1st Night Bi-Pap, high pressures = terrible

[Sleeprider]

I would increase IPAP until the UA and H events are better. This is the approach from the titration protocol posted earlier, and I would start with a 2-cm increase to 7.0, and reduce PS max to 15 consistent with ASV.  I'm not very familiar with the ST-A and am surprised EPAP did not rise on its own.  It's encouraging that this was more comfortable, but is is clearly not the therapy of ASV which would have jumped on the hypopnea faster and increase EPAP.  Your tidal volume is looks good assuming you are somewhere near 6 feet tall.

I think it's worth trying to make this work, and your AHI less than 8 is much less than without therapy, and beats all but 2 of the tests in your bilevel titration, and I suspect with your current ventilation rate, you are much better on SpO2, but the correct machine is pretty obviously ASV given the mix of CA, OA and  H events in prior tests.  I suspect we can knock down more of the UA and H events with a rise in EPAP and we might increase PS min to 5.0 later to see if that helps with hypopnea.  I would wait.  Something to look at in daily details Events tab is the duration of the events, and compare that to ST.  It's interesting because I have not dealt with someone using ST-A and not dealing with COPD or similar restrictive pulmonary issues.

Did you go through any of the Learn Targets from Page 23 of the clinical manual?

[Brando80]

Thanks for the help. I did perform the learn mode and it suggested RR 10 min ventilation 12.6L/min.  You're right the ST-A doesn't ramp up EPAP, only PS when I simulate apnea or hypopnea. I'm not sure if the target rate of 10 may be to low, it takes a long time to give me a breath when I simulate apnea, meanwhile it's ramping up PS the whole time. I'm waiting on the manual to be be emailed over. 
Thanks Brando

[Sleeprider]

The manual suggests your actual spontaneous breath rate be used in the ST-A settings. For you that was 13 BPM based on prior ST and last night's median rate, so I'm not surprised 10 left you feeling a bit off.

[Brando80]

On ST and last night the backup rate was set at 12-14 so I wonder if that skewed it? Maybe I'll do the learn mode again and see what it says. I'm leaning toward still trying to get an ASV. Scheduled a f/u with my PCP next week I'm going to just see if we can get rid of this pulmonologist and have him manage it. 
Brando

[SarcasticDave94]

Just a bit of info in case you do exchange machines for ASV:

Get the ResMed AirCurve 10 ASV.

Run it in ASV Auto mode, this gives 4 settings - EPAP Min and Max, then PS Min and Max. IPAP is automatically determined by the ASV algorithm. Both EPAP and PS ranges slide up or down independent of the other to support as required.

Life's funny sometimes, you possibly need an ASV and have an ST-A. I have an ASV and possibly need ST-A being with mixed apnea and COPD.

[Sleeprider]

Great idea. I have always used my primary physician. Never had contact with a sleep specialist other than to review my diagnostic PSG many years ago.

[Brando80]

Just a bit of info in case you do exchange machines for ASV:

Get the ResMed AirCurve 10 ASV.

Run it in ASV Auto mode, this gives 4 settings - EPAP Min and Max, then PS Min and Max. IPAP is automatically determined by the ASV algorithm. Both EPAP and PS ranges slide up or down independent of the other to support as required.

Life's funny sometimes, you possibly need an ASV and have an ST-A. I have an ASV and possibly need ST-A being with mixed apnea and COPD.

---

Great idea. I have always used my primary physician. Never had contact with a sleep specialist other than to review my diagnostic PSG many years ago.

My PCP farmed me out when I failed the titration study. I think I can talk him into taking me back as long as there are no restrictions on him ordering the ASV. 
Brando

[Brando80]

Curious if you think this is valid. Before I got this machine I had the same concern that the ASV may be better. The one piece of data that I wasn't sure about was that the ST-A had a higher pressure limit that the ASV. Because my titration study ended up at 22/17  could that be a reason why the ST-A was ordered? Sure would help if I could get in touch with my Dr. 
Brando

[SarcasticDave94]

I think my ASV tops out at 25.

Swapping machines would be great to solve both our needs, but since we can't do so legally nor would it be within AB rules to conduct business of that sort, we both have to go about it the hard way.

Otherwise, if there's any assistance I can give, I'll be glad to help you succeed in your apnea therapy.

[Brando80]

So there's no difference in the max pressure between the two? Thanks, that helps a lot. 
Brando