[Moving from Dreamstation CPAP to Resmed VPAP S/T] Need some help

[thibaulthib]

Hello!

I am moving away from CPAP in order to join the VPAP S/T community :-)

As explained in another thread briefly, I have been using PR Dreamstation CPAP for the past 6 months (Min pressure 8, max 12), but due to a very average low tidal volume (250ml-280ml), and some extreme hypoventilations when drinking, my sleep specialist (Pulmonolgist) is putting me under Resmed VPAP S/T, because the very shallow breath also happen while totally sober.

I just got a Resmed Lumis 150 S/T this morning for 2 weeks rental, that I will start using tonight. In Singapore, they do not carry AirCurve 10 yet.
As a start, my settings are the following:
- IPAP: 10
- EPAP: 6
- ST mode
- Ti min: 0.4sec
- Ti max: 2.5sec
- Respiratory rate: 16/min

However, I have few questions:
1) I am 170cm, 70kg. I will closely monitor my tidal volume. How much should it be while sleeping? 420ml (6ml/kg) ? or more likely 490ml (7ml/kg)?
2) To increase the tidal volume, shall I increase the pressure gap between IPAP and EPAP?
3) The Lumis 150 also has IVAPS and iBR, that I can use instead of ST. What is the mode that you basically recommend?
4) If I like the Lumis 150, will I like the AirCurve 10 ST-A that I am planning to get online?

Thank you guys!

Thibault

[Walla Walla]

That is a question you really need to ask your Pulmonologist. I know from reading that if there is any lung problems they usually aim for 6ml/kg to avoid causing any damage to the lungs. But your Doctor is the one who is going to know your health situation and what you require. Hey that's what you pay him for!

[thibaulthib]

That is a question you really need to ask your Pulmonologist. I know from reading that if there is any lung problems they usually aim for 6ml/kg to avoid causing any damage to the lungs. But your Doctor is the one who is going to know your health situation and what you require. Hey that's what you pay him for!

Hey Walla Walla,

Agree with you, actually he told me I need 350ml-400ml, but I wanted to check with you if the numbers would have been the same somehow... 
I like having different advise and compare them, while trying to understand why.

Cheers

Thibault

[Sleeprider]

I would monitor the tidal volume looking for improvement, rather than a specific number.  If you can improve your CPAP average by 100 mL that would be very successful, but don't stress if it is less.  The purpose of this experiment is to see what it does for you, and any improvement is a success.  You are starting at a pressure support of 4.0 cm at 10/6.  Once you adjust to that, we need to look at the AHI and verify obstructive apnea are resolved, and consider whether more EPAP or more pressure support is needed.  I usually see more significant tidal volume improvements at pressure supports from 5 to 8 cm, but we don't want to add more than necessary. PS of 4.0 is a good start. Stick with it for a few days, and let's have a look.

For your information, Resmed makes an iVAPS machine. The following explains how it uses automatic pressure support to ensure tidal volume:

[thibaulthib]

Thanks Sleeprider !

I have changed my Philips Dreamwear under the noise mask with the Gel Pillows one to avoid any leaks too.

I have made some test during the past hour:
- 10/6 seems to be quite difficult for me, at least for now: I feel dizzy and this also has an impact on increasing my heart and respiratory rate
- 10/7 is better, but still, I am a bit concerned, because I feel like after a trying for like 20min, my heart is racing

For tonight, may I start with 10/8 and check tomorrow the tidal volume in order to get confidence ?

Right now, with the PR Dreamstation and Aflex 1, min pressure = 8 and the exhale pressure relief is 1.5, so by having 2cmH20 of PS with the Lumis 150 should be a good start in order to put myself in confidence.

Don't know if it really makes sense ?

Thibault

[Sleeprider]

I would design your experiment keeping the 6.0 EPAP and reducing IPAP, rather than increasing EPAP.  We want to find the EPAP min that avoids obstructive apnea, and build pressure support from there.  I'm just going from your doctor's initial recommendation.  Here is the ST Titration Protocol you should be trying to emulate.  I am including an iVAPS titration protocol, but this does not apply to the Lumis 150.

[thibaulthib]

Thanks Sleeprider !

I will start with 9/6 tonight then, I know it is low but I guess I need to start somewhere, lol!

If I feel dizzy, I will drop to 8/6. I will check the tidal volume + AHI tomorrow morning, and we can start from there.

Thibault

[thibaulthib]

It is 5:20am here, woke up after 5h of sleep and I just feel so good !!! I can't even sleep anymore and I am not even yawning !! What's going on ! ?

Checked sleepyhead results with 10/6 settings:
- AHI: 0
- Tidal: 300ml
- Resp rate: 16

I have just increased the IPAP to 11, hence now I am on 11/6.
I have also just disabled ST mode and put S only, just to check if it has an effect on my respiratory rate and the AHI.

Will try to sleep a bit more and keep you posted in few hours! :-)

That is awesome!

[Sleeprider]

Take the changes slowly. I always thought regular bilevel would be good for you, but uncertainty about the need for timed backup. If you end up with good results on VPAP S then the Vauto will be amazing. Glad to hear that the pressure support is "happening" for you. Give it time.

[thibaulthib]

Could not sleep anymore... Actually I was on 10/7 (PS 3), attached the screenshots of my night.
Since I have been playing with many settings, don't take too much attention about the table on the left because numbers are not representing my night.

I am hopeful ! Tonight, I am going to try 11/7 (PS 4), in order to increase the tidal volume. I don't want to try 10/6 because I can see that at some point, I am doing a lot of aveoles which may lead to hypopneas/OAs.

Thank you so much for your help Sleeprider !