Back to the Vauto in CPAP/fixed pressure

[Matt00926]

Your sleepyhead charts using the full-face mask at CPAP pressure of 14 are much better; way less leaks and much lower AHI.

[zzzZorro]

I am posting a running tally sheet that I have been keeping to allow for an overall view of the proceedings. 
It starts with a S9 Autoset to see if the CPAP mode is comparable with the ST-A in CPAP mode (while I still have it), and then begins the VAUTO that replaced it.
The VAUTO S-mode with a 14/14cm setting was run as the Doctor had asked but did poorly.  It was without a C-collar and it will have to be run with the collar as it seems to be making a difference lowering the O/As.  The switching between the pillow and FullFace masks is due to the F-20s insistence to make a bridge pressure sore that the Quattro does not.
Notice there is an 'O' column that has a 'C' for collar and a 'CS' for chin strap.  the - means nothing used.  The chin strap only served to keep the P-10 headgear in place better.  The use of the Collar for me does appear to be proofing itself out by lowering O/As and not having the extended length of time in the events.  The margin on the right shows O/A>30 sec.  Left margin is Humidity- to see if it effected AHI in any way.

RUNNING TALLY SHEET

Last night I ran the VAUTO mode to see if the chart-interpreting gurus here could see if it possibly pointed out something that was missing form the CPAP mode charts.  With my limited knowledge it appears that the CPAP has pretty well proven to be superior to the auto or bi-level modes.  I will be running the S mode again with the collar just to check the variance.

Last night in Vauto- mode (w/collar) C/As way up and as long as 30 sec :

[attachment=4254]

Last CPAP on January 27 (w/collar):

[attachment=4255]


Thanks in advance..

[ajack]

you need the PS going by your MV, do your other fixed cpap show the same? you are getting more air and would affect the co2 and breathing cue from the body, because of the possibly lower co2.
CA are only a problem if there is an O2 desat or arouse you to wake. You also need to know what is your o2 meter saying.

swapping 1cm of pressure every night is one thing, swapping types of modes, is another. I would do a week on a mode to see some consistency to judge. (even a week may not be long enough for your body to adjust to a mode)

I told you you needed a collar if only to show you how to set up your pillow to keep the airway straight. These are a lot better charts, than a couple of weeks ago.

[Sleeprider]

I think it is very common for people with central and complex apnea issues to have worse results with pressure support. I'm certain we went over this quite a bit. I disagree they are not important, especially in light of the information they last up to 30 seconds. Steady pressure and lack of pressure support has been a consistent improvement for you.

[ajack]

Yest Zorro is a complex case with compounding issues. I would think, first priority would be to get enough air, to stay out of co2 retention. second would be to control the obstructions as they are more serious than CA going by the literature., third would be to control the type of CA that cause an 02 desat or arouse. How this is done, is where the problems are. So far nothing has fixed all 3, it seems. An ST would be the one to give it the best shot.

[Sleeprider]

I'm not that technically inclined ajack. I understand his Mv is over 500 with pressure support and in the middle to upper 400s without it. I do not advise on volume targets without information on SpO2 and will leave that to him and his doctor. I know which result I would prefer for comfort.

[zzzZorro]

you need the PS going by your MV, do your other fixed cpap show the same?

I told you you needed a collar if only to show you how to set up your pillow to keep the airway straight. These are a lot better charts, than a couple of weeks ago.

The ST has gone 'Bye-Bye'.  Did not work out well while it was here.  Doubt it was able to run as CPAP with back-up rate (?)

I'm not educated in MV interpretation so I can't respond; but I'll attach a few and you can explain what you see..  CPAP CHARTS

"I told you you needed a collar if only to show you how to set up your pillow to keep the airway straight."  Yes, Sir, and it appears you were right on!

Thanks

[zzzZorro]

I'm not that technically inclined ajack. I understand his Mv is over 500 with pressure support and in the middle to upper 400s without it.  I do not advise on volume targets without information on SpO2 and will leave that to him and his doctor.  I know which result I would prefer for comfort.

I'm going to have to spend a night with the oximeter but as far as I know there is no problem with low o2.  The CPAP mode DOES seem to give a more comfortable lung-full of air than the Vauto did (on the previous chart posting).

The CPAP allows the night-to-night AHI to bounce around a bit but generally it has been giving me pretty good results.  Having the Auto and S options available is a temptation to sometime use them just to see IF they can do as well or better.

Thanks

[ajack]

My thoughts are that the ps may be washing co2, giving the increased CA waiting till the co2 level built up again. It's always need to be taken to the doctor, I was just going on the minute vent of the ps4 and the cpap. There is a significant difference. I recall the doctor wanted a VA rate on the ivaps and the minute vent was also by default given. You will need to go back and see the resscan charts at the time, or give me your height and va number and I can tell you the minute vent he wanted.

https://www.amperordirect.com/pc/c-pulse...tions.html
The o2 meter doesn't care if it counts co2 or o2 gasses, so you need to look at co2 by other means, through the doctor. It might be made up of 20%co2 and 75% o2 making up the 95% number. The o2 meter will show the o2 desaturation.
getting enough air is one arm of a good guide, (providing your lung function can gas exchange the enough air for, co2/o2, which is another issue)

the actual tidal volume is secondary, the tidal volume is related to the resp rate, number of breaths per minute x the amount per breath, either can change to get to the same minute vent.

There is no mode that will run fixed cpap and then do a PS:10 on back up breath that I know of.

[Sleeprider]

...

There is no mode that will run fixed cpap and then do a PS:10 on back up breath that I know of.

That would be ASV, but ruled out so far in this case.