VPAP ST advice

Currently I'm using my backup machine which is a ResMed S8 VPAP ST. IPAP is 16 and EPAP is 8 with a rate of 14 and a rise of 3. This machine was issued as a result of a sleep study done in Aug 2010. I had another study 1n Apr 2013 as I was not getting a restful nights sleep with the S8. I was then put on a S9 AutoSet in Sep 2013. Was compliant, then after 6 months couldn't tolerate it any longer and went back to the S8. Turned in the S9 as it was ineffective.

I"m getting drowsy during the day. As an example; if I'm reading the paper in the am (9), I'll fall asleep. As I compose this, I could easily take a nap for 3-4 hours and still go to bed at 10-12 pm with no problem.

I just called the RT that set me up with the S8, and asked him to explain the different settings, and what might give me a more restful sleep. I explained the machine on exhale would cut off before I fully exhaled, want to go to the exhale cycle. Typical answer was you shouldn't do any tweaking without talking to a Dr first.

My current sleep doc is a numbers guy only. When I asked him to look at my SleepyHead graphs, and ask how the patient feels, which is like crap, he didn't really have much to say. He just wrote me a script for a new Bilevel back on 20 March. My former DME, LINCARE, hadn't done anything. When I finally talked with their office manager on 30 May (felt the people dealing with my case were dragging their feet) asking when I might get some results, and be issued a new machine. She indicated they had to wait until a patient needing exactly what I was newly prescribed in order for them to place an order for me since I was already issued a machine back in Sep. I'm 68, so Medicare is in the loop, and wanting full justification for a new machine which was done 14 Apr. Medicare is upside down and backwards. They approved everything a week after everything was faxed back in Apr. Meanwhile, the patient (me) is suffering.

Does anyone have an S8 that is getting a restful sleep. What are you settings. I'll tweak what I have until I start getting a good nights sleep. I've changed sleep doctors, have a new sleep lab lined up, asked for another referral for a sleep study yesterday. This will take about 2 weeks (retired military) as no hurry is the their motto.

Either send me a PM, or directly answer on the forum.

Thanks.

Pat

I explained the machine on exhale would cut off before I fully exhaled, want to go to the exhale cycle

If you mean that it is cutting off before you finish exhaling and wants to force you to inhale, it sounds like your backup rate is too high. If the Resmed implementation of BiLevel S/T is anything like Respironics, this would be my first guess. In the titration guidelines for S/T and AVAPS it suggests a starting backup rate setting of 2 BPM below what your normal RR is.
If the backup rate is too high, it will be delivering a mandatory breath at some point your natural breathing cycle before you are ready for it.
Respiratory Rate varies from person to person so its about finding a value that is comfortable for you.

A secondary setting to consider is the inspiration time setting. This will change how long a mandatory breath lasts (Spontaneous breaths shouldn't be affected). So if a mandatory breath is being delivered and you find you are not being delivered adequate tidal volume, the inspiration time could be increased.

It wouldn't really be right for any of us to give you medical advice and i'm certainly not advising you to change the above settings yourself, but you could at least talk to your doctor about it. I don't know why the RT couldn't at least answer your questions, dealing with ventilators is half their job after all.

I thought you were using VAuto mode?

aytikvjo wrote:

I explained the machine on exhale would cut off before I fully exhaled, want to go to the exhale cycle

If you mean that it is cutting off before you finish exhaling and wants to force you to inhale, it sounds like your backup rate is too high. If the Resmed implementation of BiLevel S/T is anything like Respironics, this would be my first guess. In the titration guidelines for S/T and AVAPS it suggests a starting backup rate setting of 2 BPM below what your normal RR is.
If the backup rate is too high, it will be delivering a mandatory breath at some point your natural breathing cycle before you are ready for it.
Respiratory Rate varies from person to person so its about finding a value that is comfortable for you.

A secondary setting to consider is the inspiration time setting. This will change how long a mandatory breath lasts (Spontaneous breaths shouldn't be affected). So if a mandatory breath is being delivered and you find you are not being delivered adequate tidal volume, the inspiration time could be increased.

It wouldn't really be right for any of us to give you medical advice and i'm certainly not advising you to change the above settings yourself, but you could at least talk to your doctor about it. I don't know why the RT couldn't at least answer your questions, dealing with ventilators is half their job after all.

I realize you're not giving me advice & I apologize if I sounded as though I was asking. My frustration level is almost, repeat, almost starting to get the better of me. What I'd like to say to Medicare couldn't be repeated on this forum.

I looked at the sleep study information, and I don't see anything that says the words Respiratory Rate. There is an area that says RERA. If this is it, those #'s are zero the entire study.

I'm not sure were on the same page, but before I complete breathing in, the machine stops breathing in, preventing me from going to sleep. The mode is set to VAuto. The is also a CPAP, ST, Timed, Spont mode. One of the settings is Ti Max which is 2.9s, and Ti Min which is 0.4s. Does this have anything to do with IPAP?

RERA is respiratory effort related arousal; You can find more information about them on this forum. Zero is a good thing for RERA's

Odd that they don't provide respiratory rate information from your sleep study. Its usually around 12-18 breaths per minute, depending on age and what you are doing at the moment. Is your machine data capable? Sleepyhead may be able to get it.
You could try to measure it yourself and get a ballpark estimate.

Explanation of modes just so we're on the same page, might be redundant:
- CPAP mode is self explanatory: it provides a constant IPAP that is the same as the EPAP
- S/T is spontaneous / timed: It provides bi-level therapy where you have an higher IPAP and a lower EPAP. The ventilator reacts to patient effort to deliver breaths, but will deliver a mandatory breath if the patient does not trigger a spontaneous breath after a set time interval.
- Timed mode is bilevel therapy that delivers only mandatory breaths at a set rate and does not react to patient effort.
- Spontateous: Bilevel therapy that only delivers patient triggered breaths

The VAuto implementation looks a lot like the Respironics Auto-bilevel implementation in that it is pretty standard bi-level therapy but the EPAP adjusts automatically in reaction to OSA symptoms, but I don't know if a backup breath rate is specified for this mode.

As to the Ti_Max and Ti_Min settings, this page will be useful to you: http://www.resmed.com/ap/products/s9_vp ... tralportal

For comparison, Ti_Max on Respironics machines is limited to 3 seconds if using Auto-Trak.'

The Ti_Max and Ti_Min settings you have listed below look pretty normal to me. If you are inhaling for nearly 3 seconds and still are not getting adequate air then something else may be amiss that you should talk to your doctor about. Do you have also specified a backup breath rate on the machine?

Maybe we're missing something else?