Questions about ResMed Lumis 150 and IPAP pressure

[larzipan]

Hello

Basically I'm writing here because I'm facing a machine swap and I'm very scared.

I'm currently using a ResMed Vpap ST and currently IPAP is 17, EPAP 4 . My lung capacity at that is around 300-340 (I'm not aware of the units at the moment, sorry. If I had to guess, I'd say ml?). It went up as high as 450 when I tried to breathe really deeply during the test period for the ResMed Lumis 150. Unfortunately I only breathe that deeply when I really concentrate on my breathing which, well, I cannot do when I'm asleep and what in turn causes me to breathe shallower and accumulate CO2.

Also before I get to my questions, I want to point out that I took to my bipap machine rather easily and I've been using them for almost 16 years by now (I think). So when I tried to get used to the Lumis 150 and couldn't, it was really unusual for me. I've never had an issue where a machine I was provided with by my respiratory therapist wasn't absolutely perfect for me before this. Only with masks (but that's a whole different story). Basically I felt like before I got my bipap, sleeping terribly and waking up with a migraine from the CO2, experiencing terrible brain fog for the rest of the day or even two. My therapist really put me down over this and it was rather upsetting because she kept saying the pressures were really high for someone my size (148 cm and 47 kg) and disability (basically scoliosis, but technically spondylocostal dysostosis). I'm scared of the new possible machine I'll be getting this coming week because my VPAP ST's flashing the motor life exceeded message and the Lumis 150 made me fear for my life (hasn't happened in a very long time).

So -

Are my IPAP and EPAP "bad" or uncommon at 17/4 respectively?

Has anyone else had problems with the ResMed Lumis 150 VPAP ST?

(I'm so sorry if this is a double-post. I tried posting but the first one never showed up and then I read the newbie topics, didn't see anything about post confirmations and tried again)

[raisedfist]

Your RT is probably ignorant and does not realize you are using a bi-level device to augment your ventilation, since due to the restrictive nature of your scoliosis, you most assuredly are hypoventilating while you sleep. The pressures you need are the pressures you need. IPAP at 17 and EPAP at 4 is outside of the norm for people on an obstructive sleep apnea forum, but not outside the norm when it comes to people with severe respiratory insufficiency. Pressures required are not due to weight or size necessarily. If you have a stiff chest wall, it requires more pressure support to achieve adequate tidal volumes.

No idea if 17/4 is right for you, but if you don't have obstructive apneas, when it comes to respiratory insufficiency, the old saying is "if you're not ventilating, you're not oxygenating." So that's why RT's often fix ventilation issues before adjusting oxygenation.

You need to be working with a pulmonologist who has experience and manages patients with respiratory insufficiency. Your average sleep doctor or home care RT's are very inadequate in my experience.

[Respiration99]

There's no need to be scared about the change - the newer Aircurve 10 ST and your existing S9 VPAP-ST use very similar algorithms to achieve the same result. It should be a fairly easy matter for the tech configure your new machine with the same settings as the old one, in which case you probably won't notice much (if any) difference. These machines have a lot of settings, apart from just pressure, to ensure your treatment is both effective and comfortable. You might like to get hold of the clinical manual for each so you can compare them.

Manuals here: https://www.apneaboard.com/adjust-cpap- ... tup-manual

S9 VPAP information: https://www.resmed.com/au/en/healthcare ... ivaps.html

Lumis information: https://www.resmed.com/au/en/healthcare ... ap-st.html

[chunkyfrog]

I agree that you need a more experienced doctor.
The one you have could be an idiot.

[larzipan]

Thank you for the replies!!

I do have a very good pulmonologist but I haven't actually discussed my NIV therapy things with her because I figured since the RT was employed by the same clinic, they'd be in contact about my treatment anyway since I present an admittedly complicated case. I think I will be contacting my pulm again now though because I do not want to go through the same thing with my RT again as I did in January. Luckily she should be offering me a new kind of a machine now, not the Lumis 150 (which I guess could have worked if she'd been more attentive to my needs :/ ).

Everything makes so much more sense now too, in reference to hypoventilation (I knew that was happening but never realised there was a term for it) and a stiff chest wall.

I'll find out what kind of a new machine I'll be getting on Wednesday. I think I will also ask my RT to discuss my treatment with my pulmonologist to see if the latter can talk some sense into her in regards to my treatment.

thank you so much, I'll update later on for sure.

[Respiration99]

Luckily she should be offering me a new kind of a machine now, not the Lumis 150 ...

I really don't think the Lumis is a problem - it's effectively the same machine as your VPAP in a different box. However there are a lot of settings that all need to be correct for you to get effective and comfortable treatment. If your VPAP is doing a good job for you, then get the Lumis set up with the exact same settings and you'll be OK. In particular you have to look at:

• Mode (S, ST, T or CPAP)
• Min EPAP, Max IPAP, pressure support
• Trigger and cycle
• Rise time
• Ti control.

All of these settings have to be considered, not just the pressure.

[larzipan]

Luckily she should be offering me a new kind of a machine now, not the Lumis 150 ...

I really don't think the Lumis is a problem - it's effectively the same machine as your VPAP in a different box. However there are a lot of settings that all need to be correct for you to get effective and comfortable treatment. If your VPAP is doing a good job for you, then get the Lumis set up with the exact same settings and you'll be OK. In particular you have to look at:

• Mode (S, ST, T or CPAP)
• Min EPAP, Max IPAP, pressure support
• Trigger and cycle
• Rise time
• Ti control.

All of these settings have to be considered, not just the pressure.

The thing is, my RT allegedly did set it up with the same exact settings, EXCEPT I had severe bouts of hypoventilation on it. I could barely even fall asleep with it because as soon as I stopped concentrating on my breathing, it didn't provide enough support. I'm feeling more and more like I need to have her discuss my treatment plan with my pulmonologist in case she really is treating some sort of sleep apnea which I don't have. I'm baffled at her at this point.

[raisedfist]

The Lumis is more or less the same machine as the one you have, and should in theory have the same modes, settings, and operate in the same fashion. It will require verification that all settings are the same as before; not just the IPAP and EPAP. A lot of the settings on ResMed bi-levels can make a big difference in therapy.

You'll probably want to use your phone camera or write down all your current settings, and then compare that to the Lumus once you have it. And if you don't already know how, we can help you access the clinical menu to very settings/make any changes necessary.

Also, if you have a disease process that changes over time, some of the settings may require adjustment to maintain the same efficacy. I find it best to write down the problems you think you are having with the device, and talk to your medical team about them. Sometimes minor adjustments can make a big difference.