If AirSense10 EPR 3 feels good, might BIPAP be even better?

[PaytonA]

A point of clarification.There is not an "auto" setting for Ti max or Ti min for either the S9 or A10 series.

Best regards,

PaytonA

[robysue]

A point of clarification.There is not an "auto" setting for Ti max or Ti min for either the S9 or A10 series.

Best regards,

PaytonA

Thanks for clearing that up for me.

What are the default settings for TiMin and TiMax?

[JSL747]

A point of clarification.There is not an "auto" setting for Ti max or Ti min for either the S9 or A10 series.

Best regards,

PaytonA

Thanks for clearing that up for me.

What are the default settings for TiMin and TiMax?

TiMax 2.0
TiMin 0.3
Trigger Med
Cycle Med

[JSL747]

Carbon

I think everyone is different and a PR works best for some and ResMed works best for some. Me I do better with a ResMed because the PS does not very. If My PS varies the least bit I triple my CSs. Pressure can go up and down, no problem. And I like the faster changing pressures of the ResMed. It keeps my OAs to ZERO. If I had aerophagia and no CA problems with the changing PS, I would do better with a PR which responds slower to pressure changes and varies the PS.

We all tend to give advice in line with our own experiences and PAP challenges. If you want a BiLevel, pick the one you think will work best for you and...go for it....I like mine and do not need it for respiratory problems. I just like the way it feels better to me...

[palerider]

Trigger and cycle settings control how sensitive the machine is in detecting the change between inhalations and exhalations, and that can affect how the switches between IPAP and EPAP feel. One of them controls the EPAP-to-IPAP transition and the other controls the IPAP-to-EPAP transition.

Trigger controls the trigger point to go to ipap, cycle is how sensitive it is to cycle back to epap. you trigger to ipap and cycle back to epap

[Carbon]

As an update, I have gone to APAP range 10-12, with 3 EPR. At the moment the outcomes are a wash as far as fatigue goes.
My periodic leg movements are completely controlled with Sifrol 0.25mg so are not a confounding element

The good...
FL 95% now 0.2 Max 0.14 (used to be ~0.4/0.22), Flow curves look a fair bit better. My pressures are not far off straight CPAP, and last night slept for 7 hours straight for the first time I can remember for >10 years. AHI's still generally under 1. No aerophagy, no increase on centrals.

The bad...
If IPAP pressures get to 11-11.5 (0-2 times a night), I wake with feeling it hard to exhale. Tends to make me feel crappy the next day. I presume the highest pressures happens in deepest part of sleep (IR camera shows I mostly sleep on back irrespective). I presume getting woken from deepest sleep is particularly disruptive from a fatigue perspective?
If this keeps up, I guess same APAP range with a bilevel machine with settings to keep "EPR equivalent 4-5" would help i.e. max EPAP under 7.

ACHE. My throat and upper chest aches all day - I am guessing thats because of overall increased median pressure.
Is it common to get more discomfort with higher pressures? - I did get a fair bit of this for some weeks early on with CPAP. I'm hoping it goes away soon.

[PaytonA]

First, if it is possible for you, staying off your back could give you the results you want without changing machines. I use bipap and my IPAP was 20 from the jump. With a PS of 4, I have never felt that it took any effort to exhale, but that is me.

It looks to me like you are very close to achieving your goals. Way to go. Since you were able to sleep 7 hours with AHI under 1, I would be tempted to dial your range back to 9.4-10.8 and then increase it a little per week to see if you could get back to 10-12 without the disadvantages. If that worked, it would be a lot cheaper than purchasing a bilevel.

Just my thoughts.

Best Regards,

PaytonA

[PoolQ]

Ah a thread after my own heart. I have read up on those additional settings and adjusted them to great benefit.
some "light reading: http://ccn.aacnjournals.org/content/31/3/30.full
you can read the first part if you want or just ignore it, the part that got my interest was the sections:
Dyspnea- I think many will find this familiar
Patient-Ventilator Dyssynchrony- this is all about those additional settings

And before we get into CPAP verses ventilator and them not being the same thing, well of course they are not. However in this article a ventilator is anything that helps "ventilate" the patient and NOT requiring that it be able to take over breathing for the patent. So by this definition CPAP machines do indeed "ventilate" patents.

The CPAP industry is starting to address COPD and how the machine can be used to help those with COPD (I am one of those), but that is not all they are used for. For me going by the setting guidelines for COPD made everything worse for me.

Timin had no impact for me and I left it alone. Timax however mad a large impact. Each breathe I took felt "cut off" as if right at the end of an inhale someone had put their had over my face to stop my breathing. I increased Timax to 3.4 and it was better. put the mask on and relax, turn the machine on and watch the pressure bar on the front of the machine. if the pressure drops while you are still inhaling then the Timax needs to be increased. It turns out that perhaps like most, my breathing slows when I sleep and I still had this cutoff feeling that would wake me up. Change to 3.7 and again better, change to 4.0 (max) and this stopped being a problem for me

Trigger and Cycle sensitives. I, one after the other, changed both to high and found that the machine no longer had a slight lagging feeling for me. Just that something was off or not quite right before the change.

NOW understand that for COPD there may be therapeutic settings for these and make sure you are not compromising your therapy. Some COPD patients tend to retain CO2 (may be evidenced by headaches) and these setting can be used to that.

Causes of Dyssynchrony- talks about, well, what causes the last section.

Remember that a true ventilator does much more and has many more settings than a CPAP machine has, but for the settings that it does have this article relates to these. When a CPAP detects that you are inhaling it changes the pressure, likewise when you start to exhale, so getting these setting accurate and not causing you to "fight" the machine or force the machine to breathe like you want,, or adjusting your breathing to what the machine wants you to do-tune up these setting so that you and the machine are both "breathing" the same way.

Of course if none of this bothers you or you are the "default" patient then read this only if you want

[Carbon]

First, if it is possible for you, staying off your back could give you the results you want without changing machines. I use bipap and my IPAP was 20 from the jump. With a PS of 4, I have never felt that it took any effort to exhale, but that is me.

Oddly enough, my pressures tend to be a bit lower the first half of the night when I am almost exclusively flat on my back.

It looks to me like you are very close to achieving your goals. Way to go. Since you were able to sleep 7 hours with AHI under 1, I would be tempted to dial your range back to 9.4-10.8 and then increase it a little per week to see if you could get back to 10-12 without the disadvantages. If that worked, it would be a lot cheaper than purchasing a bilevel.

Just my thoughts.

Best Regards,

PaytonA

Good suggestions - I'll give it another few weeks to see if I acclimatise to current set up. If no luck, then I'll give your suggestions a run.

As an aside - a video observation regarding sleep quality. I have been using an IR camera on my legs to monitor PLMD (only occurs first half of the night) while reducing Sifrol dose to minimum necessary. Since pushing my pressures up, I have noticed all the non-regular/non-PLMD leg scuffling, and tossing and turning in the second half of the night has reduced a lot. Impossible to know quite what that means without an EEG, but I'm guessing this may equate to less microarousals from the higher pressures overcoming mild UARS.

Ah a thread after my own heart. I have read up on those additional settings and adjusted them to great benefit.
some "light reading: http://ccn.aacnjournals.org/content/31/3/30.full

A good read