Need help with Philips Respironics BiPAP AVAPS

[Matt00926]

I agree. I am most interested in optimizing gas exchange and muscle rest. And improving sleep fragmentation if possible. The respiratory therapist I am working with is rather accessible by e-mail and phone, so that is helpful. I am barely skating by at work and making dumb mistakes on occasion, and that is really starting to bother me!

[Sleeprider]

A lot of people in your situation would be on disability. Good for you hanging in there.

[Matt00926]

I had to take about 6 weeks off after a hospitalization and nothing is more depressing and energy sapping than sitting around being unable to do something that you used to be able to do.

[Fastlane]

Hi Matt,

I was wondering if you ever had your AVAPS titration and if it helped?

I have a Dreamstation AVAPS30 and a Resmed Lumis 150 ST VPAP, because I also hypoventilate

I finally found a mask that fits and doesn't leak at the high pressures I require, and now I am trying to figure out how to self-titrate my AHI's down from my average of 20-25 with the machine :-(


I'm curious what settings are currently working for you?

[ajack]

Edit, Just realised it's an old post.

[Matt00926]

I am still around somewhat. The old PR AVAPS isn't working that well for me. I like the fact that it automatically does the trigger and cycle adjustments for me, but it's not sensitive enough trigger wise and I don't spontaneously trigger quite a bit while sleeping. The Trilogy Vent has better trigger and cycle control, and I might get that to use at home, and just use the ResMed when traveling since it doesn't weigh much in comparison. 

I am trying to dial in the iVAPS, but it seems like it likes to violently change the IPAP on me even while awake. And I seem to wake up more often when using it as compared to the S/T mode. But I think I will set the min and max PS pretty close to one another, so maybe that will prevent the swings.

[ajack]

If you can get a trilogy, that would be good. As you know it also has the VAPS mode.
ST mode is the same every breath, so it wouldn't disturb you by changes. It's just whether you are using the settings that's been titrated to your needs. The iVAPS is going to give you the amount of alveolar ventilation that you dial in. If you have it too high, as you know, it will increase the pressure and self trigger to get that volume of air into your lungs, whether you want it or not.

you could put up a chart and get opinions, has your doctor given you the tidal volume and minute vent he wants you to have, going by the tests he has done.

[Matt00926]

I'll put up a chart tomorrow after using the iVAPS tonight. i think it would be recommended for like 350 or 400 tidal volume. Never gotten a real answer from a Dr. I know right now I get like 280 which is too low I wake with headache. More PS helps but I use like PS 12 and that feels like a lot of pressure in s/t mode.

[ajack]

Is cost a factor to why you haven't had another titration?
If you get the trilogy, are they going to titrate you on it?
Can they titrate you on your resmed 10 in iVAPS mode?

You need what you need, as far as PS goes. Either with ST or iVAPS. You will get use to it.
I would get back to basics and work from you titrated ST settings and go from there. That will give your natural respiration rate and the volumes you needed to keep your o2 ok. It would be good if you could put up a ST chart as well.

What were your titrated pressures in the sleep study, I didn't find them posted?

Do you have a cms50 recording spo2 meter, to record your levels overnight? 60-$80? Low o2 could be the reason for your headaches.

I think there has to be a good reason not to use recommended settings, but some may change if really needed.
https://www.resmed.com/us/dam/documents/...er_eng.pdf

default restrictive lung at a respiration rate of 20pm page 40 of 45
Ti Max [sec] 1.5
Ti Min [sec] 0.8
Rise time [ms] 300
Cycle sensitivity Low
Trigger sensitivity High (have you tried different settings, so it feels natural. You aren't sucking or the machine isn't self triggering)


A more fine tuned Ti is on 43 of 45, for when your natural respiration rate is known and there is a reason to change.

[Matt00926]

ajack
Is cost a factor to why you haven't had another titration?
If you get the trilogy, are they going to titrate you on it?
Can they titrate you on your resmed 10 in iVAPS mode?

You need what you need, as far as PS goes. Either with ST or iVAPS. You will get use to it.
I would get back to basics and work from you titrated ST settings and go from there. That will give your natural respiration rate and the volumes you needed to keep your o2 ok. It would be good if you could put up a ST chart as well.

What were your titrated pressures in the sleep study, I didn't find them posted?

Do you have a cms50 recording spo2 meter, to record your levels overnight? 60-$80? Low o2 could be the reason for your headaches.

I think there has to be a good reason not to use recommended settings, but some may change if really needed.
https://www.resmed.com/us/dam/documents/...er_eng.pdf

default restrictive lung at a respiration rate of 20pm page 40 of 45
Ti Max [sec] 1.5
Ti Min [sec] 0.8
Rise time [ms] 300
Cycle sensitivity Low
Trigger sensitivity High (have you tried different settings, so it feels natural. You aren't sucking or the machine isn't self triggering)


A more fine tuned Ti is on 43 of 45, for when your natural respiration rate is known and there is a reason to change.

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Cost is not a factor to me, personally, when it comes to my health. The real issue is having qualified doctors and other hospital staff...the Pulmonologist admits that I know more about him then ventilation, the RT thinks ASV is the same as AVAPS, etc,. I've never met anyone in the real world that is even somewhat competent. I've spent nights in the lab before and nothing useful occurs. 

If I get a Trilogy it will be ordered as RT to work with patient to find what's comfortable. The RT I work with, I think I know more than her regarding my specific issues. For example, if I bring up Pressure Control (PC) mode on the Trilogy, I get a blank stare in response. 

I've been working on the iVAPS and using a tight PS range so it doesn't change too abruptly on me and disturb me. Next post will be the screenshots.

I'm using the F&P Simplus FFM mask and I do have a recording pulse ox for feedback. 
[/quote]