Help with Resmed aircurve 10 v auto settings - too many events

[nixynic]

Hi All  :  We had a follow up appointment today with the doctor.  We followed all protocol explained in the wiki to ask for an ASV machine.  The doctor did agree that my husband needs a back up breathing function on his machine due to the CA events.  What puzzled us, is that he said he will need to ask the respiratory therapist which machine and which settings my husband needs.

Is this normal?  To us it seems like this doctor has no clue what he is doing.  Is it typical that a doctor relies on a sleep therapist to recommend a machine?

[Sleeprider]

It's fine to get an opinion from an RT as long as that person is familiar with treatment of complex apnea and comes to the same conclusion we did. ASV is the correct answer, not ST.

Just a quick thought, your doctor is probably looking for confirmation and appropriate settings for the ASV. You should consider sharing with him the Resmed Titration Guide for ASV https://www.resmed.com/us/dam/documents/...er_eng.pdf This has recommended default settings, and clearly describes the intended uses of the various machines. You want to use default settings on a Resmed Aircurve 10 ASV in Vauto mode. Make that request clear to your doctor, and it is not open to negotiation with a RT.

Edited link

[jaswilliams]

RT’s seem to like ST’s as they are used to using them for treating Repiratory Type issues.... mine wanted to use an ST first (It was not pleasant)

[Michaely6]

Sleeprider the link that you posted does not work just an FYI

[Sleeprider]

Fixed it. https://www.resmed.com/us/dam/documents/...er_eng.pdf

[nixynic]

Hey All - the doctor is fighting with us and does not want to put the order in for an ASV instead he wants to do an ST. Would one of you mind giving me ammo based on his oscar results as to why an asv is better for him? I already sent him the titration guide - thank you Sleeprider!

[Gideon]

Simple question, looking at the document SR provided the ST is described as

[/url]

• 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
  

[url=https://www.resmed.com/us/dam/documents/products/titration/s9-vpap-tx/user-guide/1013904_Sleep_Lab_Titration_Guide_amer_eng.pdf]

Which of these conditions does your husband have?

E0471 is both an ST or an ASV.  The designator is for a Backup Rate.  The decision guides are for with or without backup rates.

Technically a ST will treat Centrals.  But it will apply a high PS all the time.  With that your Minute and Tidal Volumes will not be correct because the treatment is fixed, not variable.  This will intermittently over ventilate while you are breathing "normally" (without Central Apnea) when tuned for when you have Central Apnea.  And if tuned for the Obstructive Apnea will not correct the Central Apneas.

My guess is with an ST
EPAP = 12
IPAP = 24

with an ASV
Min EPAP 4
Max EPAP 15 
Min PS 4 
Max PS 15


Thus overall lower pressures, only increasing pressures as needed.

[Sleeprider]

I can't add much to what Fred already offered. Many doctors make the mistake of putting complex apnea patients on ST and I can't explain why they do this. In the absence of the pulmonary disease and weakness described by Bonjour, it is not the intended therapy. Complex and central apnea have a machine designed for that purpose and it is ASV. I have already linked the titration guideline Does your doctor really intend to prescribe contrary to the intended and approved therapy?

[nixynic]

Thank you both for your help!  I have emails in to him requesting him to re-order the ASV version with back up info as per your responses.  Hopefully we will hear back today.  I will keep you posted.

[Sleeprider]

Nixnyc I'd like you to read the Chart Envy thread by Technopauper starting here: http://www.apneaboard.com/forums/Thread-Chart-Envy Rob was originally on an auto CPAP and had a lot of centrals, but also plenty of obstructive activity. Pay attention to his progression. He was later issued the BiPAP ST machine if you want to skip ahead to here http://www.apneaboard.com/forums/Thread-...#pid286158 The ST worked, but was uncomfortable and gave him marginally acceptable results. It was clearly the wrong machine for central apnea. Now, skp ahead to his first night on ASV http://www.apneaboard.com/forums/Thread-...#pid289993

This is what we want is to avoid the waste of time and frustration of trying to make ST work to satisfy a doctor and RT that just don't get it. It's your therapy. That thread is currently 157 posts long, while we are at 30 here. You can learn from the experience of other forum members. Insist on the ASV.