zonker therapy thread redux: in the arms of morpheus

[Pugsy]

I have a massive headache right now.
Give me a bit to go fire up my machine and see what the options are and maybe play with them a bit.

You were using the "soft" response thing on the AutoSet weren't you??? I never had an AutoSet that offered it for me to try that difference. So I never really had a chance to experience how it feels.

Palerider is the one to help if you are feeling your timing of inhale/exhale doesn't match up but you also have to really describe what it is that doesn't feel right to you.

[palerider]

changed trigger and it really didn't offer much relief. i was using medium setting last night. very low doesn't seem that much better.

is there another setting i should try? i see "cycle" has some gradients to it.

"Trigger" is how sensitive the machine is to the start of your inhalation, the higher the trigger, the more sensitive, and the less you have to inhale before the machine goes "oh, right" and switches to IPAP pressure.

Cycle is how sensitive it is to the end of the exhalation, and thus to dropping the pressure back down.

I decided that I liked 'very high' on the trigger, not because of how it felt, but I'd noticed, while looking at my charts very zoomed in, that sometimes before an apnea was flagged, it would look, like I was trying to inhale, but only getting a tiny bit, so I figured "well, maybe if I set the trigger to very high, the machine will catch those sometimes, and my AHI might go down". and it did.

Are you in VAuto mode?

[zonker]

I have a massive headache right now.
Give me a bit to go fire up my machine and see what the options are and maybe play with them a bit.

You were using the "soft" response thing on the AutoSet weren't you??? I never had an AutoSet that offered it for me to try that difference. So I never really had a chance to experience how it feels.

Palerider is the one to help if you are feeling your timing of inhale/exhale doesn't match up but you also have to really describe what it is that doesn't feel right to you.

sorry, i just lost what i typed cuz pr came in and i wanted to see what he said.

please, take care of yourself. this isn't earth shattering and i'd hate to think i'm making your headache worse.

but yeah, "soft response".

[zonker]

"Trigger" is how sensitive the machine is to the start of your inhalation, the higher the trigger, the more sensitive, and the less you have to inhale before the machine goes "oh, right" and switches to IPAP pressure.

Cycle is how sensitive it is to the end of the exhalation, and thus to dropping the pressure back down.

I decided that I liked 'very high' on the trigger, not because of how it felt, but I'd noticed, while looking at my charts very zoomed in, that sometimes before an apnea was flagged, it would look, like I was trying to inhale, but only getting a tiny bit, so I figured "well, maybe if I set the trigger to very high, the machine will catch those sometimes, and my AHI might go down". and it did.

Are you in VAuto mode?

oy. not sure i'm grasping this. but i feel i should have my trigger to very low. not at all sure about cycle, but will try different settings there before i go to bed.

yup definitely in vauto mode.

[palerider]

oy. not sure i'm grasping this. but i feel i should have my trigger to very low. not at all sure about cycle, but will try different settings there before i go to bed.

yup definitely in vauto mode.

So, if your trigger is very low, then you have to inhale more before the machine says "ah, I shall raise the pressure for the inhalation" If that's what you want, then that's the setting you want.

The reason I asked about VAuto mode is that if you're in VAuto, then the machine is set to 'Easy Breathe" mode, where the time it takes for the machine to raise up to full IPAP varies depending on how you're breathing, whereas when Easy Breathe is off, you can manually adjust the rise time (time it takes to go from EPAP to IPAP).

[zonker]

The reason I asked about VAuto mode is that if you're in VAuto, then the machine is set to 'Easy Breathe" mode, where the time it takes for the machine to raise up to full IPAP varies depending on how you're breathing, whereas when Easy Breathe is off, you can manually adjust the rise time (time it takes to go from EPAP to IPAP).

oh, OH, OH!!!

in S mode, "easy breath" mode appears, as if by magic. have selected THAT and will see how she goes tonight.

thanks, my friend.

[Pugsy]

Palerider will correct me if I am wrong but I think that in Auto mode Easy Breathe is on by default and you can't turn it off.
In S mode you can turn Easy Breathe setting off or on...and when it is off additional parameters are offering to change the timing of things.

Never used it though so zero help.

[palerider]

The reason I asked about VAuto mode is that if you're in VAuto, then the machine is set to 'Easy Breathe" mode, where the time it takes for the machine to raise up to full IPAP varies depending on how you're breathing, whereas when Easy Breathe is off, you can manually adjust the rise time (time it takes to go from EPAP to IPAP).

oh, OH, OH!!!

in S mode, "easy breath" mode appears, as if by magic. have selected THAT and will see how she goes tonight.

thanks, my friend.

In VAuto, Easybreathe is always on. in S mode, it's optional.

[palerider]

Palerider will correct me if I am wrong but I think that in Auto mode Easy Breathe is on by default and you can't turn it off.
In S mode you can turn Easy Breathe setting off or on...and when it is off additional parameters are offering to change the timing of things.

Never used it though so zero help.

That's right.

[Pugsy]

The System One Bipaps had a similar function attached to their BiFlex exhale relief.
The Respironics bipaps offered their flex exhale relief in addition to PS...and when you turned BiFlex off then you could set the inhale/exhale thing more to whatever seemed more comfortable. It was tied to some sort of second thing if I remember right. RobySue used her bipap that way...with BiFlex off because she said that the timing with BiFlex off she was able to customize the cycle more to her suiting.
I never messed with it because I was happy with BiFlex set to 2.
I have no idea if that is still how it goes with the DreamStation Bipaps.
Even when I had the System One ASV the 960.....it still offered BiFlex.
Probably the one thing they ever did that ResMed hasn't. Offer additional exhale relief above the simply difference between inhale and exhale.

[babydinosnoreless]

I am so glad you go the vauto zonker. I am learning so much about my machine in the replies to you. .

[zonker]

okay, so....

good, bad and good again.

the good is that i've found out about "easy breathe". i just wish i'd had the good sense to try it out BEFORE i settled in for the night. why? because in going over to S mode, i somehow screwed up my IPAP and EPAP settings. instead of ipap at 25, it was 10. even worse, my epap was 4!!! but i didn't look, i just went to sleep.

one hour later i ripped off the mask because i couldn't breathe with that damned 4. i found out this morning, via oscar, that during that period, i had 4.05 worth of obstructives plus i leaked like a sieve. the rest of the night straightened out after i made some corrections. but it took my addled brain a bit to get the settings where i think i want them.

in the end, after much futzing around, i set back to vauto mode with ipap at 25 and epap at 16.4. i have the cycle set at medium. and i have the trigger set at very low. this felt much better. i was able to breathe naturally and much more peacefully.

now, i see in my earlier post that the trigger setting didn't "offer much relief". i have NO idea why it worked so well in the wee hours of the morning but not during the evening hours. in any event, will keep these settings for now as for seven hrs and 16 min i had 1 oa, 1 hyp and one ca. can certainly live with that.

oh and i guess one more "bad" to put in the pile. while my apnea was well treated for the time after i made corrections, it seems my subconscious mind didn't trust my conscious mind. i kept waking up worse than usual and pretty tired today.

looks like there be a nap in my future.

[Pugsy]

When you changed to S mode which is fixed bilevel pressure you ended up with the default settings (whatever they were) for S mode. You were supposed to change the EPAP. Obviously someone using 16 cm for a long time for EPAP is going to have a major problem with 4 cm EPAP plus whatever the default IPAP might be.
When anyone changes modes they have to set the pressures again to what they want. Auto mode settings won't transfer over to fixed mode. You learned that lesson last night. Same thing would happen if someone had been using fixed mode and want to change to auto mode.

Your brain went to hyperactive mode last night. Least little thing bugged your brain and made you not sleep so great.
That's why I say that sometimes our brains aren't our best friends. Happened to me last night as well. Had major problems going to sleep because the brain would just STFU. I foresee a nap in my future today as well.

You are overthinking this thing and focusing too much on the machine and your breathing. Tell your brain to STFU.

[palerider]

in the end, after much futzing around, i set back to vauto mode with ipap at 25 and epap at 16.4. i have the cycle set at medium. and i have the trigger set at very low. this felt much better. i was able to breathe naturally and much more peacefully.

Those aren't your settings.

now, i see in my earlier post that the trigger setting didn't "offer much relief".

Try setting trigger to high, or very high. trigger settings of low or very low, well, I'm not sure what they're for, since I don't see any recommendations in the titration guide that use low or very low trigger. maybe some cases of obstructive lung disease.

when I say 'those aren't your settings' it's because those settings aren't available in VAuto mode.

In S mode (which is fixed pressure, not auto mode) you have:

EPAP and IPAP. fixed pressures, don't change.

In VAuto mode, you have:
MinEPAP, :lowest pressure you'll have.
PS, pressure added when you start to inhale.
MaxIPAP: highest pressure you might ever get when inhaling.

I feel it's important to keep that in mind, and use the right terms to reduce confusion.

So you may have a MinEPAP of 16.4, MaxIPAP of 25, and some PS.

[zonker]

When you changed to S mode which is fixed bilevel pressure you ended up with the default settings (whatever they were) for S mode.

oh, that's very different then. nevermind.

Your brain went to hyperactive mode last night. Least little thing bugged your brain and made you not sleep so great.

yup. it was trying to save me from myself and failing miserably.

You are overthinking this thing and focusing too much on the machine and your breathing. Tell your brain to STFU.

but i can't really see anyway around this. it's either overthink or not think at all. and i understand that i should just let it be to try to get on with this thing. but i just had a "nap". it wasn't any better than last night.

is there any other adjustments i can make to ease myself into a gentle breathing rhythm that will let me fall easily to sleep?