VPAP lll problems

[AnotherElizabeth]

DSM said:

The buttons on the VPAP III form a + shape. Ther are the left & right buttons & in the middle the up & down buttons (crude diag below - someone on cpaptalk has an exact diag and showing two fingers holding the buttons (similar to the Resmed S)

....^....
<----->
.....u....

Press on the right arrow button and at the same time hold the down button - do so for at least 3 secs.

Thank you, DSM...it worked. I was not holding it down long enough.

I'm going to list all settings and if anyone has any comments on them, I will consider what you have said.

Before listing my settings, my machine is VPAP lll ST-A. I deal with Hypopnea....but not sleep apnea and use bi-levels. And I know that my settings are not right for me. As I said in an earlier post, I can't even use this machine with these settings because I'm setting off alarms that continue to wake me through the night. They are not the mask leak alarms but beeps.....and beep beeps. Also I'm quite certain I'm still not getting enough oxygen to my brain even with the bipap, I'm still having extremely vivid and uncomfortable dreams and still have strange visual issues upon first waking. In describing them to my doctor, he felt sure they were related to the hypopnea, especially since my blood tests are showing high CO2.

Here are all my settings. I have an appointment with a pulmonologist in a few weeks and I feel sure he will make adjustments to my IPAP and EPAP numbers but I don't know about the rest of this because as has been pointed out.....some of them are comfort settings and only I can determine my comfort.

Mode: Spont
IPAP 8.0 cm
EPAP 4.0 cm
Rise Times: 150 ms
IPAP max: 2. s
IPAP min: 0.10 s
Trigger: med
Cycle: Med
Smart Start: Off (I want that on)
Mask: Ultra (I would set to Mirage to match my Swift)
Humid: none (I would set my HumidAire 2i)
Tube Length: 2m
AB Filter: No
Max Ram: 45 min (I have that off....I don't want it on)
Start EPAP: 4.0

I listed more than you probably ever wanted to know but this machine is so new to me....I hardly know what is important.

Thank you.
Elizabeth

[dsm]

Elizabeth,

I can partly tell from your settings that you have the ENHANCED version of a VPAP III ST/A (but I didn't see a BPM rate showing in your settings data ?)
What is written on the purple panel ?

The A indicates Alarm model. That is it has various alarms that can be triggered audibly if certail breathing thresholds are crossed. This model is usually used in hospitals or for someone with a serious respiratory condition. It is by far the dearest model of the family.

Be careful about changing any of the settings. To be honest, I am not willing to suggest what you could or should change, not without AutoScan feedback and SpO2/pulse data

Good luck with your therapy & I trust the RT will sort out the difficulties.

DSM

#2 PS while looking through the settings did it not display an I:E ratio as an information screen ? - I have realised from my earlier posts that the I;E will only show on the ST models. Also your model should have a BPM (Breaths Per Minute) setting ?. - D

[AnotherElizabeth]

Hi DSM:

Yes, it is VPAP lll ST-A. The respiration rate is 15 per minute. That was listed in an abbreviated menu and I failed to add that.

My old Respironic that I'm using until I get the ResMed VPAP worked out is set at 12 breaths per minute but in timing it, I'm actually taking 15...so that part of the VPAP lll is probably right on.

Because of the times of the night that I'm setting off the beeps, I suspect that I'm exceeding the pressure limits in both directions. I think they are probably set too narrow for me. In the wee hours....about 2:00 AM when it beeps, I suspect that my breathing is too shallow and I'm going below the low limit and after an episode such as that, my need for oxygen is no doubt increased and I'm exceeding its high limit. Anyway that's what it feels like.

With Post Polio Syndrome, my breathing problem is caused both by my central nervous system lacking to send the message to breathe and my diaphragm is weak.

Thank you for your thoughts and help.
Elizabeth, determined to get this worked out before the Respironic dies completely.

[dsm]

Elizabeth,

Just to help clarify - the I:E ratio and BPM will only show when in timed or spont/timed mode.

The data you put up is correct for spont mode.

Because your VPAP III is in spont mode and is set with med trigger sens & cycle sens this means the machine will only swicth from Ipap/epep/ipap on your breathing. The trigger sens is 3 settings (low med high) that adjust the sensitivity with which the machine triggers from epap to ipap. The cycle setting is the sensitivity to the airflow for switching from ipap to epap. The rise time is how long the switch from epap to ipap takes.

Naturally, in spont/timed mode it will try to coerce you to maintain a breathing rate such as 12 or 15 if that is what is set.

If your Respironics Bipap is an ST model then I would expect the RT to have set your VPAP III in the same mode (spont/timed - esp taking into account how much the STA model costs )

What you are describing sounds like mixed apnea and with distinct hypopneas and centrals ? - if so then spont/timed or even straight timed seems the setting you should be on.

Good luck

DSM

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap

[rested gal]

Hi Elizabeth,

There was another post-polio woman who used to post on this board. Her nickname is ahujudybear. If you click the link below, that will take you to topics she posted in.

search.php?search_author=ahujudybear

Best of luck with your treatment!

[AnotherElizabeth]

Thank you, Rested Gal. I'm checking her posts out now and will read them all.

Elizabeth

[AnotherElizabeth]

I'm still stuck in VPAP lll problems.

The other day I listed on here the settings on my VPAP lll ST-A unit. Since then, I only changed things that were set to "default" to the specifics on my unit, like the mask and humidifier, just to get used to working in that settings menu/mode.

But last night it became necessary to make other changes because my old Respironics that I've still been using developed new bad habits that made me uncomfortable using it. I have been waiting to hear from the clinician with her help after she learned more about this new ResMed unit but have not heard from her yet. She has never worked with anything but Respironics and the technology of the ResMed has her stumped. I requested that they obtain this unit for me.....so I can't blame her/them.

Up until now the Respironics' biggest problem had been difficulties turning it on....it would hum but not turn on. Finally after many many tries, it would give in and start up. But until last night, the pressure stayed normal during the time using it. Last night the pressure came and went while I was using it and it didn't feel safe to use......safe to be sleeping with it acting that way. It sounded like it could quit at any moment and didn't want to be sleeping while that happened.

So, I felt compelled to make some changes with the ResMed VPAP unit so I could get some sleep.

I worked with it for quite a while trying to get it comfortable...allowing me more time to breathe before cutting me off. And I had already learned through experimenting with the Respironics that my IPAP and EPAP numbers were no longer effective for me and had raised them a notch. So I changed them in the ResMed also.

All went well with my ResMED VPAP until I began to drift off to sleep and I went through the same thing as I had before making the changes. Every time I began to drift off, an alarm went off....a beep loud enough to wake me and it continued that way until I gave up on it......and had NO sleep last night at all.

I don't want to go through that again tonight and the clinician is not available over the weekend.

I'd like to list my old and new settings on the ResMed unit and if anything jumps out at anyone that I could change to avoid this alarm, I'd be very appreciative if you'd get back to me on it.

Old settings: New Settings:

Mode: spont Mode: spont
IPAP 8.0 IPAP: 9.0
EPAP 4.0 EPAP: 5.0
Rise Time 150ms Rise Time: 200 ms
IPAP Max: 2.00s IPAP Max: 3.00s
IPAP Min: 0.10s IPAP MIN: 0.10s
Trigger: Med unchanged
Cycle: Med unchanged

Which of the above settings controls the pressure limits? Somehow I expect they might be the problem...that the limits are too narrow and as I drift off, my breathing gets more shallow and exceeds the programmed lower limit...if it even works that way.

This morning, using the email address on ResMed's website, I sent them an email asking for help on this but the email came back with a delivery failure message. I attempted two more times and they also came back with the delivery failure message. Wonder what is up with that? New email address???

Thank you for any help you can be. I certainly would like to sleep tonight....I will become a bear soon without sleep.

I feel like yelling "HELP!!!!!!!"
Elizabeth

[rested gal]

Elizabeth, since you're using the machine in Spontaneous mode (not with any Timed backup rate) I think the beep you're describing is when there's a large leak -- massive mask leak or mouth air leak. Are you sure that you don't mouth breathe or leak treatment air out your mouth when you sleep? Mouth air leaks sound like what might be happening when the jaw and tongue relax as we drift off to sleep. Just a guess.

if all you want to do is keep the "beep" from happening, there should be a setting you can get to for "Mask Alarm." I don't think you even have to go into the clinical menu to turn that off. On the regular VPAP III (spontaneous) the mask alarm is in the patient settings menu where you can choose humidifier, hose length, etc. I'd just set the Alarm to off.

But do try to figure out if you're having mouth air leaks. Mouth leaks and mouth breathing can sure wreck treatment when not using a FF (full face) mask.

[AnotherElizabeth]

Hi Rested Gal:

Thanks so much for responding. You're a great asset to this group.

In addition to my recognizing the mask leak alarm, I have that alarm set at off. In looking in the same menu where that is set, I saw what looks like a general alarm setting and I just changed that to off also. Fortunately none of these adjustments are permanent and can be set back if need be.

I'm probably changing too many things at once...out of desperation but I found low and high pressures while I was in there and changed the low to
-10 from -3 and increased the high pressure by about as much.

As far as mouth breathing, I know that I don't. When I have a cold and my nose is plugged, I have a terrible time because I can't even force myself to breathe through my mouth. Of course that is without the bi-pap. Using the bi-pap is relatively new to me again. Thirteen years ago when I first began using the bi-pap, I used it for three and a half years and after going to a Post Polio clinic in Mississippi for two weeks of treatment, I learned right after that I no longer needed the bi-pap and would constantly turn it off in my sleep. So....I was off it for nearly ten years with no symptoms until the past couple years and have just gone back on it in this past six months. Looking back at the symptoms I was having, I know now, I should have gone back sooner but didn't recognize the symptoms because they were different than I'd had before.

Guess I'll try to nap this afternoon and give myself a chance to see what effect if any my changes have made. I'm taking extensive notes about my changes so I know what they were and what I've changed.

Thank you again,
Elizabeth

[rested gal]

I'm probably changing too many things at once...out of desperation but I found low and high pressures while I was in there and changed the low to -10 from -3 and increased the high pressure by about as much.

Elizabeth, I know nothing at all about issues for Post Polio "cpap" users. You might want to talk to your doctor before making changes in treatment pressure settings. That said, I do understand "desperation" and we each do what we think best. But you've got more to consider than plain old OSA. So consulting with a sleep doctor who is very informed about Post Polio respiratory problems would be really important, imho. Before making treatment pressure changes. Just a thought.

[AnotherElizabeth]

[/quote]Elizabeth, I know nothing at all about issues for Post Polio "cpap" users. You might want to talk to your doctor before making changes in treatment pressure settings. That said, I do understand "desperation" and we each do what we think best. But you've got more to consider than plain old OSA. So consulting with a sleep doctor who is very informed about Post Polio respiratory problems would be really important, imho. Before making treatment pressure changes. Just a thought.

Hi RG:
I have an appointment with a pulmonologist/sleep doctor in two weeks. His schedule was full and I was hoping for a cancellation. I made my appointment over a month ago. The timing of all this has been unfortunate because of my old unit being in the process of dying and the clinician not knowing this new machine. If I could have at least been able to sleep with it until seeing the doctor, I could have made the best of it but with the unit waking me over and over all night, I have not been able to use it through the night yet and have had it for 3 weeks. When I was looking in the menus, I see that I have used it less than 40 hours in this past three weeks, less than 2 hours a night. I'm not at a point now where I can sleep without a unit and tried to get a loaner from the clinician because I don't want to be without a unit for this period of time but they don't have loaners.

My symptoms at this point are severe enough, it's scary to subject my brain and body to such deficits of oxygen. I'm hoping the doctor knows this machine enough to be a help with the settings. I don't know if that is part of their expertise or not.

Once in a while the road has to get a little bumpy for a bit. In the middle of this and since before the Holidays, I had an appointment with a Hematologist and had a bone marrow biopsy because he and my PC doc thought I had Leukemia. A lot of weeks involved in all that but thank God.....I do NOT have Leukemia.

Elizabeth, eager to get back into her pottery studio and throw some pots again.

[AnotherElizabeth]

Great progress. With the changes I made in my unit yesterday, I slept the entire night. That was a first with this new machine. There were no alarms waking me. I feel like I'm on the right track again and have an appointment with the pulmonologist in a few weeks. At least I can function between now and then with the help I received from this newsgroup, especially from Rested Gal.

Thank you so much for the help and encouragement. My body and my brain thank you!!!!

Elizabeth

[StillAnotherGuest]

Hey Elizabeth:

There should be an alarm setting in there called "Low Minute Ventilation." What's that set at?
SAG

[dsm]

I'm probably changing too many things at once...out of desperation but I found low and high pressures while I was in there and changed the low to -10 from -3 and increased the high pressure by about as much.

Elizabeth, I know nothing at all about issues for Post Polio "cpap" users. You might want to talk to your doctor before making changes in treatment pressure settings. That said, I do understand "desperation" and we each do what we think best. But you've got more to consider than plain old OSA. So consulting with a sleep doctor who is very informed about Post Polio respiratory problems would be really important, imho. Before making treatment pressure changes. Just a thought.

Elizabeth,

I am endorsing RestedGal's comments 100%. Naturally we here are really pleased to see anyone make progress and it is a great reward when anyone on cpap seeks out help & advice. There are some situations where even our best advice needs to be tempered with professional support and this is essential in your case.

Whatever you do, do get the changes approved by your specialist.

Good luck

DSM

PS what model Bipap were you using ? Synchrony ?

D

[AnotherElizabeth]

Hi D:

Thank you so much for your help and suggestions. It was a difficult spot to be in.....an old unit that was no longer to be trusted, a new one that I was not at all familiar with, and professional help was not immediately available.

I feel like I made great strides in my progress this past week but I'm also aware that they should be considered a temporary fix until my my appointment with the physician.

Last night was the first night I made it all the way through with the new machine. I have owned it for about 3 weeks now. But am so thankful for the sleep and the help of this generous and helpful newsgroup.

My old bi-pap is a Respironics ST. It has been a great machine and I'd have been content to have it looked at and repaired. It only has 3 1'2 years use on it....seems like such a waste. I have an idea it is something minor in the motor by the sounds of its stalling before starting up. It is very straightforward with no bells or whistles but it did the job in an excellent fashion.

It was humorous when we discussed the top notch and expensive unit my new one is. The truth of the matter is......13 years ago when we purchased my Respironic, it was more than twice the cost of my new one and we had no help from the insurance company because they had them classed as non-durable medical equipment.....along with two scooters, an electric wheelchair I was using at the time and a van with a mechanical wheelchair ramp. Now the insurance company will cover my new one. We have always had good insurance but some things have changed within their rulings. Fortunately, since major lifestyle changes, Post Polio doesn't usually rule my life.....this was just a bump in the road.

Thank you again,
Elizabeth