Need some settings help re: upgrade TO Resmed AirCurve10 VAuto FROM Resmed S9 VAuto

[bilbofett]

Hello friends!
This board is full of gentlemen+scholars, so I TIA for your time!
I need some settings help from any Resmed and/or Bipap pros in here, please

I upgraded to the Resmed newer AirCurve 10 VAuto from the Resmed older S9 VAuto.
Both are BiPAP Auto (Resmed calls it VPAP).

I'm interested in optimizing the settings for:
1) Least intrusive/most natural feeling, and
2) Keeping my RR (respiratory rate) lower..I sometimes feel I'm borderline hyperventilating because the machine is prompting me to take a high number of breaths-per-minute, or isn't allowing me to pause long enough between inhalation and exhalation. I stay awake focusing on breathing, concentrating, and its hard to get drowsy doing this.

In the past, w/ this machine and others, its felt like the machine wants me to breathe more often than is normal for me, so I almost feel like I'm running a mini-marathon in bed. I found myself taking more breaths in bed than I was during the daytime (minus intensive exercise).

I'm not even sure my S9 was optimized for what I've wanted above in #'s 1 and 2.. Before, I played w/ the settings a little using my limited understanding, and trying to keep the AHI (Apneas) still low whenever I changed something.

I understand there's a certain threshold I can cross, where, if I make it *too* comfortable, the apneas can increase!

Here's my present settings with the S9:

Max IPAP: 25.0
Min EPAP: 7.6
PS: 6.0
Ti Max: 4.0
Ti Min: 1.5
Trigger: Very High
Cycle: Very Low
Start EPAP: 5.6


   
   

In Auto mode, my highest IPAP was around 16, stabilizing around 13-14 (12 on really, really good nights) and my EPAP would go up to about 8.

The settings I still struggle to completely understand, even after reading the physicians manual, many posts here and explanations on google, are
Ti Max/Ti Min/Trigger/Cycle.
I know the relationship between trigger and cycle is something about when the machine initiates a new breath, and how long it will wait until it "backs off" or yields to allow you to exhale?

Any advice/tips/thoughts is GREATLY appreciated.

THANK YOU VERY MUCH

-P.S. Is it true the new AirCurve's have a built in modem? And if they do, they actually use Cellular wireless... to send the sleep results to Resmed, or my sleep doctor? Is there a way to disable this?

--Side note: Yes, I'm the guy who was trying the Respironics ASV, it was very aggressive and overkill and I didn't need the additional therapy. Auto VPAP seems fine for me.

[bilbofett]

FYI My RR (Respirotary Rate) has been around 12-13, sometimes higher. I think I would be much more comfortable getting around 11 or even 10, if possible. Any tips on that appreciated.

[PoolQ]

Yes there is a modem for compliance. It only transmits usage data, nothing detailed. If you don't need to worry about compliance you can put the A10 in airplane mode and it will turn off the cellnet modem

[PoolQ]

Interesting. My RR is 14-17 and I don't feel like I am hyperventilating.
My TiMin is 1 and TiMax is 3.4.

TiMin is how long the CPAP will keep trying to make you breathe, or perhaps better, how long it will try and keep you from stopping
TiMax is how long it will keep supporting your breath before it stops and hopes that you will stop also. If you stop first then based on the cycle setting it will stop with you.

So if I understand this correctly the trigger setting will tell the CPAP when you are starting to inhale. Too sensitive and it will start ramping up the pressure too soon, which can cause you to inhale too soon. Could this make it seem like you are being forced to breathe too fast?

Cycle is how sensitive is the machine at detecting when you should start to exhale. If too sensitive it will cut off your inhale, if not sensitive enough it will try and keep you inhaling longer than you want.

My guess is you need to tweak your cycle and trigger settings. I would think that the "very" settings are pretty far from standard. I think the settings might be trying to get you to breathe faster than is comfortable for you.

Just my guess and what I would do

[bilbofett]

PoolQ, thanks for the reply.
I'm reading your details about TiMax/TiMin/Cycle/Trigger.. and I'm still struggling to wrap my head around it.
They say if you can explain it to someone else, that's when you finally understand it.
I can't explain it yet..

Can you please tell me what your Trigger and Cycle settings are?
I guess factory default is medium?

[justMongo]

On the S9, trigger and cycle defaults are medium.
Defaults for TiMax is 2.0 sec
and for Timin 0.3 seconds.

I don't know how you got to the settings you are at; but, I would think those settings are why you feel you're fighting the machine. Who set up your S9?

[PoolQ]

Trigger and cycle are set at default. What was happening with me when I first got the machine was I felt that each breathe was being cut off. I put the mask on and watched the display with the bar going from low pressure up to my norm and bingo I saw that while I was still inhaling, the pressure would drop off a cliff.

I increased TiMax to 3 seconds and that was much better, then I tried sleeping and again I woke up feeling cut off, so I upped it to 3.4 and it has stayed there since.

What I do is change a setting by 1 or less and then put the mask on lay down turn the machine on and relax. I pay attention to what I feel like while breathing, everything should feel like nothing is happening. Sometimes I felt worse, changing the setting back and 1 the other direction. Testing again. If things seem good, then I try and sleep.

Sometimes I would change one setting and one thing would be better and something else would start bothering me and I had to readjust an earlier setting.

[PoolQ]

I have been thinking about these 4 settings and they all deal with our inhale and when the machine will take some kind of action to adjust our inhale.
TiMin is if we don't inhale for at least this long, the machine will try and make us inhale longer.
TiMax is if we try and inhale longer than this, the machine will drop the pressure and try and get us to stop inhaling

The last 2 help the machine find our start and end of inhale, other than this it has no way of knowing what we are doing. These two settings need to match how we breathe to we have obvious transitions or subtle ones.

Think of the trigger as someone watching you breathe and trying to figure out when you first start to inhale. When you start to inhale the machine responds by increasing the pressure. If this happens before you actually started to inhale, then you might feel rushed. If it starts after you have actually started then you might feel held back.

The cycle is cycling from inhale to exhale. I would imagine that too sensitive would feel like too short of a TiMax, dropping the pressure before you are done inhaling. Not sensitive enough would keep the pressure up while you are starting to exhale.

It's not that they should be kept at medium if you are not trying to correct something, it's matching them to how you breathe so they don't fight you.

Thanks for getting me to think this through, because I too have this machine and I had not paid much attention to these.

[PaytonA]

bilbofett,

The VPAP will sense your breathing and switch from inhalation pressure when you start to exhale and vice versa. It does this quite well.

Ti min and Ti max
Ti min is the minimum amount of time that the machine will stay at the inhalation pressure. Even if you start to exhale less than 1 second (for your setting) after you started to inhale, the machine will not drop back to exhalation pressure until the Ti min is met. Ti max is the maximum time that the machine will stay at the inhalation pressure. If you have it set at 4.0 and your average inhalation time is 1 sec, your machine will stay at inhalation pressure for 3 more seconds unless the machine has sensed an exhale. These are just limiting settings.

Trigger and cycle
These settings adjust the sensitivity of the machine to the change from exhalation to inhalation and vice versa. The best explanation of this that I have found is in the clinicians manual. I had to study the charts presented to understand it. I found these charts in the clinicians manual for the S8 and the S9 so I presume they are still in the clinician's manual for the Aircurve 10.

My advice on the settings is to set the Ti max, Ti min, Trigger, Cycle, and PS back to their factory settings and start over again. This is basically what I had to do with my S8 VPAP Auto to fix problems created by a well meaning but unenlightened RT who set it up originally for me.

Do not be concerned about your respiratory rate. Your body is what controls that not your VPAP. I have found that my respiration is faster and shallower when asleep than when awake.

I stay awake focusing on breathing, concentrating, and its hard to get drowsy doing this.

Stop doing that. Easy to say-not so easy to do.

Ti Max/Ti Min/Trigger/Cycle.
I know the relationship between trigger and cycle is something about when the machine initiates a new breath, and how long it will wait until it "backs off" or yields to allow you to exhale?

The Vauto does not initiate breaths, that is the function of the ASV machine.

Best Regards,

PaytonA

[eseedhouse]

The thing about anxiety (which I suffered from for many years) is that you can't stop being anxious by trying. You have to stop trying. Relaxing isn't something you do, it's something you stop doing. And we are trained almost from birth to try and discouraged from not trying.

I have no magic answer, the main thing that cured my anxiety (to the extent that it is cured at least) seems to have been the passage of time.

However you might try a little reverse psychology by consciously giving yourself permission to feel anxious and stop trying to escape from it. Everyone feels anxious at times, it's part of human nature. Where it gets problematical is when you start being anxious about being anxious. You feel "I have to get rid of this anxiety" and that very feeling makes your anxiety even worse! Then you are in a vicious cycle. At least that was my experience.

And if that doesn't work for you that's OK with me, it's just a suggestion based on one person's experience.