Therapy Suggestions

[Keesh23]

Hello All,


I've had a bipap with s/t before and then before the pandemic they switched it out to one without a backup rate and lower pressure (led to my OSA turning into CSA). Plus during the pandemic my compliance using my bipap was terrible but I changed that. MY sleep study last December was quite bad in the sense that 8/4 with no backup rate gave me like 70 CAI and a 102.6 REM AHI. I've attached the info at the end for those that are interested. 11/5 was the only pressure tested with a backup rate in the sleep study

And now I finally got my Bipap ST on 11/5 with 16 BUR. Idk if I should fight with the doc for the ST-A, please let me know?

For my first three nights with the machine, I had 0.3 AHI (7hr+), 0.2 AHI (7hr+), and 0.0 AHI (8hr+) and it showed up in the myair app. I think this is more successful than even my physician envisioned.

If my numbers continue to stay low, does that mean I am receiving good ventilation? I also no longer feel sluggish in the morning and my stamina is overall better. 

What I would like to know is if my numbers at the sleep study are more representative of my condition or my first three nights with the machine in the comfort of my own home. 

Also, do you guys think I need the Resmed Aircurve 10 ST-A instead? ASV is not reccomended for me.

[Keesh23]

Hello All,


I've had a bipap with s/t before and then before the pandemic they switched it out to one without a backup rate and lower pressure (led to my OSA turning into CSA). Plus during the pandemic my compliance using my bipap was terrible but I changed that. MY sleep study last December was quite bad in the sense that 8/4 with no backup rate gave me like 70 CAI and a 102.6 REM AHI. I've attached the info at the end for those that are interested. 11/5 was the only pressure tested with a backup rate in the sleep study

And now I finally got my Bipap ST on 11/5 with 16 BUR. Idk if I should fight with the doc for the ST-A, please let me know?

For my first three nights with the machine, I had 0.3 AHI (7hr+), 0.2 AHI (7hr+), and 0.0 AHI (8hr+) and it showed up in the myair app. I think this is more successful than even my physician envisioned.

If my numbers continue to stay low, does that mean I am receiving good ventilation? I also no longer feel sluggish in the morning and my stamina is overall better. 

What I would like to know is if my numbers at the sleep study are more representative of my condition or my first three nights with the machine in the comfort of my own home. 

Also, do you guys think I need the Resmed Aircurve 10 ST-A instead? ASV is not reccomended for me.

[Deborah K.]

In order to help you, we need you to download and use Oscar, our free apnea reporting program. With it, you can post charts that provide lots of useful information so that we can advise you.  At the top of this page, in the black section, you can open the Oscar link that will tell you how to download and use Oscar.

Good luck!  

[Jay51]

Hello Keesh23.  

A similar thing happened during my sleep study.  With regular bipap (bilevel), my CA's increased dramatically.  With a back up rate they stopped.  

I am unable to open the link you have in your post above.  

Good news that your AHI is so much better with the ST!  I had ST during my sleep study.  Some people have trouble tolerating the square wave pressure of the ST, but if you can tolerate it and get these results consistently, then this is a huge step forward IMO.  

You probably won't get the ST (A).  It has IVAPS for lung disease, neuromuscular disorders, etc.   I assume you don't have any diagnosis like this?  You could ask and see though.  It just has more settings than the ST that you have.

[Keesh23]

I actually do have a neuromuscular disorder (it doesn't get worse over time) but my OSA turned into CSA somehow, I attribute that to them taking away my bipap with S/T sometime before the pandemic and giving me a regular bipap with lower pressures (in hindsight this was malpractice), while also me refusing to use my bipap sometimes during the pandemic due to the Phillips recall scare, and maybe long COVID. 

My doc allowed me to choose between ST or IVAPS after my current sleep study and I went with ST to start and said if I need IVAPS later I'll switch over. He is a specialist in my condition and he agreed with me. 

Knock on wood, my first three nights in my own comfortable home compared to the scary sleep lab, have been great on just the ST 0.3 (7+hrs), 0.2 (7+hrs), and 0.0 (8+hrs). Here's to hoping these trends stay for the both of us!


Here was my nightmare of a sleep study from December 2023. Hopefully it works this time.

I'd love to hear your interpretation because it seems as though we had similar like cases.

[srlevine1]

If you do not mind me asking, why was the ASV not recommended? Was it a low ejection fraction?

[SarcasticDave94]

At least to me, it's difficult to determine much with the limited info presented. You will be best served to include OSCAR charts to track the ST data. First, you benefit from tracking your own setting efficiency of therapy. Second you can post the info here for opinions.

I think that given the choice of ST and ST-A, I'd get ST-A. Both will treat Obstructive Apnea with Central Apnea, but having tasted both therapies, to me ST-A is easier to deal with. I have Centrals and COPD, but my PFT (pulmonary function test) showed minimal restrictions despite being graded as COPD GOLD 3.

To me, both exhale and inhale ST was not comfortable. It's the old square wave feel, pressure just goes up then back down. There's no way to get it to vary therapy.

Context, I come from using a ResMed ASV for 2 years due to CA, where I'm used to higher pressures for inhale IPAP if needed, and for there to be variable exhale EPAP and inhale IPAP. ST offers neither.

ST-A on the other hand, also tried but by borrowing one, EPAP may be static, (but some later units and non US myself might have variable EPAP) I think PS and IPAP are variable when using the ResMed version of AVAPS called iVAPS. This is a ventilator mode.

ASV, ST, and ST-A can combat Central Apnea because of the breath backup rate. ST was what was used before ASV came out for CA.

What I'd recommend considering on machines:

If you're dealing with CA but not other pulmonary issues, ASV.

If you're dealing with pulmonary issues and can get it, ST-A.

I'm biased. I don't like ST. It's too abrupt in exhale to inhale, it's static, and it wakes me up.

One thing negative for some is that the ST-A has alarms that you'll want to turn off unless needed.

[Jay51]

Dave makes great points and he has more experience with this stuff than me.  It seems like you are in a no-lose situation with your pap/vent therapy.  You can keep the ST or change to the IVAPS when you want to with your Dr. at any time in the future.

[Keesh23]

I am actually not sure, but like its just never been brought up my physician, I assume that it is because I have a heart condition but I do have a higher EF than in patients it is being told to not use for. Also if ST is working, ASV might just put extra stress on my heart so it isn't necessary. Along with this all together now, I've had 0.3 AHI, 0.2 AHI, 0.0 AHI, and 0.1 AHI, all on about 7-8 hrs of sleep time on this new machine. ST isn't new to me I've had it before the pandemic before it was taken away from me. Plus I've checked and my MV is stable so its probably a sign I'm being ventilated well at night.

[Keesh23]

Thanks a ton for all your help guys and especially you Dave.

I don't seem to have that bad of a time on the machine. I've had an ST set up for like 3 yrs before the pandemic and then during the pandemic they took it away fro me and gave me a regular bipap. For my four nights it was 0.3, 0.2, 0.0, and 0.1 AHI so I'm happy I am responding well plus MV is stable so I can be assured my oxygenation is probably good. I told my doc about the ST-A, hopefully he doesn't give me a hard time on it. I've been using the resmed airfit p10 and while its comfortable, I realize that I only wake up when my mouth sometimes pops open. and also l've been sleeping on my side and sometimes I will have drool on my pillow which is really annoying. I'm assuming this is just getting used to the new treatment?