

please stop shrinking the screenshots, just post the screenshot from sleepyhead as is, all I see is fuzz over on the left.

[tan]

please stop shrinking the screenshots, just post the screenshot from sleepyhead as is, all I see is fuzz over on the left.

didn't shrink anything, just clicked PrintScreen, pasted into pbrush and saved it as an PNG, then uploaded into my photobucket storage.

UPDATE: Sent you files via email.

[palerider]

please stop shrinking the screenshots, just post the screenshot from sleepyhead as is, all I see is fuzz over on the left.

didn't shrink anything, just clicked PrintScreen, pasted into pbrush and saved it as an PNG, then uploaded into my photobucket storage.

UPDATE: Sent you files via email.

just hit f12, it's easier.

[tan]

please stop shrinking the screenshots, just post the screenshot from sleepyhead as is, all I see is fuzz over on the left.

didn't shrink anything, just clicked PrintScreen, pasted into pbrush and saved it as an PNG, then uploaded into my photobucket storage.

UPDATE: Sent you files via email.

just hit f12, it's easier.

Photobucket won't let me upload such images: "Upload failed. Please try again.: screenshot-20141218-153933.png"

[palerider]

Photobucket won't let me upload such images: "Upload failed. Please try again.: screenshot-20141218-153933.png"

use imgur, it sucks less than photobucket.

[tan]

ah, I like it (the settings of 16cm is for the second part of the night, the first sessions had 16 IPAP, 6 EPAP):

[palerider]

you were having really good luck with 13/10 on your autoset, lowering your epap to 6 is almost going to guarantee you problems, unless the 13 was just way way too much pressure in the first place.

as I mentioned in email, the vpap in s mode at 13/10 should feel pretty much the same as your autoset at 13epr3, make sure your hose settings are correct.

[tan]

you were having really good luck with 13/10 on your autoset, lowering your epap to 6 is almost going to guarantee you problems, unless the 13 was just way way too much pressure in the first place.

Yeah, I understand that. It was just not quite possible to breathe comfortably with 13/10.

as I mentioned in email, the vpap in s mode at 13/10 should feel pretty much the same as your autoset at 13epr3, make sure your hose settings are correct.

I suppose that hose was recognized properly for I was able to set climate control to "manual". What else? Set to "Pillows" for mask type P10. Turned off "Easy breathe" cause it was like "Breathe hard to train you respiratory tract muscles". Just checked the V9 VPAP clinical setup: I think Trigger and Cycle should be set "Very high" from "Med"

CORRECTION: Not "Nasal" but "Pillows" for P10

[tan]

The thing is I have another forum member who has UARS and contacted me and shared that the lab setup used to bring down AHI and RERA does not let that person breathe easily at home either. There must be some additional variable in BiPAP/VPAP setup being overlooked.

[palerider]

you were having really good luck with 13/10 on your autoset, lowering your epap to 6 is almost going to guarantee you problems, unless the 13 was just way way too much pressure in the first place.

Yeah, I understand that. It was just not quite possible to breathe comfortably with 13/10.

as I mentioned in email, the vpap in s mode at 13/10 should feel pretty much the same as your autoset at 13epr3, make sure your hose settings are correct.

I suppose that hose was recognized properly for I was able to set climate control to "manual". What else? Set to "Pillows" for mask type P10. Turned off "Easy breathe" cause it was like "Breathe hard to train you respiratory tract muscles". Just checked the V9 VPAP clinical setup: I think Trigger and Cycle should be set "Very high" from "Med"

CORRECTION: Not "Nasal" but "Pillows" for P10

the hose setting, if it's set wrong, can increase the pressure, ie, if you have a large hose and set it to slimline, it'll feel wrong because the pressure will be too high.

trigger is how sensitive it is to switching to ipap at the start of a breath, and cycle is how sensitive it is to switch to epap at the end of the inhale.

I run very high on trigger and medium on cycle, because i'd noticed on SH some times when an apnea was starting, I'd see little breaths that wouldn't trigger... so I said "hey! help me out!" and the vpap said "sure!"

[tan]

Adjusted Trigger and Cycle to be "VeryHigh" (why is it set to "Med" by default??) and set PS=5 for EPAPmin=10 and here you go - never had a flow limitation chart this flat. Still, there is snoring. Do I raise PS even higher?

[palerider]

Adjusted Trigger and Cycle to be "VeryHigh" (why is it set to "Med" by default??)

because that's the best place for them, unless there are special needs?

why do you have cycle set to very high? are you having trouble ending your breaths?

perhaps reading through this would help you understand the "why" and when it's recommended to change them:

http://www.resmed.com/assets/documents/ ... lo_eng.pdf

[tan]

Adjusted Trigger and Cycle to be "VeryHigh" (why is it set to "Med" by default??)

because that's the best place for them, unless there are special needs?

why do you have cycle set to very high? are you having trouble ending your breaths?

When had them at Medium setting, I had somewhat of inertia interfering with my breathing -- something I didn't experience with my APAP. I have just tried with Cycle reset to Medium, it is subjectively harder to breathe.

perhaps reading through this would help you understand the "why" and when it's recommended to change them:

http://www.resmed.com/assets/documents/ ... lo_eng.pdf

Thanks! Good stuff, will go through this.

[tan]

I keep having a better degree of success with a higher pressure difference -- 15/10, though subjectively not as good as night before, when I felt completely refreshed. Last night I had sleep disturbances, here is what SleepyHead shows (interestingly, imgur failed to upload the picture, whereas photobucket succeeded). The most glaring difference is a much higher level of leaking (with severe mouth drying) due to a sloppier mouth taping last night: