explanation needed for Timin and Timax

[mets123]

I am getting a resmed aircurve 10 vauto and have been doing some reading and don't understand exactly what Timin and Timax actually mean and how one can determine (if default settings don't work)how to adjust for one's individual needs. I understand that it has to do with the time one spends at ipap but a clearer understanding would be appreciated.
Also if one can also explain trigger and cycle and again how to determine how to set these.
thanks

[palerider]

I am getting a resmed aircurve 10 vauto and have been doing some reading and don't understand exactly what Timin and Timax actually mean and how one can determine (if default settings don't work)how to adjust for one's individual needs. I understand that it has to do with the time one spends at ipap but a clearer understanding would be appreciated.
Also if one can also explain trigger and cycle and again how to determine how to set these.
thanks

It's actually all quite simple, but not explained very well in the manual.. It all has to do with the handling of the IPAP pressure... so figure we're starting with the EPAP base pressure.

Trigger is how sensitive the machine is to your starting to take a breath... the lower the trigger, the more of a breath you have to take before the machine goes "AHA! time to switch to IPAP".

TiMin is the minimum amount of time that it will stay at IPAP.

TiMax is the maximum amount of time it'll stay at IPAP.

Cycle is how sensitive the machine is to your starting to exhale.... and when it'll drop the pressure back to EPAP, (if TiMax hasn't already expired, if TiMax expires, then the machine goes back to EPAP then.

For *most* people, just leave those settings at default.

After looking at Sleepyhead charts, I saw that my inspiration time was very often being cut off at the TiMax time, but it seemed I wanted to breathe slower at night, so I upped the TiMax till it wasn't cutting me off anymore.

I also set my Trigger to 'very sensitive' because while looking at the individual breaths in SH, I'd see times were it looked like I was trying to inhale, but the machine wasn't kicking over to IPAP, then I'd have an apnea... so I bumped Trigger up, and the when even if my throat was closing, it'd pick up those small attempts at breathing, and help me out.

My AHI is almost always under 0.5, and my year average is 0.19.

Those four settings are more for people with abnormal lung conditions, like COPD, and other resistive/obstructive lung diseases, so unless you notice something like I mentioned above, just leave them at default.

The Vauto is a *great* machine.

[mets123]

Thanks so much palerider for your detailed explanation . Just for completion can you give me a senario when the Ti min would be helpful to raise or lower the value?
Thanks again.

[palerider]

Thanks so much palerider for your detailed explanation . Just for completion can you give me a senario when the Ti min would be helpful to raise or lower the value?
Thanks again.

Well, say you have a restrictive lung disease, which means it's hard for you to maintain your inhalations long enough to get good gas exchange... you'd want to bump up TiMin.. an example would be 0.8 seconds. I believe the default is 0.3... I wouldn't suggest messing with it unless you've got some lung issues.

[mets123]

Got it. Will post some SH charts after I use it a few days and hopefully tell me how I’m doing.
Thanks

[Audio_mc]

I am getting a resmed aircurve 10 vauto and have been doing some reading and don't understand exactly what Timin and Timax actually mean and how one can determine (if default settings don't work)how to adjust for one's individual needs. I understand that it has to do with the time one spends at ipap but a clearer understanding would be appreciated.
Also if one can also explain trigger and cycle and again how to determine how to set these.
thanks

It's actually all quite simple, but not explained very well in the manual.. It all has to do with the handling of the IPAP pressure... so figure we're starting with the EPAP base pressure.

Trigger is how sensitive the machine is to your starting to take a breath... the lower the trigger, the more of a breath you have to take before the machine goes "AHA! time to switch to IPAP".

TiMin is the minimum amount of time that it will stay at IPAP.

TiMax is the maximum amount of time it'll stay at IPAP.

Cycle is how sensitive the machine is to your starting to exhale.... and when it'll drop the pressure back to EPAP, (if TiMax hasn't already expired, if TiMax expires, then the machine goes back to EPAP then.

For *most* people, just leave those settings at default.

After looking at Sleepyhead charts, I saw that my inspiration time was very often being cut off at the TiMax time, but it seemed I wanted to breathe slower at night, so I upped the TiMax till it wasn't cutting me off anymore.

I also set my Trigger to 'very sensitive' because while looking at the individual breaths in SH, I'd see times were it looked like I was trying to inhale, but the machine wasn't kicking over to IPAP, then I'd have an apnea... so I bumped Trigger up, and the when even if my throat was closing, it'd pick up those small attempts at breathing, and help me out.

My AHI is almost always under 0.5, and my year average is 0.19.

Those four settings are more for people with abnormal lung conditions, like COPD, and other resistive/obstructive lung diseases, so unless you notice something like I mentioned above, just leave them at default.

The Vauto is a *great* machine.

I tried to not quote your entire post but looks like I screwed the edit up to bad sorry lol. Anyways, this was the best explanation that I've seen om the TContols and cycle on the VAuto!

Can you explain a little more in detail (preferably with a sleepyhead flow rate graph if possible) how you were able to tell though Sleepyhead how you were able to see that you were trying to inhale but it wasn't kicking over to Ipap? I guess I'm just not that advanced at looking at the detailed info on sleepyhead. Did you just look at the flow rate graph to see this info or did you use other info in sleepyhead in order to come to this conclusion as well?

Thanks

[palerider]

I tried to not quote your entire post but looks like I screwed the edit up to bad sorry lol. Anyways, this was the best explanation that I've seen om the TContols and cycle on the VAuto!

Thank you... you can always hit the pencil icon and go back and edit a post afterwards. Try it, it's good practice.

Can you explain a little more in detail (preferably with a sleepyhead flow rate graph if possible) how you were able to tell though Sleepyhead how you were able to see that you were trying to inhale but it wasn't kicking over to Ipap? I guess I'm just not that advanced at looking at the detailed info on sleepyhead. Did you just look at the flow rate graph to see this info or did you use other info in sleepyhead in order to come to this conclusion as well?

You have to zoom in(up arrow on the keyboard) close enough to see individual breaths. Right click on the chart title, pick 'dotted lines' and turn on the zero line. Then you can see any inhales (anytime the trace goes above zero. what I was seeing were breaths, then smaller breaths, then finally tiny humps where it looked like (guessing, since I wasn't awake to know ) I was trying to inhale, but nothing was happening. the mask pressure line showed no response from the machine.

apnea.png

Note that there's no response on the mask pressure line to the two attempted breaths before the OA is flagged.

After setting trigger to very high, these all but disappeared, and my AHI went down.

note: I don't advocate people just twiddling with the settings, or setting theirs to very high just because it helped me. But, if they see something along those lines, then it might work for them, if they've got a Resmed S or Vauto machine.

[Audio_mc]

Makes alot of sense. Thanks palerider!!

[Gryphon]

I worked with my TiMin and Max settings when I first got my Bi-PAP as I noticed I like to inhale slower then usual when I'm trying to fall asleep. The machine would hit the limit and then the PS would kick in and the pressure would drop and this would ether jar me awake as I was nearing falling asleep or just annoy the heck out of me, keeping me from settling down to sleep to begin with.

When I was doing my in-lab Bi-PAP titration study, this was a big problem. I didn't know what it was that was so annoying about the machine. I wished I knew then so I could have told them to try and fix it. They may not have been able to though.


For me - the adjustments I made were more for my benefit as I was awake and falling asleep... I noticed that the changes I made to the settings would take effect in real time as I was using the machine, so I rolled over and laid there with the mask on... turning the TiMin and Max settings up and down - "After making sure I remembered what they were to start with" and then breathing normally for a few breaths to see what effect my changes had to the machine... It's how I learned what those settings did. After a few min of tweaking the settings I found that giving my self more time to "In-hale" was very helpful... If I started to exhale early the machine would switch anyway but if I continued to take long deep breaths like I do as I'm falling asleep, by changing the settings I was able to eliminate the machines tendency to change pressure on me as I was still breathing in which was very jarring and highly annoying.

Unless you can think of a specific reason for changing those settings it's best to leave them be... but once you understand what they're for if you think you can benefit from modifying them slightly I don't see any reason not to. "That is unless you have some other complicating lung or breathing issue" You don't want to accidentally make some other breathing issue you may have worse. Also, "always write down, or take careful mental notes" of any settings before you start making changes so you can change them back later if they don't work out for you.

Best of luck!

Rest well,

Gryphon

[palerider]

(These corrections are to avoid confusing people that are trying to learn).

I worked with my TiMin and Max settings when I first got my Bi-PAP

Not a "Bi-PAP", a BiLevel... BiPAPs don't have the TiMin/TiMax controls.

The machine would hit the limit and then the PS would kick in and the pressure would drop

PS is a pressure increase, so PS would *stop*.

. If I started to exhale early the machine would switch anyway

That's where the 'cycle' setting comes in.

Also, "always write down, or take careful mental notes" of any settings before you start making changes so you can change them back later if they don't work out for you.

The Resmed S9 S+ST+VPAP Auto clinical manual has the default settings listed, I don't know why the neglected to put that in the Aircurve 10 manual, but I think they were remiss in doing so.

[Gryphon]

BiLevel... OK. Sorry I'm still learning the terms.

I keep thinking of the machines in terms of
CPAP
APAP
BiPAP
VPAP
in that order as far as what it could do.

So there's BiPAP and BiLevel - and they're not the same thing.

PS - I thought was Pressure Support. IE: when you exhale it backs off to make it easier.
I'm sure your right. I just thought of it the other way around.

Originally I kept thinking of PS - Pressure Support as a fancier user adjustable exhalation relief that goes beyond 3.
I know that's not the case with my machine.

I should have an AirCurve VAuto

I made my "Ti" adjustments based on feel while I was laying in bed - trying to get the machine to give me more time to breath in with out changing pressure on me.

Thanks for the updates. I'll do my best to remember them. I don't ever want to cause someone else confusion if I say the wrong thing.

Take care!

Gryphon

[zonker]

[quote=Gryphon post_id=1275578 time=1542151957 user_id=16019

Thanks for the updates. I'll do my best to remember them. I don't ever want to cause someone else confusion if I say the wrong thing.

Take care!

Gryphon
[/quote]

gryphon! that was incredibly well said.

kudos.

[palerider]

BiLevel... OK. Sorry I'm still learning the terms.

I keep thinking of the machines in terms of
CPAP
APAP
BiPAP
VPAP
in that order as far as what it could do.

So there's BiPAP and BiLevel - and they're not the same thing.

Actually, there's
CPAP, with a subset of that being APAP.

Then there's Bilevel CPAP, and there are a number of different types of bilevel machines, spontaneous, timed, Auto, ASV, VAPS, (primarily).

An Auto bilevel is like an auto cpap... just auto adjusts throughout the night.

Now, "BiPAP" is a respironics marketing term for their generic bilevel machines. like 'mustang' is a Ford marketing term for their muscle car.

VPAP is the Resmed marketing term for their older bilevel machines, like Camero is the chevy name for THEIR muscle car. Just imagine walking into a Chevy showroom and asking to see the new Mustang.

The newer Resmeds are called 'aircurve' instead of 'vpap', though you can still find 'vpap' on their websites... and it's referred to in the name of the auto bilevel machine 'VAuto".

PS - I thought was Pressure Support. IE: when you exhale it backs off to make it easier.
I'm sure your right. I just thought of it the other way around.

Yes, PS=Pressure Support. that's the pressure *increase* to help you take a breath. ie, it "supports" your inhale.

With most of the auto bilevel machines, you set the EPAP (base pressure, and the PS, which is just how much the pressure increases when you breathe, or it forces a breath (on the more advanced machines).

EPAP + PS = IPAP

Originally I kept thinking of PS - Pressure Support as a fancier user adjustable exhalation relief that goes beyond 3.
I know that's not the case with my machine.

Only, PS goes UP, and EPR goes DOWN.... other than that, they have the same effect.

with EPR, you set a pressure, and it drops pressure between inhales. With PS, you set a pressure and it raises pressure when you inhale.

Thanks for the updates. I'll do my best to remember them. I don't ever want to cause someone else confusion if I say the wrong thing.

You bet... that's why I nitpick, because it's easy for newbies to get the wrong idea by reading things that aren't quite correct... and that increases the confusion level, and makes it harder for them to figure out what the living hell is going on.... there's so much to this cpap thing that nobody needs MORE confusion

[elsueno]

x

[palerider]

:sigh: spare us from newbies that think they have figured out something new.

None of your "revelations" alter the facts that I have stated above.
s
It is *foolish* for you to fiddle with things when it is not necessary, you are, as you said NOT a respiratory therapist, nor are you a doctor. Those settings in the VAuto are used by RTs to treat lung disease as indicated in the manual.

For me, it seems wise to elevate TiMin to .8 or even 1.0 seconds

No, that is STUPID. You're going to screw up your respiration cycle, I've seen people do this, and it does NOT end well.

As stated above, if you don't have lung diseases, then DO NOT MESS WITH Ti Min.

Further, it seems wise, given my data which shows 95% insp. time to be about 1.6 seconds, to reduce TiMax to 1.8 or 1.7

This is also dumb, you're cutting off inspiration when your body wants to keep inhaling, again, without having a lung disease, this is just a stupid thing to do.

Your ASSumptions about how the machine works are poor, you've vomited out so much text, I'm not even going to bother trying to address all of your foolish thoughts.

I'll just say I STRONGLY advise everyone that is reading dpeterzell's post above to just IGNORE IT.

This person is new, and has shown the fallacy of thinking they know anything meaningful about what they're talking about.

(Caveat: I’m not a respiratory therapist, nor am I a medical doctor, so any suggestions from me are not from a professional. If I’ve got something wrong here, please let me know.

It's pretty much all wrong, but if I picked apart all of the errors, the response would be 3x as long as your waste of everyone's time.