Question - Don't Know If Anyone Knows

[Madalot]

It is now 2:42 AM for me and I'm up, after being asleep (on the vent & oxygen) for about two hours.

I woke up, on my SIDE, with the ventilator pulsing at me rapidly. I waited for a second to make sure I wasn't sleep in a sleep fog, but I wasn't. I turned over as quickly as I could and turned off the screen saver. Sure enough, the ventilator was pulsing at me at my maximum IPAP (23). I was now wide awake and trying to breathe normally (for me anyway) and the ventilator was freaking out, pulsing at the allowed maximum IPAP.

I sat up and watched for a second or two, but it was too hard to breathe so I turned it off.

This happened once before last year and the DME thought it was a machine malfunction, but I don't believe so. Plus, this is a different unit.

Any thoughts about this?

[Breathe Jimbo]

Do you have data on your machine?

[Madalot]

Do you have data on your machine?

Oh yeah, there's data, but I can't get the software for it. This is a Respironics Trilogy 100 Ventilator. We've discussed it numerous times since I've gotten in and the software just isn't available to patients.

I will probably ask my DME & RT if nobody here comes up with a viable explanation. See if they can figure out what went on.

[Madalot]

Well, I think I'm going to go back to bed and give this another try. I'll also check the Event Log on the vent and see if anything was put there to explain this. But I'll check back in the morning sometime and see if anybody has any ideas.

[HoseCrusher]

I love to speculate and since you asked...

Keep in mind that this may be more of a apples and tomatoes comparison, but they both are kind of round.

When I started xPAP therapy my machine was set to APAP with the pressure set to 5 - 20. I woke up several times with the machine blowing full pressure and it did not want to go down. I would shut it off and then it would reset.

After this "less than perfectly restful" first night, I changed the machine to CPAP and adjusted my pressure to insure that I had no oxygen desaturation below 90%, and to minimize my AHI number.

I arrived at a pressure of 11.6, and after further monitoring have upped that to 12. Since this is much lower than the full pressure of the machine, a jump to full pressure wakes me up.

In an effort to duplicate the problem and to further check on my pressure, I periodically switch over to APAP for a night or two. It is difficult to know what goes on when you are sleeping, but the best guess I have is that the machine notices that I may have created a leak while rolling over and it tries to compensate for the leak.

To check this I have put on the mask while awake and created a leak and held my breath. Sure enough, the machine ramped up. When the leak was removed and my breathing returned to normal, it took a long time for the machine to reduce the pressure.

With the machine set to a fixed pressure I don't have this problem.

My situation is much different than yours, but there may be something in this that can help you figure out what is going on.

[builta]

Hi,

If the machine is "acting up" then try pressing ramp. That should settle it down and let it recover. I have found that mask leaks can cause my unit to sometimes just go off into "Never Never" land. I used ramp to stop the crazies and have over time adjusted both my mask's head grar tension and limited EPAP max so that I don't have those "blast off" events.

Cheers

[Madalot]

I love to speculate and since you asked...

Keep in mind that this may be more of a apples and tomatoes comparison, but they both are kind of round.

LOL -- You're funny. Thank you.

Leaks are an interesting theory. I can't rule it out, but CAN say I was SOUND asleep when this happened and when I got turned over and got the screen saver off, the leak rate was fine.

I DID check the Event Log before I laid back down and there was NOTHING listed except the power on and power off events.

I DO know that I was told, by Respironics, that when the ventilator ramps up high, for whatever reason, it takes quite a while for it to back the pressure back down. Going from 23 down to 14, two tenths at a time, takes a long time. I could deal with it if it allowed me to breathe at MY regular rate, but it won't. It pulses those high pressures rapidly and it is NOT a comfortable feeling.

Hi,

If the machine is "acting up" then try pressing ramp. That should settle it down and let it recover. I have found that mask leaks can cause my unit to sometimes just go off into "Never Never" land. I used ramp to stop the crazies and have over time adjusted both may mask and limited EPAP max so that I don't have those "blast off" events.

I could do this, but we don't use the ramp on my machine at all. I think that turning it off and back on is probably just as easy. I think, though, that this is a problem with me more than the machine.

[aguest]

I don't know if this applies but my old cpap auto would "run away" with pressure on the few occasions that my pillow (side-sleeper) blocked the vent. Not a comfortable situation!

[Madalot]

I don't know if this applies but my old cpap auto would "run away" with pressure on the few occasions that my pillow (side-sleeper) blocked the vent. Not a comfortable situation!

This is an interesting thought. I frequently put my hand under my head & cheek and I guess it's possible that I moved and blocked the exhaust vent.

I know I woke up and felt the high pressure and my mask was also "pulsing" on my face. It took me a few seconds to fully wake up to know what was happening.

This is something I will be watching for IF this occurs again. Thanks.

[Madalot]

I know this is hard to understand, but envision this:

You have this equipment set up with EPAP at 6 and an IPAP that can go from 14-23, with the average being around 14-15, sometimes 17-19. You have a nice, slow breath rate of 7. While relaxing to fall asleep and while asleep, this is a nice, easy pattern of breathing -- in and out, in and out -- no problem.

You wake up at 2:30 in the morning with the machine going from 6-23 about every 2 seconds -- imagine that. Your mask is pulsing off your face and you cannot breathe fast enough, or deeply enough, to keep up with the machine. You wake up going "what the hell???" You have an idea what's happening because you can feel it and check the machine and sure enough -- the bar showing the pressure is going rapidly, pulsing from 6-23. You sit up and watch and try to breathe regularly but there's just no way you can -- the machine won't allow it.

I don't have the Ramp set up because I don't use it. My only choice was to shut the machine down completely. But going back to sleep right away after that just wasn't going to happen. I was almost hyperventilating at that point.

Assuming the machine is NOT malfunctioning -- what on earth would cause it to do that? Would blocking the "exhaust" port cause this type of thing?

[archangle]

I don't know how relevant it is to your particular problem, but whenever a computer controlled device has an episode of strange behavior, turn it off and unplug the power for several minutes. It's cheap and sometimes it helps.

[Madalot]

I don't know how relevant it is to your particular problem, but whenever a computer controlled device has an episode of strange behavior, turn it off and unplug the power for several minutes. It's cheap and sometimes it helps.

If I could get a firm answer, from anyone that would know, that it's simply a machine SNAFU and not the machine responding to something with me, I'd be okay with it. But if something went haywire with me and that's the only thing the machine could do in response, I have a big problem with it.

[HoseCrusher]

OK, that's different. In my case the pressure went to the maximum then started to gradually drop. In your case the pressure is pulsating.

Perhaps your machine is dreaming of being on a hot date and just is going wild with anticipation...

Another thought is that the machine may think you are "dead" and is trying to get your attention. However, that seems unlikely because it should score some kind of event when that happens.

OK, throw those out.

How about this? Is it possible to set the IPAP to a fixed pressure? Perhaps you have already tried that...

The breath rate is interesting. While awake and during rest the breath rate slows way down. While sleeping, it seems that you take shallow breaths and the breath rate increases.

How about this idea...? This idea may actually be useful...

At 2:30 you aroused from a deeper sleep stage. Being "near wake" you altered your breath rate from the normal 15 breaths per minute closer to your waking rate of 7 breaths per minute. The machine thinks something is wrong and increases the pressure to compensate, but keeps your sleeping breath rate.

In re-reading this, it actually makes some sense. It explains the machine behavior, but it doesn't address what woke you up at 2:30 in the morning.

Perhaps you are dreaming of the first hot date with your hubby...

[Madalot]

I need to clarify what is actually happening with my breathing rate. On the Respironics Trilogy, what is commonly called "Backup Rate" is referred to as "Breath Rate."

When I first get masked up and turn the machine on, it lists my Respiratory Rate and after moving around and getting settled in bed, it's usually somewhere between 16-20. It drops fast once I relax and try to fall asleep. It's usually down to 10-12 within a few minutes and if I check it after a few more minutes, it can be as low as 8.

The Breath Rate (Backup Rate) of 7 is to ensure that I don't drop below that. If I don't inhale on my own enough to maintain a Respiratory Rate of 7, the machine will force an inhale on me, thus giving me a breath.

The machine does not care if I breathe FASTER than 7 BPM. There is a bar showing pressure on every inhalation. A blue/green dot displays when I initiate the breath - no dot if it is machine generated.

The way I'm figuring it, what happened last night was forcing breaths on me at a rate of approximately 30 BPM, a level I can't maintain when awake and moving around, let alone when I'm trying to sleep.

Does this make more sense?

This is where it would be SO nice to have the software or at least the ability to get a download from that point last night. I would love to know what happened, if anything with me, that caused that machine to think I needed to breathe that fast. It makes no sense to me. Unless the machine thought I was dead because I refused to breathe at all.

[Slinky]

I see where the Trilogy requires the Respironics DirectView software. Interesting. An entirely different software than their PAPs.

http://www.healthcare.philips.com/main/ ... efault.wpd