Aircurve ST vs VAUTO to tackle Central Apnea

[palme]

Hello experts.

 I've been suffering from complex sleep apnea diagnosed via sleep study. With the help of. Resmed S10 auto and information from this forum AHI is down to below 10 from 27. However. I'm still struggling to get my central apnea under  control and day time fatigue. General consensus  in this forum is to use ASV device but unfortunately  this device is not available in India. So I am left with either. Air Curve S 10 ST or VAUTO to try . Could you please advise which one would be the best to tackle Central apnea and settings ? or any other brand or device I should look for? I have attached a copy of Oscar data and my Sleep study. 

Thank you

[Gideon]

Welcome to the forum.
Please ask for the whole, complete sleep study not just the overview tables. This study hints of ideopathic central apnea.

To actually treat central apnea you need a backup rate to initiate a breathe. Thus ST over VAuto though on the VAuto we can alter the trigger setting to help initiate a breath sooner. The preference though is still for the ASV which responds on the same breathe that the event occurs.

But you may need neither.

I would like to see 10 minute views of your OSCAR chart to see the character of your centrals. I expect there may be the waxing waning pattern of cyclic CO2 driven, possibly treatment Emergent Central Apneas.

EPR, in addition to comfort, is very good at treating obstructive events but also flushes CO2 out of your system, and in some unlucky individuals does so to below the apneic threshold resulting in a central apnea. This often occurs in a cyclical pattern, the waxing waning I refered to above.

First let's reduce the flushing,
Set EPR=1

Then repost and let's see what you have.

[Sleeprider]

I agree with Gideon, we can probably try optimizing the CPAP to use a fixed pressure of 7.0 and cut back the EPR and you will reduce central events significantly. If necessary, we can help you to source a used Resmed S9 VPAP Adapt at a relatively low price that can be shipped to you from U.S. and provide ASV therapy. The S9 is just the previous generation of the Aircurve 10 ASV and provides the same therapy.

Consistent with Gideon's suggestion, set minimum pressure to 7.0, maximum pressure to 7.0, EPR full-time at setting 1.

[SarcasticDave94]

Some of these, ST and ST-A at least, may be under the ResMed Lumis line. For ST and ST-A they each can be called Lumis 150. Not saying any of these are needed, but they may be under other names internationally.

[palme]

Thank you all for the quick response.
I tried reducing the EPR = 1 didn't help, i will try again with EPR = 1 with fixed pressure  7 as per Sleeprider suggestions
Attached is 10min graph and daily graph.
I am not able to upload full sleep study which is in PDF format, what formats are allowed in this forum ? 


i can see Lumis 150 VPAP ST is available in India
SarcasticDave94 are you referring this model ?

i also found another Chinese brand Entrust Bipap with • Work Mode: CPAP, Auto, S, T, ST  available
Are you guys familiar with this brand ?

[Sleeprider]

I am not familiar with the Entrusted brand of machines, but it appears to be manufactured in India rather than China.  That's a plus to me.  The software package looks better than any of the Chinese brands.  I'm not a fan of ST for central apnea,, but it has moderate success if the pressure support can be dialed in. The problem is that the machine uses the same pressure support on every breath, and that usually has to be high enough that it increases CA event to the point where the patient becomes dependent on the ST for every breath, rather than as needed, when needed. 

I think it would be a very good idea to try to buy one of the used Resmed VPAP Adapt 36007 machines on Dotmed. They are relatively inexpensive because they have hours on them, but it would immediately give you the therapy you need.  You would of course have to pay international shipping and deal with whatever import restriction apply in India. 

[Sleeprider]

Palms, I have recently used some analogies to explain the difference between CPAP, ST and ASV. I hope these little comparisons help you to understand. 

Jay, I used an analogy in a post to another member, maybe it will help you.  Here is what I posted in response to a member needing bilevel pressure support for UARS:

Now, let's apply this to ASV.  Suppose you are driving in your car on cruise control, but instead of responding to the terrain and accelerating as needed for a hill when needed and as needed, the car accelerates every 7-seconds to full throttle regardless of the need for more power.  I'm sure you would turn off that uncomfortable and dangerous cruise control very quickly.  ADAPTIVE cruise control only applies pressure when it is needed and only as much as is needed.  It gets you over the hill of inspiration whether you have no spontaneous effort, weak spontaneous effort, or if you are breathing normally, it just gets out of the way and lets you do the work.  ST is on or off, and it hits the throttle 12 times per minute at the same pressure.  ASV reads the terrain and keeps you moving at the same speed, even when the hills are not evenly spaced.  

Do you want a device that will make you crash into the car in front of you on flat ground, or one that can detect speed, effort and maintain a constant speed.  On or off, or modulated assistance.  The answer is obvious.  The ST and ASV work very differently with different designed objectives. The ST is for a rusty car that needs constant pushing, the ASV is designed for the car that needs more power when it needs it.

[SarcasticDave94]

I think what I was meaning is in some regions the ResMed AirCurve 10 ST would be equal to the ResMed Lumis 150 ST in other regions than the US.

Just from my experience I would rather stay with ResMed. Their treatment of Apnea is excellent in consistency and the ResMed's are compatible with OSCAR.

[palme]

Thank you i have contacted seller in Dotmed, checking if he can do internati0nal delivery