AVAPS-AE on MY Trilogy - Ongoing

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Madalot
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AVAPS-AE on MY Trilogy - Ongoing

Post by Madalot » Mon Aug 19, 2013 1:55 pm

I finally remembered to browse through the settings on this loaner Trilogy I am using (Mine is getting it's maintenance & updates).

The Maximum IPAP is now 49 (my Trilogy only goes to 36).

I post this only because the Trilogy has been discussed recently and the Maximum IPAP was discussed.

This Trilogy also has a new Mode: AVAPS-AE. This mode has a few news settings including pressure support & min/max EPAP settings, neither of which has been available on the Trilogy I've been using. They WILL be when I get mine back and obviously are available on the loaner unit.

I may have to read up on pressure support and see *IF* these options might be beneficial to me.

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Mask: FlexiFit HC431 Full Face CPAP Mask with Headgear
Humidifier: HC150 Heated Humidifier With Hose, 2 Chambers and Stand
Additional Comments: Trilogy 100. S/T AVAPS, IPAP 18-23, EPAP 10, BPM 7
Last edited by Madalot on Thu Oct 24, 2013 9:47 am, edited 10 times in total.

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Re: Trilogy 100 Options

Post by STL Mark » Mon Aug 19, 2013 2:58 pm

I have always been curious about the required maintenance on these machines. What is the usual service interval? What parts are considered consumable?

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oak
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Re: Trilogy 100 Options

Post by oak » Mon Aug 19, 2013 3:36 pm

spam

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Re: Trilogy 100 Options

Post by StuUnderPressure » Mon Aug 19, 2013 3:46 pm

oak wrote:spam
Huh????

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oak
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Re: Trilogy 100 Options

Post by oak » Mon Aug 19, 2013 4:44 pm

it was deleted

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Madalot
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Re: Trilogy 100 Options

Post by Madalot » Mon Aug 19, 2013 5:19 pm

My trilogy went for maintenance after one year. Thereafter, it goes every two years. I don't know what all they do to it but they are upgrading software to the latest features.

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Mask: FlexiFit HC431 Full Face CPAP Mask with Headgear
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Additional Comments: Trilogy 100. S/T AVAPS, IPAP 18-23, EPAP 10, BPM 7

jnk
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Re: Trilogy 100 Options

Post by jnk » Mon Aug 19, 2013 7:30 pm


jnk
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Re: Trilogy 100 Options

Post by jnk » Mon Aug 19, 2013 8:02 pm

Some AVAPS-AE info . . .
AVAPS-AE is a Bi-level therapy mode that automatically adjusts Expiratory Positive Airway Pressure (EPAP), PressureSupport, and the backup breath rate. AVAPS-AE monitors the resistance in the patient’s upper airway and adjusts EPAP automatically to maintain a patent airway. AVAPS-AE mode also monitors delivered tidal volumes and automatically adjusts pressure support to maintain the designated target tidal volume. AVAPS-AE also has the ability to automatically set and maintain a backup breath rate based on the patient’s own spontaneous breathing rate. AVAPS-AE is intended for non-invasive applications only.

AVAPS-AE is enabled in the Settings and Alarms Screen. When in AVAPS-AE mode, the AVAPS feature is always enabled. Similar to AVAPS, AVAPS-AE supports tidal volumes from 50 to 2000 ml (in 5 ml increments).

The following new parameters should be set to ensure appropriate therapy delivery and maximize patient comfort:

• Maximum Pressure: When in AVAPS-AE mode, the Maximum Pressure delivered can be set from 6 to 50 cmH2Oin increments of 1. Settings lower than the maximum setting of 50 cmH2O may limit other pressure settings.
• Pressure Support Max: When in AVAPS-AE mode, Pressure Support Max can be set from 2 to 40 cmH2O in increments of 1. This setting may be limited by the Maximum Pressure setting and EPAP Min Pressure setting.
• Pressure Support Min: When in AVAPS-AE mode the minimum pressure support may be set from 2 to 40 cmH2O in increments of 1. It may not exceed the Pressure Support Max setting. This setting may be limited by the Maximum Pressure or EPAP Max Pressure setting.
• EPAP Max Pressure: When in AVAPS-AE mode, the EPAP Max Pressure can be set from 4 to 25 cmH2O in increments of 1. This setting cannot be lower than the EPAP Min Pressure and may be limited by the Maximum Pressure setting and Pressure Support Min setting.
• EPAP Min Pressure: When in AVAPS-AE mode, the EPAP Min Pressure can be set from 4 to 25 cmH2O in increments of 1. This setting cannot exceed EPAP Max Pressure and may be limited by the Maximum Pressure setting and Pressure Support Min setting.
• Breath Rate: When in AVAPS-AE mode, the breath rate can be set from 0 (off) to 60 BPM. The breath rate can also be set to “Auto”. Note: When “Auto” Breath Rate is selected, the Inspiratory Time will be set by the device and is not user settable.

AVAPS-AE Troubleshooting

Question: Why can’t I increase my Pressure Support Max to the full range of 40 cmH2O? Answer: Some settings, such as Pressure Support Max, can be limited by other pressure settings. For example, reducing the Maximum Pressure setting will impose the same reduction on the Pressure Support Max capability of the device. Increasing the EPAP Min Pressure will also reduce the Pressure Support Max that can be applied. You may have to modify one setting in order to extend the range of another setting.

Question: What happens if the device needs to increase EPAP but the Maximum Pressure setting has already been reached?Answer: The EPAP will increase as high as the EPAP Max Pressure setting. The amount of Pressure Support applied may be reduced in order to reach the EPAP Max setting. Airway patency and hence the EPAP pressure will take precedence over Pressure Support in these situations.

Question: How does the Ramp function work when using AVAPS-AE? Answer: Ramp: Activation of the Ramp Feature in AVAPS-AE will reset the EPAP setting to the EPAP Min Pressure and restart the Auto EPAP algorithm. Additionally, the Pressure Support will be reduced to the Pressure Support Min level and ramp as high as the Pressure Support Max, as required by the AVAPS algorithm, to allow for a comfortable transition to sleep. Note: If using AVAPS, the pressure support capability will ramp from the IPAP Min (or Pressure Support Min) to the IPAP Max (or Pressure Support Max). The AVAPS feature has been changed to allow for the adjustment of the rate. The AVAPS Rate setting allows you to adjust the maximum rate at which the pressure support automatically changes to achieve the target tidal volume. The actual rate may be less than this maximum setting depending on how far the current estimated tidal volume is from the target tidal volume. A higher rate allows the AVAPS algorithm to change pressure support faster to meet the target tidal volume. It can be set from 1 cmH2O per minute to 5 cmH2O per minute in increments of 1 cmH2O per minute.
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Madalot
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Re: Trilogy 100 Options

Post by Madalot » Tue Aug 20, 2013 5:05 am

Thank you, Jeff, for posting all that fabulous information. A little of it I had seen, but most of it I hadn't read.

The on-screen waveform I haven't seen on this Trilogy (maybe there are settings to get it to display).

I'm very interested in the AVAPS-AE mode and the increased functionality that goes with it. On the other hand, I'm not sure I want to mess with what has turned out to be the most comfortable settings I've had since I got the Trilogy in February 2010.

But dang -- those AVAPS-AE options sure are intriguing.

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Madalot
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Re: Trilogy 100 Options - Question for Experts

Post by Madalot » Tue Aug 20, 2013 10:51 am

I'm curious if any experts out there have an opinion about this. I'm on the fence.

I'm finding the increased functionality in the AVAPS-AE intriguing. I WANT to try it. I don't see the harm in giving it a test drive, knowing I can push a couple buttons and get right back to my current regular AVAPS settings.

My current settings are working as well as anything has.

And if I WERE to test the AVAPS-AE, how would you recommend I set some of this stuff? I understand most of it, but for some reason, I just cannot get my mind wrapped around Pressure Support and/or how it would apply in this mode.

Any takers?

Current AVAPS Settings:
Tidal Volume: 400
Min IPAP: 18
Max IPAP 23
EPAP: 9
BPM: 7
Inspiratory Time: 1.5
Rise Time: 4
New AVAPS Setting: 3

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Mask: FlexiFit HC431 Full Face CPAP Mask with Headgear
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Additional Comments: Trilogy 100. S/T AVAPS, IPAP 18-23, EPAP 10, BPM 7

jnk
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Re: Trilogy 100 Options - Question for Experts

Post by jnk » Tue Aug 20, 2013 12:14 pm

As you well know, I'm not a pro anything. But here are my guesses as nothing more than a fellow human being who cares about you and who has the gall to post his opinions on things he has no education on:

Tidal volume would not need to change.
Min IPAP would not need to change unless the doc/RT wanted to give the thing more room to run, depending on the range of EPAP and range of PS desired. (See below on Pressure Support range.)
Max IPAP would only need to change if the doc/RT wanted to give the thing more room to run, depending on the range of EPAP and range of PS desired. (See below on Pressure Support range.)
EPAP could now be set to a range with a Min and Max. If your EPAP is fixed at 9 now, a reaonable range, depending on other factors only your team would know, might be something like 7 to 10 or 11, maybe. Whatever most comfortably prevents obstruction, IF you want it to run more as an APAP than a CPAP as far as obstruction prevention.
BPM could be tried in auto mode, if the machine reads your rhythm well enough. If not, it could be set to 7 as it is now.
Inspiratory Time would not need to change if BPM is set to 7. If BPM is in auto mode, the machine chooses the Inspiratory time.
As for Pressure Support Min and Max, your machine right now is running a PS range of 9-14 (since you are at steady 9 EPAP and an 18-23 IPAP). To keep that range and allow the EPAP to move at the range of 7 to 11 I mentioned, your Max IPAP would likely need to be set at 25 instead of 23, since at some point your EPAP could up to 11 and your PS could get up to 14, and your Min IPAP would likely need to be set to 16 instead of 18, since at some point the EPAP could get down to 7 and the PS down to 9.

That all represents only one of many, many possible ways to set things up in relation to your present settings.

If I were you, I would place my (jnk's) non-pro personal opinion on the value scale well below your (Madalot's) personal opinion, since you are more experienced with this stuff than I am. But maybe that gives you some ideas about what to discuss with your team. Hopefully a real expert will post in this thread to correct any improper assumptions I have made. I sure wish you had a team that would walk you through all of that as they should be doing, in my opinion. It's a shame just how proactive and involved so many of us end up being with this stuff on our own.

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Madalot
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Re: Trilogy 100 Options - Question for Experts

Post by Madalot » Tue Aug 20, 2013 12:44 pm

Thank you so much, Jeff. This is exactly the information I was hoping to get. I will hold off doing anything right now so others can chime in if they want. But what a great starting point you have put me at, Jeff! Again, I thank you so much.

One of the main reasons I'm thinking of doing this is that my current settings work great as long as I'm sleeping on my side. When I go to my back, my settings need to be higher to prevent apneas. Those settings are too high if I'm on my side. Recently, pain has forced me to sleep on my back and my husband has been waking me up saying I'm snoring. It seems to me that these new settings might allow for it to automatically go lower when I'm on my side, then switch to the higher settings if needed if I sleep on my back.

If not for the recent problems with side sleeping, I probably wouldn't even bother messing with this. But knowing this Trilogy has the more sophisticated AVAPS mode, I have the option to try it and see if it does the trick.

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Mask: FlexiFit HC431 Full Face CPAP Mask with Headgear
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jnk
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Re: Trilogy 100 Options - Question for Experts

Post by jnk » Tue Aug 20, 2013 12:49 pm

I might choose to write out what settings I planned on using and then try to get my team to sign off on them.

But it sounds to me that you are planning to attempt to use that mode for the very purposes for which it appears to have been designed.

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Madalot
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Re: Trilogy 100 Options - Question for Experts

Post by Madalot » Tue Aug 20, 2013 1:04 pm

I have sent an email to my respiratory therapist asking if she can authorize this test. She may tell me that my doctor has to approve it, in which case I'll contact him and ask him. Based on my experience with him, he won't have a problem with what I'm trying to do. But I will make sure that they know and approve of what I'm doing before I do anything. I'm getting this input so that when they ask me for specifics on the settings I'll have them ready.

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Mask: FlexiFit HC431 Full Face CPAP Mask with Headgear
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Additional Comments: Trilogy 100. S/T AVAPS, IPAP 18-23, EPAP 10, BPM 7

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Madalot
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Re: Trilogy 100 Options - AVAPS-AE

Post by Madalot » Wed Aug 21, 2013 1:53 pm

My Respiratory Therapist responded with - " ' Officially' we have to have your doctor's approval." -- I took that to mean if I wanted to do it, she didn't have a problem but it might be smart to cover our butts and get his approval.

I emailed my doctor, who is out of the country at the moment, but his Assistant said he has been good about replying to emails and she promised to forward it to him this morning.

Both my RT and I think he'll say okay, so I am going to start setting up the Secondary Prescription for the AVAPS-AE.

Jeff, thanks so much for that input. Gives me a FABULOUS place to start. And as my RT pointed out, you have to really test them before you know how well they work for you.

_________________
Mask: FlexiFit HC431 Full Face CPAP Mask with Headgear
Humidifier: HC150 Heated Humidifier With Hose, 2 Chambers and Stand
Additional Comments: Trilogy 100. S/T AVAPS, IPAP 18-23, EPAP 10, BPM 7