New VAUTO, strange settings pulmonologist

[edgnoj]

I received my VAUTO today. This has replaced an Autoset10. I was a little surprised at the settings recommended by the pulmonologist.

The settings of the autoset were
pressure 10-14, epr 3

The pulmonologist had the VAUTO set to
Mode S
IPAP 12.0
EPAP 7.0
PS 5.0
Backup Frequency: 10
Easy breath: off
Ti Max: 2.0 sec
Ti Min: 0.3 sec
Rise time: Min
Trigger: Medium
Cycle: Medium

I did some tests with these settings and it felt like I was on active ventilation. Each inhalation was with a push of air and it feels like some of the air was being blown directly into my stomach. With these settings I won't be able to sleep I'm afraid.

I don't know if the chosen settings have to do with the poor pumping function of my heart (ejaction fraction is 15-20%, so severe heart failure).

What strikes me in particular is the Rise-Time=low setting. What does this setting do and can this setting make it feel like you are getting a blast of air with every breath?

Anyway, I am thinking of changing te settings to:
Mode VAUTO
IPAP 9-12
EPAP 5
PS 4.0
Backup Frequency ?????
Easy Breath: On
Ti Max: 2.0 sec

Ti Min: 0.3 sec
Rise Time: ?????
Trigger Medium
Cycle Medium

What do you think?

[Sleeprider]

Based on your Autoset settings of 10-14 EPR 3, the bilevel notation would be 10/7 to 14/11 PS 3.0. The bilevel settings going straight to PS 5 is a bit aggressive, and assuming you would want to set this to EPAP min 7.0, Max IPAP 15.0, PS 4.0. This results in the range of 11/7 to 15/11 fully bracketing your Airsense Autoset settings. You should keep Easybreathe On. The U.S. version of the Vauto does not have the backup frequency setting, however it should be at least 3 breaths per minute less than your median respiration rate, and is mainly to mitigate centrals by creating a timed IPAP trigger. You may have an option to turn it off if you choose. The other settings are default and rise time is only available if Easybreathe is off. I don't know your respiratory timing, but many people use a slightly longer TiMax than the default of 2.0, especially for slower breath rates. We can make a judgement on that after seeing a chart, but I find 2.7 seconds is a good setting unless you need to preserve more expiratory time. Do not change cycle sensitivity from medium, however after using the machine you can change the trigger sensitivity to high if there are centrals or a number of triggered breaths based on the backup rate.

[edgnoj]

Thank you very much for your very prompt and comprehensive response! I can learn a lot from this.

I just spent an hour trying to sleep with the settings suggested by the pulmonologist and was a bit shocked by the results. Since it's only an hour I don't think it makes sense to post the chart, but some of the numbers I think are striking:

Tidal Volume median in autoset about 500; in VAUTO: 840
Inspiration Time in autoset 2:32 in VAUTO 1:86
Experation Time in autoset 2:44 in VAUTO 4:64 !!!
Respiration rate in Autoset 12.2 in VAUTO 6.0 !!!

Respiration Rate is always difficult to measure because when I lie on my right side I suffer a lot from cardioballistic echoes that obscure the image.

I think I would be wise to change the settings the way you suggested?

edit: I'm just thinking, could the pulmonologist have chosen the S-Mode instead of VAUTO because he doesn't want the pressure to rise too much due to my bad heart? (Fixed IPAP)

[Sleeprider]

I suggested those settings with the full expectation you would use them and come back with feedback.

[edgnoj]

Sorry about that!

I had a pretty restless night. Slept with a new mask and I had to adjust it several times. The mask was farting on my face, which I think explains the phases of snoring, which I don't normally do.

I have used the suggested settings from Sleeprider, EPAP min 7.0, Max IPAP 15.0, PS 4.0, Easybreath=On and the TiMax I left on 2.0 for now.

Attached is a report from last night and a detail shot of the 2nd period with CAs

[Sleeprider]

Change trigger sensitivity setting to High. Everything else the same.

[Jay51]

Edgnoj, your close up OSCAR looks, "Cheyne-Stokes" - ish.  With the low ejection fraction and heart condition, it may be.  I am glad you are using the VAUTO and getting it optimized with Sleeprider.  That should help.

[edgnoj]

I need to get something off my chest. Today I did my daily walk of about 8 kilometers. Halfway through, I noticed on my watch that my heart rate had risen to 160 beats per minute. I decided to take it easy and a few minutes later I got very dizzy and before I knew it I had a huge thump on my chest.... the icd had gone off. I was alone where this happened, but fortunately I was able to call the emergency number myself. Fifteen minutes later, first a police car and then an ambulance rushed in. At the hospital, it turned out that the icd had rightly gone off because of a life-threatening cardiac arrhythmia. Since the icd did its job well, the hospital took no further action and I returned home. It is not easy to go through life with a time bomb in your body.

I now read Jay51's comment and along with him I hope the VAuto will work well with my shaky cardiac condition. The rising/falling breathing curve with or without CAs occur regularly during the night and I hope the VAuto will help with that.

Sleeprider, I am going to sleep tonight with the Trigger setting on Active. Thank you.

[Sleeprider]

That's a scary thing to happen out of nowhere, and thank goodness it all turned out well.

By using a high trigger sensitivity, it takes less airflow or spontaneous effort to trigger IPAP on your machine. That increase in pressure can stimulate a breath when you might otherwise have a pause, or flow so low that it triggers a CA flag. That's the idea, and we have used it with many others including myself, to reduce CA events.

[edgnoj]

I didn't sleep great last night after the consternation with the ICD yesterday, but breathing seemed a bit more natural with the new trigger setting.

I also only had a few CAs, less than usual. I have attached some notable breathing patterns.

The EPAP setting seems like it could be a little lower right?