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02-28-2020, 10:24 PM (This post was last modified: 02-28-2020, 10:24 PM by Geer1.)
RE: [split] Mal777 Lumis 150 ST-A iVAPS Therapy
I got focused on your autoset results and was trying to match that, forgot you had the titration done... Their recommended settings were a PS of 9 which we don't need thanks to iVAPS. We want to start PS on low side to minimize centrals and then rely on iVAPS to provide the higher PS when you need it to maintain ventilation. PS of 4 is probably a good starting point.
The titration study comments about timing settings but it is for a Philips Respironics machine and some of the numbers must be different (either that or for some reason they used a very long rise time). They used a backup rate of 10.
Just for Bonjour/Sleeprider, the inspiratory pressure support is only similar if you make the rise time longer to get a waveform closer to the easybreath waveform which has a rise time of ~1 second. Here is a visual representation.
I have used rise time in S-mode and it makes a difference. I figured we would move off the default 300 to 500, but at some point cold extend it to 800-plus for comfort. Pressure support is pressure support. With this machine, we get more of a square wave, and it is not proportional to spontaneous effort, but it is definitely PS that should keep inspiration from cycling early. The shape of the curve with Easybreathe is a comfort feature that actually reduces the effective PS.
My main focus right now is overcoming what appeared to be significant flow limitation and chaotic cycling with the previous machine. That is why I wanted a minimum PS of 4 and minimum time of inspiration of 1-second. I hope we will see the end of the high respiration rates, and a more complete inspirations and normal expiration. iVAPS is something we are all learning about, and I know of several past members like ajack that used if very successfully. His experienced input to this would have been very interesting.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(02-28-2020, 10:46 PM)Sleeprider Wrote: The shape of the curve with Easybreathe is a comfort feature that actually reduces the effective PS.
That is all I was trying to say. It does so primarily in the inspiration process, providing minimal help in that stage and then just topping up the pressure at the end of the breath to help with exhalation.
I agree shorter rise time in combination with Timin is what I was hoping would overcome the fluctuating breaths as well. Wasn't as sure that they are caused by flow limitations but the high PS in sleep study may be indicating that they were.
Well I tried the Lumis 150 ST-A last night for the first time. Unfortunately I only got about half of my sleep recorded as I got up around midnight for a bathroom break, left my mask on but in my dreammy sleep forgat to turn the machine back on. From what I can see there was some improvemnet in my RR, and for the forst time since starting CPAP July 2019, I had no Centrals, so it appears we are on the right track
M7 settings were
*Target PT 15
*Target VA 6.2 (was calculalted by machine after I entered my average TV and MV over 5 nights, in periods of "good" breathing) (Changing my height did not affect this reading)
*MV 8.2 (automatically done)
*VT (automatically done)
*EPAP min 4
*EPAP max 15
*PS min 4
*PS max 10
*Ti min 1.0
*Ti max 2.5
*Rise 600
*Trigger High
*Cycle Low
(My own averages (for machine to do its calculations on target VA etc) for sections of normal breathing over 5 nights were (as suggested by Geer1)
There were times in night it felt like air was rushing into my mouth when not required by me, and sometimes it fell short of letting me complete a breath, but overall not too bad for first night. But I was happy to see no centrals and some smoothing out of breathing.
Tonight I will be sure not to switch it off!!
The ST-A doesn't report central apneas, those UA's and H's were likely central in nature.
The air being forced onto you is the backup rate in action. Did you determine your backup rate the same way (looking at previous days good periods of respiration rate)? Looking at this data it looks like it wants to be closer to 12 (Target Pt Rate). The lower it is set the less it will effect you but in your case it is important because it is also what combats the central apneas.
Your minute ventilation too high as is respiration rate, seems your odd breathing waveform may still be present in some manner. Post a zoomed in view of your data during that period. Replace the pressure graph with mask pressure before doing so.
That's unfortunate the ST-A doesn't report centrals, as I was very concerned about them becoming a problem. I suppose getting the total AHI down is now the goal to make sure centrals are not an issue. And of course my breathing issues...
And yes, I determined my breathing rate by the average of the good episodes in the past. Average was 14.5. Maybe I could now try 14 to start?
Can you provide a zoom of some UA events? Overall this is a significant improvement and the chaotic breathing pattern has evolved into a somewhat rapid, but well-formed respiration. The respiration seems to calm down after midnight. I'm reluctant to suggest any changes since this is just the first few hours of therapy. It's interesting to see the EPAP response, and it appears that a higher EPAP of 6.0 is something we should consider in the near future.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Same breathing issue as APAP but made uglier with the current timing controls.
Somehow we have to try and get IPAP to trigger when your breath should be occurring. Maybe Sleeprider and others have ideas on how to do that without using timed mode which I believe cannot be used in conjunction with iVAPS. My main idea is to use a lower trigger sensitivity (because this breathing prematurely triggers IPAP) and a longer Timin, say 1.3, to try and start the IPAP a bit later and hold it on so that hopefully your breaths turn into single breaths.
I can't remember have you dealt with a pulmonologist? If so have you asked them about that breathing? I'm kind of surprised there wasn't a comment about it in the polysomnogram. I'm sure something is causing it but I don't know what.
As for target PT rate sure try 14 and see if that feels better. Your respiration rate may be slightly different on this machine due to the timing controls, different waverform and increased PS.
(02-29-2020, 05:08 PM)Sleeprider Wrote: Can you provide a zoom of some UA events? Overall this is a significant improvement and the chaotic breathing pattern has evolved into a somewhat rapid, but well-formed respiration. The respiration seems to calm down after midnight. I'm reluctant to suggest any changes since this is just the first few hours of therapy. It's interesting to see the EPAP response, and it appears that a higher EPAP of 6.0 is something we should consider in the near future.
Very pleasing that my chaotic breathing has improved. I will be sure to turn machine back on tonight after my bathroom break :-)
Attached is zoomed in screenshot of UA'a. Do they look like centrals?
I will leave settings the same tonight to get a second look at everything.
(02-29-2020, 05:21 PM)Geer1 Wrote: Same breathing issue as APAP but made uglier with the current timing controls.
Somehow we have to try and get IPAP to trigger when your breath should be occurring. Maybe Sleeprider and others have ideas on how to do that without using timed mode which I believe cannot be used in conjunction with iVAPS. My main idea is to use a lower trigger sensitivity (because this breathing prematurely triggers IPAP) and a longer Timin, say 1.3, to try and start the IPAP a bit later and hold it on so that hopefully your breaths turn into single breaths.
I can't remember have you dealt with a pulmonologist? If so have you asked them about that breathing? I'm kind of surprised there wasn't a comment about it in the polysomnogram. I'm sure something is causing it but I don't know what.
As for target PT rate sure try 14 and see if that feels better. Your respiration rate may be slightly different on this machine due to the timing controls, different waverform and increased PS.
Yes I saw a pulmonologist last week for the script. He didnt mention the erratic breathing, and was not interested in looking at my Oscar screenshots, so I got no explanation. He had never heard of IVAPS I dont think, as he looked at me with a blank face when I mentioned it. He did give me a chest xray, and a lung function test, both which were normal . The script he gave me was for an ST machine at 16 Ipap, and 8 Epap with backup rate of 8. (ridiculous!) I had no problem using that script to get the ST-A
I also saw an Ear Nose and throat specialist who said the was no problem in my upper airways and throat, apart from some nasal valve prolapse which I can use nasal dilators for. I also had a second echocardiogram (one 19.12.19 and one 24.2.20) to confirm Ejection faction. Both normal of around 60-62%.
