Questions about TiMax setting on AirCurve 10

[Sleeprider]

Going back to your question on TiMax, it is the maximum amount of time that VPAP will hold IPAP pressure before cycling back to expiration pressure. When set too short, it can feel like the breath was cutoff, and can feel disruptive. Your median respiration rate is 12 bpm and currently just over 2.5 seconds Ti. Since we are not concerned with preserving expiration time as might be the case with COPD, it is fine to se the TiMax to a longer time than default, and we trust you will spontaneously cycle at your own pace. So a TiMax setting of 2.8 or 3.0 is fine for you. More importantly, we will be increasing the pressure support from what you had with the Autoset, and normally this shortens the Ti because you are using less inspiratory effort to take the breath volume you need or that feels right. It would not be unusual for your Ti to fall under 2-seconds once flow limitation is addressed with pressure support. Your Autoset statistics suggests your FL is 0.02 and that is very good, however there is some flattening of the inspiratory wave. I think you will like the Vauto, even though your therapy was excellent with the Autoset based on the example posted.

[SakimaStorm]

Going back to your question on TiMax, it is the maximum amount of time that VPAP will hold IPAP pressure before cycling back to expiration pressure.  When set too short, it can feel like the breath was cutoff, and can feel disruptive. Your median respiration rate is 12 bpm and currently just over 2.5 seconds Ti.  Since we are not concerned with preserving expiration time as might be the case with COPD, it is fine to se the TiMax to a longer time than default, and we trust you will spontaneously cycle at your own pace.  So a TiMax setting of 2.8 or 3.0 is fine for you.  More importantly, we will be increasing the pressure support from what you had with the Autoset, and normally this shortens the Ti because you are using less inspiratory effort to take the breath volume you need or that feels right.  It would not be unusual for your Ti to fall under 2-seconds once flow limitation is addressed with pressure support.  Your Autoset statistics suggests your FL is 0.02 and that is very good, however there is some flattening of the inspiratory wave.  I think you will like the Vauto, even though your therapy was excellent with the Autoset based on the example posted.

Thank you Sleeprider. I had trouble falling asleep with the TiMax at 2.0, but after waking 2 hours later, I upped it, conservatively, to 2.6. That seemed to make a difference. It was more comfortable falling asleep and it didn't feel like my inhalation was being cut off as the 2.0 setting did. Ironically, looking at the data this morning (I love how much more information the AirCurve gives you), my Ti was 1.7s   .... so I guess I needed a bit more Ti to fall asleep but it dropped below 2 for my sleep cycles. And my I:E ratio was 1:2.0 which is much more normal that the almost 1:1 I always had with the AirSense.

Will post some Oscar data after a few more nights. But ... already loving the AirCurve.

thanks,

s.

[Crimson Nape]

You don't need to be conservative on the TiMax setting. Actually, you need to set it for a period longer than you need. Otherwise, when you take those occasional long slow deep breaths, it will drop the pressure support before you're finished inhaling and make it feel uncomfortable.

[SakimaStorm]

You don't need to be conservative on the TiMax setting.  Actually, you need to set it for a period longer than you need.  Otherwise, when you take those occasional long slow deep breaths, it will drop the pressure support before you're finished inhaling and make it feel uncomfortable.

Thank you Crimson Nape. Nice to hear I have some flexibility in the TiMax setting. 2.6 worked great last night but will keep an eye on how I feel and adjust accordingly.

s.

[SevereApnea]

Hi SakimaStorm.

Excellent comments above. I always enjoy reading others' posts to see what I can learn.

When I started using my Vauto with TiMax = 2 seconds, I found it awkward to have TiMax of only 2 seconds, and quickly raised it to 3 seconds.
But back then I would climb into bed, whack on the mask and hit the start button. At the beginning of the sleep sessions I could see that on my Flow charts there were larger Tidal volumes at the beginning of my sleep session, as I was trying to get my breath back and settle in to sleep. 
So in effect that was only a problem and the beginning of my sleep session.

These days I settle in/relax/calm down first, 5 - 10 minutes and only then mask up when my breathing has settled down and I am ready to nod off.

Even though I have the TiMax at 3 seconds it still gets there from time to time, maybe the odd cough or two and a recovery breath or two, who knows, but by then I am asleep and it does not bother me.

I like the way ResScan shows the set upper and lower limits and where I am in the range: 

[attachment=34287]

@Sleeprider

Thanks for that explanation!

On my AutoSet For Her my Median Insp times were between 2 and 2.6 seconds.
On the Vauto my Median Insp Time is generally somewhere between 1.5 and 1.7 seconds.
I am not sure I ever understood why, but do now
(Maybe that increased insp effort contributes to frequent awakenings?)

[SakimaStorm]

Hi SakimaStorm.

Excellent comments above. I always enjoy reading others' posts to see what I can learn.

When I started using my Vauto with TiMax = 2 seconds, I found it awkward to have TiMax of only 2 seconds, and quickly raised it to 3 seconds.
But back then I would climb into bed, whack on the mask and hit the start button. At the beginning of the sleep sessions I could see that on my Flow charts there were larger Tidal volumes at the beginning of my sleep session, as I was trying to get my breath back and settle in to sleep. 
So in effect that was only a problem and the beginning of my sleep session.

These days I settle in/relax/calm down first, 5 - 10 minutes and only then mask up when my breathing has settled down and I am ready to nod off.

Even though I have the TiMax at 3 seconds it still gets there from time to time, maybe the odd cough or two and a recovery breath or two, who knows, but by then I am asleep and it does not bother me.

I like the way ResScan shows the set upper and lower limits and where I am in the range: 



@Sleeprider

Thanks for that explanation!

On my AutoSet For Her my Median Insp times were between 2 and 2.6 seconds.
On the Vauto my Median Insp Time is generally somewhere between 1.5 and 1.7 seconds.
I am not sure I ever understood why, but do now
(Maybe that increased insp effort contributes to frequent awakenings?)

Thanks for the comments SevereApnea. Yes, I too find that happening when I mask up w/o relaxing for a few minutes first. I fall asleep pretty quickly, usually w/in 5 minutes so I can't let myself get too relaxed! But a half dozen slow relaxing breaths and I am ready.

I have only used SleepyHead (and then moved to OSCAR). Rescan looks interesting, will check it out.

I noticed the same thing w/ inspiration times and the I:E ratio when shifting from the AirSense to the AirCurve. My inspiration time was in the 2.4 to 2.8s range with an I:E of 1:1 or a little less on the AirSense! That's not healthy according to what I have read. Ideally your exhale should be twice as long as your inhale. Since going to the AirCurve w/ a PS of 4 (instead of 3 EPR on the AirSense), my inspiration time has been between 1.6 and 1.76s (very much like yours!) and my I:E ratio is now 1:20 which is ideal .... I don't know if it is because of different parameters on the AirCurve or because I have bumped up my PS from 3 to 4. Either way, since starting on the AirCurve 2 nights ago, I definitely feel better and more alert. Maybe the increased oxygen transfer due to longer exhale cycles.

And when I awake I feel like I am in a nice comfortable breathing rhythm. Never felt that w/ the AirSense. Happy to be making progress.

s.

[SevereApnea]

Ok here is something interesting in the Vauto....
[attachment=34480]
what would be the purpose of this Ti Max arrow on Sleep Report 3/3 screen? 

This appears in Screen 3/3, but only when I deliberately take a long slow breath in that exceeds the TiMax setting (in my case 3s): then the arrowed highlighted message comes up with, I presume, and warning of some sort. Is this telling me my TiMax is too short?

Why would this appear: I mean, after all, I am awake, and watching the screen.
So all the values of I:E etc are meaningless since I am not asleep.

Is this data stored somewhere?

Is this meant to be read by someone (e.g. sleep supervisor/spouse) while I am asleep?

Just curious, as usual!

[Sleeprider]

I have to speculate because I don't know what purpose this could serve you or a clinician. When you intentionally exceed TiMax the machine will cycle to EPAP and that subtracts from your spontaneous cycle %. I don't sit around looking at my therapy screen when I'm sleeping, so I don't see this much. I seem to recall that Oscar used to report the spontaneous cycle metric, but it's been a long time since I've seen it, and it could be we just deemed it to be insignificant. When I look at my inspiratory time graphs, I never or rarely hit my maximum of 3.0. When looking at inspiratory time in other individual's graphs, I only look for long periods of flat Inspiratory times indicating the TiMax is hit regularly. This is really only a relevant metric for the VPAP.