IVAPS bipap settings

[KazzaRazza]

Very new to all this so on a very big learning curve. Started bipap for respiratory weakness from myasthenia gravis (don't actually have sleep apnea) but finding either the inspiration is too short or if adjust the Ti max the exhale is worse. Also obviously being an AI disease my breathing issues change regularly. Is there a reason the IVAPS settings aren't used more often? I have a Lumis ST-A 150 VPAP which I believe is the Australian equivalent to the Aircurve 10 or close. It seems to ask for patient learning so is this actually intelligent settings or is it still using my breathing from that learning session only or does it continue to adjust during each session? Hopefully this makes sense!

[SarcasticDave94]

Your Lumis ST-A should be much like the US ResMed AirCurve ST-A. Both run iVAPS ventilation mode. As you are aware your vent is due to respiratory conditions other than Apnea.

Why the iVAPS isn't used more is that it's a ventilator junior. This board is heavily focused on Apnea not ventilation. An RT of mine in the past wanted me to go from ASV to full ventilator, ResMed Astral 150 due to Apnea and COPD. Doctor refused to script after testing.

Anyway, a few things then we'll do our best to help. Do you have a PC that you can download OSCAR charts for free?

Do you have an SD card on the left side of your ST-A?

It'll save your detailed data once it's inserted. But it doesn't capture from old data, just from time of inserting the SD card into the left panel of the ST-A.

Final item for now, what are the settings you're using on the ST-A?

[KazzaRazza]

Sorry I just meant generally speaking why aren't the auto settings on all types of machines used more - these are available on auto CPAP too. Is there a medical reason why not? Just makes no sense that we wouldn't allow the machine to calibrate them based on the algorithm instead of trying to find them ourselves so that's my actual question as I want to try them. Thanks

[SarcasticDave94]

The auto abilities of most machines tends to be used as a self Titration to find what is needed to treat well. From there, the info gathered is used to narrow the otherwise wide range of settings to put the user in the therapy sweet spot. This is where the user gains the best combination of comfort and therapy effectiveness. Note that most doctors that order these machines will not take time to do this with, or for, the patient, leaving you to do it for yourself.

[Jay51]

Dave explained it perfectly.  I have used several "smart" ventilators with auto -adjusting "self titrating" "find targets" algorithms.  I like them personally.  The one major problem I have personally found (and have seen a few posts by other here at ApneaBoard as well) is that the ideal settings chosen by the machine's algorithm may not be tolerable by the patient (they can even cause injury if set incorrectly).  The first ventilator I had caused lung pain (the pressure was too high).  I have read where others could not sleep with or tolerate the pressure(s) that their machines calculated for them either.  There has to be a balance between best possible ventilator settings and tolerability.  Ventilators can be very aggressive.  Settings that are at least tolerable are better than perfect settings that can't be tolerated (and therapy is stopped altogether).

[KazzaRazza]

The auto abilities of most machines tends to be used as a self Titration to find what is needed to treat well. From there, the info gathered is used to narrow the otherwise wide range of settings to put the user in the therapy sweet spot. This is where the user gains the best combination of comfort and therapy effectiveness. Note that most doctors that order these machines will not take time to do this with, or for, the patient, leaving you to do it for yourself.

Dave explained it perfectly.  I have used several "smart" ventilators with auto -adjusting "self titrating" "find targets" algorithms.  I like them personally.  The one major problem I have personally found (and have seen a few posts by other here at ApneaBoard as well) is that the ideal settings chosen by the machine's algorithm may not be tolerable by the patient (they can even cause injury if set incorrectly).  The first ventilator I had caused lung pain (the pressure was too high).  I have read where others could not sleep with or tolerate the pressure(s) that their machines calculated for them either.  There has to be a balance between best possible ventilator settings and tolerability.  Ventilators can be very aggressive.  Settings that are at least tolerable are better than perfect settings that can't be tolerated (and therapy is stopped altogether).

Thanks Dave & Jay . Can you please explain what is the actual issue or downside to having/ retaining these wider settings - if they're working? Also what type of settings can cause injury and what I can do to ensure I avoid any? Is this even possible with a recently manufactured machine? I just expected that it wouldn't allow settings that could cause injury without a big disclaimer U had to accept. 

Over the past 2 days I've been the most comfortable using the auto settings the machine has gained from the patient learning session and it seems I'm also utilising a wide range of those pressures to maintain that comfort. Trying to get an appointment with my RS anytime soon is impossible. 

Just FYI also this machine for me is not just used during sleep but when my respiratory weakness requires it when awake so I'm not sure if this differs slightly for me to most others as obviously our breathing usually differs during these 2 times and therefore I'm guessing my pressures might need to have a wider scope than usual to accommodate me. Thanks

[SarcasticDave94]

Then you're using it like an actual ventilator. Pressures can't blow up, explode your lungs, so they're all safe.

Given the possible day and night use, the ResMed Astral 150 full ventilator is a better choice. It's got built-in batteries internally, plus can have external packs. The ST-A is a CPAP looking mini vent.