AirCurve 10 ST-A

[Shin Ryoku]

How do you know the leaks are skewing your AHI? Maybe nasal PAP just works better for you? Have you tried a standard nasal mask like an N20?

[zzzZorro]

How do you know the leaks are skewing your AHI?  Maybe nasal PAP just works better for you?  Have you tried a standard nasal mask like an N20?

I have a Philips PICO nasal mask they tried at the sleep test but always felt it restricted air passage into my nostrils.  Taking-in air through the snout as versus FFM has crossed my mind as possibly creating a lower AHI.  Perhaps the PICO should be revisited as the C-collar I modified seems to help the mouth leaking.

[Sleeprider]

Don't discount the possibility of the popular Resmed P10

With regard to O2 additions, I have seen on the forum people treated with straight CPAP and O2, achieve unexpecedly excellent result with lower AHI unrelated to the pressure. It seems that stabilizing O2 while maintaining the airway against obstruction works amazingly well as an alternative to ASV. I have no idea why, but I guess I need to keep that experience in mind.

[zzzZorro]

Don't discount the possibility of the popular Resmed P10

With regard to O2 additions, I have seen on the forum people treated with straight CPAP and O2, achieve unexpecedly excellent result with lower AHI unrelated to the pressure.  It seems that stabilizing O2 while maintaining the airway against obstruction works amazingly well as an alternative to ASV.  I have no idea why, but I guess I need to keep that experience in mind.

Maybe we will be seeing that happen up-close-and-personal.  Supposed to have an appointment with the Wizard in a couple weeks.

Thanks SR

[ajack]

I very much appreciate all that you have contributed to helping me along the path to apnea improvement, but when I see anything anymore saying "may increase the risk of heart disease" I must avoid it.  Nothing meant to disparage your suggestion as I have heard it before elsewhere and it could well be correct.

Thanks ajack

So many things in medicine are uncertain.  The best diet composition for someone with heart disease is uncertain.  It's probably a safe bet to follow the AHA recommendations on this page while at the same time trying to keep portions of even the "good" starches (like whole grains) relatively smaller and replacing some of those portions with vegetables.  And it's certainly important to choose healthy fats (not saturated or trans) - that is something that studies have consistently shown for decades now.

At the same time, it's impossible to avoid absolutely anything that any doc thinks may increase heart risk.  There are so many things that fall into that category.  As an example, some sleep specialists feel that BPAP-ST may increase risk in people with heart disease because BPAP-ST has a lot in common with ASV.  And some docs feel that those therapies may even increase risk even in people without heart disease since it did so with people with a certain type of heart disease.  Etc etc.

If I had central apnea and a decreased EF, I would rather be on CPAP than on ASV or BPAP-ST unless I was getting poor results on CPAP.  How poor?  I don't really know.  If you are consistently under an AHI of 10 on CPAP and it could be under 5 on the right BPAP-ST settings, is that a good tradeoff?  I'm thinking that would depend on how you feel, but that would be a good thing to talk about with your sleep specialist.

Appreciate your response.  Turns out that the CPAP mode is giving me the best (so far) AHI at 14cm.  Although it has been with the P-10 pillow and always showing large leaks; so I guessed the leaks were skewing the final count/apnea pattern.  I am in the process of doing some tests with the ST mode in that pressure range and leaning on a back-up to see if it will break the OAs.  Problem is that the ST-A only records Unknown apneas (UA) and does not differentiate OA and CA on SleepyHead so I have to figure it out.

I have been told that a local doctor (not the one I went to) when he has people with LVEF and high CA, they always get a CPAP and O2.  Maybe that is where I am headed eventually but I'm going to have to be convinced first.

There are charts attached both showing CPAP at 14cm. One uses the P-10 with leakage (and c-collar) and the other a F-20 FFM with no leakage (and no c-collar).  From these two charts the leakage badly skews the AHI.  The unknown here is that the collar was not used with the F-20.. so the conclusion is premature at this point. Still working on it..

My sleep specialist is usually 'not available'- so I wing it  

[CHARTS]

you will find that none of the modes on the st-a will show oa/ca, everything is ua or h
do you have your old apap? that will show you what is going on.
I trust the f20 stats, I wouldn't trust the nasal with the leaks.

[zzzZorro]

you will find that none of the modes on the st-a will show oa/ca, everything is ua or h
do you have your old apap? that will show you what is going on.
I trust the f20 stats, I wouldn't trust the nasal with the leaks.

Yes I own the S9.  If I do that I need to check the ST-A against it with the same equipment on two consecutive nights.  Good idea.

The P-10 and I do not integrate well.  Damn thing leaks and squeaks all night no matter what I do.  It keeps me from going into a good sleep.  Last night was lousy trying to prevent large leaks (which I almost did).  AHI looks good but there was really very little sleep time... did manage to keep it running for the 4 hour requirement.

I only took P-10 out to allow an 'owie' on the bridge of my nose to heal that was created by the F20. Not so sure the memory foam does not create a long-term exposure skin irritation.  The P-10 is going back in the box and is only going to be used if there is a repeat.

[LAST NIGHTS CHART]

[zzzZorro]

Here is an update of the journey to slay the apnea dragon:
 
Keep in mind the first sleep study (I have had two) concluded that I “FAILED CPAP”.  AND that I am not allowed an ASV.
That report put me into the first device VAUTO (Bi-PAP) that was consistently giving me mid-teen AHIs. Not as good as expected.  In the quest to get the AHI to stay at least in the 5-10 range I was prescribed the ST-A, a device that can provide supplemental breaths when you forget (like in CAs that were predominant) and which was designed to target alveolar 02 in the iVAPS mode.  iVAPS was the mode prescribed for me by the Doctor.


ST-A has along with it several other functions but chief in them are CPAP and S-mode.  The S-mode is a spontaneous device without the back-up breathing.  It allows for setting IPAP and EPAP like Bi-PAP does.  I have found by trial and error that 14cm IPAP has been more ‘magical’ along this trek than anything else so I use it as a touch-stone.  The ST-A in iVAPS mode has algorithms to target alveolar 02 and a program called iBR (intelligent Breath Rate programmed with it).  The machine is lacking in algorithms that other ResMed have available to them.  The ST-A definitely has a purpose for certain lung disorders, but not for me.  It does not differentiate CA, OA from UA (unidentified apnea), only bunching them under UA.  It does not have EBR available, and the alarm for power outage (can’t be shut off) .. Just what I need when there is a power failure.  Been there..


In a nut shell, the ST-A works by brute force and lacks all the finesse that can be found in other ResMed machines.  Again, this is my personal conclusion.  It is not my ticket but it obviously has its purpose.  Feel free to correct me if you believe me wrong about machine functions.

Consider:
January 8; (LAST- like not going there again )   iVAPS was AHI-59.27
January 9; (LAST- like not going there again)   S-mode was AHI-34.5  IPAP-14cm/EPAP-11cm
January 10; Fixed 14cm (No EBR available or used)  CPAP mode was AHI-4.4    
 
The DME representative is most perplexed with me for changing things.  Guess I treaded on hallowed ground!  I have to wonder, ‘how many months would it have taken to figure this out had I followed protocol?
 
I do not believe it takes a rocket scientist to conclude the CPAP has not“failed”
 
 [CPAP mode January 10]
 
The apnea times are dramatically reduced in both frequency and time.  Is there any way to visually read the UAs as either CA or OA?
 
Due to a sore nose bridge I am using the P-10 for a few days instead of the F20 AirTouch.  Using the cervical-collar to keep the mouth closed and the chinstrap to help hold the P-10 harness in place.  LL I am dealing with in this configuration seems to be leakage past the pillow-plugs.  I have read that nasal induction of air vs FFM could have a different effect on AHI.  Going to be working on sorting that out..

[ajack]

If you can get ahi in the 4's on fixed pressure. That is where I would be. The doctor may have some reason why this is happening. If you are running fixed pressure, you are also excluding any breath shaping from the S modes and backup breaths. It seems you have a breathing pattern that makes the machines algorithm max out the available pressure settings and the higher pressures cause more ahi.
The only thing I would want to add for a while is a machine O2 meter. To see where any desaturation occurs? I understand the CMS isn't working for you.

[zzzZorro]

If you can get ahi in the 4's on fixed pressure. That is where I would be. The doctor may have some reason why this is happening. If you are running fixed pressure, you are also excluding any breath shaping from the S modes and backup breaths. It seems you have a breathing pattern that makes the machines algorithm max out the available pressure settings and the higher pressures cause more ahi.
The only thing I would want to add for a while is a machine O2 meter. To see where any desaturation occurs? I understand the CMS isn't working for you.

You may be onto something here. 

[As an aside] Along with CPAP fixed 14 cm I noticed the Nocturia was greatly reduced along with AHI.  Thinking restriction (higher exhale pressure) of fixed pressure may have something to do with it by keeping C02 higher than complete exhale, but this is in opposition to the study showing HIGHER C02 exacerbates the symptom (Nocturia).  Your theory that machine elevated pressure increases AHI would proof out, but increasing 02 with adequate exhalation should also LOWER C02 and also reduce Nocturia- which it didn't.
But that is for another discussion

[ajack]

You are going to need to google this...peep or min pressure is for your heart and it increases it's function. They now think that is the reason it cpap works on pulmonary oedema, rather than the increased pressure pushing the fluid out of the lung. The heart works better and is able to clear the fluid.

As to Nocturia, that and HF goes hand in hand and the peep/min/fixed pressure may have a similar effect? It is also associated with just getting older and the urine production increases at night?