AVAPS-AE on MY Trilogy - Ongoing

[jnk]

. . . I'm wondering if I should put the rate back to a set 7 rather than on Auto. . . .

My guess is yes.

But I sure hope -SWS finds time to look the info in this thread over to provide his much-more-knowledgeable observations.

[Madalot]

. . . I'm wondering if I should put the rate back to a set 7 rather than on Auto. . . .

My guess is yes.

But I sure hope -SWS finds time to look the info in this thread over to provide his much-more-knowledgeable observations.

Thanks, jnk. I hope he does as well, but don't think for a second that your input isn't just as appreciated. Because it is...

[-SWS]

Something isn't quite right since my PTBs took that dive. I'm wondering if I should put the rate back to a set 7 rather than on Auto. Based on your info, that might be a factor. I do remember feeling rushed to inhale several times.

Generally it's a good idea to change one variable at a time, Madalot. That makes it much easier to isolate the effects of each change.

At present, you're not sure if PTB took a nose dive because of auto back-up rate incompatibilities----or if PTB took a nose dive for an altogether different reason or confluence of reasons introduced by multiple changes. If it were me, I would put all settings back the way they were (your baseline)---and then change ONLY the backup rate parameter from 7 to auto. That single-change experiment will tell you if your breathing is presently too ataxic/disorganized for the auto-backup-rate part of the algorithm.

If PTB is fine after implementing that single change, then you can suspect last night's PTB nose-dive was more related to over-ventilation or under-stenting. At that point you might look more closely at the PS and EPAP auto ranges respectively.

P.S. Yes, definitely get your RT in the loop with what you're up to.... please.

[Madalot]

Generally it's a good idea to change one variable at a time, Madalot. That makes it much easier to isolate the effects of each change.

At present, you're not sure if PTB took a nose dive because of auto back-up rate incompatibilities----or if PTB took a nose dive for a particular reason or confluence of reasons introduced by multiple changes. If it were me, I would put all settings back the way they were (your baseline)---and then change ONLY the backup rate parameter from 7 to auto. That single-change experiment will tell you if your breathing is presently too ataxic/disorganized for the auto-backup-rate part of the algorithm.

If PTB is fine after implementing that single change, then you can suspect last night's PTB nose-dive was more related to over-ventilation or under-stenting. At that point you might look more closely at the PS and EPAP auto ranges respectively.

P.S. Yes, definitely get your RT in the loop with what you're up to.... please.

I have an email into her. She knew I was planning on trying this, but we both agreed I should try to get my doctor's okay first. With him being out of the country and my ending up supine so much, I decided to try anyway. While she didn't say she was okay with it, she didn't say she wasn't either.

Here's what I'm thinking. By having those two settings (PS Min & EPAP Min) set the way they were, we had my minimum IPAP at 16 where it should have been at 18. I would also need to set the Rate to 7 to get things back to baseline.

I can make those three changes for tonight and check the data tomorrow.

The only other significant change I made from regular AVAPS setting was upping the maximum IPAP, but I'm not overly concerned as the data indicates the highest it has gotten in the last week is just under 22 (my regular max is 23 and we have it set to 26).

Note: The data from last night showed everything else was within the parameters set forth by my previous doctor (Tidal Volume, Minute Ventilation, etc).

[-SWS]

Your baseline settings are the treatment modality and associated settings you ran to produce these results:

I'm typically at 97% - 99% PTB so 33% is a pretty radical drop.

Ideally each experimental change will affect one variable. That's possible with a backup-rate change from 7 to auto. However, that's not possible when turning on the auto-EPAP range since your IPAP range will fluctuate as well.

Hypothetically you might choose one of these changes tonight, departing from your baseline settings mentioned above: a) change only backup rate from 7 to auto, or b) change EPAP from fixed modality to auto-EPAP modality. If you'd prefer that second experiment, then I'd suggest initially selecting a smaller auto-EPAP range. By starting with a smaller auto-EPAP range, you minimize how much/little change you ALSO impose on the IPAP range.

As I read through this thread later tonight, I'd like to correlate your new settings and results with your baseline settings described in my first sentence above, Madalot. So what were all your AVAPS settings before turning on AVAPS-AE? Please bear with me as I get up to speed...

[Madalot]

-SWS, there is nothing to bear with you on! I am just grateful you're reading and responding.

These are the settings I have been using for the last few months. The beauty of doing this is the dual prescriptions on the Trilogy. The following are still there on the Primary Prescription. The AVAPS-AE is on the SECONDARY Prescription. So, if the AE settings are horrible, a couple switches and I'm back on the regular AVAPS.

Mode: S/T with AVAPS Enabled
Tidal Volume: 400
IPAP Max: 23
IPAP Min: 18
EPAP:9
Breath Rate: 7
Inspiratory Time: 1.5
Trigger Type: Flow Trigger
Flow Trigger Sensitivity: 6
Flow Cycle Sensitivity: 25%
Rise Time: 4
AVAPS Rate: 3
All Alarms Disabled

My last sleep study, they determined that when SUPINE, I need to make the following changes:

Tidal Volume: 440
EPAP: 12
Rate: 9

The problem is those settings are unbearable if I'm sleeping on my side, which is how I always start out. I am flipping to my back, trying to turn over, and getting stuck on my back. Hubby says that when supine, I start snoring and he pokes me to wake me up.

This is the reasoning behind trying the AE settings. Settings low enough to allow me to fall asleep and sleep okay on my side, but will automatically increase if/when I end up on my back, then lower again if/when I get back on my side.

[-SWS]

This post is mainly a reminder to myself, as I carefully read through your thread late tonight, Madalot.

Mode: S/T with AVAPS Enabled
Tidal Volume: 400
IPAP Max: 23
IPAP Min: 18
EPAP:9
Breath Rate: 7
Inspiratory Time: 1.5
Trigger Type: Flow Trigger
Flow Trigger Sensitivity: 6
Flow Cycle Sensitivity: 25%
Rise Time: 4
AVAPS Rate: 3
All Alarms Disabled

My last sleep study, they determined that when SUPINE, I need to make the following changes:

Tidal Volume: 440
EPAP: 12
Rate: 9

Madalot's AVAPS baseline above directly translates to these AVAPS-AE baseline settings (although AVAPS-AE setup rules might prohibit identical EPAP min & EPAP max values):

Mode: S/T with AVAPS-AE Enabled
Tidal Volume: 400
PS Max: 14
PS Min: 9
EPAP Max: 9
EPAP Min: 9
Breath Rate: 7
Inspiratory Time: 1.5
Trigger Type: Flow Trigger
Flow Trigger Sensitivity: 6
Flow Cycle Sensitivity: 25%
Rise Time: 4
AVAPS Rate: 3
All Alarms Disabled

My last sleep study, they determined that when SUPINE, I need to make the following changes:

Tidal Volume: 440
EPAP: 12
Rate: 9

If it were me, tonight I would change the red parameter set or the blue parameter set. If I changed the blue parameter set, then I'd try auto instead of 7. If I changed the red parameter set, then I'd probably try one of these two changes:

a) drop EPAP min from 9 to 8 (while leaving EPAP max at 9) if I felt EPAP was more often too high than too low in the past, or
b) increase EPAP max from 9 to 10 (while leaving EPAP min at 9) if I felt EPAP was more often too low than too high in the past

[Madalot]

I have printed your post so that I can read it later and make sure I grasp what you are suggesting. I will not do anything until I'm sure I understand. I will be up until 11pm EST and will see posts until that time.

Thanks so much, -SWS. I don't think you know how much this means to me to have your input and assistance on this. I don't think either my current doctor nor my RT are very up on AVAPS, let alone the newer AE. I found it on this loaner Trilogy and was a little surprised nobody had mentioned it to me. If *I* didn't ask, I doubt very seriously if they would have brought it up.

[jnk]

. . . grasp what you [-SWS] are suggesting . . .

If I understand -SWS' posts, his words imply the wisdom of starting out by setting the new mode as closely alike as possible to the old mode and then making one adjustment at a time, gradually, to see if there are indications that a change made to one adjustment in a particular direction is bringing benefits. That may make more sense for you, given your present circumstances of little direct medical-team involvement, than your attempting to get all possible eventual benefits out of the new mode right away by immediately setting a large range for EPAP variation to fully cover side-to-back-to-side transitions of sleep positions during the night. In other words, instead of just doing it all at once and seeing if it helps, doing it a little bit at a time to make sure things are going the right direction without disrupting too much else. That approach could still reach the eventual goal of having pressures that will cover both side sleeping and back sleeping for obstruction-prevention.

Madalot, I post that (1) as an interpretation for others following the thread, (2) as an expression of my learning from what -SWS is saying, and (3) as something for -SWS to correct, if I'm not following him well. I hope you don't mind.

[-SWS]

Yep, that's it in a nutshell, Jeff. The idea is to first convert Madalot's previous AVAPS settings to identical AVAPS-AE settings. Then, to cautiously proceed from that baseline with a series of changes that are each small and few.

To recap, these AVAPS baseline settings:
IPAP Max: 23
IPAP Min: 18
EPAP:9
Breath Rate: 7

Directly translate to these AVAPS-AE settings:
PS Max: 14
PS Min: 9
EPAP Max: 9
EPAP Min: 9
Breath Rate: 7

The two sets above say the same thing, and result in the same pressure delivery. That first set is written using AVAPS parameters. The second, identical set is written using AVAPS-AE parameters. Madalot and her medical staff will ideally apply a sequence of small, controlled changes against her baseline above.

[Madalot]

Yep, that's it in a nutshell, Jeff. The idea is to first convert Madalot's previous AVAPS settings to identical AVAPS-AE settings. Then, to cautiously proceed from that baseline with a series of changes that are each small and few.

To recap, these AVAPS baseline settings:
IPAP Max: 23
IPAP Min: 18
EPAP:9
Breath Rate: 7

Directly translate to these AVAPS-AE settings:
PS Max: 14
PS Min: 9
EPAP Max: 9
EPAP Min: 9
Breath Rate: 7

The two sets above say the same thing, and result in the same pressure delivery. That first set is written using AVAPS parameters. The second, identical set is written using AVAPS-AE parameters. Madalot and her medical staff will ideally apply a sequence of small, controlled changes against her baseline above.

First thing is to set the AVAPS-AE as indicated so it's the same as my regular AVAPS. Will follow your instructions exactly.

Getting my medical team involved as you suggest is probably not going to happen, I'm sorry to say. I will definitely run all this by him, but I'm not sure when that will be and I'm not sure he knows enough about this AVAPS stuff. He seems to trust that I can find out on my own and lets me go with it. I think if I want to make these changes, it's thee & me. So, that being said...

I have read, re-read and re-read again the post from above where you outlined an "either/or" change. So, once I get everything to baseline (thank you again for telling me EXACTLY how to do that) -- I think I will change the "red parameter set" as follows:

Increase EPAP max from 9 to 10 (while leaving EPAP min at 9)....

That's the ONLY thing I plan to change for tonight. However, I am SO tired tonight (company for dinner) and may not feel like changing anything and if that is the case, I will switch back to basic AVAPS settings and worry about making the changes to the AE settings tomorrow.

Thank you for "dumbing this down" for me to make it easier.

I know I need to be patient and do this the way you suggest. I know, in my mind, that you are 100% correct. The issue with not being able to turn over has only recently begun and it's come on like gang busters (damn this stupid disease). The regular AVAPS settings are inadequate on my back and until a few nights ago, I was able to stay on my sides. Now, I'm STUCK on my back, sometimes for 2-3 hours a night. It scares me.

Again, I will be up until 11 and will watch for any additional posts in case there is something else I need to know. If I decide to go to bed before 11, I'll just use regular AVAPS.

[Madalot]

Madalot, I post that (1) as an interpretation for others following the thread, (2) as an expression of my learning from what -SWS is saying, and (3) as something for -SWS to correct, if I'm not following him well. I hope you don't mind.

I forgot to thank you for this, jnk! It helped me just as much as anybody! I not only DON'T mind, but appreciate your doing it.

[-SWS]

So, once I get everything to baseline -- I think I will change the "red parameter set" as follows:

Increase EPAP max from 9 to 10 (while leaving EPAP min at 9)....

That means your first small change from baseline will result in the red text below:

AVAPS-AE mode:
PS Max: 14
PS Min: 9
EPAP Max: 9===>10
EPAP Min: 9
Breath Rate: 7

All other parameters will stay at baseline for now.

[Madalot]

I have made that one change. There is one thing I don't remember seeing in your posts. The AE has a max pressure setting. I set that at 23 like my regular AVAPS. I hope that was right.

[-SWS]

That max pressure setting sounds good, Madalot.