DavidAM - Treatment

[DavidAM]

This also looks somewhat like CSR, I think.
   

[DavidAM]

Hi. I was with the guy from the PAP distributor today, and he didn't want me to have an ASV, but a Lumis 150 ST. So I ended up renting it for a month. Now, this thing's settings seem very complicated. My APAP settings were EPR 3, and a pressure range of 7-11.4; I saw my pulmonologist the other day and she insisted that I don't go over 7 with the minimum pressure, when I told her that I had it set at 10.

Could anyone help me set it up?

[Sleeprider]

The Lumis ST is a fixed pressure bilevel machine with a back up rate. From your post your EPAP is 7.0, IPAP 11.0 which is a pressure support of 4.0. The other settings we need to know are mode and backup rate. The ST does S-mode, ST mode and CPAP. Let's hear how yours is setup. Also, you can request the clinical manual for a Resmed Aircurve 10 ST and it is basically the same machine. https://www.apneaboard.com/adjust-cpap-p...tup-manual

[DavidAM]

Hi, Sleeprider. It's good to see you, thank you for your answer. My machine has modes CPAP, S, ST, T, PAC and iVAPS. I currently have it set to ST. 

Last night I set Cycle to Very Low because the exhale was too steep and I felt like I was having all the air rapidly pulled out of my lungs (and I still kinda do); and Trigger to Medium, because when it was higher I felt like I couldn't get enough air. Breathing with this machine feels pretty weird.

Even though it has iVAPS and all the other modes, the machine still says just "VPAP ST" on the front, and not "ST-A", I don't really know why. 

My backup rate is on, and the "Target Pt Rate" is set to 12.

[Sleeprider]

In posting future Oscar graphs, we would rather see the full night and the pressure, respiratory, settings data on the left, along with any wave form you want to ask about. This is covered in the Organizing your OSCAR Chart wiki http://www.apneaboard.com/wiki/index.php...ganization

Cycle sensitivity does not change the rate of transition from IPAP to EPAP, just the threshold at which the transition occurs. Cycle does not have a setting like the rise-time for IPAP. I don't think you're going to feel a lot of relief by lowering cycle sensitivity. This feeling is somewhat typical for ST which produces a square-wave pressure transition (on/off) you can visualize in your mask pressure chart. We now know your backup rate but not your pressures.

[DavidAM]

My pressures are 7.0 EPAP and 11.0 IPAP. What mode should I use? Should I continue being on ST?

[StuartC]

My best suggestion for iVAPS is to stick with ST mode if you can. 

Whether ST or iVAPS, I would suggest the following settings for you:

• iBR = On
  
• TPR = 12 (because that about matches your median RR on the charts of yours that I looked at)
  
• Ti Max = 2.5 s (based on TPR = 12
  
• Ti Min = 1.0 s (because it must be longer than Rise Time)
  
• Rise Time = 900 ms (for comfort and because you have not indicated that you have an obstructive lung disease)
  
• Trigger = High or even Very High (to counter CAs / increase Spont. Trigger percentage in the sleep report on your machine)
  
• Cycle = Med (because you adjusted this instead of Ti Max, I think)
  

If you wanted to use iVAPS to maintain a constant minute vent and could not do that adequately in ST mode:

1. First you need to decide what minute vent (or tidal volume) to target
   
2. Confirm and set the EPAP setting that you want / need.
   
3. I suggest you then increase IPAP in ST mode until you approximately achieve that target minute vent / tidal volume before you switch to iVAPS
   
4. Set Target Va with reference to the target minute vent or tidal volume that you have chosen, after setting your height and TPR.
   
5. Set PS min to IPAP - EPAP - 4 and PS Max to PS min + 8.  Treat these as initial values though.
   

In some people, iVAPS has a nasty habit of banging IPAP from the max to the min and back in very short periods of time.  It can be brutal, especially with a PS range as high as 8.  If that happens, swicth back to ST and post that on this thread.  You can set iVAPS (unconventionally) to simply assure a minimum pressure, and I can help you try that.  Please be patient though as I am not here often and only check the email address to which notifications are sent about once a week.