AVAPS-AE on MY Trilogy - Ongoing

I went ahead and tried to duplicate the pulses as SWS suggested. After trying for a while and getting light headed from exhaling so hard, both through my nose and my mouth, I was unable to duplicate the pulsing in any way on any settings. I guarantee you they will happen again tonight though no matter what. Unless, of course, I go back to regular AVAPS settings in which case I'm not sure whether or not the pulses would occur.

Madalot wrote:This loaner machine has had all those errors in just under 2 years? Would the patient or user been aware of them? Is there any point in doing more testing to see if there's something else going on or should I not worry about it at this point and just wait for my trilogy to come back?

I would insure that your mask and circuit are working perfectly, especially the AA valve. If they are, then call them up and tell them it ain't working right.

Madalot wrote: Could be coincidence, but this was not happening on regular AVAPS. Happened either the first or second night on AVAPS-AE. If port is faulty, shouldn't it be happening in regular AVAPS as well?

Dunno why that is, Madalot. But your waveforms look like a one-way check-valve with an intermittent breach. Bear in mind the pressure dynamics on BOTH sides of the port block will factor in---and we simply don't know how those internal pressure dynamics differ in the two configuration modes (AVAPS versus AVAPS-AE). Energy dynamics can be tough to predict.

mollete wrote:I would insure that your mask and circuit are working perfectly, especially the AA valve. If they are, then call them up and tell them it ain't working right.

Agreed. If you're on lease, Madalot, I think they're obligated to provide you with a working Trilogy----even if it means expediting the return of yours or fixing the loaner on the spot. Replacing a faulty port block---or incorrect port block type---should be fairly simple.

We have just checked and the hose is fine. The AA valve is opening and closing like it should.

This is a rental.

I might switch back to regular AVAPS for tonight for my own peace of mind when I call them. They are likely to ask me if it happened just in AE.

Curious if you spend more time running the supine settings (@EPAP 12cm) or more time running the side-sleeping settings (@EPAP 9cm).

It might not boil down to AVAPS -vs- AVAPS-AE. It might boil down to a unique combination of pressure dynamics relative to PS in tandem with EPAP:

With Min EPAP 9, Max EPAP 11, Min PS 9, Max PS 14, and Max Pressure 23, these will be the allowable PS ranges, per auto-EPAP value:

@auto EPAP 9===>PS 9cm through PS 14cm
@auto EPAP 10===>PS 9cm through PS 13cm
@auto EPAP 11===>PS 9cm through PS 12cm

The old AVAPS side-sleeping settings used fixed EPAP 9cm, allowing PS 9cm through PS 14cm
The old AVAPS supine-sleeping settings used fixed EPAP 12cm, allowing PS 6cm through PS 11cm

Without a doubt side settings. Supine settings are very uncomfortable when falling asleep on my side.

Madalot wrote:Without a doubt side settings. Supine settings are very uncomfortable when falling asleep on my side.

Ah... see what I edited into my post above. In short, I'm thinking the EPAP and PS pressure levels might be more relevant than whether AVAPS-AE is turned on. For instance, what if EPAP 10cm were the trigger threshold? Then hitting 10cm becomes more relevant than which modality happened to be turned on. PS factors in as well, since it represents sudden drops from IPAP to EPAP of varying pressure magnitudes...

I see what you mean. Now I'm not sure what is the wisest choice for tonight. I suspect the DME will blame the mode and just say to go back to my regular settings. I suppose I could go back and set EPAP to 10. A lot of variables.

-SWS wrote: Mode: S/T with AVAPS-AE Enabled
Tidal Volume: 400
PS Max: 14
PS Min: 9
EPAP Max: 9
EPAP Min: 9
Breath Rate: 7
Inspiratory Time: 1.5
Trigger Type: Flow Trigger
Flow Trigger Sensitivity: 6
Flow Cycle Sensitivity: 25%
Rise Time: 4
AVAPS Rate: 3
All Alarms Disabled

Can you place the machine in AVAPS-AE mode and then set both EPAP Min & EPAP Max at 9cm as above? Those will be your old AVAPS settings exactly, but with AVAPS-AE modality entered. Be curious to see if the pulsing goes away.

Absolutely. That's what I will sleep on tonight. Should answer several questions. Great thinking! Thank you!

I hope AVAPS-AE mode allows EPAP Max & EPAP Min to be set at the same value.... Dunno if that's allowed.

It does. Already set and ready.

Great... We'll see if you still have "check valve chatter" on that exhalation port block.

Perhaps it is a bad blower motor bearing.

Up after setting AVAPS-AE to mimic regular AVAPS settings (min & max EPAP at 9).

No pulses. Smooth as usual. Which brings me to a question. The FIRST night I used AVAPS-AE, I had the machine set a little more "open" with a wider EPAP range. I do not remember pulses from that night. Only with EPAP at 9-10 has it happened.

Again, coincidence? We may never know. I'm not sure if I should bother calling the DME or just table the AVAPS-AE testing until my Trilogy comes back in hopefully 6 weeks.

It's a shame because I'm anxious to see *if* I can get the AVAPS-AE mode to function the way we hope and have a little more freedom, and peace of mind, sleeping supine when needed.