Total Inspiration ?

I am having a huge issue, where it feels like my mask is making things worse. I do have a appointment with the sleep center that originally gave me the settings but all I remember them giving to the VA to give to me was 18 IPAP and 8 EPAP and 16 BPM backup rate.

I have messed with my settings A TON since I got and things have gone really wrong, I believe I have messed up the TI time, that is what I think is causing me such much problems. I am so tired lately I can take 4 times the dose they give me of adderall for sleepiness and it doesnt even effect me, modafinil wont either.

So my question is what is a typical TI setting? TI=Total Inspiration. If you dont know this answer can you at least post a reply with your current TI time and if you use a backup rate / breaths per minute what is it my current TI time is set to 1.5 with 16BPM



I added a graph from last night if that helps.

Please go to the control panel and fill in your equipment....Machine and mask.

Did you not write down the previous settings before you started changing things?

Anyway, here is some text from an older VPAP manual, but may be helpful to you.

Den

.


VPAP assists spontaneous breathing by cycling between two pressures in response
to the patient flow or a preset fixed time.
The inspiratory positive airway pressure (IPAP, or the sum of EPAP and the pressure
support level) assists inspiration.
The lower expiratory positive airway pressure (EPAP) eliminates exhaled air through
the mask exhaust vent. This facilitates exhalation comfort while providing a splint to
maintain an open upper airway.
The difference of the two pressures—pressure support level—contributes to
improved patient ventilation.

(So PS is pressure support

Triggering and Cycling
(S, ST and VAuto modes) Under normal conditions, VPAP triggers (initiates IPAP)
and cycles (terminates IPAP and changes to EPAP) as it senses the change in patient
flow. Patient breath detection is enhanced by VPAP’s automatic leak management
feature—Vsync.
In addition, VPAP has adjustable trigger/cycle sensitivity to optimize the sensing level
according to patient conditions.
Rise Time Adjustment
(S, ST and T modes) Rise time sets the time taken for the VPAP to reach IPAP. The
greater the rise time value, the longer it takes for pressure to increase from EPAP to
IPAP.
Patients with a high ventilatory demand may prefer a shorter rise time, while patients
who are slow breathers may prefer a longer rise time.
Note: A prolonged rise time inhibits fast pressurization, therefore, rise time should
not be set longer than Ti Max or the patient’s normal inspiratory time.

TiControl™ – Inspiratory Time Control
(S, ST and VAuto modes) Unique to ResMed bilevel devices, TiControl allows the
clinician to set minimum and maximum limits on the time the device spends in IPAP.
The minimum and maximum time limits are set at either side of the patient’s ideal
spontaneous inspiratory time, providing a ’window of opportunity’ for the patient to
spontaneously cycle to EPAP.
The minimum time limit is set via the Ti Min parameter and the maximum time limit
is set via the Ti Max parameter.
TiControl’s Ti Max and Ti Min parameters play a significant role in maximizing
synchronization by effectively intervening to limit or prolong the inspiratory time
when required. This ensures synchronization even in the presence of significant
mouth and/or mask leak.
The following table is a guide to selecting the Ti Max and Ti Min values that best
correspond to the patient’s respiratory rate and inspiration and expiration ratio,
depending on the respiratory conditions.Notes:
• Factory default values are Ti Max = 2.0 seconds and Ti Min = 0.3 seconds.
• I:E = 1:1 – Ti Min prevents the premature cycling to EPAP for patients whose
inspiratory effort is extremely weak.
• I:E = 1:3 – Ti Max limits the inspiration time for patients who require a longer
expiration time.
(Table omitted)
Exhalation
(VAuto mode) You can adjust the Exhalation rate so the rate of pressure drop is at a
level that is most comfortable for the patient. The medium rate is usually most
comfortable. If required, you can select a rate that is faster or slower.

Min EPAP, Max IPAP & Pressure Support
(VAuto mode) Pressure support allows you to set the difference between inspiratory
and expiratory pressure. Min EPAP and Max IPAP settings allow you to restrict the
range of pressures in which the AutoSet algorithm can operate.
The AutoSet pressure will vary across the session according to the patient’s needs.
It responds to snoring, apneas and flattening of the patient’s flow curve.
Min EPAP and Max IPAP can be adjusted to limit the upper and lower delivered
pressure limits.
Notes:
• The device will stay at Min EPAP (with the selected amount of pressure support)
during the Settling time (if selected) at the beginning of a session.
• If Pressure Support is set above 6 cm H2O, treatment efficacy may be reduced.

.

LSAT wrote:Please go to the control panel and fill in your equipment....Machine and mask.

I edited my equipment and I have added a screenshot of last nights graph, though I only slept for 3 hours with the mask on.

I read through this but my machine doesn't give the same Ti MAX or Ti MIN, but it was insightful. Thanks.

Wulfman... wrote:Did you not write down the previous settings before you started changing things?

Anyway, here is some text from an older VPAP manual, but may be helpful to you.

Den

.


VPAP assists spontaneous breathing by cycling between two pressures in response
to the patient flow or a preset fixed time.
The inspiratory positive airway pressure (IPAP, or the sum of EPAP and the pressure
support level) assists inspiration.
The lower expiratory positive airway pressure (EPAP) eliminates exhaled air through
the mask exhaust vent. This facilitates exhalation comfort while providing a splint to
maintain an open upper airway.
The difference of the two pressures—pressure support level—contributes to
improved patient ventilation.

(So PS is pressure support

Triggering and Cycling
(S, ST and VAuto modes) Under normal conditions, VPAP triggers (initiates IPAP)
and cycles (terminates IPAP and changes to EPAP) as it senses the change in patient
flow. Patient breath detection is enhanced by VPAP’s automatic leak management
feature—Vsync.
In addition, VPAP has adjustable trigger/cycle sensitivity to optimize the sensing level
according to patient conditions.
Rise Time Adjustment
(S, ST and T modes) Rise time sets the time taken for the VPAP to reach IPAP. The
greater the rise time value, the longer it takes for pressure to increase from EPAP to
IPAP.
Patients with a high ventilatory demand may prefer a shorter rise time, while patients
who are slow breathers may prefer a longer rise time.
Note: A prolonged rise time inhibits fast pressurization, therefore, rise time should
not be set longer than Ti Max or the patient’s normal inspiratory time.

TiControl™ – Inspiratory Time Control
(S, ST and VAuto modes) Unique to ResMed bilevel devices, TiControl allows the
clinician to set minimum and maximum limits on the time the device spends in IPAP.
The minimum and maximum time limits are set at either side of the patient’s ideal
spontaneous inspiratory time, providing a ’window of opportunity’ for the patient to
spontaneously cycle to EPAP.
The minimum time limit is set via the Ti Min parameter and the maximum time limit
is set via the Ti Max parameter.
TiControl’s Ti Max and Ti Min parameters play a significant role in maximizing
synchronization by effectively intervening to limit or prolong the inspiratory time
when required. This ensures synchronization even in the presence of significant
mouth and/or mask leak.
The following table is a guide to selecting the Ti Max and Ti Min values that best
correspond to the patient’s respiratory rate and inspiration and expiration ratio,
depending on the respiratory conditions.Notes:
• Factory default values are Ti Max = 2.0 seconds and Ti Min = 0.3 seconds.
• I:E = 1:1 – Ti Min prevents the premature cycling to EPAP for patients whose
inspiratory effort is extremely weak.
• I:E = 1:3 – Ti Max limits the inspiration time for patients who require a longer
expiration time.
(Table omitted)
Exhalation
(VAuto mode) You can adjust the Exhalation rate so the rate of pressure drop is at a
level that is most comfortable for the patient. The medium rate is usually most
comfortable. If required, you can select a rate that is faster or slower.

Min EPAP, Max IPAP & Pressure Support
(VAuto mode) Pressure support allows you to set the difference between inspiratory
and expiratory pressure. Min EPAP and Max IPAP settings allow you to restrict the
range of pressures in which the AutoSet algorithm can operate.
The AutoSet pressure will vary across the session according to the patient’s needs.
It responds to snoring, apneas and flattening of the patient’s flow curve.
Min EPAP and Max IPAP can be adjusted to limit the upper and lower delivered
pressure limits.
Notes:
• The device will stay at Min EPAP (with the selected amount of pressure support)
during the Settling time (if selected) at the beginning of a session.
• If Pressure Support is set above 6 cm H2O, treatment efficacy may be reduced.

.

If I'm correct what he has is a ventilator, ASV machine.

squid13 wrote:If I'm correct what he has is a ventilator, ASV machine.

It says BIPAP S/T on it

Actually that text you posted may have helped me, I have my rise time set at 3, I was under the impression that rise time was just a comfort thing... I dont think that it is my problem but it is something I will test out tonight though I am contimplatiung just sleeping without the bipap until my appointment and seeing if maybe just sleeping on my side or something will let me get better sleep. It seems like I sleep fine until I hit REM sleep then something changes either BPM or something and I wake up go to the bathroom then go back to sleep cycle and repeat

Sprockets_Zomie wrote:

squid13 wrote:If I'm correct what he has is a ventilator, ASV machine.

It says BIPAP S/T on it

I wasn't sure which make/model of machine you had, but found that file in my ResMed directory.

Here's some info from some older Respironics ASV and S/T manuals.

Timed Inspiration:
Range: 0.5 to 3.0 seconds
Accuracy: ± (0.1 + 10% of the setting) seconds


Den

.

I also wonder if maybe a lower EPAP would help me, I believe because of narcotics that my breathing gets very shallow, could it be there is too much pressure to exhale?

Your backup rate of 16bpm is rather high for most people. It could be causing asyncrhony where you're trying to take spontaneous breaths but the machine is constantly cutting in because you're breathing spontaneously below 16bpm.

What is your spontaneous breathing rate on the machine (lying down with your mask on your face, machine turned on) while awake?

I would lower your backup rate to 10 or 12bpm and see if it works out better. Your patient triggered breath percentage is low which means the machine is taking a lot of breaths for you while you sleep.

With the Respironics BiPAP, S/T the set Ti only applies to machine initiated timed breaths, not spontaneous ones. Your set Ti of 1.5s is most likely not the culprit. Only in pressure control (PC) mode can you apply the Ti to all breaths.

The Sleepyhead shot shows you running S/T with AVAPS enabled? So not a straight bi-level pressures...you need to list out all your exact therapy mode and settings for us so we can help you.

You also have a high leak percentage -- you need to take some time and carefully practice fitting your Simplus mask.

Matt00926 wrote:Your backup rate of 16bpm is rather high for most people. It could be causing asyncrhony where you're trying to take spontaneous breaths but the machine is constantly cutting in because you're breathing spontaneously below 16bpm.

What is your spontaneous breathing rate on the machine (lying down with your mask on your face, machine turned on) while awake?

I would lower your backup rate to 10 or 12bpm and see if it works out better. Your patient triggered breath percentage is low which means the machine is taking a lot of breaths for you while you sleep.

With the Respironics BiPAP, S/T the set Ti only applies to machine initiated timed breaths, not spontaneous ones. Your set Ti of 1.5s is most likely not the culprit. Only in pressure control (PC) mode can you apply the Ti to all breaths.

The Sleepyhead shot shows you running S/T with AVAPS enabled? So not a straight bi-level pressures...you need to list out all your exact therapy mode and settings for us so we can help you.

You also have a high leak percentage -- you need to take some time and carefully practice fitting your Simplus mask.

I dont even see those settings, I dont even know where you turn AVAPS on and off ill post all the settings I can see:
Mode: S/T
IPAP: 18
EPAP: 8
BPM: 16
Ti: 1.5
Rise Time: 1
Tubing Type: 22
SystemOne Resistance: 0
hPa/cmH20: cmH20

Sprockets_Zomie wrote:

Matt00926 wrote:Your backup rate of 16bpm is rather high for most people. It could be causing asyncrhony where you're trying to take spontaneous breaths but the machine is constantly cutting in because you're breathing spontaneously below 16bpm.

What is your spontaneous breathing rate on the machine (lying down with your mask on your face, machine turned on) while awake?

I would lower your backup rate to 10 or 12bpm and see if it works out better. Your patient triggered breath percentage is low which means the machine is taking a lot of breaths for you while you sleep.

With the Respironics BiPAP, S/T the set Ti only applies to machine initiated timed breaths, not spontaneous ones. Your set Ti of 1.5s is most likely not the culprit. Only in pressure control (PC) mode can you apply the Ti to all breaths.

The Sleepyhead shot shows you running S/T with AVAPS enabled? So not a straight bi-level pressures...you need to list out all your exact therapy mode and settings for us so we can help you.

You also have a high leak percentage -- you need to take some time and carefully practice fitting your Simplus mask.

I dont even see those settings, I dont even know where you turn AVAPS on and off ill post all the settings I can see:
Mode: S/T
IPAP: 18
EPAP: 8
BPM: 16
Ti: 1.5
Rise Time: 1
Tubing Type: 22
SystemOne Resistance: 0
hPa/cmH20: cmH20

According to sleepyhead you are using a philips respironics system one bipap avaps machine. It also shows varying IPAP and EPAP levels in the summary data on the left. It's possible that sleepyhead is misreading your machine, but i can't see why since both are older models and I'm sure support has been improved by now.

On your actual machine, below the therapy screen, does it say BiPAP S/T? If so - then yeah your machine does not have AVAPS function. The BiPAP AVAPS version has that name above the therapy screen instead of below.

It also says PAP therapy mode is AVAPS on sleepyhead. On some machines it's a stand alone therapy mode, and on some it's just an option you can add to therapy modes to target a specific tidal volume. Ex: you can use S/T with AVAPS enabled or not.

Are you positive that you are using straight pressures of 18/8?

Anyway, I wouldn't take any action regarding the AHI until you get the leaks under control.

A Ti of 1.5s is normal and as I said before, only applies to timed breaths anyway on respironics unless in more advanced therapy modes than s/t. I would definitely lower that backup rate though.

Depending on what type of condition you have, maybe raise the rise time as well - 1 is very fast must feel like a wack in the face. Could be causing mask sealing issues as well, especially with a pressure support of 10.

Matt00926 wrote:

Sprockets_Zomie wrote:

Matt00926 wrote:Your backup rate of 16bpm is rather high for most people. It could be causing asyncrhony where you're trying to take spontaneous breaths but the machine is constantly cutting in because you're breathing spontaneously below 16bpm.

What is your spontaneous breathing rate on the machine (lying down with your mask on your face, machine turned on) while awake?

I would lower your backup rate to 10 or 12bpm and see if it works out better. Your patient triggered breath percentage is low which means the machine is taking a lot of breaths for you while you sleep.

With the Respironics BiPAP, S/T the set Ti only applies to machine initiated timed breaths, not spontaneous ones. Your set Ti of 1.5s is most likely not the culprit. Only in pressure control (PC) mode can you apply the Ti to all breaths.

The Sleepyhead shot shows you running S/T with AVAPS enabled? So not a straight bi-level pressures...you need to list out all your exact therapy mode and settings for us so we can help you.

You also have a high leak percentage -- you need to take some time and carefully practice fitting your Simplus mask.

I dont even see those settings, I dont even know where you turn AVAPS on and off ill post all the settings I can see:
Mode: S/T
IPAP: 18
EPAP: 8
BPM: 16
Ti: 1.5
Rise Time: 1
Tubing Type: 22
SystemOne Resistance: 0
hPa/cmH20: cmH20

According to sleepyhead you are using a philips respironics system one bipap avaps machine. It also shows varying IPAP and EPAP levels in the summary data on the left. It's possible that sleepyhead is misreading your machine, but i can't see why since both are older models and I'm sure support has been improved by now.

On your actual machine, below the therapy screen, does it say BiPAP S/T? If so - then yeah your machine does not have AVAPS function. The BiPAP AVAPS version has that name above the therapy screen instead of below.

It also says PAP therapy mode is AVAPS on sleepyhead. On some machines it's a stand alone therapy mode, and on some it's just an option you can add to therapy modes to target a specific tidal volume. Ex: you can use S/T with AVAPS enabled or not.

Are you positive that you are using straight pressures of 18/8?

Anyway, I wouldn't take any action regarding the AHI until you get the leaks under control.

A Ti of 1.5s is normal and as I said before, only applies to timed breaths anyway on respironics unless in more advanced therapy modes than s/t. I would definitely lower that backup rate though.

Depending on what type of condition you have, maybe raise the rise time as well - 1 is very fast must feel like a wack in the face. Could be causing mask sealing issues as well, especially with a pressure support of 10.

I dont believe I have a leak issue at all. First I have asked this question to my doctor about leaks and they said as long as its under 50 I am good, it usually runs right around 40. I have also read on the internet that Phillips Resperonics machines give readings on leaks different than most machines. However if you know better than that please let me know why you think I have such a bad leak issue. Further, the pat triggered breaths, what is a good number to get?

Looking at last nights graph I noticed that my resp rate seems high but I am not versed on these subjects, seems like it spikes up to 30/minute
My machine does say BIPAP S/T under the therapy window

Sprockets_Zomie wrote:My machine does say BIPAP S/T under the therapy window

What is the model number of your machine?
It's on a sticker on the bottom of the blower and may have DS or REF in front or behind those the 3 or 4 digits?

SleepyHead has some troubles with those high end specialty machines in terms of settings and naming stuff.
Do you happen to have Encore Pro software available?
Encore is Windows only software though.