introduction, and a history of apap->bipap->central apneas?

@ Barbee - I won't hold using a constant pressure against you ha. In fact, I'm probably quite jealous you are able to make it work

@Palerider - Thanks, I see now that I was confused and I didn't quite understand how the AutoSet for her algorithm worked!

@Pugsy - I hope the AirCurve 10 suits you, or that you find a suitable replacement with whatever you change your mind to

It would be cool if there were someone on cpaptalk who worked for ResMed and somehow queried the long time users for experience and input on their new releases. One can always dream, right?

That's an interesting problem on how to distinguish between awake and asleep with just an xpap. I wonder if that's the next wave of the future - portable EEGs that give feedback/feedforward loops into the xpap software? I guess putting the EEG stuff on would be one more thing to have to wear at night and gooey stuff to wash off in the morning, but I would certainly be willing to do it for better quality sleep and I bet others would too.

And yes, when I read back on the history of xpap development from some of the users in the 1980s/1990s - so no ramp up to high pressure, really noisy machines, unwieldy masks, lack of humidification, I feel grateful for all the improvements that are available now.

So an update on my sleep therapy and some questions!

I had problems with downloading Resscan 6.0, but I knew that I was having awful dreams and waking up feeling like I was having major flow limitations if not outright hypopneas that weren't getting marked in sleepyhead, so even though I was scared of aerophagia, I did a couple of things -
1) raised my pressure from 15/8.4 to 17.8-18/11.8
2) played with my trigger and cycle settings to make the machine better match my slowed breathing at night (trigger is now low and cycle is now very low, and those pressure settings feel much more comfortable to me now which seemed to help my aerophagia a lot!

The result? a higher AHI but I feel a lot better. I am still having some nightmares of dying which for me correlate to suffocation/low air flow that are causing wakeups and thus the big gap in the middle of the night, but my mood, alertness, ability to think, pain, etc are all much improved at this higher pressure over sleeping at 15/8.4.

Surprisingly sleeping at 17.8-18/11.8 isn't too much more uncomfortable than 15/8.4.

I think I might be one of those cases Pugsy talked about where she's seen someone have trouble at one pressure with aerophagia, but then once things got up to a higher pressure they were actually fine? can't seem to find this post but I think I did read it somewhere...

I just mention that since the aerophagia hasn't been too bad at this higher pressure and that surprises me. If anyone knows what post I am talking about from Pugsy and can link to it that would be nice, otherwise I'll just try and search for it again.

Here are my questions, which may or may not be answerable

1) with my vpap s9 auto, should I set the starting point at 15/8.4 or 17.8/11.8? I'm sort of scared of regressing and that the machine won't be able to react fast enough to my flow limitations. I think I know what I want to do, but I'm just curious to hear what others might think - if there's any value to letting the s9 vpap auto be more open than I am planning on doing right now.

1a) The s9 vpap auto has different accessories than the aircurve 10. drat! Why was so I so dumb to think that the hoses and power cords would be interchangeable? If you have an s9, do you have trouble getting replacement parts? Wondering if maybe I should try to sell the s9 now and go for an aircurve 10 vpap auto. sigh. you live you learn. too bad secondwindcpap.com doesn't do returns. Should I just go ahead and use the s9 vpap auto for now and worry about selling it later, or is it better if I sell it as it is (0 hours on it, but from secondwindcpap.com)

2) My breath waveforms look pretty ugly? Ever since I've realized my nostrils can only do so much I've probably allowed my natural breathing tendencies to take over - so a mix of nose, mouth, and then both. I saw that palerider posted that contrary to popular belief, the s9 vpap auto will raise pressure not based on the amount of flow, but on the shape of the flow and I guess I'm wondering how vpap auto takes into account flow limitation when someone has messed with the trigger and cycle like me. (I'm guessing there's no real way to know unless I take the plunge and sleep with the s9 vpap auto)

Thank you as always for helping peel back the sleep onion! hope you all are doing all right.

dogsarelife wrote: ↑

Tue Mar 12, 2019 4:54 pm

2) played with my trigger and cycle settings to make the machine better match my slowed breathing at night (trigger is now low and cycle is now very low, and those pressure settings feel much more comfortable to me now which seemed to help my aerophagia a lot!

Trigger and cycle don't have much of anything to do with the *speed* of breathing.

Trigger is how sensitive the machine is to the start of your inhalation, the higher the trigger setting, the more sensitive it is, and the less of a breath you have to take before the machine switches to IPAP.
Cycle is how sensitive it is to the *end* of your exhalation, and thus when it switches back to epap.

If you want to breathe slowly, taking long inhalations, then TiMax is what you probably should increase, so that the machine doesn't cut off the IPAP before you've finished inhaling. I found that the default of 2.0 seconds was too low for me sometimes, so I bumped mine up... Mine's at 3.5 or something now.

dogsarelife wrote: ↑

Tue Mar 12, 2019 4:54 pm

1) with my vpap s9 auto, should I set the starting point at 15/8.4 or 17.8/11.8? I'm sort of scared of regressing and that the machine won't be able to react fast enough to my flow limitations. I think I know what I want to do, but I'm just curious to hear what others might think - if there's any value to letting the s9 vpap auto be more open than I am planning on doing right now.

You don't set the auto the same as you do the S. With the S you set IPAP and EPAP.
With the Auto, you set a minimum epap (MinEPAP) a maximum IPAP (MaxIPAP) and a PS.

Last night your PS was 6.2 (18-11..

So, in vauto mode, I'd suggest something like

MinEPAP 10
MaxIPAP 20 (normally I'd say 25, but let's see what happens with your aerophagia.)
PS 6
TiMax 3.5

Honestly, I wouldn't change trigger and cycle from their default settings.

dogsarelife wrote: ↑

Tue Mar 12, 2019 4:54 pm

1a) The s9 vpap auto has different accessories than the aircurve 10. drat! Why was so I so dumb to think that the hoses and power cords would be interchangeable? If you have an s9, do you have trouble getting replacement parts?

No, parts are readily available. The heated hose is different, but you don't need to replace those often. The filters are the same, the water tanks are different, but you shouldn't need to replace that unless you somehow manage to break one.

dogsarelife wrote: ↑

Tue Mar 12, 2019 4:54 pm

Should I just go ahead and use the s9 vpap auto

Yes.

dogsarelife wrote: ↑

Tue Mar 12, 2019 4:54 pm

2) I saw that palerider posted that contrary to popular belief, the s9 vpap auto will raise pressure not based on the amount of flow, but on the shape of the flow

I'm pretty sure he never said that.
What he said was that auto machines raise pressure because of snores, flow limitations, hypopneas and apneas.

Flow Limitations are a restriction in the *rate* of airflow that show up with flattened (like yours) breath shapes.

Hypopneas are a reduction in flow *volume*, (as are apneas).

dogsarelife wrote: ↑

Tue Mar 12, 2019 4:54 pm

and I guess I'm wondering how vpap auto takes into account flow limitation when someone has messed with the trigger and cycle like me. (I'm guessing there's no real way to know unless I take the plunge and sleep with the s9 vpap auto)

Like I said, trigger and cycle just control exactly *when* the machine switches to IPAP in the intake breath, and back to EPAP as the intake ends.

Your charts are a mess, for some reason (probably not something you did, more likely sleepyhead acting stupid..)
Could you please do these things, and repost those two charts:

On the 'flow rate' chart, right click 'flow rate' select 'x-axis' then pick 'override' and -60 to 60 right now you've got -90 to 50 and that skews the chart. Also while in that right click, select 'dotted lines' and turn on the zero line.

Then, on the mask pressure, right click, x-axis and put in something more meaningful, like an override of 5 to 25. sleepyhead's auto scaling is pretty brain dead sometimes.

Hi Palerider, thanks for responding to me. I fixed the formatting of the other charts formatting and tried to maintain the same for last night's.

I did everything that was suggested, including increasing Timax to the level you suggested. I increased epap min to 11 and ipap min to 17, because even as I was just laying down the machine was going up that high. and aerophagia was fine, but I did play with trigger and cycle for comfort otherwise I just couldn't fall asleep

I zoomed in and checked most of the events and while I had a few arousals, a surprisingly large number of the events are real. but I"m also quite fuzzy and might be letting how bad I feel color how I am analyzing the data.

I feel headache-y and absolutely terrible not sure why that would be the case with just dropping the ipap/epap lower by about 1 cm from where I had been sleeping, but I think that's a sign to me I need to go back up? or maybe the new Timax wasn't quite right for me? or both? (apologies if these questions don't make any sense, I am just grasping at straws /desperate to get good sleep).

I know pressure support can contribute to centrals, but i have slept with PS around 6 and been fine before.

and I'm sorry I misquoted you on flow limits palerider! Need to go back and think about what you wrote.

something that is frustrating for me is that sleepyhead no longer allows me to do user flagged events with the s9 vpap auto not sure what that's about? I miss that functionality because it still seems that because of my needing to resort to both nasal and mouth breathing that there are events missed by the machine and kind of makes me want to go back to the AirCurve 10 S :/ because I would like User Flagged Events as a sort of double check on the machine. hmmm.

dogsarelife wrote: ↑

Wed Mar 13, 2019 9:07 am

but I did play with trigger and cycle for comfort otherwise I just couldn't fall asleep

Why?

dogsarelife wrote: ↑

Wed Mar 13, 2019 9:07 am

I zoomed in and checked most of the events and while I had a few arousals, a surprisingly large number of the events are real. but I"m also quite fuzzy and might be letting how bad I feel color how I am analyzing the data.

I feel headache-y and absolutely terrible not sure why that would be the case with just dropping the ipap/epap lower by about 1 cm from where I had been sleeping, but I think that's a sign to me I need to go back up? or maybe the new Timax wasn't quite right for me? or both? (apologies if these questions don't make any sense, I am just grasping at straws /desperate to get good sleep).

Sometimes, all it takes is a little too little pressure, however, your pressure didn't go up much. Upping the TiMax doesn't ever have any adverse effects on someone with normal lung function... now, if you had one of those "exhaling is difficult, but inhaling is fine" lung diseases, then restricting the TiMax helps to keep you from being 'over inflated'.

You can up your MinEPAP back to where your EPAP was on the S machine, if you want to try that, it won't hurt anything.

dogsarelife wrote: ↑

Wed Mar 13, 2019 9:07 am

I know pressure support can contribute to centrals, but i have slept with PS around 6 and been fine before.

Why do you need that much pressure support? The zoomed in part does suggest too much ventilation (too much PS) causing your respiratory drive to be depressed... but, even so, the amount of centrals isn't bad.

dogsarelife wrote: ↑

Wed Mar 13, 2019 9:07 am

and I'm sorry I misquoted you on flow limits palerider! Need to go back and think about what you wrote.

No worries.

dogsarelife wrote: ↑

Wed Mar 13, 2019 9:07 am

something that is frustrating for me is that sleepyhead no longer allows me to do user flagged events with the s9 vpap auto

Sure it does, I've got the exact same machine, and I use the user flagged events.

Hi palerider, thank you for responding!

on playing with trigger and cycle - you said -

palerider wrote: ↑

Wed Mar 13, 2019 3:06 pm

Why?

It seems to help with aerophagia to play with trigger and cycle for me. It doesn't feel like I'm getting slammed in the face/nostrils by the pressure increase, but the slope of pressure change is ever so slightly decreased such that I can tolerate it. At least that was what I understood from reading the manual.

palerider wrote: ↑

Wed Mar 13, 2019 3:06 pm

[...]restricting the TiMax helps to keep you from being 'over inflated'.

Why do you need that much pressure support? The zoomed in part does suggest too much ventilation (too much PS) causing your respiratory drive to be depressed... but, even so, the amount of centrals isn't bad.

Ah ok, I might try decreasing TiMax.

And I guess I used pressure support of 6 because I have had that feeling of being over inflated when using apap and EPR of 3 and I didn't at pressure support of 7. Just slowly working on decreasing my pressure support - and actually playing with trigger and cycle were instrumental in getting me from pressure support of 7 to 6.

I'm a little uncomfortable playing with so many variables at once! but I figure the most important thing is that I'm comfortable, first and foremost, and then once I get that down, to go ahead and mess with pressure support.

Thank you Palerider for looking at my graphs and letting me know it looked like my respiratory drive was being suppressed.

Maybe I'll try PS of 5, raised epap min, decrease the Timax back to 2.5, and see how that goes? I am just taking mild WAGs as Pugsy says, just like it was a WAG to raise epap and ipap to see if that helped things in the first place (and I'm so glad I saw some relief!)

dogsarelife wrote: ↑

Wed Mar 13, 2019 9:07 am

something that is frustrating for me is that sleepyhead no longer allows me to do user flagged events with the s9 vpap auto

palerider wrote: ↑

Wed Mar 13, 2019 3:06 pm

Sure it does, I've got the exact same machine, and I use the user flagged events.

hmmm for some reason I created a new profile for the vpap auto (don't ask me why! it seemed like a good idea at the time) and when I did that I couldn't see user flagged events, but when I loaded the s9 vpap auto info into my original profile, I could see the user flagged events. Weird. Thank you for letting me know the capability was available with your machine!

dogsarelife wrote: ↑

Wed Mar 13, 2019 10:05 pm

Hi palerider, thank you for responding!

on playing with trigger and cycle - you said -

palerider wrote: ↑

Wed Mar 13, 2019 3:06 pm

Why?

It seems to help with aerophagia to play with trigger and cycle for me. It doesn't feel like I'm getting slammed in the face/nostrils by the pressure increase, but the slope of pressure change is ever so slightly decreased such that I can tolerate it. At least that was what I understood from reading the manual.

Whatever you think you read in the manual, you've misinterpreted it.

Trigger and cycle in no way change HOW the pressure increase is delivered, they change exactly *when* it's delivered.

Under normal conditions, the 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 the VPAP’s automatic leak management feature—Vsync.
In addition, the VPAP has adjustable trigger/cycle sensitivity to optimize the sensing level according to patient conditions.

If you look on pages 38 and 39 of this manual
https://www.resmed.com/us/dam/documents ... er_eng.pdf
You'll see examples of when one should actually change trigger and cycle.

With easybreathe on, (which it always is in vauto mode) the pressure starts to increase as soon as you start to take a breath, and finishes increasing right at the end of your inhalation.

You can see this by looking at zoomed in flow rate and mask pressure charts one over the other.

Those settings aren't meant to be played with for some perceived "comfort".

dogsarelife wrote: ↑

Wed Mar 13, 2019 10:05 pm

Ah ok, I might try decreasing TiMax.

The only reason to *increase* TiMax is if your inhalation is being cut of by the machine before you're done inhaling.

dogsarelife wrote: ↑

Wed Mar 13, 2019 10:05 pm

And I guess I used pressure support of 6 because I have had that feeling of being over inflated when using apap and EPR of 3 and I didn't at pressure support of 7. Just slowly working on decreasing my pressure support - and actually playing with trigger and cycle were instrumental in getting me from pressure support of 7 to 6.

That's strange, since most people report a great feeling of being over inflated, (and hyperventilated) with high pressure supports.

dogsarelife wrote: ↑

Wed Mar 13, 2019 10:05 pm

I'm a little uncomfortable playing with so many variables at once!

But, you're playing with things I suggested NOT playing with.

dogsarelife wrote: ↑

Wed Mar 13, 2019 10:05 pm

decrease the Timax back to 2.5,

If you're taking 2 seconds or less to inhale, it doesn't matter *AT ALL* if your TiMax is 2, 3, or 4. Likewise, if your longest inhalation is 2.5 seconds, it doesn't matter AT ALL if you set TiMax to 2.5, 3, or 4.

dogsarelife wrote: ↑

Wed Mar 13, 2019 9:07 am

I created a new profile for the vpap auto (don't ask me why! it seemed like a good idea at the time) and when I did that I couldn't see user flagged events

You have to turn them on.

Hi palerider -

Thanks for replying!

I see you are right and I made a mistake in what I wrote - the slope of the line of pressure is not changed, just the timing as you said.

I have a feeling that you don't think comfort is important, but I will walk you through my logic (which I'm already aware you think is crap!)

The manual says on page 25:

Adjustable trigger and cycle sensitivity settings can
be used to optimize synchrony between the device and the
patient’s own respiratory efforts.

So I come to page 38, the page you referred me to and it says:

Things to consider:

Adjust TiControls and Synchrony features if
• Patient complains of pressure discomfort
• Chest wall movement is not in sync with mask pressure tracing
• Inspiratory efforts don’t trigger the device

For me, I was experiencing pressure discomfort.

As well, my inspiratory efforts were triggering the device before I was ready and it was resulting in a lot of aerophagia. It felt like air was getting slammed into my stomach and I was vomiting air after 5 minutes of trying to breathe at high pressure. that's what led me to play with trigger and cycle in the first place. I didn't feel as big a difference playing with Timin and Timax.

page 42:

"Recognizing that each patient is different, ResMed provides five
levels of Trigger & Cycle sensitivity to help you tailor and fine-tune
triggering and cycling values to different patient conditions.
• The Trigger sensitivity setting helps care providers customize the
sensitivity level of the device to better recognize patients with
decreased inspiratory efforts.
• The Cycle sensitivity helps the care provider ensure appropriate
breath termination for every patient, promoting patient-device
synchrony."

From page 43:

'

A Low (or Very Low) trigger sensitivity setting is
recommended for the following conditions:
• Cardiogenic oscillations and subsequent auto-triggering
• Any time the patient complains that breaths are starting
before inhaling you can decrease the trigger sensitivity to
assist the patient in transitioning from EPAP to IPAP

I don't have cardiogenic oscillations as far as I know, but I was experiencing the second one. So again, it was my personal experience that I felt that the breaths were starting before I was actually trying to inhale, thus why I switched to low trigger, which felt more natural to me.

Later on, the manual says this:

Recommend the Low (or Very Low) cycle sensitivity setting
for the following conditions:

• In situations where a longer inspiratory time is desirable
(eg, neuromuscular diseases or patients with a very weak
respiratory effort). Ti Min can also be used to lengthen
inspiratory time
• Any time the patient complains that the device seems
to switch from IPAP to EPAP too quickly or is cutting off
their breath, adjust the cycle sensitivity to help the patient
transitioning from IPAP to EPAP

I don't have the first bullet point, however, it was my personal experience that it felt like the machine was switching from IPAP to EPAP too quickly and cutting off my breath, and I tried very low cycle and since it enabled me to stick with bilevel therapy, I stuck with it.

So is it really that awful for me to customize the trigger and cycle to my liking, if it helps me actually stick with and enjoy the bilevel, and relax enough to fall asleep, as opposed to feeling stressed falling asleep while sticking to medium trigger and medium cycle, and waking up burping/vomiting air?

Why is it bad to recognize that each patient is different, as the linked document states - and goes on to mention trigger and cycle to achieve better patient synchrony? Are there specific example of harm coming about from changing trigger and cycle?

Thanks for hearing me out and helping me understand.

Oh, and I did switch on user flagged events in sleepyhead for the new s9 vpap auto profile. Trust me- if I had not done and that was the reason why, I would have admitted it! But I definitely like to check out as much data as I can to understand what's going on, and I definitely checked all the boxes and the top chart unfortunately never reflected user flagged events, so I'm not sure if I should submit that as a sleepyhead bug or just leave it be.

dogsarelife wrote: ↑

Wed Mar 13, 2019 11:31 pm

Hi palerider -

Thanks for replying!

I see you are right and I made a mistake in what I wrote - the slope of the line of pressure is not changed, just the timing as you said.

I have a feeling that you don't think comfort is important, but I will walk you through my logic (which I'm already aware you think is crap!)

No, you're wrong. Comfort is important, but trigger and cycle aren't *comfort* features. Trigger just controls how much of a breath you have to take before the machine starts going to IPAP. I've got mine on very high, because I saw times leading up to obstructive apneas where I could see attempts at a breath, but no response from the machine, setting trigger to very high enabled the machine to respond to those tiny breaths and help me breathe, which lowered my AHI.

dogsarelife wrote: ↑

Wed Mar 13, 2019 11:31 pm

The manual says on page 25:....
For me, I was experiencing pressure discomfort.

They're talking about people who suffer from breath stacking. People who's lung conditions make it hard for them to breathe normally, and you don't want the machine to trigger when they're not actually trying to breathe yet.

dogsarelife wrote: ↑

Wed Mar 13, 2019 11:31 pm

As well, my inspiratory efforts were triggering the device before I was ready and it was resulting in a lot of aerophagia.

That's not how that works.

dogsarelife wrote: ↑

Wed Mar 13, 2019 11:31 pm

It felt like air was getting slammed into my stomach and I was vomiting air after 5 minutes of trying to breathe at high pressure. that's what led me to play with trigger and cycle in the first place. I didn't feel as big a difference playing with Timin and Timax.

Did you have easybreathe turned on in your S model?

dogsarelife wrote: ↑

Wed Mar 13, 2019 11:31 pm

I don't have the first bullet point, however, it was my personal experience that it felt like the machine was switching from IPAP to EPAP too quickly and cutting off my breath, and I tried very low cycle and since it enabled me to stick with bilevel therapy, I stuck with it.

The *proper* thing when the machine cuts off IPAP too early is to increase TiMax.

dogsarelife wrote: ↑

Wed Mar 13, 2019 11:31 pm

Why is it bad to recognize that each patient is different,

It's not, but you're diddling with things that you *don't understand* and then stubbornly sticking to what you've misconceived and arguing about it when I try and tell you what's proper.

That's fine, do what you want. At some point, I just give up.

dogsarelife wrote: ↑

Wed Mar 13, 2019 11:31 pm

the top chart unfortunately never reflected user flagged events, so I'm not sure if I should submit that as a sleepyhead bug or just leave it be.

Knock yourself out, it requires rebuilding the data for them to show up....

Of course, the sleepyhead lead programmer has apparently had a paranoid schizophrenic event and has shut down development.

Did you do the rebuild of the data thing after turning on User controlled flagging? That has to be done before the new UCF shows up.

Won't do any good to submit any bugs needing fixing.....no one is fixing any bugs in this version of SleepyHead and right now there are no more planned versions of SleepyHead.

palerider wrote: ↑

Thu Mar 14, 2019 12:20 am

No, you're wrong. Comfort is important, but trigger and cycle aren't *comfort* features. Trigger just controls how much of a breath you have to take before the machine starts going to IPAP. I've got mine on very high, because I saw times leading up to obstructive apneas where I could see attempts at a breath, but no response from the machine, setting trigger to very high enabled the machine to respond to those tiny breaths and help me breathe, which lowered my AHI.

Palerider - Thanks for your response. I figured that you wouldn't be swayed by what I had to say.

I'm just trying to do the best I can to tolerate my bilevel at high pressure, and while I suppose I don't exactly understand why what I'm doing is bad for me versus the alternative of vomiting air and being unable to sleep, I really would like to grasp things better!

I promise I have tried out sleeping with the suggestions you said and it was just so uncomfortable for me.

I understand that you have a better handle on theory and I wish my lived experience could enable me to breathe with medium to high trigger and medium cycle, but it's not right now and I don't quite know why, but I am hopeful I can understand.

Is it possible I have hiatal hernia that's mucking things up? the mild scoliosis I was told that I had when I was a kid affecting things? Damage to muscles from having untreated OSA for so long? All of the above?


Edited to Add: - I found the following slides from a respiratory therapist.
https://studylib.net/doc/5598306/are-yo ... ddins-rrt And this slide says if the patient complains "pressure is too STRONG" (which has been me in trying to adjust to higher pressures) to play with rise time. Rise time is actually grayed out on my Aircurve 10 S and I assume remains at factory default, and not even an option on the s9 vpap auto to mess with, unless I have missed it.

Since I can't change rise time, I'm thinking that's why it felt better for me to futz with trigger and cycle?



Are you in agreement with the respiratory therapist presentation that perhaps I should look into altering rise time, by asking my doctor or nurse, who would then tell my DME to change it? (
Is this one of the things that the answer could vary from respiratory therapist to respiratory therapist?

If you don't feel like you have the time to answer, then I understand and thanks for informing me that my grasp of the theory needs some work, and I will try those two above sources - Jason and my doctor's office- to try and better understand what could be happening. Or look into books. Don't worry - I won't be defeated.

oh and Easy-breathe is definitely turned on for both of my machines! I once turned that off to see how it felt to breathe without it, and it was immediately clear that easy-breathe helps A LOT with transition from epap to ipap and ipap to epap. It's a very abrupt, jarring pressure change without easy-breathe, and I'm grateful that easy-breathe exists otherwise I would not be able to tolerate bilevel pap at all.

Thank you for letting me know about the health of the sleepyhead developer. I hope he can be well, that sounds quite scary to endure and I hope he has loved ones and good therapeutic and medical care to support him.

I appreciate your time and thank you for your responses to my thread.

Pugsy wrote: ↑

Thu Mar 14, 2019 6:48 am

Did you do the rebuild of the data thing after turning on User controlled flagging? That has to be done before the new UCF shows up.

Won't do any good to submit any bugs needing fixing.....no one is fixing any bugs in this version of SleepyHead and right now there are no more planned versions of SleepyHead.

Hi Pugsy - I did do the rebuild of the data thing after turning on User controlled flagging, several times. It's fine, I'll just make a note in my personal log and keep everything under the one profile.

I guess if, in the future, there are planned versions of SleepyHead, I will make note of this one small bug. I'm sure there are others that are more pressing than my one small concern

Sorry the rebuild didn't fix your problems.
SleepyHead is Beta software and has been Beta for a long time. It's buggy but the bugs aren't always addressed completely as the new versions were released. Long story there as you are probably aware of. It is what it is and not much we can do about it right now.
Most of the times the bugs are minor and we have just learned to live with them.
The choice is live with them or use ResScan (or Encore Pro for Respironics users) which have their own little bugs and we can't do nearly as much with it as we can SH.
So it's pick your poison.

dogsarelife wrote: ↑

Thu Mar 14, 2019 9:03 am

Since I can't change rise time, I'm thinking that's why it felt better for me to futz with trigger and cycle?

It's clear that no amount of facts will sway your preconceived notions.
Rise time (which is automatic and extremely gentle with easybreathe turned on) has nothing to do with trigger and cycle.

dogsarelife wrote: ↑

Thu Mar 14, 2019 9:03 am

Are you in agreement with the respiratory therapist presentation that perhaps I should look into altering rise time, by asking my doctor or nurse, who would then tell my DME to change it?

You can't change rise time in vauto mode, it's already automatically set at the most gentle setting. All any change would do would make the pressure transition more abrupt.

dogsarelife wrote: ↑

Thu Mar 14, 2019 9:03 am

If you don't feel like you have the time to answer,

It's not that I don't have *time*, it's that I'm losing the *will*, because you've got an idea in your head, and you refuse to let go of it.

Palerider - believe it or not I am open to learning, and once I understand the theory behind what is occurring, changing what I am doing.

Side note - If you have heard of Gretchen Rubin, she writes these books about the 4 tendencies - upholder, obliger, rebel, and the questioner. It's interesting to see these people all across cpaptalk.com.

https://gretchenrubin.com/2014/03/quiz- ... -obliger/

In a nutshell, here are the four tendencies)

Upholders respond readily to outer and inner expectations (say, people who decorate for the holidays both because they want to, but also because their family and neighborhood has the expectation of it)
Questioners question all expectations; they’ll meet an expectation if they think it makes sense; essentially, they make all expectations into inner expectations (pretty self-explanatory; they might even question these four tendencies, which is fair )
Rebels resist all expectations, outer and inner alike (someone who's always playing devil's advocate, or when someone tells them they can't do something they think "i'll show you!)
Obligers meet outer expectations, but struggle to meet expectations they impose on themselves (the people-pleaser perhaps, or the person who can't say no is what this makes me think of)

I am a questioner in terms of health things - I'll meet an expectation if I think it makes sense. I think if I were an obliger, then I would just do what you tell me to do - but then I don't think that would result in the best xpap outcome - or at least right now. I've seen that there are people who used less pressure than they need due to aerophagia, under the assumption that some therapy is better than no therapy, and that's sort of where I am with trigger and cycle right now - maybe in time I can get those dialed back in to medium. I can tolerate medium trigger and cycle at lower pressure (15/8.2) and higher pressure support for whatever reason, and I honestly don't know what is the lesser of two evils at this point in terms of what is the proper thing to do? I know that with 15/8.2 I had more feelings of choking/bad dreams even though the trigger and cycle were both set to medium.

I was thinking that since the manual you linked to actually does suggest varying Rise time in the area of 150-300 milliseconds in cases of complaints like mine since

"A prolonged rise time inhibits fast pressurization,
therefore, rise time should not be set longer than Ti Min or the
patient’s normal inspiratory time."

that if I am one of those few cases that needs to alter rise time, I suppose I have to work with my doctor's office / DME since it's inaccessible on my machine.

Anyway, you have already given me a good amount of your time and effort, as have everyone else on this thread. I am appreciative to have you and others exposing me to different concepts and ideas that have furthered my understanding of my bilevel therapy and people to bounce off ideas, and I wish you well with your efforts to help others on this forum.

hope you have a good Friday!