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+--- Thread: NEED EXPLANATIONS RE: Ti MAX/MIN, TRIGGER, CYCLE please? (/Thread-NEED-EXPLANATIONS-RE-Ti-MAX-MIN-TRIGGER-CYCLE-please)
NEED EXPLANATIONS RE: Ti MAX/MIN, TRIGGER, CYCLE please? - Plmnb - 02-03-2020
Good morning. I know we are supposed to keep our questions/comments together, but I thought this question might get lost in my other threads. If this post needs to be moved, let me know.
This question has to do with the possibility of changing some or all of the settings for Ti MAX, Ti MIN, Trigger, and Cycle. As we know I have had extremely varied results regarding Flow Limitations and Events. My graphs for FL and Events show that they have gotten better, but I still am having trouble feeling like I got any decent sleep, low AHI or not.
Although we have changed the PS a gazillion times, we only changed these other settings once.
At one point early on it was suggested I change some of the above settings, which I did. However, after the initial change of these other settings, they have not been adjusted. (Just the PS).
I'd like to settle in for a few days with my PS set at 6.6. I have tried to do a search in these forums on TI, Trigger, and Cycle but I can't figure out the formulas for adjusting them, or if I should/need to do so.
For the longest time now I have been at Ti Max of 2.0s, Ti Min 0.7s, Trigger High, Cycle Low.
Would there be any reason/benefit for further tweaks of these particular settings?
I have I have cleaned up my sleep hygiene quite a bit...earlier to bed, no marijuana, no caffeine after noon time, taking my meds, trying to sleep later, addressing Large Leaks, etc. So the only thing I can think of at the moment is perhaps making adjustments to these other settings. (I'm not sure how much of an impact my insomnia, parasominias, and the arrival home of my husband from work are having, but I'm sure they need to be addressed as well).
Here is my chart from last night. If there is any interest in other charts and/or zooms please let me know.
Thank You,
Plmnb
[attachment=19641]
RE: NEED EXPLANATIONS RE: Ti MAX/MIN, TRIGGER, CYCLE please? - OpalRose - 02-03-2020
Hi Plmnb,
I'm glad your posted this question. I haven't noticed a lot of explanation on these particular settings, except some say to leave it at default, which doesn't make much sense to me.
It could just be something that is not readily understood.
There is a chart in the VAuto Clinicians Manual on setting T1 Min and T1 Max.
I haven't looked at in in depth, but it appears that the settings should be made based on your respiratory (BPM).
I'm unsure about the Triggering and Cycling settings and what it's based on.
Hoping someone with more knowledge on these settings will be along.
I'd love to see these settings show up somewhere on the OSCAR Daily Page so we could compare how these particular settings affect therapy numbers.
EDIT: I see several threads on this subject below in the "Possibly Related Threads" section. I'm going to start reading through them to see if I can glean any useful information.
RE: NEED EXPLANATIONS RE: Ti MAX/MIN, TRIGGER, CYCLE please? - Sleeprider - 02-03-2020
Phoebe, I will get back to this on what the settings do. I'm having a visual migrane this morning and have a lot of flashy things bouncing back off the screen. The clinical manual for Resmed Vauto does a great job of explaining these settings, and that is where to start to understand.
For you there would be no harm in increasing Ti Max to 2.2. Ti Min is used to ensure IPAP lasts a minimum amount of time, and we use that where weak inspiration, uneven respiration or tendency for centrals occur. Ti Max ensures that IPAP is available as long as you need it but the machine will cycle ti EPAP when that time expires, or spontaneously. Since you have had flow limitation with longer inspiration in the past, a longer Ti Max might be useful
Your chart...wow!
RE: NEED EXPLANATIONS RE: Ti MAX/MIN, TRIGGER, CYCLE please? - geauxdbl - 02-03-2020
Coincidentally, I just did this myself over the weekend and found that it helped. See where your Inspiration time max is 2.0 in the chart? That means there are times when you're inhaling, the VAuto says "nah, 2 seconds are over", and cuts off flow to switch you to exhale pressure. Fun fact: fire up the machine and turn the click wheel clockwise a few times, and you can watch this happen live with a numerical representation of your inhale and exhale times and ratios calculated in the moment. You can also see a figure for spontaneous cycles, which is what percentage of your breaths are happening naturally.
Trigger is how sensitive the VAuto is to detecting the start of your inhale. A high trigger setting means it starts faster.
Cycle is how long it waits to stop the flow upon switching to exhale. A low cycle setting means it waits longer.
Ti Max is the amount of time it will give you to finish inhaling. If you're hitting the 2 second max, it's cutting your breath off short before you're done. I have that problem from time to time. Mostly when I'm awake, and as I was watching the screen I was seeing spontaneous cycles in the 50% range. That creates a feeling of working against the machine.
I switched Ti Max to 3.0. That means it gives me more time to finish breathing in. If you naturally start exhaling before the 3 seconds are up, it will switch to exhale pressure. After messing around with trigger and cycle, I settled on Trigger High and Cycle Medium. It feels way more natural to me and I've slept better since.
You may need different settings, but hopefully that helps make sense of what they do. Definitely try the trick of turning the wheel and watching your insp/exp times.
RE: NEED EXPLANATIONS RE: Ti MAX/MIN, TRIGGER, CYCLE please? - slowriter - 02-03-2020
Trigger and cycle controls how quickly the machine cycles between IPAP and EPAP.
You can experiment while awake with those to see what feels most comfortable.
Also, if you tend to get CAs, sometimes raising the trigger will resolve those. They did with me, for example.
I have never been entirely clear on how to fine-tune Ti.
My current understanding, which I would appreciate someone to confirm or correct, is you want to look at your Ti numbers in OSCAR, and make sure the max is above your max.
Not sure when or why you'd change the min.
RE: NEED EXPLANATIONS RE: Ti MAX/MIN, TRIGGER, CYCLE please? - Plmnb - 02-03-2020
Thanks bunches OpalRose & Sleeprider.
I hope you feel better soon Sleeprider.
There is a wow factor with the fact that although I had limited sleep time, I didn't record any Obstructives or Hypopnea. (Though those infrequent CA still annoy me for showing up, lol . I know, I know no worries there in my case
) There has been only one other time I had no events except for a measly one CA and that was the night I only had 1 1/2 hours of sleep. It is just so fascinating how all the numbers don't really have the ultimate impact on HOW ONE FEELS. For example the night of the holy grail, on 1/12 when I had the nirvana of feeling refreshed I still had one H and one O and slept a stinking 2 3/4 hours). And it is just so nutso how every darn night my numbers especially the AHI jump around. January was definitely better than December, mostly due to switching from CPAP to BIPAP I suppose.OpalRose, I appreciate you looking in to the information in the clinician manual. If I am not mistaken I can look up the info as well. However I expect that it may be above my head, so anything you can glean would be helpful.
Look forward to your input.
Best Regards,
Plmnb
RE: NEED EXPLANATIONS RE: Ti MAX/MIN, TRIGGER, CYCLE please? - Sleeprider - 02-03-2020
The flashy things have gone away. I can't improve on the very good posts by Geauxdbl and Slowriter, so I won't try. I have sometimes intentionally exceeded the Ti Max by taking a slow breath, and the loss of pressure support is pretty noticeable. The only reason I can think of to intentionally cut inspiration time short is with COPD there is a need to preserve expiration time. I have used all of these tools from time to time with various problems on the forum, and it's interesting to observe the outcomes.
RE: NEED EXPLANATIONS RE: Ti MAX/MIN, TRIGGER, CYCLE please? - Plmnb - 02-03-2020
Thanks so much for the quick replies! Nice to meet you geauxdbl.
All very very interesting information. So let me see if I can wrap my head around this.
For a moment I thought I had an AH HA moment, but now I'm not sure. In reviewing my INSPIRATION graph in the non-zoom mode it had looked like I had hit that 2.0 TI MAX like a brick wall. However, when I zoom in on the individual waves (?), although I hit 2.0 approximately 2 - 3 times, I actually only get extremely close to 2.00 the rest of the time. Is the machine so sensitive that I shouldn't bother switching the Ti MAX any higher? The Trigger is already set at HIGH, so based on what my graphs show changing this to VERY HIGH wouldn't be useful, is this correct?
Also, what would or wouldn't be the benefit of adjusting the Ti MIN?
And in my case what about the CYCLE setting? I am looking at my MASK PRESSURE waves but am uncertain if these wave forms provide any clues as to the tweaks to the TI, Trigger, and Cycle if any.
I hope this chart helps to decide what to do?
[attachment=19645]
As always,
Loving the help,
Plmnb
RE: NEED EXPLANATIONS RE: Ti MAX/MIN, TRIGGER, CYCLE please? - geauxdbl - 02-03-2020
My personal opinion is that the machine is very sensitive, but for whatever reason ships with the default Ti Max value of 2.0, and in my experience changing that to 3.0 gave it way more time to "do its thing."
Looks to me as well like you are indeed hitting 2.0 like a brick wall from 3:00-3:15 and then again from 4:30 on. But it's hard to tell at this zoom level. Confirmation, though, can be found in Statistics -> Insp. Time, where BOTH 95% and Max Insp. Time are 2.0.
2.0 is simply the default setting that the machine ships with. No reason to stick with it at this point. I would change the Ti Max value first and see how it feels. After that, maybe, Cycle back to the default of medium (or not).
RE: NEED EXPLANATIONS RE: Ti MAX/MIN, TRIGGER, CYCLE please? - Plmnb - 02-03-2020
I went to the Statistics tab but could not find the titles for these categories. I checked some boxes off in the preferences section but this didn't result in these category titles showing up. I did however, give a look to the overview tab and hovered my cursor over the colored stacks for the Expiratory Time and Inspiratory time.
For the last 5 nights and the majority of my nights, my 95% reading states I am at 2.0 Inspiratory Time.
My 95% readings for Expiratory Time are all over 3.50 on the low end and closer to 4 or more on the high end.
So what I think I will do is tweak to Ti Max 3.0s tonight and see what happens, then go from there.
Thank you for this new information!
Regards,
Plmnb