Thanks for the PM. This finished up being a lot longer post than I thought it would be. It still isn't clearly explained, but ask if you want something more.
This may help till you see your doctor. I'm pleb, but I'll tell you what I think, to take onboard. Put a "i guess' in front of every sentence and 'as you know', for saying something obvious.
If anyone thinks I've got something out of place, please jump in.
As sleeprider said, I would go back and get titrated on the unit. You have to make sure the lab tech does this level of titration. It really is a specialist thing and you are a hard case, even though resmed say it can be set up out of the box. I can only point to the out of the box info available.
The main thing I'm seeing is you aren't getting enough pressure during an episode. I think the one you showed is obstructive, because of the deep rapid breaths at the end of it. During the event, there is little flow and the PS is maxed out. The other thing that indicates it's obstructive is the very low minute vent, even though you can see the PS:10 being used.
Was it you who had neck problems? If it is, you still need to get your chin up and head back, as much as comfortable. If you could, I'd still try a nap with a soft foam cervical collar on and make sure I'm not closing the airway unnecessarily. That would be my first guess, to what is going on.
Have you got your st-a manual? anything I say is going to be based on the resmed s9 manual or philips and you should confirm it to be right for the resmed 10.
The rise time min would be 1 and 150 on resmed. The default on the st-a is 150 and is the quickest rise setting.
https://onlinestore.resmed.com/images/pr...017278.pdf
https://www.scribd.com/document/36766484...ser-Manual
you need to dial in the Va, page 31 you adjust the Va to get the iVAPS working.
you put in your height
you set your RR at your actual RR rate. so going by sleepyhead, I would set 'target pt rate' at 12. going by an older chart without back up that I posted, it would be 15
https://imgur.com/a/qAfzc so somewhere between 12 and 15 would be a guess.
you can adjust the RR as you go and the 'Learn Targets' will do it all automatically.
I'd also use your median minute vent of 6.75 or 7 off of sleepyhead charts posted here, as a guide, as well as the ml/kg
The ml/kg could be between 6 and 8. Respironics would suggest initially 8ml/kg , as one possibility on their vaps, along with their tidal volume and height values..
https://i.imgur.com/ciLBxT8.jpg?1
epap 10 ? What was your pressure on apap to sort out the obstructive events? this is you at cpap 13 and full of obstructives, so I can't see epap 10 PS 3 working for you. The machine doesn't adjust the epap, like on the
asv and vauto. it's a single pressure that is done manually. So the first job I'd do, is to go back through your charts. Till you find a cpap pressure, where the OA were treated and use that as an EPAP
https://imgur.com/a/qAfzc
I think I have commented on the high pressure you have needed on the vauto.
If your doctor says, I think you are going to use the available higher pressure of the ST-A of 30cm, because you were maxing out the vauto 25cm. Has the doctor cleared you for 30cm. There are also other machines that go higher, if needed when you are being titrated.
min ps 3 for now, I think it could be adjusted later.
You can go to ST mode if you think it's best. It's going to be hard when the numbers you were given don't work and is another reason to go back to the doctor.
As you know, the ST IPAP/PS is always set at the maximum you need. The ST-A will ramp up pressure more slowly that an
ASV. so the difference in modes need to be taken into account. The iVAPS raise pressure on each breath cycle, it takes 3-4 breath cycles to get up to max. (I work it out to 15-20 sec at RR 12, before it is fully treated. I think it will flag, even when adjusted properly, but it should be better than the 1 minute apnea going untreated, that you posted.) The ST has the max pressure/ipap at what could be between your sleepyhead 95% and max pressure. As you know. You need to trial ipap to find out that pressure. It will do that pressure all the time, for when it is needed. The
ASV raises pressure multiple times during the breath cycle and is very quick at resolving apnea and PB and CA.
If you want to set it up in ST mode, you need a max PS/IPAP.
You can titrate the ST or the iVAPS mode should be able to show you what the ST IPAP should be, as you use it.
![[Image: jNzog8P.png]](https://i.imgur.com/jNzog8P.png)
![[Image: KrrzIJz.png]](https://i.imgur.com/KrrzIJz.png)
