AirCurve 10 ST-A

[zzzZorro]

Ajack; THANKS so much for your response.  I REALLY appreciate the time and study you put into it.
Spent the day going into the big city and fighting Christmas traffic to get a new generator.  We just had two full days Tues-Thurs) without power and PAP use.  Got 24 inches of wet snow and lines went down big time.  Emergency generator decided it was time to roll over and die. 

So, I have to digest all that you and SR so graciously provided.  In the meantime a quick update. Doctors nurse could not find time during a full 8 hours Friday to respond to me after the gawd-awful results from the iVAPS settings he prescribed so I dialed in what SR suggested: Target Pt. Rate-15; Target Va 6kg; EPAP-11; Min PS-3.0; Max PS-15; Ti-Max 2.0s; Ti Min 0.3s; Rise Time- Min; Trigger Med; Cycle-Med.  My wife woke me up after an hour of this as she was alarmed by my breathing pattern.  I think it was the higher pressure induced 4 1/2 breaths that make me grunt(?) 
(The first chart reflects the 10/4 setting instead of the figures just shown which were correct for the ST-A chart)

About half awake I recalled the 16/10 back-up 10 from the sleepstudy (ST Mode) that 'gave me the best results' so I dialed that in and went back to sleep. (first part of second chart) I woke up abruptly feeling hyper ventilated- like I was drowning in 02 and shut it down, going back to sleep without it.  After I woke up in the morning decided to try the 10/4 back-up 12 setting while still in the ST Mode.  Did not fall asleep but left it run about 15 minutes- it was comfortable.  This was the last part of the second chart.. 

When I checked the data in sleepyhead I was amazed! SLEEPYHEAD CHARTS

Think I'm going to go with the ST Mode 10/4 settings tonight..

[Sleeprider]

Wow! It sure would be nice if someone who supposedly knows what they are doing would at least titrate you. The new settings show the UA can be beat. To me it looks like the EPAP pressure can come down and Pressure support dialed back a bit and Resp Rate at 13. It's not supposed to work this way. I could give you some settings in ASV and have you dialed in quickly, but I just don't know AVAPS /ST. Isn't this your doctor's job?

[SarcasticDave94]

Well well, looks like Duck Dodger is at "work". Sincerely hope you get this mess straightened out, zzzZorro. And hoping your generator issue got fixed too. Happy holidays as well.

Dave

[ajack]

2nd that they have done the wrong thing and not titrated you on it. It's bordering on malpractice.
When you are awake, you could use the 'learning mode', to see what the machine wants to set for you. It takes a half hour or so. It would be interesting to see what the numbers are. I prefer ivaps or asv to ST, when they are set up.

[zzzZorro]

Think I'm going to go with the ST Mode 10/4 settings tonight..
..THAT DIDN'T GO WELL!

Apparently the Unclassified apneas are [i]not counted as apneas?  The short test with the ST mode yesterday morning was totally erroneous.  
Now- For some reason sleepyhead has decided it will not 'start', just acknowledges the click and.. nothing.
Have gone back to a system copy and repeated removal/reloads and same thing. 

ajack; Would love to try the 'learning mode' but so far have not found any such thing??

More later after I collect my thoughts  

 

[/i]

[zzzZorro]

Wow! It sure would be nice if someone who supposedly knows what they are doing would at least titrate you.  The new settings show the UA can be beat.  To me it looks like the EPAP pressure can come down and Pressure support dialed back a bit and Resp Rate at 13.  It's not supposed to work this way.  I could give you some settings in ASV and have you dialed in quickly, but I just don't know AVAPS /ST.  Isn't this your doctor's job?

Have been to two sleep studies already and they were miserable.. not even sure if they really proved much that was not obvious.  "Doctor" aka- Wizard of Oz, is only a guy in the fog that sometimes is available for a brief comment.  His nurse, who is the 'curtain', will only return calls IF she is of a mind to. 
I KNOW you are not familiar with iVAPS but I'm going to get on top of this somehow and acknowledge your input are only 'non professional suggestions'.  EPAP was set at 11, what would you suggest it be set to.. and PS 'dialed back' to? Min PS was 3.0 and Max PS 15.0 (as was). "Dialed back a bit" from say 15, to 12-13 maybe stopping the 'grunting' during the 4 1/2 pressure increase pulses that alarms my wife?
Much appreciated input it is sir...

Well well, looks like Duck Dodger is at "work". Sincerely hope you get this mess straightened out, zzzZorro. And hoping your generator issue got fixed too. Happy holidays as well.

Dave

9 degrees F this morning and two feet of snow on the ground.  Power company is up and running- Yay!  But, all the fir trees look like pointed piles of snow... waiting to unload on power lines.

2nd that they have done the wrong thing and not titrated you on it. It's bordering on malpractice.
When you are awake, you could use the 'learning mode', to see what the machine wants to set for you. It takes a half hour or so. It would be interesting to see what the numbers are. I prefer ivaps or asv to ST, when they are set up.

(iBR) Intelligent Back-up Rate is only thing I can locate.  Thinking I should be using that anyway?!

[ajack]

It really is time you went back to your doctor, or find another one. The treatment plan hasn't worked.
As you know, I'm guessing here.
Given on the vauto you had ipap going to 25 and still had high obstructions. The sleep lab 10/4 was a good night and not the norm.
I think the wild swings could be positional. I would put a lot of effort into fixing this.

On the s9 manual I put up, it's on page 31. You should have similar instructions on the 10 manual for setting the ivaps. If by chance they have deleted this function. You can use sleepyhead and do a similar thing to what you did with the 15 minutes in ST while awake.
I'd use S mode only. epap 10 IPAP 14. first lay down for 10 minutes, to let your breathing and body relax. Then put the machine on for 30 minutes. I think the RR, MV and TV results, should be able to be used as the base.

I would use your sleep lab epap/PS as your base, for when you are having a good night. 10cm/4cm. Given the vauto maxing at 25 and still having obstructions. If the doctor allows it, I would set it to access the st-a 30cm pressure. So I would have max ps 20. I have my doubts that even 30cm will clear your obstructive apnea. I really would work on positional stuff, even with your neck, I'd be modifying a cervical collar to get my throat open as much as I could. Making myself sleep on my stomach could be another viable option.

[zzzZorro]

Thanks again ajack.  Without going into a string of things that only allow for back-sleeping with only a quarter turn right or left; I'm an old goat by age so have to make do with what I have
I'll try again the c-collar to see if it helps.  Been chasing my tail all day and will have to digest all the info from you guys over tomorrow.
Have a Merry Christmas down in kangaroo land ..

[Sleeprider]

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.

[zzzZorro]

2nd that they have done the wrong thing and not titrated you on it. It's bordering on malpractice.
When you are awake, you could use the 'learning mode', to see what the machine wants to set for you. It takes a half hour or so. It would be interesting to see what the numbers are. I prefer ivaps or asv to ST, when they are set up.

Finally found it. AIRCURVE 10 [ST-A] CLINICAL GUIDE Page 23.

'Learned'; Target Pt. Rate- 17; Target Va- 6.9
So I guess those two figures are a 'given' for my data input.