Issued Resmed Aircurve 10 ST Is this right?

[wking]

Thanks.  Don't know if they still make/distribute my machine (AirCurve 10 ST--don't know what ST stands for) but it seems to be very poor/limited at displaying Oscar data and distinguishing events.  Pretty much seems to treat everything as a hypopnea or unclassified.  So, if you provider should mention this one I would stay clear.  Unfortunately, I was not intuitive to do more research or visit this site before accepting the one prescribed.

My machine is about 3 years old. I was thinking of buying a new one on my own but need to do more thinking about the ins and outs of doing that.

[Gideon]

ST (Spontaneous/Timed)
Spontaneous means patient-initiated breathing for our purpose it also means manual like a non-auto CPAP.

CPAP choice to treat OSA, CA, obstructive or pulmonary restriction


The Auto CPAP such as the AirSense 10 AutoSet is typically the initial machine of choice for treatment of obstructive apnea and hypopnea
Just to clarify The VAUTO, ASV, S, and the ST are all BiLevel machines for treating three different conditions, they are NOT interchangeable. They are not a choice between them to treat a single condition.
They should be chosen to treat the specific condition that the user has, Here are the various CPAP machines and what they are designed/intended to treat
This info is from the ResMed Sleep Lab Titration Guide

• CPAP (continuous positive airway pressure) Fixed pressure delivered with optional expiratory pressure relief (EPR). It Treats OSA
  

• AutoSet/APAP (automatic positive airway pressure) Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. It treats OSA
  

• AutoSet for Her/APAP Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas along with an increased sensitivity to each flow-limited breath, providing a more comfortable therapy for women. Increases sensitivity to each flow-limited breath, providing a more comfortable therapy for women (OK for men too). It Treats OSA
  

• VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA
  

• S (Spontaneous) Senses when the patient is inhaling and exhaling, and supplies appropriate pressures accordingly. Both treatment pressures are preset: inspiration (IPAP) and expiration (EPAP). It treats Non-compliant OSA and COPD
  

• ST (Spontaneous/Timed) Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• T (Timed) Supplies a clinician-set respiratory rate and inspiratory/expiratory time, regardless of patient effort. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• iVAPS (intelligent Volume-Assured Pressure Support) Maintains a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and automatically providing an intelligent backup breath. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• PAC (Pressure Assist Control, also known as Pressure Control) The inspiration time is preset in the PAC mode; there is no spontaneous/flow cycling. Inspiration can be triggered by the patient when respiratory rate is above a preset value, or delivered at a set time at the backup rate. It Treats Neuromuscular disease (NMD), pediatric patients
  

[Sleeprider]

wking, ST stands for Spontaneous and Timed. Yours is a bilevel machine usually issued to individuals with COPD, hypoventlation and other conditions requiring a ventilator. In a new thread we can explore what kind of machine was intended in your prescription and get you back on track to a more effective, comfortable device. The ST seems to be one of the most inappropriately issued machines on the market. It provides plain S-mode bilevel which is fixed inhale and exhale pressures (IPAP/EPAP) and relies on your spontaneous effort to trigger IPAP and cycle to EPAP. The pressure is delivered in a square-wave, and there is no EasyBreathe™ smoothing algorithm. The machine also has ST mode where the machine will trigger IPAP on a timed basis if you don't spontaneously initiate a breath. There is a lot of good information in the Resmed Titration Guide page 37 https://www.resmed.com/us/dam/documents/...er_eng.pdf

The ST is in common use as an inexpensive ventilator witha backup rate, but it is far surpassed by the new ST-A which has much more intelligent algorithms. For most of us that don't need the backup rate, the best machine is the Aircurve 10 Vauto (page 24). I suspect that is what you should have. Let's review your apnea history and prescription and see if there was an error. If you have complex or central apnea, the ASV was the correct machine. In short, the ST is almost always the wrong choice.

[Gideon]

Let's understand your apnea, why you are on the ST, and see some OSCAR charts first.
And redacted copies of your sleep studies please, full copies with the charts and tables, not just the summaries.

[wking]

Sleep rider, thanks again.  Bonjour...recently read your mask primer so thanks for that.  

I have scoured my files for a copy of my sleep study.  But cannot find one.  Our sleep study clinic is still "underwater" and am waiting for an appointment.  Will see if they can at least send me copies of my last sleep study.  But, I remember going to the sleep clinic (long story) and afterwards told I had sleep apnea (OA, I think).  I was given a machine which looked very much like the one I have.  After a period of time and some follow up visits I was given a home sleep study.  I was then told I have central sleep apnea.  Can't remember if the word complex was used but was told I have both.  Was then given the ST machine I now have.  Has been a bit of a battle since then accommodating to the machine etc.  At one point I was told that since I was borderline then just don't use the machine.  I hope the Snapshot will appear.  It is very typical of my nights.  Before the break (about 00.45) virtually all the H's are, I believe, of the WSJ type as I'm sure during that time I am reading or awake most of the time (chronic insomnia).  After the "break," (about 01.00)  I am reasonably sure that most of the time I am asleep or getting there.  Occasionally, I will get a UA or two but mostly H's.  I think that's how the machine is set up. 

[wking]

Sleep rider, thanks again.  Bonjour...recently read your mask primer so thanks for that.  

I have scoured my files for a copy of my sleep study.  But cannot find one.  Our sleep study clinic is still "underwater" and am waiting for an appointment.  Will see if they can at least send me copies of my last sleep study.  But, I remember going to the sleep clinic (long story) and afterwards told I had sleep apnea (OA, I think).  I was given a machine which looked very much like the one I have.  After a period of time and some follow up visits I was given a home sleep study.  I was then told I have central sleep apnea.  Can't remember if the word complex was used but was told I have both.  Was then given the ST machine I now have.  Has been a bit of a battle since then accommodating to the machine etc.  At one point I was told that since I was borderline then just don't use the machine.  I hope the Snapshot will appear.  It is very typical of my nights.  Before the break (about 00.45) virtually all the H's are, I believe, of the WSJ type as I'm sure during that time I am reading or awake most of the time (chronic insomnia).  After the "break," (about 01.00)  I am reasonably sure that most of the time I am asleep or getting there.  Occasionally, I will get a UA or two but mostly H's.  I think that's how the machine is set up. 

I'm sorry.  I hope this copy of the Snapshot (which displays the AHI is better.  Sorry.

[Sleeprider]

wking, I'm going to give you some homework, that if you complete it will let you challenge your prescription and get what your need. The Resmed Sleep Lab Titration Guide is a resource for sleep technicians, respiratory therapists and doctors to help them select the correct machines for patient needs, and to titrate the devices to provide the optimum treatment. I think there is a lot of good information in this resource and it is worthwhile reading to get up to speed. https://www.resmed.com/us/dam/documents/...er_eng.pdf

Now, I'd like to draw your attention to two different devices. The Resmed Aircurve 10 ST that has been issued to you, and the Resmed Aircurve 10 ASV, the device that should have been prescribed. Look at the comparison and applicability of the machines on page 5. We can see at a glance that the ST is intended for COPD, NMD, OHS and other respiratory conditions. The ASV that applies to you is intended for Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB). Consider you issues and the choice is obvious. Now read about ASV on pages 28-32. and the ST on page 37 that has been replaced by the more intelligent ST-A. Okay, the ST is still a current machine but it is NEVER the right machine.

Do you understand that the ST is a fixed pressure bilevel that delivers the same pressure all the time whether you need it or not? Do you see how the Adaptive Servo ventilator stays out of the way and provides pressure support to cause a breath for central apnea patients when needed and at the pressure needed? If so, you now know enough to ask your doctor why the hell he prescribed this POS machine!

[wking]

wking, I'm going to give you some homework, that if you complete it will let you challenge your prescription and get what your need.  The Resmed Sleep Lab Titration Guide is a resource for sleep technicians, respiratory therapists and doctors to help them select the correct machines for patient needs, and to titrate the devices to provide the optimum treatment.  I think there is a lot of good information in this resource and it is worthwhile reading to get up to speed. https://www.resmed.com/us/dam/documents/...er_eng.pdf

Now, I'd like to draw your attention to two different devices.  The Resmed Aircurve 10 ST that has been issued to you, and the Resmed Aircurve 10 ASV, the device that should have been prescribed. Look at the comparison and applicability of the machines on page 5.  We can see at a glance that the ST is intended for COPD, NMD, OHS and other  respiratory conditions.  The ASV that applies to you is intended for Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB).  Consider you issues and the choice is obvious.  Now read about ASV on pages 28-32. and the ST on page 37 that has been replaced by the more intelligent ST-A. Okay, the ST is still a current machine but it is NEVER the right machine.

Do you understand that the ST is a fixed pressure bilevel that delivers the same pressure all the time whether you need it or not? Do you see how the Adaptive Servo ventilator stays out of the way and provides pressure support to cause a breath for central apnea patients when needed and at the pressure needed?  If so, you now know enough to ask your doctor why the hell he prescribed this POS machine!

Thanks.  Have done the readings a couple of times and, other than the more technical stuff on page 37, am getting gist of why the prescribing ST machine was questionable.   Will  read the material again and take some notes or photo copy of some highlighted pages with me to my next consultation which the clinic, at this time, has not even started scheduling.  At this time, is even using my machine doing me any good?  Also, if I do get the right machine, will it be able to reduce or correct the H's that occur/reported during the sleepy/wake portion of the night?  Thanks.

[Sleeprider]

The machine is providing fixed bilevel therapy. We don't know what your needs are based on a diagnosis or past experience with CPAP. The machine is beneficial when it reduces events below what you experience without therapy, and allows you to get better sleep than without it. We don't know if you need CPAP, Auto Bilevel or ASV. Based on what we see in your posted results, with bilevel pressure at 15/11, you have hypopnea. That would suggest a need for more pressure support. To do that just increase IPAP from 15 to 16, and that will take you from PS 4.0 to PS 5.0. We're kind of shooting in the dark. The ST is a good bilevel machine, but very short on features.