How to get prescribed Bipap?

jnk... wrote: ↑

Wed Mar 21, 2018 1:48 pm

adjustable Ti and rise time

ResMed dudes" wrote:Inspiratory Time and Trigger and Cycle Sensitivities: ResMed’s S therapy mode includes a number of secondary settings that can be used to fine-tune therapy for your patients. While default values should be appropriate for most patients, these technologies can be used to accommodate their unique needs. TiControl™ provides minimum and maximum inspiratory time limits (TiMin and TiMax settings, respectively) for each breath. TiMin and TiMax can be used to prolong or limit, respectively, the time the device spends at IPAP. Along with Vsync, TiControl can ensure synchronization even in the presence of significant mouth and/or mask leak. Adjustable trigger and cycle sensitivities can be used to optimize synchrony. The device triggers (initiates IPAP) and cycles (initiates EPAP) as it senses changes in patient flow. At higher sensitivity settings, smaller flow changes make it easier for the patient to trigger and cycle the device. -- https://onlinestore.resmed.com/images/p ... 017278.pdf

As far as I know, Resmed is the only bilevel that offers that level of customization.

palerider wrote: As far as I know, Resmed is the only bilevel that offers that level of customization.

That is correct - you need the way more expensive Respironics like the dreamstation avaps, or the trilogy ventilator, to do the stuff that a basic ResMed can do. And then you have the issue of whether or not the machine even works with sleepyhead...the direct view is good for respiratory stuff, but useless for examining OSA related data.

Matt00926 wrote: ↑

Wed Mar 21, 2018 5:39 pm

palerider wrote: As far as I know, Resmed is the only bilevel that offers that level of customization.

That is correct - you need the way more expensive Respironics like the dreamstation avaps, or the trilogy ventilator, to do the stuff that a basic ResMed can do. And then you have the issue of whether or not the machine even works with sleepyhead...the direct view is good for respiratory stuff, but useless for examining OSA related data.

The prs1 avaps didn't have trigger/cycle and TiMin/TiMax... they do have a 'ti' setting, but their crappy manual doesn't say what it does.

If I get anything new it will have to be a Dreamstation that much I know for sure.

jnk... wrote: ↑

Wed Mar 21, 2018 1:48 pm

adjustable Ti and rise time

ResMed dudes" wrote:Inspiratory Time and Trigger and Cycle Sensitivities: ResMed’s S therapy mode includes a number of secondary settings that can be used to fine-tune therapy for your patients. While default values should be appropriate for most patients, these technologies can be used to accommodate their unique needs. TiControl™ provides minimum and maximum inspiratory time limits (TiMin and TiMax settings, respectively) for each breath. TiMin and TiMax can be used to prolong or limit, respectively, the time the device spends at IPAP. Along with Vsync, TiControl can ensure synchronization even in the presence of significant mouth and/or mask leak. Adjustable trigger and cycle sensitivities can be used to optimize synchrony. The device triggers (initiates IPAP) and cycles (initiates EPAP) as it senses changes in patient flow. At higher sensitivity settings, smaller flow changes make it easier for the patient to trigger and cycle the device. -- https://onlinestore.resmed.com/images/p ... 017278.pdf

yes the S mode has ti cycle and rise time, users of the vauto on another forum corrected me, when I suggested changing the Ti and rise time in vauto, they said it wasn't an option and it was fixed.

USMCVet wrote: ↑

Wed Mar 21, 2018 9:03 pm

If I get anything new it will have to be a Dreamstation that much I know for sure.

with the dream station, a good machine for an obstructive/restrictive lung is the AVAPS

ajack wrote: ↑

Wed Mar 21, 2018 10:34 pm

USMCVet wrote: ↑

Wed Mar 21, 2018 9:03 pm

If I get anything new it will have to be a Dreamstation that much I know for sure.

with the dream station, a good machine for an obstructive/restrictive lung is the AVAPS

So my question is how do I sell them on it? Everything is normal (thankfully) except total lung capacity, Functional reserve capacity and reserve volume. So if I understand it correctly my lungs in simplest form have less air then normal at the end of normal expiration meaning that the lungs themselves (besides total lung capacity) are fine but the relationship of the "tug of war" so to speak between the chest wall and lungs is abnormal.

This is where I'm probably grasping at straws.

I know and have been saying for a while that I breathe shallow. My oxygen both during sleep and during the day at least for a while increased with increased CPAP pressure.

So maybe a Bipap would help based on this.
https://www.sciencedirect.com/topics/ne ... l-capacity
"Functional residual capacity is the volume of air in the lungs after a normal relaxed expiration and is determined by the balance between the tendency of the lungs to recoil inwards and the chest wall to pull outwards.10,33,47,48,60,63 Decreases in functional residual capacity are primarily due to decreases in the outward pull of the chest wall. Changes in chest wall recoil occur over time in people with tetraplegia and are due to patients’ inability to regularly expand the chest wall to large lung volumes (see discussion above).9,33,47–49,60 During periods of acute respiratory illness reductions in functional residual capacity are common and due to underlying lung pathology."

My theory is this..... I do need to increase pressure to help with oxygenation which means a higher EPAP because that's what helps with oxygenation. However because of that I will need a higher IPAP which will help with tidal volume meaning greater expansion of lungs. This coupled with a lot more exercise could help strengthen chest muscles?

Or as always I'm over thinking lol

ajackass wrote: ↑

Wed Mar 21, 2018 10:32 pm

jnk... wrote: ↑

Wed Mar 21, 2018 1:48 pm

adjustable Ti and rise time

ResMed dudes" wrote:Inspiratory Time and Trigger and Cycle Sensitivities: ResMed’s S therapy mode includes a number of secondary settings that can be used to fine-tune therapy for your patients. While default values should be appropriate for most patients, these technologies can be used to accommodate their unique needs. TiControl™ provides minimum and maximum inspiratory time limits (TiMin and TiMax settings, respectively) for each breath. TiMin and TiMax can be used to prolong or limit, respectively, the time the device spends at IPAP. Along with Vsync, TiControl can ensure synchronization even in the presence of significant mouth and/or mask leak. Adjustable trigger and cycle sensitivities can be used to optimize synchrony. The device triggers (initiates IPAP) and cycles (initiates EPAP) as it senses changes in patient flow. At higher sensitivity settings, smaller flow changes make it easier for the patient to trigger and cycle the device. -- https://onlinestore.resmed.com/images/p ... 017278.pdf

yes the S mode has ti cycle and rise time, users of the vauto on another forum corrected me, when I suggested changing the Ti and rise time in vauto, they said it wasn't an option and it was fixed.

Why don't you do something *intelligent* for once, and only comment on things you actually have actual knowledge about? cuz, you're still wrong about the capabilities of the vauto.

I have the the S9 VAuto and needed to adjust the Ti max upwards to stop the machine thinking I was going to exhale well before I was ready to. It made a huge difference when I increased it.

The only thing I notice is that when I exhale (while awake obviously) I get this 'chuffing' sensation at the end of each breath. I'm not sure what to adjust to get rid of this sensation. A longer Ti minimum doesn't make sense though I could be wrong here.

Adjusting the Rise Time may help as this controls the change from EPAP to IPAP.

palerider wrote: ↑

Wed Mar 21, 2018 6:14 pm

Matt00926 wrote: ↑

Wed Mar 21, 2018 5:39 pm

palerider wrote: As far as I know, Resmed is the only bilevel that offers that level of customization.

That is correct - you need the way more expensive Respironics like the dreamstation avaps, or the trilogy ventilator, to do the stuff that a basic ResMed can do. And then you have the issue of whether or not the machine even works with sleepyhead...the direct view is good for respiratory stuff, but useless for examining OSA related data.

The prs1 avaps didn't have trigger/cycle and TiMin/TiMax... they do have a 'ti' setting, but their crappy manual doesn't say what it does.

For Respironics the "Ti" setting only applies to timed breaths, when you're in s/t or s/t with AVAPS enabled. Aside from Respironics ventilators, the trigger/cycle is all automatic with their "digital auto-trak" algorithm so there is way less customization possible compared to ResMed. In my experience the auto-trak doesn't work very well...

If you have a problem with inhalations cutting short, unless you have the Trilogy vent, you are pretty much screwed with a bi-level Respironics machine - you can really only increase the rise time to extend inhalation. On the Trilogy vent you can adjust the cycling and trigger thresholds/sensitivity very specifically, like on the ResMed bi-levels.

The more "advanced" Respironics (like the Trilogy vent or Dreamstation AVAPS) can use PC "pressure control" mode, where the Ti is constant for all breaths - but still the Ti min / Ti max range is unique to ResMed.

Cliffs: ResMed > Respironics

raisedfist wrote: ↑

Thu Mar 22, 2018 9:09 am

palerider wrote: ↑

Wed Mar 21, 2018 6:14 pm

Matt00926 wrote: ↑

Wed Mar 21, 2018 5:39 pm

palerider wrote: As far as I know, Resmed is the only bilevel that offers that level of customization.

That is correct - you need the way more expensive Respironics like the dreamstation avaps, or the trilogy ventilator, to do the stuff that a basic ResMed can do. And then you have the issue of whether or not the machine even works with sleepyhead...the direct view is good for respiratory stuff, but useless for examining OSA related data.

The prs1 avaps didn't have trigger/cycle and TiMin/TiMax... they do have a 'ti' setting, but their crappy manual doesn't say what it does.

For Respironics the "Ti" setting only applies to timed breaths, when you're in s/t or s/t with AVAPS enabled. Aside from Respironics ventilators, the trigger/cycle is all automatic with their "digital auto-trak" algorithm so there is way less customization possible compared to ResMed.

The Ti setting (according to the manual I've got) ranges from 0.5 to 3.0, so, is that meaning how long it'll stay at IPAP?
That's much less flexible than the way Resmed does it.

raisedfist wrote: ↑

Thu Mar 22, 2018 9:09 am

In my experience the auto-trak doesn't work very well...

I'm not surprised.

raisedfist wrote: ↑

Thu Mar 22, 2018 9:09 am

If you have a problem with inhalations cutting short, unless you have the Trilogy vent, you are pretty much screwed with a bi-level Respironics machine - you can really only increase the rise time to extend inhalation. On the Trilogy vent you can adjust the cycling and trigger thresholds/sensitivity very specifically, like on the ResMed bi-levels.

The more "advanced" Respironics (like the Trilogy vent or Dreamstation AVAPS) can use PC "pressure control" mode, where the Ti is constant for all breaths - but still the Ti min / Ti max range is unique to ResMed.

Cliffs: ResMed > Respironics

Thanks for the info.

Holden4th wrote: ↑

Thu Mar 22, 2018 4:18 am

I have the the S9 VAuto and needed to adjust the Ti max upwards to stop the machine thinking I was going to exhale well before I was ready to. It made a huge difference when I increased it.

I noticed that a lot of my inhalations were being cut of at the default time, so I bumped up my TiMax too, and I'd noticed sometimes before an apnea when there'd be an attempt to inhale, but the machine wasn't catching it and kicking up to IPAP, so I set trigger to more sensitive... my AHI went down as a result of those two changes. Now it's usually under 0.5.

Holden4th wrote: ↑

Thu Mar 22, 2018 4:18 am

The only thing I notice is that when I exhale (while awake obviously) I get this 'chuffing' sensation at the end of each breath. I'm not sure what to adjust to get rid of this sensation. A longer Ti minimum doesn't make sense though I could be wrong here.

Perhaps if you could describe the sensation better, cuz I've got no idea what you mean, unless you sound like a steam train

Jas_williams wrote: ↑

Thu Mar 22, 2018 5:42 am

Adjusting the Rise Time may help as this controls the change from EPAP to IPAP.

More accurately stated, it controls the time it takes to go from epap to ipap, and trying to make it too slow could result in a feeling of the machine not providing air quickly enough on inhalation.

USMCVet wrote: ↑

Wed Mar 21, 2018 9:03 pm

If I get anything new it will have to be a Dreamstation that much I know for sure.

Then, if you can't get them to give you a *capable* machine, and you've got your heart set on a bilevel...

Buy it yourself. (send a PM to grayghost4)