VPAP lll problems

[BarryBlust]

Thanks so much for this site and all the wonderful help! I have enjoyed reading and learning. After almost dying, I was diagnosed with 99+ episodes per hour (ouch). After normal adjustments to the machine and masks, I began to heal and am now at the 'mental zest' stage of health. I have lost @ 80 pounds since my clinical sleep study.

For the past few weeks I have been experiencing a fighting sensation with my machine. It breathes too fast for me, not deep enough or long enough on the inspiration, and the same on expiration... so my natural breathing patterns are at odds with the machine.

Is this a matter of settings (now at 13-6)? Please help!

Thanks very much,

Barry in Scotland

[dsm]

Barry,

You have lost what !!! - 60 lbs that is 4st 3lb or 27.2 kilos - sheesh I was feeling smart because I lost about 16 kg.

I am impressed !. It has been a damned hard slog but am convinced it was due to getting my Bilevel settings just right for me.

What Vpap do you have

1) Vpap III S
2) Vpap III S Enhanced (updated Vpap III s)
3) Vpap III S/T

My 1st thoughts are that your epap to ipap gap seem on the high side ?

Do you have AutoScan software to read the machine ? - worth its weight in gold to be able to check your AI HI data on a per nigh basis.

Cheers & welcome

DSM

Once lived in Banchory on tha Braemar rood joost oot of Aberdeen. Mi father was thir exporting Kippers believe it or noo

Ar ye a highlander or a true Scot

(Trrrooth is my scottish side o the fumly are true Scot & frrrum near Edinburgh (Crichtons) )

[blarg]

Don't the Vpap III machines have an IPAP max setting?

[rested gal]

Barry, besides the EPAP/IPAP pressure settings, the VPAP III has other settings that probably need adjusting to get the machine to be in synch better with your natural breathing.

When I played around with a VPAP III, I found that it felt like it cut off my inhalation prematurely unless I set the IPAP max adjustment for as many seconds as it would go. It also felt smoother to me when I had the Rise Time set for as long as it would go.

Looking back on the notes I made of the settings that worked best for me with the VPAP III, I was using:

IPAP 12

EPAP 9

Rise Time 900 mS

IPAP Max 4.00 s

IPAP Min 0.10 s (see edit below)

I kept Ramp turned off.

To change any of those, you'd have to go into the clinical setup menu by holding down together the right arrow button (the red arrow) and the down arrow button (the black double-arrow button.) If a person does go into the clinical menu on any machine I think it's a good idea to walk through the menu making NO changes at all the first time. Simply write down every setting, every symbol, every word on the screen to have a record of all the original settings.

It's ok to press the button under the word "Change" and use the up/down arrow button to see what changes could be made. Just don't press the button under the word "Apply" unless you really want to make a change in that setting. "Apply" will save a change and let it take effect the next time you turn on the machine.

Pressing the button under the word "Exit" backs you out of whatever menu screen you're in. Press "Exit" several times if you want to be sure you're completely out of the clinical menu.

Edited to correct a typo in the list of my settings:
Originally typed: EPAP Min 0.10 s
Should have typed: IPAP Min 0.10 s

[dsm]

Barry, besides the EPAP/IPAP pressure settings, the VPAP III has other settings that probably need adjusting to get the machine to be in synch better with your natural breathing.

When I played around with a VPAP III, I found that it felt like it cut off my inhalation prematurely unless I set the IPAP max adjustment for as many seconds as it would go. It also felt smoother to me when I had the Rise Time set for as long as it would go.

Looking back on the notes I made of the settings that worked best for me with the VPAP III, I was using:

IPAP 12

EPAP 9

Rise Time 900 mS

IPAP Max 4.00 s

EPAP Min 0.10 s

I kept Ramp turned off.

To change any of those, you'd have to go into the clinical setup menu by holding down together the right arrow button (the red arrow) and the down arrow button (the black double-arrow button.) If a person does go into the clinical menu on any machine I think it's a good idea to walk through the menu making NO changes at all the first time. Simply write down every setting, every symbol, every word on the screen to have a record of all the original settings.

It's ok to press the button under the word "Change" and use the up/down arrow button to see what changes could be made. Just don't press the button under the word "Apply" unless you really want to make a change in that setting. "Apply" will save a change and let it take effect the next time you turn on the machine.

Pressing the button under the word "Exit" backs you out of whatever menu screen you're in. Press "Exit" several times if you want to be sure you're completely out of the clinical menu.

RG,

Am sure that is good data - for you - but I doubt I would be suggesting risetimes of that extraordinary length & some of those other settings without getting more detail from Barry.

Cheers

D

[rested gal]

Don't the Vpap III machines have an IPAP max setting?

Yup. I was typing and missed your post, blarg. You're exactly right. That's the particular adjustment that helped me the most -- kept the inhalation from feeling cut off too soon.

[rested gal]

RG,

Am sure that is good data - for you - but I doubt I would be suggesting risetimes of that extraordinary length & some of those other settings without getting more detail from Barry.

Cheers

D

D, I wasn't suggesting particular settings for Barry -- or for anyone else.

I listed the settings that suited me with the VPAP III. I doubt Barry (or anyone) would think his IPAP max or Rise Time settings should necessarily match mine, anymore than a person would think they should use the same EPAP/IPAP pressures another person uses.

With emphasis added:

I found that it felt like it cut off my inhalation prematurely unless I set the IPAP max adjustment for as many seconds as it would go. It also felt smoother to me when I had the Rise Time set for as long as it would go.

Looking back on the notes I made of the settings that worked best for me with the VPAP III, I was using

Barry, I'm glad to hear you're feeling so much better. Congratulations on the weight loss and getting your treatment going so well!

[dsm]

RG,

Am sure that is good data - for you - but I doubt I would be suggesting risetimes of that extraordinary length & some of those other settings without getting more detail from Barry.

Cheers

D

D, I wasn't suggesting particular settings for Barry -- or for anyone else.

I listed the settings that suited me with the VPAP III. I doubt Barry (or anyone) would think his IPAP max or Rise Time settings should necessarily match mine, anymore than a person would think they should use the same EPAP/IPAP pressures another person uses.

With emphasis added:

I found that it felt like it cut off my inhalation prematurely unless I set the IPAP max adjustment for as many seconds as it would go. It also felt smoother to me when I had the Rise Time set for as long as it would go.

Looking back on the notes I made of the settings that worked best for me with the VPAP III, I was using

Barry, I'm glad to hear you're feeling so much better. Congratulations on the weight loss and getting your treatment going so well!

RG,

What it seemed was you offered a range of settings you liked & then expalined how Barry could change his machine settings.

But what we really need to do when someone on a BiLevel asks for help is

1) Get as much info on the persons problem(s) as possible

2) Find out (by gentle questioning) if they are on an S/T machine - this matters because if they are the next gentle question is are they a COPD patient & if so then we proceed with *great* care)

3) The next important question is does this person have the software to monitor their machine (if they don't I would now be very cautious about telling them how to change settings & suggesting variations)

4) If they can monitor their AHI (AI & HI) then perhaps comes the time to point out some changes that they can measure the results of.

The above cautions for me, really apply to people on Bilevels & what we see repeatedly here is that VPAP III users don't always spell out if they have an S/T model (thus potentially COPD patients).

For Cpaps & Autos (other than the Bipap Auto) I am much less constrained about passing on how to change settings

Cheers

DSM

PS Hope the hols are going well - r u in a cyber cafe ?

[BarryBlust]

Well... balancing on the new language of respirations, I can feel myself swooning more than a wee bit. (not a Scot but a Welshman spying on the Lochs).

I think part of my problem is that I am a classical singer... my breathing patterns reflect a huge volume... so deep and long like the river.

As a stop gap help I set ramp to 25 minutes and did manage to fall asleep... at about 7 AM... lol.

If I was with my support group in the States I would be in contact there and dealing with the 'we can't do anything without the MD's say so, and them wanting another sleep study... which might be a good idea since my situation has changed drastically. Here I just want a fix for the meantime... something to help continue the progress.

Oh... I do seem to be sleeping lots of hours (9-12/night). Normal? Good sign?

I don't take your advice as gospel... but I am paying close attention!!

Ba

[dsm]

Ba me bhoyo, I ope you ar enjoy-in the os-pitality there in lochland

Back to your Vpap III

Is it an S/T ?

Do you know what the settings are for

Ipap
Epap
MaxInsp time
Min Insp
Risetime

Does it have the word 'ENHANCED' on the purple part of the front panel.

(if yes then there are additional settings for adjusting between ipap/epep & epep/ipap

Cheers

DSM

[rested gal]

Barry, you'll be able to tell quickly and easily what IPAP max setting and what Rise Time setting match your breathing. You don't have to sleep all night with a new setting to feel what suits you in the adjustments for those comfort settings.

I simply laid down on the bed in the daytime; tried an "IPAP max" setting while I breathed normally for a few minutes. If it cut off my inhalation, I tried a longer timed IPAP max setting for awhile, and so on...until I found the time that allowed me to inhale normally.

I kept trying different IPAP Max and Min, and Rise Time combos for a few minutes each while laying there awake. Those are primarily comfort timing settings, not treatment pressure settings like the EPAP/IPAP pressure settings are. There are probably people whose treatment is affected by comfort settings. But what you described in your initial post.. "I have been experiencing a fighting sensation with my machine. It breathes too fast for me, not deep enough or long enough on the inspiration, and the same on expiration... so my natural breathing patterns are at odds with the machine." sounds like the IPAP Max time is not set long enough for the length of time you normally inhale.

Unfortunately, many DMEs who set up a bi-level machine probably set only the EPAP/IPAP pressures and don't even know that the comfort settings exist...or always just leave them at their default values. If they didn't take the time with you when they gave you your machine to see what length IPAP max time and Rise Time felt comfortable to you, you might want to adjust those comfort settings yourself.

I think part of my problem is that I am a classical singer... my breathing patterns reflect a huge volume... so deep and long like the river.

There may not be a long enough IPAP Max adjustment to let you draw in a breath as long as you normally do. I don't think the IPAP max goes by volume -- I believe that setting is governed by how long in seconds (edited to "seconds", not milleseconds) it will let the IPAP pressure continue.

I'd go on and set the IPAP Max at 4.00 s ... the longest it can be set for.... if it were me.

[BarryBlust]

That work does not appear... and I cannot find any reference to s/t on the casing. As for the alphabet soup, not really no... but I do not wish to change the clinical settings just now... only the 'comfort' settings.

I live right on Loch Ness... little village on the hill side. Incredibly beautiful!!

Ba

[BarryBlust]

My recollection of the less than a minute discussion with the nurse who made the settings did not include any 'comfort' settings... you are probably correct that she had no clue they existed.

Is my machine supposed to adjust itself to my breathing patterns? Besides duration of both in and out breath, there is the problem of breaths per minute... the machine wants to 'breathe' about twice as fast as I do. I diaphragm breathe all the time... not just in sleep... years of training.

I will explore the settings as you suggest... and like your idea of trying it out during the day to find comfort settings I can sleep with!

Ba

[rested gal]

Besides duration of both in and out breath, there is the problem of breaths per minute... the machine wants to 'breathe' about twice as fast as I do. I diaphragm breathe all the time... not just in sleep... years of training.

I wouldn't think it would matter which extreme one employs for breathing - entirely from down deep with the diaphragm, or through raising the shoulders up and down. Either way, I think what the bi-level machines are looking for...sensing...is the airflow itself...not what part of your anatomy is at work.

As best I could tell when trying some "let me see how well a bi-level keeps up with what I'm doing while I try to trick it", any slight hesitation or miniscule interruption, or momentary diminishment of the "steadiness" (for want of a better word) of the airflow coming in during inhalation can make a bi-level think you are starting to exhale and cause it to switch to the lower EPAP pressure.

I really think the feeling of the machine breathing about twice as fast as you want to is still related to the comfort settings not being set long enough for you. I believe most, if not all, of that rapid breathing feeling from the machine will go away after you adjust the comfort settings longer.

A regular bi-level is designed (I think) to follow your breathing...your breathing cues. But when it comes to the length of time it will allow the higher inhalation pressure to stay in place, there is that built-in setting that can only be set "so long"...that IPAP max timer adjustment. I'm not sure why that particular time limit is set for inhalation...the 4.00 s. Or why it is not longer ... perhaps a max of 6.00 s instead of the max of 4.00 s, since that seems to be the #1 complaint of people who have any complaint about bi-level machines at all...that feeling of having the inhalation pressure cut off abruptly if they happen to take a really long breath.

On the other hand, when you exhale, I believe the lower EPAP pressure will stay down there "forever"... until you start to draw another breath in. You can test that yourself by holding your breath as long as you can at the end of your exhalation. I don't think the higher IPAP pressure will happen until you inhale again.

[BarryBlust]

My experience in the now with the machine is that it begins the in breath long before I actually take the in breath... and if I block it off it will persist with its in breath... this is the biggest problem I am having. The length of out breath is 'cut off' but the machine's in breath cycle (sorry for lack of precise language).

But I will experiment with the comfort settings tomorrow and give it another go... you may be spot on about that!

Thanks so much.