Plmnb's New Therapy ResMed AirCurve 10 ST-A

[Sleeprider]

Don't worry about the report error. It just shows the higher pressure as EPAP and the lower pressure as IPAP, doesn't change the fact the titration looked at a very minimal group of bilevel pressure and didn't find efficacy with the pressures attempted.

[Plmnb]

Hi.

It is now 3:59 AM.  I made a very conscious effort to go to sleep at a "decent" time last night, (I was off work earlier than my 11PM shift), so I started my sleep at around 9PM ish.  I was tired and my husband didn't put up much of a fuss about it.  I decided to try the clonazepam my doctor had prescribed because I told him I could not stay asleep.  Obviously it hasn't worked.  . At this point I have finally realized that I just will never get 6-7 hours of sleep.  When my body and brain say it is time to finally get up, I get up.  I felt a little groggy for about 10-15 minutes, now I'm ok. (5:30AM).  

The biggest issue is still fatigue during the day and early evening.  SOOO, obviously I am not getting the results I should be getting.  I don't think it boils down to the leaks because I have in the past not had a ton of leaks and still wasn't rested.  Some of  the leaks woke me up, some did not.  (I didn't set the leak alarm because I was afraid it would bother my husband, but if these leaks continue to happen, I might really have no choice).  There are some smaller periods of leaks in the later part of the night that did NOT wake me up, that I know of anyway.

Am I in a catch 22?  I need my pressure high but it also causes leaks?

I kept the EPAP at 12 last night after changing it from 15 as suggested by Sleeprider the other day.  Should I try to slowly increase it back to the 15 that was prescribed? 

Are there ANY other setting changes I can try?
  
I finally have the Clinical Manual.  However, since I am totally clueless to what everything boils down to, guidance is appreciated. For instance, I looked in the manual (pg 19-20) for definitions/instructions on settings for RISE TIME, TRIGGER and CYCLE.  I wasn't sure if altering these settings would make therapy more effective and or comfortable. But I don't know how to determine from reviewing my charts/graphs if this is necessary?  I am posting charts from last nightt that show some of these other graphs just in case they need to be viewed to determine some of these other settings.

The PRESSURE graph shows my pressure nearly or definitely off the chart.  In reading the manual (pg 18-19) talks about adjustments being able to be made for things relating to pressure. But, the manual charts (pg 18-20) show in which mode of treatment these settings may be changed.  Certain things in iVAPS can be changed and certain things in ST can be changed.  I'm quite confused.  I'm posting three charts just in case any of the graphs are pertinent to my situation.

The first chart is a personalized set-up of the graphs.  If you only want the standard or advanced, please let me know:

   

Since I haven't had a lot of events with this therapy (and didn't have at the end of my last go around with ST-A therapy/Ivaps) this chart shows Insp time and Exp time.  I just wonder if these times might have anything to do with my sleep quality???:

   

Chart three is in case something else might be helpful data for determining improving my sleep quality:

   

I also have an individual view of my Respiration Rate that I think might be helpful and will post in next post.

Regards.

[Plmnb]

The RESPIRATION graph:

[attachment=49370]


I am now going to zoom on my Flow waves and see what I can find.  Will post with results.

[Plmnb]

OH WOW, I was doing some Googling and came across this:

ResMed Practical Guide ASV-ST-iVAPS in sleep labs From diagnosis to therapy


At the very beginning it talks about breathing types!

What do you think Sleeprider?  Can we use some of the information in this guide?

[Sleeprider]

Here is a corrected link to the ASV, ST, iVAPS Practical Guide for Sleep Clinics https://resmedwebinars.com/assets/upload...de_Web.pdf Thanks for pointing me towards this source, however none of the described therapy modes really describe the issues you are experiencing. My recollection over the spectrum of devices you have used is that you have a chronic, intermittent inspiratory flow limitation that results in all auto-algorithms seeking the maximum set pressure. Your flow limits respond reluctantly, or not at all to either increased pressure or pressure support. Your respiration seems to meet your volume needs, even with less pressure support than you are currently using. We could probably use some flow rate zooms of your current therapy to verify this is still the case, and be sure to include a mask pressure graph.

When we reduced your EPAP max and increased the respiration rate, your results became more "normal", but I still think your respiration is mostly driven by the machine rate and pressure support. In the current charts, this appears to be true for all sessions except after 06:00. There does not seem to be any significant advantage to increasing EPAP max pressure back to 15 as there was nothing that looks better with the crazy high 30/15 pressure. I'm actually thinking more along the lines of dropping EPAP max back to 10 and reducing PS max to 10 to try to wean you off the machine pressure. As I said before, I am yet to see any pressure or algorithm that resolves the apparent flow limits better at higher pressure than at lower pressure.

[Plmnb]

Sorry Sleeprider, was at work all day.

Tonight I will try your suggestion: Dropping EPAP max back to 10 and reducing PS max to 10

So I will change EPAP on the machine to 10 and Max PS to 10.

BTW, I have been informed that certain medications I am on for my Bipolar, including antidepressants might be having an effect on my current treatment.  Do you have any experience with this from helping other people?

Also, regarding some zooms, are there particular portions that are of interest to you?  Or should I just pick some areas myself?

Sincerely.

[Sleeprider]

I'm not familiar with those medications. I'm pretty proficient at beer.

[Plmnb]

   


Not sure a Zoom during a leak is helpful but here it is:

   


And then there is this:

   

[Sleeprider]

Let's just see what we get as pressure and pressure support are reduced. The third set of graphs looks okay, the first has very abrupt inspiratory and expiratory transitions and I don't know what that is. On future close-up graphs include the flow rate, mask pressure, tidal volume and leaks.

[Plmnb]

Morning Sleeprider and all.

Looking at chart below...not a great night....AHI much higher than it has been not only this go around so far but higher than I can remember from the end of my last go-around with therapy.  OBVIOUSLY a huge problem with leakage the first part of the night.  I remember getting up for a few then going back to sleep.  I don't remember getting up during the second half of the night.  So strange that the leaks during the second half of the night don't appear.  I don't feel HORRIBLE, but don't have the refreshed feel at all.  I definitely am calling the doctor this morning about the length of time I am sleeping.  I have been experimenting with what time I go to sleep and no matter what, I wake up super early. 4 - 6 hours just isn't ENOUGH sleep.

Where do we go from here ole sage one? 

(OVERVIEW CHART IN ADVANCED ORGANIZATIONAL VIEW). Will now gather a few zoom shots in order requested and post next.