WW4B Therapy thread

[WW4B]

Thank you for making me feel a little more at ease with my therapy...much appreciated. As noted, numbers look good but results are less than stellar. Still feel tired and breaths do not feel as long or deep as i think they should be. Does this make sense. At times I want or feel the need to have more deeper breaths. Do my inspiration times seem normal, Tidal Volume and other specs. What tweaks or experiments may I try to hmore natural breathing pattern which does not feel shallow or short. Can try minuscule adjustments, just don't know what I should try. Suggestions please...

[WW4B]

Hi, it has been awhile since I last posted but regularly visit the site to read other posts and educate myself further. In a another post the OP was questioning periodic respiration and centrals. Part of the reply was.... Therapy onset centrals are often the result of an imbalance of CO2 as a result of improved ventilation. CO2 is a major driver of respiration and when it fluctuates your respiration tends to follow, leading to "periodic respiration" with higher and lower tidal volumes, occasionally punctuated by a CA event. Reducing EPR often helps to resolve this.
Question: On a AirCurve 10 VAuto in auto mode what would the equivalent changes be to mimic reducing EPR. Changing PS? Minimum EPAP? 
Not one for being numbers driven, although mine appear to be good, but I am always tired and breathing always feels out of sync. When I first put my mask on and lay down my breathing pattern is rhythmic, easy, not shallow, not very long or deep...it feels just right? As the night goes on I feel that my breaths get shorter and not as deep? Can someone please comment on my latest chart and on above inquiries. 

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[WW4B]

Bump !

[WW4B]

Bump Bump Bump

[Jay51]

Hello WW4B.  Possibly reducing your PS would be the equivalent to reducing EPR.  Also, if you have a static, set epap and ipap, that could be the same equivalent also. I am not super familiar with the VAUTO settings, so I am speculating.  

Everything looks good on your last chart (except the leaks).  You could try to reduce leaks more to increase therapy effectiveness.  You have a nasal mask.  Either the sizing of the nasal pillows or nssal cradle is off, or large amounts of air could be escaping through your mouth.  

This is just what I see.  If anyone sees anything else, please post.

[WW4B]

Thanks Jay for the reply. I have attached last nights sleep data. Could I please get a review on your findings and impressions on my data. I still wake up tired and not as alert as I hoped I would be. Leaks are better, but as a side sleeper they are expected. I use a nasal pillow mask and/or a nasal cradle mask. One of my main issues is my breathing pattern does not feel in synch or natural. It feels like I am always taking short and shallow breaths whereas, at times I want to take or feel the need to have a deeper or longer breaths. Does my chart indicate the shallowness of my breaths. Are inspiration and expiration rates within normal ranges or not in synch. Are respiration rates and minute vent normal?  The only setting from default that I use is that I have trigger set at high. I would really appreciate any Resmed Air Curve 10 VAUTO users to chime in on how to better achieve a more satisfying breathing pattern. Can anyone offer some advice.

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[WW4B]

Bump...looking for suggestions.

[Jay51]

Your chart looks very good to excellent to me.  Everything category you mentioned looks good.  You have a very quick 1.32 second inhalation median rate that achieves a 500+ tidal volume.  That is excellent.  It says that your airway is practically wide open - you can get a good healthy tidal volume very quickly.  People with a long inhalation median, say over 3 seconds or more, usually are struggling to get in enough air during the inhalation phase.  You are the opposite.  

If any VAUTO user sees any improvements that can be made to your settings please post.  I don't see any based on your charts.  You might possibly change the trigger setting either to very high or down a notch (to medium?).  Your results and comfort may change.  You can always go back to the high trigger and these excellent results.  Changing the trigger mechanism might improve your sync (but the way you have it now at high may be the best).

[WW4B]

[attachment=52371][attachment=52372][attachment=52373]
Jay51, Thank you very much. Never a numbers chaser but very pleased to know my therapy "numbers wise" is encouraging and going well. As explained before, just not comfortable and waking up tired still. There are times when I want or feel the need to breathe deep where my chest fully expands instead of the constant feeling of shorter and shallow breaths that I seem to take. Without dial winging I would like to know what the effects of changing certain settings would/could/will do to therapy before changing anything as I seem to learn and understand much better this way when I know what to look for as in the "cause and effect" scenario.
Still working on my leaks, mask styles and mask fittings. Prefer nasal pillow and nasal cushion, especially the over the head style masks.  
Can any VAuto forum members chime in and help me by recommending some changes or what effects the following changes could effect therapy for the better.
Change cycle from med to low or high.
Change trigger from high to default med or very high.
Change TI Max and/or TI Min from default to a higher or lower value.
I have enclosed the last three nights charts. Again, good numbers do not equate to restful sleep! 
I thank you all in advance for any and all comments and advice as well as appreciate respect those who run and monitor this forum. Take a bow all !

[Sleeprider]

We can use the Vauto to resolve a number of issues, but I don't see anything in your results that would merit tweaking the trigger or cycle sensitivity or the time of inspiration controls. Defaults are working well, and there is just no reason to make changes.