Aircurve 10 ST-A and Lumis 150 VPAP ST-A just a UK branding difference?

[SingleH]

Are you using this machine in the iVAPS mode?

I read there is a "learn targets" features, are users on here typically applying settings manually rather than using that feature?

[McDee]

Right… it’s all odd… the way the AutoEPAP feature is mixed in and limited geographically and by PS range.  The Lumis S9 vs. S10 discrepancy.  And there are some hardware differences as well versus the rest of the ResMed S10 line… the ST-A has more RAM and possibly the entire Lumis line.  And a different SKU numbering prefix as well.  Seems it’s a slightly different generation overall.  I wonder if this will all be evened out whenever S11 is fully rolled out.

I think generally for the various machines and modes that ResMed has a target condition/demographic in mind, and builds and tests everything around that.  Which can be rather limiting… especially for users that don’t neatly fit that demographic.  I think the machines could be much more flexible and adaptive than they are currently.

[SingleH]

Hi McDee, thanks for your replies.

Maybe the reason why the two features of Auto EPAP and iVAPS are only available together setting is for marketing reasons.

I saw there was a Resmed funded study performed using both these features together vs the manual EPAP setting.

https://academic.oup.com/sleep/article/4...36/4082801

[SingleH]

Further to my last message the study was funded by Resmed Australia. I know there are very strict laws around the world for making health claims, so it may be a case that certain features are only available in regions where a feature has been studied domestically rather than in another country.  The result is a variety of different permutations of model names, hardware and features as you highlighted!

[McDee]

Sure… yeah, I’m curious about it all… I’m sure various business, logistical, clinical, and regulatory factors come into play.  I wonder where things will go next.

I believe the Lumis 150 ST is generally available in the UK and Europe… it’s listed on the ResMed UK support site (and some other UK shops):
https://support.resmed.com/en-gb/ventilators

My understanding is that the Learn mode generally doesn’t work very well because awake breathing while training the device is typically rather different than asleep breathing.

[SingleH]

Thanks for sharing that link, very useful as the main UK page just listed two models. Good to know there are more options available.

I guess the learn mode was added to make it more user friendly, but as you say, breathing patterns when your awake are not the same as when your sleeping.

[StuartC]

The models ResMed make are:

• Lumis VPAP 100 S - S mode only
  
• Lumis VPAP 100 ST - S and ST modes only
  
• Lumis VPAP 150 ST - S, ST and iVAPS modes
  
• Lumis VPAP 150 ST-A - S, ST and iVAPS modes, plus alarms
  

I have just done a quick Google of the phrase "ResMed Lumis UK" and do see a company selling the 150 ST for GBP 1,150 and the 150 ST-A for GBP 1,299, so not as big a difference as in Australia.  Actually, they are really good prices because the 150 ST-A machine costs three times as much in Australia.

Yes, I presume the problem with the reporting of EPAP must be some sort of software bug.  I did report it previously (https://www.apneaboard.com/forums/Thread...e-Settings) and, now that I look back, I see that my memory is faulty once again.  To get EPAP reported correctly when Auto EPAP is off, you need to set both min EPAP and max EPAP to the same as your fixed EPAP.

There is a similar / related problem on the Pressure Overview chart that correctly shows EPAP and max IPAP but always has 95% IPAP and median IPAP shown as 0.  You can see that too in the thread where I reported the EPAP problem - the yellow bar on the chart at the bottom of the image.

I think the number of Lumis machines in use is low so it is not surprising that it has a low priority in terms of software issues to be resolved.

[SarcasticDave94]

When I used an ST-A for a few weeks I began setup with the learn target. It didn't get it quite right so I had to drop it down a bit.

[StuartC]

Yes, I am using my machine in iVAPS mode.  I tried the learn targets early on but, no, I did not find it helpful.  What SarcasticDave says sounds fair since my experience is that it is better to have Target Va set too low rather than too high.

I have seen charts for someone who was achieving good steady control of pressure, with small, continuous changes through the night to maintain their minute vent at a target volume.  So I know that it is possible, but my charts don't look like that.

My problem is that I do not need iVAPS during NREM, S mode is fine.  When REM hits, my respiratory rate drops from 15 to 10 but my tidal volume does not increase to compensate, so my minute vent follows RR, taking O2 with it.  Why that happens is still a mystery, though I do have a new clue to investigate.  So my PS min is my S mode setting and my PS max is enough to boost my tidal volume when RR drops.  I don't aim to keep my minute vent steady, just support it at a lower level (about 80% of median, 5 ml/kgIBW), which is enough to keep my O2 from dropping much.  It is a control strategy taken from industry and it is working really well, for me at least.  I have attached a chart so you can see what I mean.

However, I have been thinking for a while that I could possibly increase my volume target to about 95% of my median minute vent and drop my PS min to make the machine work to keep it there.  That might produce a more stable IPAP.  

Something else  that I have known for a while is that I often need EPAP to be a little higher when I am on my back.  However, I have tested and can normally get by with it where I have it set currently, just small disturbances during REM such as the one you see in the chart at 05:00.  What this conversation is making me think about is if I reduce PS min, could I set it as low as zero and bump PS max up to 8 (I have tested with it set there before) and then enable Auto-EPAP with a narrow range to see what happens.  I am going to stew on that idea for a while and maybe test it over my Christmas break.

[SarcasticDave94]

FWIW I've got emphysema based COPD and breathe deeper and slower than I used to. The ASV I had worked very well with the complex apnea, but when COPD got a touch worse, then the ASV was not the right answer, with it's auto adjust of BR, trigger, cycle. Since it's not an editable value, it became a no go. Thinking I had to set ST-A to get the target pt rate of 10.