RE: In anticipation of my BIPAP Re: New Thread

[Plmnb]

Soooo, here’s the scoop. I have tried 3 different settings for my height. Each one a click lower than the previous. Noticeable difference...for the better. Right now I’m at 56 inches and it is PURRFECT. I’m afraid too good to be true actually.

Should I still expect I’ll be getting appropriate therapy with my height set so many inches lower than my true height? I guess tonight will tell.

I’ll report back in am!!!!

Thank you, thank you everyone for getting me this far.

[Geer1]

The feeling of being forced to breath is probably because target RR is too high at 16. Some of your recent charts appear to be in 13-14 range. If you look at overview tab in OSCAR you can get a better idea of your median respiration rate then set it to that value. 

The reason lowering your height is making things feel better is because it is lowering your target Va. I didn't realize Va was so much lower than MV (at least in that screenshot Sleeprider posted). Your spontaneous MV has only been around 6.25 and the corresponding MV you should be targeting is only around 5.6-6 imo so Va probably around 5 to get that.

[Plmnb]

 Good Morning all.

Well, first night on the long awaited ST-A is under the belt.  I'll post last night's chart shortly.  Just want to mention/ask a few things:

1) Re: Large Leaks
I have been having them for the last few nights at different portions of my sleep.  I attribute most of them to trying to get used to smaller head gear size.  I may have to switch back to the larger size, but the velcro no longer is allowing for sticking.  I'm going to have to figure something out on this.

2) I believe it was mentioned that in Ivaps mode I will not get a FLOW LIMIT reading.  As that graph sort of defined my therapy, which chart on iVaps takes its place as being the main one we should be looking at to determine appropriate tweaks.  Perhaps since this is brand new territory for me, we need to look at most all of them?  Which graphs and in what order should I post my images?   I'm sure you will want zooms as well. This is why I will post after hearing from you.

3) I have just this morning submitted my request for the Clinician Manual.

4) The results and/or numbers on the screen of the machine after awaking for the day, I am curious as to if these are needed to help us fine tune?  Here they are:

Pressure: 30
Exp Pressure: 12
Vt: 480
RR: 16
Mv: 7.3L/min
Ti: 1.4s
I:E: 1:1.6
Spontaneous Trigger: 69%
Spontaneous Cycle: 69%

Setting tweaks made to the machine last night:

Mode: iVAPS
Height: 56 inches
Target Pt Rate: 16
Target Va: 6.0L/min
(NOT SET BY ME, AUTOMATIC BY MACINE: Mv 7.1L/min, Vt 445 mml)
Vt/Kg 12.1ml/kg IBW
EPAP: 12
Min PS: 4.0
Max PS: 18.00
Ti max: 1.95
Ti min: 0.7s
Rise Time: 300ms
Trigger: Med
Cycle: Med

As to how I feel this morning, pretty much the same, not bouncy or anything, I don't feel like a truck hit me, but that is how I have been feeling for the past week or so.  I guess I am wearing the mask enough to not get the OA headaches like I did a few times recently.  I won't get tired until later this afternoon, probably.  I still need to review video for last night as well.

Speak to you shortly,
Plmnb

[slowriter]

On another thread, bonjour has suggestions for chart organization on the ST-A, though they seem generic.

http://www.apneaboard.com/forums/Thread-...#pid319089

I'm pretty sure people would be curious what happened with the extreme flow limitations you were earlier experiencing. Did they go away entirely? Reduced?

[Sleeprider]

I would probably back out the Va until MV falls to 6.0 to 6.4. That will keep it from being too aggressive. Your approach of reducing that value and feeling better was a good one. The Learn Targets seems to way over-estimate needs and that was true of the other person I know that used it. I think to evaluate this, we can look at the overall chart, but you are going to have to scan the flow rate through the night to see what is happening. Your statistics for last night look fine, but hard to put them into context.

[Plmnb]

Morning Sleeprider, glad to hear from you.

I checked out bonjour's chart organization for the ST-A user, but you are correct, they seem generic.  For instance I thought I read somewhere that the FLOW LIMIT graph is not reported in iVaps? I don't have a FLOW LIMIT graph anymore. Would we then be keeping a closer eye on the FLOW RATE among other things? 

Once we get the exact chart organization figured out, I will post the charts.

Plmnb

[Plmnb]

oh, also.  Would it be ok to post the graphs for the sessions that don't show mostly LARGE LEAKS?

[Sleeprider]

I think a general overview with Events, Flow Rate, Mask Pressure, Leaks is the basic organization. As I said, you will need to zoom into the flow rate to see flow limitation, and just scan manually. It would be nice if flow limit was reported, but since this machine does not rely on that to adjust pressure, it just isn't a data channel.

If you have not already done so, you should PM Bonjour and join the OSCAR beta test group. This will get you access to the latest beta version that more accurately transcribes your settings and results. I'm sure the development team could benefit from any input you have in looking at your results on the ST-A.

[Geer1]

If OSCAR doesn't have a flow limit chart you need to look at and interpret the flow rate chart. You know what these bad flow limitations look like so you should be able to see them.

It will most likely be moments where the machine is running at higher IPAP.

[Plmnb]

Here we go!

This post has the main chart with the graphs I think are needed.  I didn't include the Leaks graph because they are obvious in the first graph with their little gray bars.  I am now working on some zooms, especially of the Flow Rates.  I might try a medium mask tonight if I can find all the right parts.  Maybe this would help with leaks.

It is interesting to me that the Mask Pressure waves were so flat topped last night.

Plmnb