Bipap Unclassified Apneas

[Sleeprider]

You should have been prescribed a Resmed Aircurve 10 Vauto or VPAP-S. The ST is intended for individuals that do not spontaneously maintain respiratory rate and is usually dispensed for COPD, obesity hypoventilation and neuromuscular thoracic disorders. We can work with the ST, however it will never have the comfortable feel of the Vauto due to lack of Easybreathe. The one tool we do have however is the "Rise-Time". This affects how long the transition from EPAP to IPAP takes, and the default setting is a very fast rise time. The greater the rise time value, the longer it takes for pressure to increase from EPAP to IPAP. Your current median inspiratory time is pretty short at just over 1-second, and a slower rise time may help you to have a longer duration of pressure support. That may normalize the inspiratory wave that seems to have a sharp downward slope leading into expiration, rather than the rounded peak inspiration flow we normally see. With your respiration rate, the recommended Ti Min is 1.0 and Ti Max 2.0, and I would suggest rise time of 0.5 seconds, and you can experiment with rise time up to 1.0, but I think the sweet spot is 0.5-0.7. Finally, consider changing from ST mode to S-mode. You probably don't need the timed backup rate.

I encourage you to read about the different bilevel machine in the Resmed Clinical Titration Guide https://document.resmed.com/en-us/docume...er_eng.pdf This information might support a request to get a more appropriate machine prescribed and dispensed for your needs. Note in particular the health conditions these different machines are intended by the manufacturer to treat. As a bonus this also gives you the method for titrating pressure.

[SarcasticDave94]

Sleeprider brings up a good question, why an ST? Was there something unique on a sleep study?

In the past, here on Apnea Board, we've had members ask for help on an ST that was issued to combat central apnea, which is absolutely the wrong machine. ASV is the best answer for Central or Complex Apnea.

ST may be right for a select few with a select few breathing conditions or needs, but I think better machine choices exist to make the ST sales drop to minimal.

ST-A and ST may be set similar both having S T and ST modes, with ST-A being smart while ST is dumb. However ST is cheaper, and supposedly would make the user reliant on doctor to change your settings when needed, in part due to it being rather dumb and does little automatically, at least compared to ST-A.

If it's just a more regular bilevel you need, enter the VAuto, likely even cheaper than ST, but the VAuto might outdo the ST.

[Insomniac230]

I definitely can see that change in wave pattern as sleeprider suggested 500ms rise time, after the change a more rounded curve. Changed also pressure settings to 12.8/7.8, seems like just for this night hypopneas increased but was way easier to breathe with the new settings on rise time.

Not sure why I got ST i dont have those complications. Went ahead and changed my sleep doctor to talk to him about options. 1.5 years ago I was initially prescribed 17/12 bipap st and it was unbearable for a few days, then changed it to 12.8/7.8 .Months later when I saw the sleep doctor he said i got lucky and scoffed that I was able to "guess" it correctly. The only difference now is that the rise time from MIN to 500ms . He never changed any settings during the whole time and said I didnt know what I was talking about with ASV or Apap and said to leave it to the professionals after prescribing me sleep medication.

[Insomniac230]

Sleep test results attached

[SarcasticDave94]

On the only the professional can edit your PAP settings, this does a few things, all negative if I were asked.

1. Ties setting edits to doctor visits tied to billing you for a visit.
2. Delays edits because of #1, try getting a visit now and immediately afterwards the PAP has changed settings.
3. Dr. Dolittle isn't the one using PAP, so how does he know that this new setting will work. He can't, so go back to #1 AGAIN and pay him MORE.
4. Even if the setting works it still might need more tweaks. Go back to #1 yet again.

Here at AB you've broken that above cycle. Self titrate.

When I was issued my ResMed 10 AirCurve ASV, the DME RT told me she was at a loss how to set it up. She basically left it at default. I set it at first to the script in less than 5 minutes of getting home with the ASV, and made every edit afterwards, even when my own Dr. Dolittle changed the script. I asked for a hard copy to deliver to the DME. I copied the script info for self use BTW. Later that day they called to say they could change settings over the air the next day. Dave says thanks but I've already got it changed.