Help asking for right bilevel

[Sleeprider]

I hope you will continue to keep us informed of what machine is being authorized, and your results. I would really like to see you get the ST-A which can continue to adapt to your needs.

[MagnoliaSolana]

Can someone help me with settings for the ST-A? Should I make a new thread?

Here’s where I’m at. My doctor said she will prescribe it. But she needs to know what settings to write out. What I have is my original bipap settings (which after telling her verbally twice and three times written she still claims not to have *eyeroll*). I understand she just needs numbers to write on the Rx and we can change it later. I had to explain to her that I cannot even come in for a titration now because the effort would risk landing me back in the hospital. So we really have to wing it to get started. I’d hope to go for a titration later if needed, once I am breathing better.

My new DME is fantastic. I will be getting a machine once they get their shipment - in 4 weeks. Hopefully the changes in medication and adding in a ton more rest during the day will get me through. I had a rough time the last few days and almost went to the hospital but remembered my last ambulance trip when the paramedic was so amazing and used the CPAP they had and just kept removing it from my face to let me breathe out, so I’ve done that with just the hose of my bipap and it got me out of a couple of really bad breathing episodes. My bipap is blowing air really well, but once I have it on for a few minutes the ipap gets weaker than the epap. Using just the hose is a bit wild and temporary and of course only works when I’m awake, but at least I have that.

Now whether or not the insurance is paying for it is up in the air. My original prescription and sleep study and hospital records are all coded for Myasthenia Gravis. I’m a difficult seronegative case, however, so this new sleep doctor is having trouble with that as far as checking all the boxes because I tick boxes that don’t appear on insurance forms. So I will appeal to my neurologist and see if he can approach this and get the insurance to cover, or reimburse, because he is the one that sees me and treats me and prescribes my medication, as well as referred me to this sleep doctor.

[Gideon]

I would go with the initial settings for IVAPS as stated in the Titration protocol on pg 38

Initial iVAPS settings: 
• Set Patient Height (eg, 70 inches for 5’10”) 
• Set Target Pt Rate equivalent to patient’s spontaneous respiratory rate (recommended no less than 15 bpm) 
• Set Target Va such that Vt is equal to 6ml/kg IBW 
• EPAP = 5 cm H2O 
• Min PS = 4 cm H2O 
• Max PS = 20 cm H2O



IBW female = 45.5kg + 2.3 x (height in inches – 60)

[MagnoliaSolana]

Gideon that is exactly what I need, thank you so much. I think this will also make the doctor feel very comfortable as we start out like this, rather than me guessing at numbers. I had no idea this existed and wouldn’t have guessed technical info was available.

Frankly I don’t know why she was even fine with using my old settings for the regular bipap, as they were determined when I was 300 lbs and just after an mg crisis. I’m now 168 lbs and still losing. I eventually had to try settings on my own until I was comfortable and kept me out of the hospital. I’m shocked how even my neurologist was useless with all this, though he came on board after I had the bipap but was happy I had one. I’ve explained to the new sleep doctor (the pulmonologist sat in on the appointment) how I’m so tired of continually adjusting the machine. After looking at the ResMed titration I can now see why my original settings were what they were; they were setting it for obesity hypoventilation (I’m sure that affected me but was not my main breathing issue by far!).

[SarcasticDave94]

The ST-A has a Learning Mode, or something like that, to determine tidal volume or you can use the math and manually input the info. I think it goes by height. To do the learn mode, you need to mask up and initiate the test. It takes 20 minutes, and you must breathe slow and even the whole time. It should configure backup breath rate and tidal volume.

I got my test wrong and had to manually set it. My breath rate is slow and the backup rate needed lowered. And I had to lower tidal volume some as well. If you have the ST-A clinical manual, it'll go over this.

The directions will look like this: