[Equipment] Resmed ST-A with IVAPS comfort/smoothness

[Sleeprider]

I missed the concern about the respiration rate as the graph you posted averaged 14.8 and had a minimum of 8.0. Your choice of graphs to choice is good to show the problem, and it is unusual to see Vt, Mv and RR all decline in sync. I have not seen ASV or ST machines used to increase the respiration to a target rate and volume, but iVAPS might do this. It might help if we looked closer at periods of low respiration rate and volume and see if we can detect what is going on.

In terms of machine function, your graph shows that your respiratory rate and volume changes occur over a long period of time. The way the Resmed ASV works is it samples your breathing rate and volume over the past several minutes, so it is not detecting the long-term declines as below target. In effect they are long-duration hypopnea, and the machine is not triggering greater PS to combat this; instead the machine settles into nearly constant minimum PS at minimum EPAP as seen in three long periods after 03:12. With that said, the periods from 03:12 to 03:40, and 03:50 to 04:05 appear to be some of the best of the night.The area of greatest concern is from 02:55 to 03:05 where volume and rate clearly drop off, but this is during a period of very high pressure support. Your green time-marker is at that point we might want to look at.

I wish we could ask Resmed Customer service for input, but they will refer you back to your doctor and will not discuss any therapeutic information, nor review your data.

[ajack]

Sleeprider You you would be right, that they would refer back to the doctor for individual advice. It may need the doctor to contact resmed or the lab. Hopefully there is an answer from Resmed. Equally the lab may say, we said to get the philips. As you know, the phillips ASV can set a fixed backup rate and may be the best option. NT said :"my ASV was prescribed from a sleep study. I was prescribed a backup rate, but I couldn't tolerate the Respironics machine, so I got Resmed instead, it says it has an unadjustable backup rate of 15, but obviously that's not working for me." The Resmed seems to have a min 8 backup rate.

This is the second person with the same situation in a week. I linked the other thread to this one. I thought some may be new user pressure issues on that thread. The cycling CA, winding down the RR to about 8, the same as NT. NT has been on ASV for 5 years, so it's a pattern that shouldn't be pressure induced

[Sleeprider]

Ajack, in a perfect world and ASV machine, Resmed would allow "Pacewave" to be over-ridden with manual or minimum BPM backup rate. I thnk this is a significant oversight in this level of therapy machine. At the same time, the Easybreathe flow shaping is a tremendous comfort advantage, and likely a key reason so many users favor the "feel" of Resmed over Philips. I don't disagree at all with what you've said, only that Resmed will only provide feedback to a physician or DME, but not directly to the patient. I think we need to fall back on the stated intended use of the various machines.

In the absence of the kinds of conditions the iVAPS is intended to treat, I would continue to look for ways to make SV work properly. Using some out of the box thinking how would one logically improve respiratory drive to maintain the respiration rate? I think this might be a case where EERS in combination with ASV might be useful.

[ntntnt58]

Ajack, in a perfect world and ASV machine, Resmed would allow "Pacewave" to be over-ridden with manual or minimum BPM backup rate. I thnk this is a significant oversight in this level of therapy machine.  At the same time, the Easybreathe flow shaping is a tremendous comfort advantage, and likely a key reason so many users favor the "feel" of Resmed over Philips.  I don't disagree at all with what you've said, only that Resmed will only provide feedback to a physician or DME, but not directly to the patient.  I think we need to fall back on the stated intended use of the various machines.

In the absence of the kinds of conditions the iVAPS is intended to treat, I would continue to look for ways to make SV work properly.  Using some out of the box thinking how would one logically improve respiratory drive to maintain the respiration rate?  I think this might be a case where EERS in combination with ASV might be useful.

The condition is there, it's just the 2 doctors I've been to do not recognize it, they didn't even want to look at the graph, they only looked at the 95% statistics which are absolutely irrelevant because they don't show prolonged under-ventilation when it's being offset by hyper-ventilation (me breathing deeply when I'm awake). Here is the graph from last night where my TD stayed in the lower 300s for 13 minutes while my MV and RR remained normal. This might not even show up on sleep study as they only watch oxygen and not excess carbon dioxide which could be causing me to wake up gasping. I doubt Resmed is going to help, they would just refer me to another doctor.


   

[Sleeprider]

In your case, seeing the mask pressure is more useful than pressure. Upper percentile values are most useful when looking at common OSA rather than a complex apnea. Unfortunately, you have to get into the details to understand things. Have you considered using a recording oximeter? It would let you make a stronger case to point to patterns that coincide with poor SpO2.

[ntntnt58]

In your case, seeing the mask pressure is more useful than pressure.  Upper percentile values are most useful when looking at common OSA rather than a complex apnea.  Unfortunately, you have to get into the details to understand things.  Have you considered using a recording oximeter? It would let you make a stronger case to point to patterns that coincide with poor SpO2.

I've never bought an oximeter because I've read that those cheap drug store ones are inaccurate (my doctor doesn't even believe in graphs and says they are not accurate either). Also that wouldn't tell me anything about carbon dioxide.

[Sleeprider]

Lots of members use the ones from Supplier #19. Some are compatible with OSCAR, so you can see your graphs along with heart rate and SpO2. Even the good ones only cost $99 and they are available for much less. I guess it may be time to find a doctor with a more open mind and that listens to his patients. You have taken the time and effort to educate yourself about your condition, and it is simple disrespect for your doctor to dismiss that. I don't perceive a lack of information hypochondria or other issues here; you actually know somethng about what you're saying and have genuine concerns.

[ntntnt58]

Lots of members use the ones from Supplier #19.  Some are compatible with OSCAR, so you can see your graphs along with heart rate and SpO2.  Even the good ones only cost $99 and they are available for much less.  I guess it may be time to find a doctor with a more open mind and that listens to his patients.  You have taken the time and effort to educate yourself about your condition, and it is simple disrespect for your doctor to dismiss that.  I don't perceive a lack of information hypochondria or other issues here; you actually know somethng about what you're saying and have genuine concerns.

I guess I'll give the Sp02 sensor a try. I also have a sleep study coming up (titration for a new ASV machine), we'll see how it goes. Thanks for your support.

[ajack]

Print out example of this data happening and take with you to the titration, so the lab tech can see what is happening. You could even take the sd card that will show the last 7 days in detail. There should be examples during that period.

You could also get the resmed ResScan program, and load data into that and take your notebook. they prefer that to oscar.

[ntntnt58]

Just wanted to update...


I've been on IVAPS for 6 months with great results. I should have done it years ago, but I was too grossed out by the concept of a used machine, while new ones were expensive. I bought an S9-STA with 1800 hours and the difference is night and day. Sure it's not as smooth as ASV, but it works so much better. I could have an early morning job, which was something unthinkable when I first tried it with ASV. With IVAPS I could function far better with fewer sleep hours.