Machine is hyperventilating me!

[Sleeprider]

ASV is still correct.  I honestly don't know the IVAPS settings well enough to make a certain suggestion. If I was setting you up in ASV, I would set EPAP min 8, EPAP max 15, PS min 0 and PS max 15, then fine-tune from there. (BTW, please avoid splitting your threads in the future, it's inconvenient to go looking).

Here is what you posted on settings:

Here are the settings: IPAP 15, epap 8, iBR off, backup rate 12 (I dialed it back to 9, but that didn't help much),Timax 2.7s, Ti min 0.3s, rise time min, trigger medium, cycle medium, I set the ramp settings from off, to ramp time 30 min, ramp down on, start epap 5.0, all alarms off except alarm vol test medium, essentials plus, confirm stop and smartstart off, desat rule 3%. I will try to get my script.

And this is the chart with unknown IVAPS settings after 0640. What were these settings?

[Josephdfco]

The ovals settings were height 68", target pt rate 12, target VA 5.5L, epap 6,min ps 4, max ps 24, Ti max 2.7s, Ti min 0.3, rise time min, trigger med, cycle med, (I set these for very low in ST for tonight, and the rise time to 300) start epap 4.

[Josephdfco]

This also has PAC, T, S, and CPAP in addition to ivaps and ST. What do you think I should try tonight?

[Sleeprider]

First, your machine in indicated to resolve obstructive apnea or respiratory insufficiency, not central apnea.  Now let's first review what those modes on your machine are for.

CPAP
A fixed pressure is delivered.
S (Spontaneous)
You may set two treatment pressures-–one for inspiration (IPAP) and one for expiration (EPAP). The device senses when the patient is inhaling and exhaling and supplies the appropriate pressures accordingly. The difference between IPAP and EPAP levels helps determine the tidal volume.
ST (Spontaneous/Timed)
The device augments any breath initiated by the patient, but will also supply additional breaths should the patient breath rate fall below the clinician’s set “backup” breath rate.
T (Timed)
The fixed breath rate and the fixed inspiration/expiration time set by the clinician is supplied regardless of patient effort.
PAC (Pressure Assist Control)
The inspiration time is preset in the PAC mode. There is no spontaneous/flow cycling. The inspiration can be triggered by the patient when respiratory rate is above a preset value, or time triggered breath will be delivered at the backup breath rate.
iVAPS (intelligent Volume Assured Pressure Support)
iVAPS is designed to maintain a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and providing an intelligent backup breath automatically. The iVAPS therapy mode is indicated for patients weighing 66 lbs (30 kg) and above.

Of all those mode, the only one with adjustable pressure support (PSmin, PSmax) is iVAPS, and that is what we're going to use.  
For EPAP set the pressure at 8.0 cm.  

Set IPAP max to 22.

For PS min, you should use the lowest PS you can select. I'd rather see you on 0 or 2 cm PS, but I don't know what the machine will allow.

Your median respiration rate on older graphs you submitted was 11.0, so we are going to target that rate minus 2, or 9 BPM http://www.apneaboard.com/forums/attachm...bnail=4008 

Your ventilation rate Target Va should be set to 5.2 L/min. Your average in past charts is 6.2, 5.2 is a default, and all we are concerned with is triggering a breath during centrals. This may avoid the feeling of hyperventilation.

For PS max, the machine should be able to trigger a breath with 10 cm pressure.

If you use ramp, limit to 10 minutes and start EPAP at 8.0.

Set Ti Max to 2.0
Ti Min can stay at 0.3.

I think that is all the important points, and other settings can remain at default for trigger sensitivity, rise time and cycle.

This is truly the blind leading the blind, and I'm relying on what I know works in ASV to try to give you a shot at iVAPS.

[Josephdfco]

Last night's data. I had to change some settings. I'll post them after class. https://imgur.com/a/mHdIT

[Sleeprider]

I'm so sorry! You just need a different machine and treatment. It's like being prescribed high blood pressure medication for a urinary tract infection...It's not the medicine that's bad, it's the person mis-applying it.

[Sleeprider]

Your best results so far were CPAP mode at 8.0. That will be inconsistent, and the VA techs may argue you didn't give the ST-A technology a fair chance, but you do need live your life to some degree.

[Josephdfco]

I'm so frustrated. I feel like absolute hell. On top of everything, I've got 2 little ones, and one of them just got diagnosed with ADHD. To say that these 2 are a handful is a ridiculous understatement, and it's supremely challenging to be patient when you feel like this. I feel like I'm saturated with cortisol. Oh well, my appointment is in an hour. Here goes nothing.

[Josephdfco]

Sorry about all the bellyaching.

[Josephdfco]

He says its the right machine, that asv isn't always the best choice for complex. He says I need to keep trying, that he'll see me in 2 months. He says they may be able to tweak it a little here and there as needed. I don't know, he's wearing a Yale school of medicine lab coat, but I can't help being frustrated and wondering if he has all the information. I can't imagine being able to sleep the way that machine was initially set up. Even on ivaps, which was better, I had to screw around with it for a couple hours before I could sleep.