Ok .. here is my first question. After reading a bit on this forum (and links provided) it seems that complex sleep apnea is not something that is being treated yet. But I was told that this machine I have is designed to treat this combination of centralized and obstructive (which is what I have). It is funny though, I don't know if I showed signs of centralized during my first study (without a machine)... I'll have to check on that.
Anyway, I am wondering if this machine I have: Respironics BiPaP S/T is the real deal for this disorder ... or are they just 'treading water' until they develop something else. I just got this machine, and actually had to wait because (they said) this machine was so new. Truthfully, I felt great the first couple days I used it .... then I got a chest cold and now I keep waking up feeling like the machine is cutting short my breaths (I am trying to inhale when the machine is trying to make me exhale).
Gee, this is fun. But seriously, the first night I wore this machine .. I actually had dreams that were 'not' panic or nightmare filled. Imagine that.
Anyway, I read some of that 14 page thread but am hoping some of you can bring me up to speed about my disorder and the machine I'm using. I'm puzzled because the techs/Docs etc acted like this combo of centralized and obstructive was no big deal, yet the lit I read on this forum/online tells me that the medical community is not yet up to speed on treatment for compex sleep apnea (which I assume simply means having C and O SA).
Am I missing something here?
Thanx,
Brian
complex sleep apnea and BiPaP use.
I have one of these machines (Bipap S/T Gray Model).
It is designed to treat mixed apnea. The way it does this is by having what is known as 'Timed' mode (The T in the S/T).
The Timed mode relies on there being at least a 4cms gap between inhale pressure and exhale pressure. How this gap helps is this ...
1) You exhale (machine is in epap mode)
2) You inhale (machine flips to ipap mode)
The epap CMS setting is considered to be the min pressure needed to keep your airway open for obstructive apneas.
The ipap CMS setting is higher & intended to be high enough to clear other symptoms (snoring, flow limitations, etc:)
3) If you exhale & fail to inhale the S/T models have a 'Backup Breathing Rate' that can kick in to flip the machine from epap mode to ipap mode thus allowing for the difference between epap & ipap CMS (usually a min of 4) the switch from epap to ipap mode is enough to overcome the central and trigger a new inhale cycle.
The Bipap S/T model differs from the other 2 key brands (PB330 A/C & VPAP III S/T) in a few ways. One way it differs is in a feature called 'AUTO-TRAK' this feature is supposed to detect the difference between a leak and normal breathing. In normal circumstances this works well but if people have difficulty breathing through their nose (cold, limited nasal air flow or other reason) the Bipap S/T seems to attempt to trigger the switch from one mode to the other to early. This has been my experience but others who have better nose air-flow may well not experience what I have.
A number of people here have commented on experiencing this early flipping over the past year or so.
I had planned to use my Bipap S/T as my primary bilevel but had so much difficulty with this early 'flipping' that I reverted to my PB330.
The VPAP III doesn't seem to have this early flipping problem. (pity the blower is so noisy (varying whine) else it would be my #1 machine).
The Bipap Pro 2 also does does this. Both the Bipap Pro 2 and the Bipap S/T (gray model) have the same software and AUTO-TRAK feature. The Synchrony S/T model appears to be different & I have not had the opportunity to trial the Synchrony S/T so can't say it behaves the same. I trialled one new & one used Bipap Pro 2 & experienced this same early flipping phenomenon. I tried all the variations of setting on the machines - none improved this issue for me.
Hope this experience from this user helps in understanding how these may work.
DSM
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, auto
It is designed to treat mixed apnea. The way it does this is by having what is known as 'Timed' mode (The T in the S/T).
The Timed mode relies on there being at least a 4cms gap between inhale pressure and exhale pressure. How this gap helps is this ...
1) You exhale (machine is in epap mode)
2) You inhale (machine flips to ipap mode)
The epap CMS setting is considered to be the min pressure needed to keep your airway open for obstructive apneas.
The ipap CMS setting is higher & intended to be high enough to clear other symptoms (snoring, flow limitations, etc:)
3) If you exhale & fail to inhale the S/T models have a 'Backup Breathing Rate' that can kick in to flip the machine from epap mode to ipap mode thus allowing for the difference between epap & ipap CMS (usually a min of 4) the switch from epap to ipap mode is enough to overcome the central and trigger a new inhale cycle.
The Bipap S/T model differs from the other 2 key brands (PB330 A/C & VPAP III S/T) in a few ways. One way it differs is in a feature called 'AUTO-TRAK' this feature is supposed to detect the difference between a leak and normal breathing. In normal circumstances this works well but if people have difficulty breathing through their nose (cold, limited nasal air flow or other reason) the Bipap S/T seems to attempt to trigger the switch from one mode to the other to early. This has been my experience but others who have better nose air-flow may well not experience what I have.
A number of people here have commented on experiencing this early flipping over the past year or so.
I had planned to use my Bipap S/T as my primary bilevel but had so much difficulty with this early 'flipping' that I reverted to my PB330.
The VPAP III doesn't seem to have this early flipping problem. (pity the blower is so noisy (varying whine) else it would be my #1 machine).
The Bipap Pro 2 also does does this. Both the Bipap Pro 2 and the Bipap S/T (gray model) have the same software and AUTO-TRAK feature. The Synchrony S/T model appears to be different & I have not had the opportunity to trial the Synchrony S/T so can't say it behaves the same. I trialled one new & one used Bipap Pro 2 & experienced this same early flipping phenomenon. I tried all the variations of setting on the machines - none improved this issue for me.
Hope this experience from this user helps in understanding how these may work.
DSM
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, auto
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
Please read the info again. It is my impression that "comlex sleep disordered breathing" and "mixed apnea" are not the same thing. You seem to have mixed sleep apnea - a mixture of central and obstructive sleep apnea.
O.
O.
_________________
| Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
| Additional Comments: Machine: Resmed AirSense10 for Her with Climateline heated hose ; alternating masks. |
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kinnerstreet
- Posts: 5
- Joined: Sat Oct 14, 2006 1:25 am
Sorry if I seem stupid .. but I am not experienced with this stuff.
What do you mean by "CMS"?
Are you saying that the problem is with the "rise" time? I can overcome the "cutting off" feeling by lengthening my IPAP time from 1 sec to 1.5 secs. However, for some reason this seems to cause me to have more central (I think) apneas. I know when I have a bad apnea (I assume it is centralized) because I wake up feeling dizzy and like my body is in a panic ... vibration feeling from head to toe etc. I know this sounds weird .. but it's true. Anyway, please elaborate on what you are saying. It seems to make sense but I am having some difficulty understanding what you are saying eactly. I'm not totally stupid (I have an MS and I teach science ... lol) but I am very naive when it comes to this area. Thanx so much.
Brian
What do you mean by "CMS"?
Are you saying that the problem is with the "rise" time? I can overcome the "cutting off" feeling by lengthening my IPAP time from 1 sec to 1.5 secs. However, for some reason this seems to cause me to have more central (I think) apneas. I know when I have a bad apnea (I assume it is centralized) because I wake up feeling dizzy and like my body is in a panic ... vibration feeling from head to toe etc. I know this sounds weird .. but it's true. Anyway, please elaborate on what you are saying. It seems to make sense but I am having some difficulty understanding what you are saying eactly. I'm not totally stupid (I have an MS and I teach science ... lol) but I am very naive when it comes to this area. Thanx so much.
Brian
dsm wrote:I have one of these machines (Bipap S/T Gray Model).
It is designed to treat mixed apnea. The way it does this is by having what is known as 'Timed' mode (The T in the S/T).
The Timed mode relies on there being at least a 4cms gap between inhale pressure and exhale pressure. How this gap helps is this ...
1) You exhale (machine is in epap mode)
2) You inhale (machine flips to ipap mode)
The epap CMS setting is considered to be the min pressure needed to keep your airway open for obstructive apneas.
The ipap CMS setting is higher & intended to be high enough to clear other symptoms (snoring, flow limitations, etc:)
3) If you exhale & fail to inhale the S/T models have a 'Backup Breathing Rate' that can kick in to flip the machine from epap mode to ipap mode thus allowing for the difference between epap & ipap CMS (usually a min of 4) the switch from epap to ipap mode is enough to overcome the central and trigger a new inhale cycle.
The Bipap S/T model differs from the other 2 key brands (PB330 A/C & VPAP III S/T) in a few ways. One way it differs is in a feature called 'AUTO-TRAK' this feature is supposed to detect the difference between a leak and normal breathing. In normal circumstances this works well but if people have difficulty breathing through their nose (cold, limited nasal air flow or other reason) the Bipap S/T seems to attempt to trigger the switch from one mode to the other to early. This has been my experience but others who have better nose air-flow may well not experience what I have.
A number of people here have commented on experiencing this early flipping over the past year or so.
I had planned to use my Bipap S/T as my primary bilevel but had so much difficulty with this early 'flipping' that I reverted to my PB330.
The VPAP III doesn't seem to have this early flipping problem. (pity the blower is so noisy (varying whine) else it would be my #1 machine).
The Bipap Pro 2 also does does this. Both the Bipap Pro 2 and the Bipap S/T (gray model) have the same software and AUTO-TRAK feature. The Synchrony S/T model appears to be different & I have not had the opportunity to trial the Synchrony S/T so can't say it behaves the same. I trialled one new & one used Bipap Pro 2 & experienced this same early flipping phenomenon. I tried all the variations of setting on the machines - none improved this issue for me.
Hope this experience from this user helps in understanding how these may work.
DSM
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, auto
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, auto
-
rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
I agree with ozij. It's also my understanding that "Complex Sleep Disordered Breathing" (CSDB) does not mean "a mixture of central and obstructive sleep apnea."
To oversimply way too much, CSDB has to do with carbon dioxide (C02) levels and the way that effects some people's respiration. Some need a higher level of C02 in order to allow cpap treatment to work properly.
That's not to be confused with pure CSA (Central Sleep Apnea) nor with a study having turned up "mixed" apnea -- some centrals and some obstructives. The type of machine you were prescribed -- a machine with timed backup rate capability -- is what is used generally to try to treat pure CSA as well as mixed sleep apnea IF there were a great many centrals in the "mix."
The "S" (spontaneous) lets you be the driver, and the "T" (timed, if enabled) delivers a "timed" rate of backup breaths if the machine calculates that your spontaneous breathing rate is not going to be "enough" breaths per minute or if your breathing pauses too long.
It can take quite a bit of tweaking to get all the settings right so that any bi-level (particularly an ST type of machine using a timed backup rate) doesn't feel like it's fighting you at times. One brand of bi-level machine, (not just the ST types) might gee and haw better for some people than another in certain circumstances, as was dsm's experience when he used a Full Face mask with several brands. But for most people it's a matter of getting the settings fixed optimally. And for most, using any bi-level machine is extremely smooth and comfortable.
The person who sets up a bi-level machine may or may not take the time to do that well, or even know what some of the "comfort" settings do. Even with optimal settings there can be times that any bi-level, especially one set for timed backup breaths, could feel out of sync. Congestion, mask issues, leaks... those things can very much affect any kind of cpap treatment, and even more so with sophisticated machines like bi-levels and auto-titrating cpaps.
I may be describing all that poorly. I'm not a doctor or anything in the health care field. But yes, if you had a significant number of centrals within the "mixed sleep apnea" diagnosis they gave you, an "ST" machine is what would usually be prescribed.
As for the machine you read about in the very long thread... Jul 22, 2006 subject: Resmed VPAP Adapt SV - for Central Sleep Apnea
It was originally developed to treat a very specific type of breathing pattern called Cheyne-Stokes Respiration which is often associated with Congestive Heart Failure patients.
Despite this...
resmed's sweeping marketing claim
"VPAP Adapt SV is an adaptive-servo ventilator designed specifically to treat central sleep apnea (CSA) in all its forms, including complex and mixed sleep apnea."
I believe the jury is still very much out regarding how effective the VPAP ASV can be, at present, in treating central sleep apnea in ALL its forms. It can certainly dramatically normalize a particular very specific type of breathing -- Cheyne-Stokes respiration, and breathe new life (pun intended) into people suffering from sleep disordered breathing associated with Congestive Heart Failure.
To oversimply way too much, CSDB has to do with carbon dioxide (C02) levels and the way that effects some people's respiration. Some need a higher level of C02 in order to allow cpap treatment to work properly.
That's not to be confused with pure CSA (Central Sleep Apnea) nor with a study having turned up "mixed" apnea -- some centrals and some obstructives. The type of machine you were prescribed -- a machine with timed backup rate capability -- is what is used generally to try to treat pure CSA as well as mixed sleep apnea IF there were a great many centrals in the "mix."
The "S" (spontaneous) lets you be the driver, and the "T" (timed, if enabled) delivers a "timed" rate of backup breaths if the machine calculates that your spontaneous breathing rate is not going to be "enough" breaths per minute or if your breathing pauses too long.
It can take quite a bit of tweaking to get all the settings right so that any bi-level (particularly an ST type of machine using a timed backup rate) doesn't feel like it's fighting you at times. One brand of bi-level machine, (not just the ST types) might gee and haw better for some people than another in certain circumstances, as was dsm's experience when he used a Full Face mask with several brands. But for most people it's a matter of getting the settings fixed optimally. And for most, using any bi-level machine is extremely smooth and comfortable.
The person who sets up a bi-level machine may or may not take the time to do that well, or even know what some of the "comfort" settings do. Even with optimal settings there can be times that any bi-level, especially one set for timed backup breaths, could feel out of sync. Congestion, mask issues, leaks... those things can very much affect any kind of cpap treatment, and even more so with sophisticated machines like bi-levels and auto-titrating cpaps.
I may be describing all that poorly. I'm not a doctor or anything in the health care field. But yes, if you had a significant number of centrals within the "mixed sleep apnea" diagnosis they gave you, an "ST" machine is what would usually be prescribed.
As for the machine you read about in the very long thread... Jul 22, 2006 subject: Resmed VPAP Adapt SV - for Central Sleep Apnea
It was originally developed to treat a very specific type of breathing pattern called Cheyne-Stokes Respiration which is often associated with Congestive Heart Failure patients.
Despite this...
resmed's sweeping marketing claim
"VPAP Adapt SV is an adaptive-servo ventilator designed specifically to treat central sleep apnea (CSA) in all its forms, including complex and mixed sleep apnea."
I believe the jury is still very much out regarding how effective the VPAP ASV can be, at present, in treating central sleep apnea in ALL its forms. It can certainly dramatically normalize a particular very specific type of breathing -- Cheyne-Stokes respiration, and breathe new life (pun intended) into people suffering from sleep disordered breathing associated with Congestive Heart Failure.
ResMed S9 VPAP Auto (ASV)
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
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rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
Yeah, message board shorthand is confusing to follow at first.
cm or cm's - message board shorthand for talking about a pressure setting.
10 cm H20 - the amount of air pressure it takes to raise a column of water 10 centimeters.
cm or cm's - message board shorthand for talking about a pressure setting.
10 cm H20 - the amount of air pressure it takes to raise a column of water 10 centimeters.
ResMed S9 VPAP Auto (ASV)
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
Hi Brian,Are you saying that the problem is with the "rise" time? I can overcome the "cutting off" feeling by lengthening my IPAP time from 1 sec to 1.5 secs. However, for some reason this seems to cause me to have more central (I think) apneas. I know when I have a bad apnea (I assume it is centralized) because I wake up feeling dizzy and like my body is in a panic ... vibration feeling from head to toe etc. I know this sounds weird .. but it's true. Anyway, please elaborate on what you are saying. It seems to make sense but I am having some difficulty understanding what you are saying eactly. I'm not totally stupid (I have an MS and I teach science ... lol) but I am very naive when it comes to this area. Thanx so much.
I don't recall mentioning rise time ?
Re your symptoms. You really need the advice of a good respiratory physician. You are very very brave to come here and imagine we humble plebs will provide you with complex professionl advice
Most you will get here is how these things work & how to use panty hose & fisihing line to fix masks
Good luck
DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
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StillAnotherGuest
- Posts: 1005
- Joined: Sun Sep 24, 2006 6:43 pm
Mixed Apnea
In reading the above posts on "mixed apnea" it seems to suggest that the presence of both central and obstructive apneas constitutes a "mixed" picture. And while I suppose this is not technically an incorrect assessment, the term "mixed apnea" is generally reserved for a specific type of apnea. It is traditionally described as an apnea that starts out central and then becomes obstructive in nature. They look like this:
The second mixed apnea looks to be a good example. You can see that the chest and abdominal effort starts about halfway through the event. Of interest is the "sum" channel, which represents the addition of the chest and abdominal efforts. Since it is flat during the obstructive portion of the mixed apnea, it is clear that the efforts are paradoxical, and therefore obstructive in nature.
It's probably better conceptually (and realistically) to consider that a mixed apnea starts out as both obstructive and central. The airway is probably closed, but this is not fully realized until effort brings it to the forefront.
SAG
The second mixed apnea looks to be a good example. You can see that the chest and abdominal effort starts about halfway through the event. Of interest is the "sum" channel, which represents the addition of the chest and abdominal efforts. Since it is flat during the obstructive portion of the mixed apnea, it is clear that the efforts are paradoxical, and therefore obstructive in nature.
It's probably better conceptually (and realistically) to consider that a mixed apnea starts out as both obstructive and central. The airway is probably closed, but this is not fully realized until effort brings it to the forefront.
SAG
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Guest
SAG,
Just to clarify, (attempting to restate your words in a way that helps me comprehend) Am I right is saying that the evidence of the difference
is that at the end of the 1st mixed apnea, there is a 'large' effort shown in the 'sum' data of abdomen & rib lines & that doesn't how after the central.
The point being that the 1st episode started out as a central but became obstructive (evidenced by the effort required to breath again).
The second just shows the patient recommencing the breathing effort with out difficulty.
DSM
Just to clarify, (attempting to restate your words in a way that helps me comprehend) Am I right is saying that the evidence of the difference
is that at the end of the 1st mixed apnea, there is a 'large' effort shown in the 'sum' data of abdomen & rib lines & that doesn't how after the central.
The point being that the 1st episode started out as a central but became obstructive (evidenced by the effort required to breath again).
The second just shows the patient recommencing the breathing effort with out difficulty.
DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
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rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
Thanks soooo much for taking this, SAG.
I really appreciate your clearing up my misconception of what "mixed" apneas are.
Cool histogram. You're a good teacher. Thank you!
I really appreciate your clearing up my misconception of what "mixed" apneas are.
Cool histogram. You're a good teacher. Thank you!
ResMed S9 VPAP Auto (ASV)
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
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kinnerstreet
- Posts: 5
- Joined: Sat Oct 14, 2006 1:25 am
Thanx for all the clarifications. I am learning more as I read your posts and reflect on what I've read. Thank you very much for clearing up my confusion re: the difference between mixed and complex. I don't fully understand the intricacies but I now know that there is a difference and this is all I need to know at this point. I think it is terrific that there are folks out there who are able to explain this stuff (the sleep lab and home peeps didn't seem to understand either my questions, or their own answers - they first described Rise time as the time right before I exhaled... that totally lost me).
I seem to be having fewer problems now that my chest cold is clearing up, but still feel more comfortable setting my IPAP to 1.5 seconds (the original Rx had it at 1 sec) I get concerned though, because I 'believe' that I may be more susceptible to central episodes with a longer IPAP. I don't know yet.
The thing that does puzzle me though is this: the machine is set at 16 breaths per minute. If the machine has IPAP and EPAP set to function within those parameters and it allows a certain amount of time for inhale and exhale (IPAP = 1 sec and Rise = 2 secs) how can I change the IPAP and still only be taking 16 breaths a minute. I mean: if it gives me 1 second to inhale and 2 seconds to exhale and it divides that up over 16 breaths (assuming this divides out evenly) how can any change in the IPAP etc still maintain within a 16 breath per minute parameter?
Sorry again for my lack of understanding.
Brian
I seem to be having fewer problems now that my chest cold is clearing up, but still feel more comfortable setting my IPAP to 1.5 seconds (the original Rx had it at 1 sec) I get concerned though, because I 'believe' that I may be more susceptible to central episodes with a longer IPAP. I don't know yet.
The thing that does puzzle me though is this: the machine is set at 16 breaths per minute. If the machine has IPAP and EPAP set to function within those parameters and it allows a certain amount of time for inhale and exhale (IPAP = 1 sec and Rise = 2 secs) how can I change the IPAP and still only be taking 16 breaths a minute. I mean: if it gives me 1 second to inhale and 2 seconds to exhale and it divides that up over 16 breaths (assuming this divides out evenly) how can any change in the IPAP etc still maintain within a 16 breath per minute parameter?
Sorry again for my lack of understanding.
Brian
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Guest
Brian
There is a lot to be confused about with these machines. The best person to explain this level of intricay is someone like FrequenSeeker - very good understanding of ipap duration times etc:
But this is the little that I know ...
- The ipap duration is a 'maximum' and not an absolute. When I set up my Bipap S/T I set it as follows (based on advice from other helpful here at cpaptalk) ...
-BPM 12
-INSP 2.5s (maximum duration of inspiration time - machine actually follows your breathing but will flip after this time if you haven't already done so spontaneously)
- RISE TIME 3 (this is a conmfort factor based on how the flip feels)
Now based just on what you have posted here, it seems to me someone has set your INSP to to short a period.
The BPM of 12 (or in your case 16) is the back up breathing rate. This is what the machine is looking for as the minimum rate to sustain.
My own problem with this machine relates to my constant nasal restriction which means I tend to take very long breaths through my nose exacerbated if I have a cold or sinus problems which in turn can be further exacerbated by a GERD flare up (but I usually have the GERD under control with 'pariet').
Some machines work better with people who have restricted nasal airflow.
If I mouth breath with this machine it works exactly as hoped.
But getting back to your settings. My semi educated (IANAD) guess is that 1.5 INSP is just too small. Also, perhaps 16 BPM is to fast!.
Cheers
DSM
(IANAD = I Am Not A Doctor)
There is a lot to be confused about with these machines. The best person to explain this level of intricay is someone like FrequenSeeker - very good understanding of ipap duration times etc:
But this is the little that I know ...
- The ipap duration is a 'maximum' and not an absolute. When I set up my Bipap S/T I set it as follows (based on advice from other helpful here at cpaptalk) ...
-BPM 12
-INSP 2.5s (maximum duration of inspiration time - machine actually follows your breathing but will flip after this time if you haven't already done so spontaneously)
- RISE TIME 3 (this is a conmfort factor based on how the flip feels)
Now based just on what you have posted here, it seems to me someone has set your INSP to to short a period.
The BPM of 12 (or in your case 16) is the back up breathing rate. This is what the machine is looking for as the minimum rate to sustain.
My own problem with this machine relates to my constant nasal restriction which means I tend to take very long breaths through my nose exacerbated if I have a cold or sinus problems which in turn can be further exacerbated by a GERD flare up (but I usually have the GERD under control with 'pariet').
Some machines work better with people who have restricted nasal airflow.
If I mouth breath with this machine it works exactly as hoped.
But getting back to your settings. My semi educated (IANAD) guess is that 1.5 INSP is just too small. Also, perhaps 16 BPM is to fast!.
Cheers
DSM
(IANAD = I Am Not A Doctor)
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StillAnotherGuest
- Posts: 1005
- Joined: Sun Sep 24, 2006 6:43 pm
On Rise Times &c
Perhaps a better starting point would be to ask what the heck it is you're trying to fix. In your opening comment, you said
Rise time is discussed in this thread:
Rise Time in the Synchrony S/T
Where it is noted:
While changing rise time on BiPAP machines may give you a feeling of additional comfort while you are awake, the effect it has on breathing while you're sleeping may be something you don't necessarily want. Keeping in mind that the BiPAP S/T is designed primarily to address respiratory failure, sleep apnea as a hobby, and two kinds (at least) of sleep apnea at that, not all adjustments are interchangeable.
To illustrate this, here's a range of rise time settings (1, 3, and 6) for a Respironics Synchrony BiPAP S/T. The Inspiratory Time is set at 3.0 seconds (a little long, but it'll show the effect a little more clearly) and it is allowed to trigger in the Timed Mode.
The effect of rise time is to gradually increase the pressure over period of time. Feels comfortable, yes, but reduces the time spent at peak (effective therapeutic) pressure. If you're using this to overcome the effect of hypopneas, this may not be an issue.
If you're using it to address central apneas, however, a change in rise time could significantly change the effect of trying to generate a reasonable facsimile of a normal breath. Using BiPAP in this case is trying to create a volume breath, and the volume delivered is based on the flow rate times the duration of flow. By prolonging rise time, flow rate is reduced for a significant portion of the breath, resulting in a lower tidal volume (the infamous "area under the curve" concept).
Using BiPAP to overcome central apnea is frequently not completely effective. Adding a lengthy rise time may further compromise the ability of the machine to treat CSA.
BiPAP can be used to address obstructive events, in which case it is used chiefly as a comfort measure (especially if the baseline CPAP requirement is over about 13 cmH2O).
BiPAP S/T can be used to address central events (also respiratory failure, but let's skip that for now). In this case, one of the chief goals is to control pCO2 (usually to try to get it a little bit higher, as contradictory as that sounds). Long inspiratory times, high rates, and rapid rise times are all contrary to that goal.
If that's what your goal is.
SAG
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap, CPAP, CSA
And getting all the way up to BiPAP in S/T Mode if you didn't have any central or mixed apneas on diagnostic opens up a whole new discussion. You might want to investigate that before you wing them dials around too much.kinnerstreet wrote:It is funny though, I don't know if I showed signs of centralized during my first study (without a machine)... I'll have to check on that.
Rise time is discussed in this thread:
Rise Time in the Synchrony S/T
Where it is noted:
While changing rise time on BiPAP machines may give you a feeling of additional comfort while you are awake, the effect it has on breathing while you're sleeping may be something you don't necessarily want. Keeping in mind that the BiPAP S/T is designed primarily to address respiratory failure, sleep apnea as a hobby, and two kinds (at least) of sleep apnea at that, not all adjustments are interchangeable.
To illustrate this, here's a range of rise time settings (1, 3, and 6) for a Respironics Synchrony BiPAP S/T. The Inspiratory Time is set at 3.0 seconds (a little long, but it'll show the effect a little more clearly) and it is allowed to trigger in the Timed Mode.
The effect of rise time is to gradually increase the pressure over period of time. Feels comfortable, yes, but reduces the time spent at peak (effective therapeutic) pressure. If you're using this to overcome the effect of hypopneas, this may not be an issue.
If you're using it to address central apneas, however, a change in rise time could significantly change the effect of trying to generate a reasonable facsimile of a normal breath. Using BiPAP in this case is trying to create a volume breath, and the volume delivered is based on the flow rate times the duration of flow. By prolonging rise time, flow rate is reduced for a significant portion of the breath, resulting in a lower tidal volume (the infamous "area under the curve" concept).
Using BiPAP to overcome central apnea is frequently not completely effective. Adding a lengthy rise time may further compromise the ability of the machine to treat CSA.
BiPAP can be used to address obstructive events, in which case it is used chiefly as a comfort measure (especially if the baseline CPAP requirement is over about 13 cmH2O).
BiPAP S/T can be used to address central events (also respiratory failure, but let's skip that for now). In this case, one of the chief goals is to control pCO2 (usually to try to get it a little bit higher, as contradictory as that sounds). Long inspiratory times, high rates, and rapid rise times are all contrary to that goal.
If that's what your goal is.
SAG
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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap, CPAP, CSA