AirCurve 10 ST-A

[ajack]

It won't be a bad place to start and a lot better than a guess.
I think the main thing is to get something working for you, till you can get back to the doctor.

[zzzZorro]

zzz, my last suggestion was to relax settings in IVAPS so they are not quite as aggressive.  Overall, the revised settings did eliminate a lot of events.  I'm thinking EPAP back to 9 or 10, PS max to 12 and BPM at 13 so you can set your own pace.  Good luck.

As stated above I found the 'learning' mode and ran it.  The figures for Target Pt. Rate- 17 and Target Va- 6.9 l/min I will go with as they are supposedly personalized.
Tonight I will go with your suggestion and use EPAP-9 (haven't been there yet) PS Min-3 and PS Max- 12.  These figures are building on the figures (below) used last night.  Had a new AirFit mask seal and it was 'squeeky' with the 25 IPAP (high).. annoying.

The setup you recommended and was used on 22nd seemed to be the most promising yet as far as bumping pressure for what I guess was attacking apneas yet except the grunting sure alarmed my wife

Last Nights settings: (gleaned from studying ResMed manuals and Apnea Board)  At 0023 I dinked with a setting that is reflected in the pressures but do not recall if it was too much pressure or if I didn't think it was supporting breathing properly.  Not sure if the numerical data on the chart is what I started with or what I changed it to.  From what I recall reading the iBR (intelligent Breath Rate) is automatically part of iVAPS so it is apparently a backup rate override based on how you have been breathing previously.
Target Pt. Rate- 17
Target Va- 6.9
EPAP- 15
Min PS- 4
Max. PS- 12
Ti Max- 2.0s
Ti Min- 0.3s
Rise Time- 300ms
Trigger- High
Cycle- Med.
LAST NIGHTS CHARTS

I have had an appointment scheduled in about three weeks with the Wizard himself but I do not think he is all that familiar with the ST-A machines as the prescription he gave the DME was incompatible for this machine.  Not really expecting any real help there and two sleep studies are enough.  I really appreciate you and ajack working with me on this machine, I still think you have a better handle on it than the Wizard.

Merry Christmas to You and Yours!

[ajack]

I think that is as good as the machine can do for you, for now. It's still not a good result. You are maxing the 25cm, after you see the doctor, there is another 5cm? The specs will tell you what it will go to, but I don't think that will help much.

You didn't have the cervical collar on? I really think it's obstructive, still. You can see the high pressure and low flow rate around 22:20 and next to it, the higher flow rate and lower pressure around 23:00. I don't have another idea why this would be so?
The minute vent was ok for both periods. It's only when the apnea kick in, that the minute vent tanks and oscillates.

If it isn't positional and is all in your throat. They have higher pressure machines and worse case, they may have an operation that can help or do a tracheotomy.

[zzzZorro]

ajack; Cervical collar tonight. Hate it but will proof it as positive or negative factor. It did help greatly when on APAP. Cannot even imagine a 25cm increase to 30cm.. stuff the mask down the throat

Thanks!

[ajack]

Nearly 200 posts and 3 machines . It's been a journey for you and it's still not done.

[Hojo]

ajack; Cervical collar tonight. Hate it but will proof it as positive or negative factor. It did help greatly when on APAP. Cannot even imagine a 25cm increase to 30cm.. stuff the mask down the throat

Thanks!

What do you hate about the cervical collar, other than the fact that it is another thing to have around and need to put on prior to going to sleep?  I know when I picked up a newer collar I was 'fitted' for it and I too hated it, it was much to big so I went with my older size which isn't sized for a serious neck injury, just enough to give me neck/chin support and I have no problem sleeping and it clears all OA events.

[zzzZorro]

Good morning; the 'ole goat-roper is still alive and well 
 
The cervical collar was useless.  Strange that it worked so well the first time I tried it.  Like the day to day charts it is "consistently inconsistent" as SR said early-on.

I'm beginning to think there is a possibility that the straight ST mode may be where I should be going..  Higher pressures appear to be more productive except for the mask leaks and aerophagia issues which interrupt sleep.

No one has confirmed but UNCLASSIFIED apneas are apparently not calculated into the AHI figures even though they have shown up to 67 seconds in duration; if so that is ridiculous!

[Notice the alveolar target ventilation reference and how it is wildly above and below that mark]
The variation between Sleepyhead and ResMeds ResScan is interesting: LAST NIGHTS CHARTS

[ajack]

Sorry the collar didn't help. It's going to be a matter of getting back to the doctor, to go to the next step in titration and treatment
Sleepyhead hasn't had the full ivaps integration, ResScan has.

Given you were choking half the night, I think the Va of 5.5 on a target of 6.6 is brilliant

[Shin Ryoku]

There was an ST titration but not a ST-A.


https://imgur.com/a/ZKNsH

Thanks for inviting me to have a look at this thread.  Sorry, I'm sure I've missed a lot here from this and other threads.

From what I found in your earlier posts, you are not overweight or obese; don't have neuromuscular disease, chest wall disease, or COPD; and you do have heart disease with history of heart attack and EF < 45%.   If I understood correctly, you were given an ST-A machine instead of an ST machine without explanation or apparent reason

Also, do you use oxygen at night?  Any opioid medications?  Other important factors to mention?

Big picture, I agree with what seems to be the general consensus, which is to see your doc asap and if necessary, change docs.

Have you tried the settings from your BPAP-ST titration (ST mode, BPAP 16/6 with backup rate of 10) ?

[zzzZorro]

Shin; Thanks for stopping in. 

From what I found in your earlier posts, you are not overweight or obese; don't have neuromuscular disease, chest wall disease, or COPD; and you do have heart disease with history of heart attack and EF < 45%.   If I understood correctly, you were given an ST-A machine instead of an ST machine without explanation or apparent reason

-All correct.  Not eligible for ASV (that would have made it too easy).  I have the feeling the Doc was not really too familiar with ST models.  When I last saw him I was a couple days out from an appointment with a pleurologist for chronic mucus in throat and upper chest.  Sleep Doc was made aware of this and that I suspected some kind of COPD, and I suggested (If) he prescribed a ST perhaps an ST-A might be a better choice (If) the congestion thing went south.  He apparently agreed as the ST-A was prescribed.  Turns out chest was 'clear as a bell' and no indications of COPD.  Problem was either silent GERD and/or persistent sinus drainage.

Also, do you use oxygen at night?  Any opioid medications?  Other important factors to mention?

-No oxygen used.  Prefer to keep that as a last resort.  No opiods, only common battery of Heart meds.  Nothing else I can think of except I HAVE to sleep supine or quarter right or left.

Big picture, I agree with what seems to be the general consensus, which is to see your doc asap and if necessary, change docs.
 
-Have about three weeks before an appointment.  I refer to him as the Wizard of Oz as the (office management) 'curtain' makes it difficult to actually engage him otherwise.  I think he probably is knowledgeable if and when one has a hard-fast appointment.

Have you tried the settings from your BPAP-ST titration (ST mode, BPAP 16/6 with backup rate of 10) ?

-This is the third machine I have been on.  First was APAP then BiPAP, now iVAPS.  I have run the figures in the BiPAP but do not recall exact results.  On top of everything else the Sleepyhead crashed and stats/charts on previous two machines are kaput!  The iVAPS automatically recommended a Target Pt. Rate of 17 so probably that is the correct breath rate to be using.  Been considering going back to the ST mode and the 16/6 would probably be a good place to try it.

With other machines results were always inconsistent.  Occasionally would get significantly improved results, then they would go in the tank. That is why I have progressed to this machine that is the best/only one left that can be prescribed.  I have a hunch the cardiac adventure in March is the cause of the heavy C/As, unless of course, the C/As caused the adventure in the first place..

Thanks much..