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KimT

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PALS
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I was going to send a PM to Laurie on this one but I wanted to put it out there for everyone to read and comment.

The RT came today with my new ResMed VPAP ST-A with H5i heated humidifier. It is under a Medicare rental and I do have the option to switching to a Trilogy or the ResMed equivalent within 90 days.

The RT had NEVER set up this model and knew nothing about ALS or my particular sleep study. Aside from severe pain I've been sleeping OK and not waking up much during the night.

Anyway, she had me try it for 20 minutes, the last five being used by the machine to "calibrate to my breathing." I was relaxed and went the 20 minutes. She got an error message that it didn't work. We tried again and it worked. After it was "set" it felt very awkward. During the testing part, I was pretty comfortable but after the machine took over it felt like I was not able to breathe out well.

Here is what is written on the order:
IVAPS Mode
PSMN 0
PSMAX 15
EPAP MIN 4

It's a mask that covers my nose and mouth. It was a medium and she thinks a small might work better. She is coming back but wants me to try it this weekend.

If I'm understanding her correctly, I'm breathing out against pressure. I guess I don't understand that part.
 
Kim, when my husband was brought his Trilogy, the RT instructed me how to set it up and had my husband connected to it in her presence for 2 minutes. You were lucky that you got a 20 minute trial!

We have been having a very difficult time using the Trilogy and the RT who comes monthly has been very little help. I have had much more help from Laurie on this forum. Our RT just quit to take a new job and we are praying that her replacement knows more about the Trilogy.

Sharon
 
Living in Daytona Beach has limitations in health care quality. I'm just too exhausted and in pain to try it. I'm going to take a nap.
 
Breathing out against pressure just keeps the lungs open and makes it easier to get all the air out. Sounds counterintuitive, but it works.
Vincent
 
She was here for 3 hours total.

What would happen if I set the PSMax down to 10?
 
NO--not PS min of 0! Your doc obviously doesn't understand iVAPS at all. That's the setting for CPAP -- equal IPAP/EPAP. Of course it feels weird. It's wrong. The PS min (PS is IPAP minus EPAP) should be at least 4 to start, more if the breaths seem too shallow for you.

And on this machine, there isn't any EPAP min, just a single EPAP.

More importantly, what did the tech set as a target Va? Because there's not one on the rx. Brilliant. Bet it's set too high. That drives the IPAP.

Also, what did she set for Ti min and max? That machine learning thing is fantasy since you were at the wrong pressure setting. Anyway, easy to fix. Look at the screen and see how long your breaths are, once you have reset PS min. Then set the min lower and the max higher; tweak to comfort.

To change settings, press/hold Setup and the push dial for 3 seconds. By scrolling down (turn the dial), you can tell me what the Va and Ti settings are. Push the dial when you reach a setting to change it, then again to lock it in. Feel free to PM me if this doesn't make sense.
 
Personally I really like seeing these posts answered in forum threads as I think it will encourage more and more PALS to get Laurie helping them keep their bipap working right all the time.

If it is done by PM, then lots of PALS, particularly newer ones won't realise what a resource we have here in Laurie's deep understanding of all brands of bipap type machines.
 
When I went into settings, here are the things in dark black
Mode IVAPS
Height 66 inches
Target Pt Rate 15
Target Va 2.8L/Min

the rest is grey
4.3L/Min
Vt 286 ml
Vt?Kg 4.8 Ml/Kg

She did two test runs of each 20 minutes. When I try seeing what the results were, it says 0. I think after she figured out she wasn't understanding, she zeroed everything out.

Should I put it on for another 20 minutes, then check?
 
Last edited:
Tillie & Laurie,

I feel so stupid, frustrated, and overwhelmed. I'm so grateful for all you both do to help us.
 
You need to scroll down to see all the settings, but like I said, I'd start by setting PS min to 4 -- that's the worst thing she did. The grey settings are the ones that aren't set directly. So with that Va, Vt becomes 4.8 ml/kg of ideal body weight, which is based on your height and frame size -- she used a medium frame. That is an OK number to see how it goes.

That's a pretty high target rate, though, so I'd see how you breathe normally and set it 2-4 less.

The trigger and cycle settings probably need tweaking as you go -- trigger determines how fast the machine sets up for the next breath, cycle how fast it goes from inhale to exhale.

Why feel stupid about what's not your area of expertise? Let's just say there's a reason why I didn't go into accounting!

Best,
Laurie
 
We never used a bipap (long story, FTD), so I can never give any advice except get one. But how would anyone who has never used something like this have any idea - even the RT didn't know what to do!

I think many people just struggle along, with poor settings, and then often don't use the bipap as much as they should because I hear the complaints about it being uncomfortable. What I have learned is that it should not be uncomfortable, but all those settings and numbers are gibberish to me - again why I would never try to give any advice.

The more who ask and get help, the more help others are likely to get :) Don't feel stupid, but I would sure be frustrated!
 
Is it measured in breaths per minute? I just relaxed on the bed and was breathing 8-9 breaths per minute. She was stressing me out during the actual 20 minute tests so I was probably breathing fast. I know I was upset because she was on the phone and getting all frustrated.
 
Yup, it's set at 15 breaths per minute as the target. I'd set your target rate to 8 for now, see how it pans out. Above all, the machine will adjust pressure to reach your target volume based on your actual rate.
 
Thank you, Laurie.
 
The RT came back today. I convinced her to ignore all previous settings and work with me on how I feel comfortable breathing. I had to explain to her that 300 ms was faster than 1 second and that helped her with the settings. I was having a problem with the machine trying to force me to inhale before I was ready.

Laurie, Here is what we ended up with and I know it will have to be played with but I want to post it for any glaring errors.

Target Pt Rate 10
Target Va 3.5
EPAP 4
MinPs 2
Max Ps 12
Ti Max 4 sec
Ti min 4 sec
Rise time 400 ms
Trigger Med
Cycle Sensitivity Low

I set the humidity on 3

My specific issues. I'm a slow breather (8 per minute when I'm totally relaxed) Sometimes my breathing is irregular if my heart is "off". I usually have long inhalations.
 
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