Where do I begin? [AirCurve 10 ST to Aircurve 10 ASV ]

[SarcasticDave94]

I think it's best to exhaust all possible setting combos before enacting an extreme opposite pressure changes like this. You're not going to gain anything flip flopping between higher and lower pressures.

S Manz has a very rare situation that he for some reason cannot tolerate pressures. This is not how everyone is however. Yes, keeping pressures down is commendable, but you still need to keep the handcuffs off enough to properly treat events.

[SleepyDwarf123]

I recently (5 weeks) started therapy with this same machine (ST). Unfortunately, ASV is not in my future right now as the ST is treating my events well.

When I first started using the machine, I felt that the changes between IPAP and EPAP were very 'abrupt' and you mention the same sensation in your notes. My pressures were initially 16/9 with backup rate of 12. After a visit to the doc (after 4 weeks), they agreed to lower it to 14/9, backup rate of 12. I am unable to comment on what numbers work for you, but what made the therapy, MUCH comfortable for me was to increase the Rise Time setting a bit (mine is set at 350ms). The Rise Time setting controls how quickly the pressure changes to IPAP. I also changed the Cycle Sensitivity to Very High. The rise time and Cycle sensitivity settings made the therapy much more comfortable for me - even at 16/9. Not at 14/9, I am very comfortable. I am not sure if it will work for you, but wanted to share.

[SarcasticDave94]

I'm thinking that timing settings will play into overall success and comfort. This is loosely similar to my therapy issue in that machine to patient sync is a hindrance. I myself recently did a trial on ResMed's ST-A. I ran trigger high which seemed to enhance the sync issue.

What I propose is take one change at a time, and in its own time we may try trigger edits for you. There's the other time controls to consider, Cycle, Ti Min and Max, rise time and of course the already mentioned trigger.

[Bird Brain]

Well, here is last night data. Changes are as Gideon suggested.

Mode: ST
IPAP: 19.0
EPAP: 14.0
Resp Rate: 10.0
Ti Max: 4.0
Ti Min: 0.3
Rise Time: Min
Trigger: Med
Cycle: Low
Ramp Time: Off

Still had headache in the early morning but, felt brain fog was less did not take as long to get on with day and concentration does not feel as difficult as it has been.

[Sleeprider]

As your results get better, your doctor feels more confident in his choice, even when it's wrong. We can practically make a pig fly on Apnea Board. That doesn't always make the pig happy, but it beats wallowing in the mud of apnea.

[quiescence at last]

The results you are getting sound great, and hope it will just get better. I noted that you mentioned it is tough arguing with the machine when you are trying to get to sleep. I think your awakey body wants to take bigger swigs of air, and exhaust same amount, so we run smack into the sleep helper machine. What Gideon said - find a transition activity that takes little effort and allows to transition to a more calm and restful state before beginning the pressure. I sometimes purposely take 80% to 90% volumes in my breaths, and kind of wait to see when my body says to breathe. Someone suggested that as a tool for softer transition to sleep breathing.

QAL

[SarcasticDave94]

I guess ole square waves can fit round lungs sometimes. I'm still convinced your doc is a cousin to my former idiot team of pulmonary non support.

[Bird Brain]

After letting Doc know I am ready for ASV titration and will take first available, he reviewed my data and said there was no need for another study, said data indicates I should be on ASV. That was 2 weeks ago. Have been running through stop signs, first with Doc’s prescription next with DME. Finally received a call from DME today to pickup ASV machine, when I arrived RT said he could not release machine because prescription was outside of machine settings and there was no backup rate indicated, so still on BIPAP ST. When I got home, I fired off email to Doc’s nurse requesting he write prescription for the following:

Mode = ASVAuto
Min EPAP = 6 cm H2O
Max EPAP = 15 cm H2O
Min PS = 4 cm H2O
Max PS = 19 cm H2O

Will see how this goes. My BIPAP ST settings are as follows:

Mode: ST
IPAP: 19.0
EPAP: 14.0
Resp Rate: 10.0
Ti Max: 4.0
Ti Min: 0.3
Rise Time: 200
Trigger: Low
Cycle: Low
Ramp Time: Off

Still having headache in the early morning, brain fog still present and concentration still difficult.

[Gideon]

Ask doc to specify ResMed ASV, DAW
Especially since at this point any Philips unit is suspect to recall

[SarcasticDave94]

Inform the doctor the ResMed AirCurve 10 ASV time controls are algorithm controlled. Suggest he script backup rate, etc. for "Auto" or default. And yes DAW is a great idea.