Breathing Test Numbers Questions

[Green Queen]

Hey Marty.
Hope you get it sorted, and that it makes a difference for you.

I also know why the company doesn't set things 'properly ' when you first buy them.
You ring them, ask how to change a setting, it works, you gush at how awesome they are, they get big heads, probably a pay rise...all big companies are in the same bowling league and cook up their evil plans together....

I'm joking of course...but also serious...

J x

 

[mpnatx]

Marty, lots of people make their own adjustments, since needs vary as you go and there is some trial and error.
Here is a link to the quick start guide to the T200 (let me know if you need the one for the 100 but they are obviously pretty similar).
https://www.dropbox.com/s/5x8bffppc24kr2m/T200QuickStartGuide.pdf?dl=0

It shows how to get into the setup screen (pg. 6) and set "full access" to the clinical menu (p.7). Obviously, you don't need to touch the circuit type since that is already set. From there, look at the settings as the picture shows. If your air is blasting you, there are 2 key settings to look at: the IPAP maximum and the tidal volume if AVAPS is enabled. They are both on the same screen. I don't know your height, but a good TV to start from might be 400 or so. IPAP, you could start at 8 or so. Unless you have pre-existing lung disease or apnea, 4 is a nice setting for EPAP, for most (you may have to scroll to see it; it's under the other two). You can try those settings, using the step-by-step shown, and you're done.

Let me know if you need anything clearer. It takes longer to type than to do!

Best,
Laurie
https://www.dropbox.com/s/zxbm1heucnm26s3/T200productmanual.pdf?dl=0

Laurie,
I set the TV from 600 to 400 and the epap to from 6 to 4. Mine doesn't have an ipap setting, so I couldn't adjust that one. It is so much better! Thank you so much!

One other problem is that when I breath in, it stops about three quarters and then reverses. Also breathing out does the same. Is there a setting to increase those a little bit?
You're a lifesaver!
Marty

 

[lgelb]

Yes, Marty, you want to increase the Ti min and/or max (should be in the same set of screens you were in) to get a longer breath in, and the trigger sensitivity (how soon it switches from out to in) needs to be decreased. You can also make the rise time longer in certain modes.

There are other possibilities, like your backup rate, if any, but I'm a little confused about which mode your machine is in -- if AVAPS is enabled, you should be showing an IPAP max and min that can be changed -- and the mode affects what settings can be changed. So if you can tell me the current settings, that would help. I am attaching the full manual that lists what you can change in each mode, as well.

 

[mpnatx]

Hi Laurie, I was reading the manual and it says the ipap setting displays if Avaps is off.
Page 81.
I also noticed in settings that my menu has dual prescription and then mode next. No circuit type.
These are the current settings:
Dual prescription off
Mode avaps-ae
Avaps-ae rate5.0cm
Tidal volume 400 ml
Max pres 40 cm
Pressure support max and min 4.0
Epap max and min 4.0
Breath rate 12bpm
Insp time 1.0
Trigger type auto track
Rise time 3
Ramp 20 min
Circuit alarm 60 sec
Thanks!

 

[lgelb]

"Max pres" would operationally be the same as max IPAP, since your EPAP will never be > IPAP.

40?

That would blast anyone -- and possibly blow out your lungs. I would reduce it to 15 or something for now.

Ironically, your pressure support max is set way too low. That's why you were being blasted, too -- both your EPAP and IPAP were rising because they could only be separated by 4 cm! There are times when you need deeper breaths than the minimum. I'd reset that to 11, given that I'm recommending IPAP max=15 and your EPAP=4 now.

Insp time = "Ti" and is too low. Most people need more than a second. That will only apply if your backup rate is triggered, but still, I would take it up to 1.6 or so, depending on your normal breathing rate, which is?

Once we know your normal breathing rate (you can check the data screen if you aren't sure, or ask your wife to count when you're asleep and seem peaceful), set the backup rate to 2-3 breaths lower. 12 implies your normal rate is 14-15, which may be true.

As I say, I'd start w/ rise time at 6 and work your way down if desired. My bet, you'll end up at 4 or 5.

The "AVAPS rate" is set at 5 cm, the max. That's the measure of how aggressively the machine changes IPAP to respond to a target volume below range. I might set it more in the middle, 2.5cm, and see how you do.

The auto-trak trigger thing should be left alone until you make the other adjustments and then see if you're getting IPAP when you want it.

You don't need a 20 min ramp -- just delays delivery of the air you need -- unless you like it.

The circuit alarm is saying if you are offline for a minute, it'll squawk.

Let me know what does not make sense...

 

[mpnatx]

Thank you. These are the new settings. Did I miss something?

Avaps-ae rate5.0cm
Tidal volume 400 ml
Max pres 15 cm
Pressure support max and min 4.0
Epap max and min 11 and 4
Breath rate 12bpm
Insp time 1.5
Trigger type auto track
Rise time 5
Ramp off by default now
Circuit alarm 60 sec

 

[lgelb]

Pressure support max should be 11 (and if you end up increasing IPAP later for any reason, increase it the same amount)

Take EPAP max back down to 4, unless you have pre-existing sleep apnea and need more. So EPAP min and max would be the same for now, lacking evidence they need not to be.

EPAP is expiratory pressure. In ALS, breathing against pressure is harder. People w/ sleep apnea need more pressure on expiration so their airways don't collapse.

Pressure support is IPAP minus EPAP -- the size of the breath. We want the machine to be able to select that within the IPAP/EPAP parameters that we set -- not hem it in -- based on how much air you are moving every minute (the target volume).

If you tell me your height, I can do better than 400 on TV. It's a formula based on height.

 

[mpnatx]

I'm 6' tall. Hopefully I can get it right this time. Also, I don't have anyone to count my breaths.
I'm going to set it and try it. Goodnight Laurie.
Thanks much for your patience!
Marty

 

[mpnatx]

I just wanted to let everyone know that my trilogy issues have all been resolved. Got a great nights sleep for the first time in a long time. I'm very grateful for Laurie's help and patience. And, for this forum!
Gratefully yours,
Marty

 

[affected]

HOORAY!

We are indeed lucky to have Laurie here with her knowledge of bipap settings. Well done Marty

 

[lgelb]

Tillie, you're too kind. Always happy to help, thanks for the update, Marty, and so sorry I absentmindedly assigned you a wife.

When you get a chance, check out what the SD card captures (hopefully, there is one in your machine, or you can pick one up), and we can see what your breathing rate actually is. It's always good to know where the data are being stored in case you do want evidence for making a change. But I doubt your backup rate is being triggered at the moment.

Given your height, your target volume could be as high as 460, if you ever want to try it to see if that makes you feel more rested.

--Laurie