Switching from PR BiPap ST to ResMed AirCurve 10 ST

[milesarcher]

I bit the bullet and bought a new AirCurve 10 ST.  Of course, the Dr wanted a visit before he would write a script, but he understood and wrote a script for a generic ST machine with 14.5/7.5 and BPM of 12.

My old PR ST had these settings:
 
Mode. ST
IPAP. 14.5
EPAP. 7.5
BPM. 10
Ti. 1.4
Ramp off
Rise 5.0

My new Resmed ST has these settings:

Mode. ST
IPAP. 14.4
EPAP. 7.4
BPM. 10
Ti  Min 0.3
Ti Max 2
Ramp off
Rise time =  min
Trigger = med
Cycle= med

After one night, the AHI is good at 0.35, but the comfort needs work.  Any suggestions would be welcome.  The comfort issues seem to be at the end of the inhale.  I know that comfort is subjective, but compared to the PR it is more difficult to fall asleep.

Another question has to do with waking up after a few hours.  While I was waiting for the machine, I slept through the night.

Once again, thanks.

[SarcasticDave94]

The comfort issue near the end of inhale question involves what exactly? You're wanting to inhale less, as in shorter duration, or longer? If either, that's a timing issue.

Note that ResMed and Respironics are going to feel quite different. Breath patterns and feel will be unique to each.

Sleep sessions probably are disrupted now as you've changed more than you realize by getting a ResMed ST. Again timing and synchronization will be different. That's probably why my RT is willing to allow me to pursue ResMed as she said going to Respironics will feel a lot different.

I'm not saying it was bad of you to get ResMed, it's just that you'll need time to adapt to ResMed.

[Sleeprider]

Can you expand on the discomfort at the end of inspiration? It sounds like you may benefit from experimenting with the cycle sensitivity to either switch to EPAP sooner or later based on more or less spontaneous flow as you cycle. The ST consistently provides the pressure support set, but does not alter the flow with Easybreathe which is a major comfort feature of other Resmed bilevels. What is the reason you are prescribed ST with PS 7.0?

[milesarcher]

I changed the "Rise Time" up a couple of clicks from min to 250 and that seem to have reduced the issue greatly. (AHI was .31 so it stayed low) Since there is still a lot of room to adjust, I may try inching up a little more. After last night, I am glad that I made the switch to the AirCurve.

Thanks to all.

[Sleeprider]

Rise time is important to comfort as the machine triggers from EPAP to IPAP and is the milliseconds of time for the machine to reach IPAP pressure. A typical value that works for most is 300 (0.3 seconds). I believe this is the default for Philips.

[milesarcher]

My original prescription for the Philips was 14.0/7.0. I found that the CAs were eliminated if I kicked the pressure up .5 tp 14.5/7.5

I do not know what the reason for the PS of 7. I can't find the sleep study right now, but I don't remember any rational. Basically I was at AHI 60 and would stop breathing now and then.

[Sleeprider]

Seems to be working well, but if your problem was to resolve obstructive sleep apnea with some centrals, ASV would have been more comfortable and effective for most. ST is intended for pulmonary diseases where the patient cannot get adequate tidal volume without adequate pressure support. Seep pages 37-40 about ST in the link below and compare to the ASV at pages 28-31 https://document.resmed.com/en-us/docume...er_eng.pdf

[milesarcher]

That is a lot to process. I started this journey after a heart attack which brought on AFIB. Also have bad allergies and a plethora of other issues. I will have questions for the cardiologist, pulmonologist, and allergist. Thanks for all the help.

[Sleeprider]

The Clinical Titration Protocol document is a lot to process, but it shows the intention of the manufacturer for the use of its products and how they recommend optimizing the therapy. It is intended for professionals, but anyone can learn more about their machine and how it works, and engage in second-guessing of their doctors. That's not a bad capability for reading a few pages.