[split] Mal777 Lumis 150 ST-A iVAPS Therapy

[Mal777]

Thankyou Geer1.   If i had to guess my problems could be cardiogenic oscillations. I feel  this tremor in my body/hands frequently, and a recent holter monitor showed I had this "tremor" going through my ECG, and it was diagnosed as slow AF abherrant conduction by the cardiologist. Two further Electrophysiologists said it was not A Fib, , and they couldn't really say what it was.!!  I do have a pacemaker too. They couldn't suggest any treatment except blood thinners and beta blockers which I am already on. Maybe it is something I have to live with. I have read the clinical manual and titration guide of ST-A, and am slowly getting a handle on it, despite the complexity.
It is seriously a waste of time asking my pulmonologit about it all. As I said yesterday, he doesn't even know the IVAPS machine exists, and has no interest in my Oscar reports. I know he wouldnt want my SD card to examine. I see him in another month ....and cannot get in earlier. The  Cardiologists and Electrophysiologists dont now about this stuff also.....I have asked. And as you said the sleep report said very little about my breathing except the mention of hypoventilation.  Maybe it is just very weak breathing and I dont need a backup.  More something to make me inhale deeper

Now back to last nights sleep.  It was not good. The only change I made was epap to 5.0 minimum. AHI's were down but that is probably because I used ramp for 15 minutes which does not show early events, when most of my positional apneas were happening. 
During the night I would breath fairly normally, although much faster than usual, then the machine gave 3-4 short and forceful breaths, and then would repeat cyle a minute or 2 later.  Very uncomfortable..
My RR is more stable as was the first night I used the ST-A though, but overall I awoke at 3 am feeling worse than I usually do.
  
I also wear an O2 ring oximeter. With the Airsence I was getting quite good O2 results.....about 96% average most nights, with drops over 4%  variable with anything from 6-25.   Last night on ST-A oxygen was excellent for first 3 hours, (97% approx,  then dropped to around 90% for last 3 hours. Drops below 4% were good though....only 9

I had mentioned previously, that originally I was going to try the Vauto, in the hope it may assist, and was advised it would be a big improvement on Airsence, but the only way I would know if I tried it. So I bought it about 2 weeks ago (Supplier #33) at an excellent price. I know it does not have a backup rate, but if it helps me take deeper breaths with my weak breathing, it may help with AHI's and eratic breathing. I still have it here in sealed box, and am tempted to open the box and try it for several nights.  If it is reurned within next 10 days or so, I will still get 70% of what I paid, and if it does work, would not only save me $6000+ on ST-A, but also be far easier to tolerate. I'm not sure I can use this ST-A indefinitely...unless we can get settings more comfortable. The Vauto has all the Ti controls, trigger, rise, cycle etc as well as PS . Alos Easybreathe. It has to be retuned in about 7-10 days as I said, so if I go this course I need to start very soon....within next couple of days anyway. I'm only hiring ST-A so can keep it long term at $35 a week.
I also read on Vauto titration guide, it prevents hypoventilation. reduces CO2, increases O2,stabilizes upper airways, rests repiratory muscles etc etc
I know it does not do all the ST-A does, particularly backup rate, but maybe worth the trial gamble..and I'm sure it will be better than my airsence, and far easier for me to tolerate. I'm certainly prepared to take gamble. In addition many on here are well versed with the machine, and could easliy fine tune it , unlike the ST-A which people are still learning about

I have attached last nights screenshots. One the 2nd half of Oscar report to show inspiration time, also a zoomed one

thanks again everyone. You are the only ones I have to guide me on this, and I appreciate it immensely...

Mal

[Geer1]

Thanks for that information I imagine the tremor or maybe something to do with the pacemaker are what causes these fluctuations. The fluctuations do occur roughly in time with your heart beat.

The Vauto is not capable of dealing with your central apneas nor is it capable of providing increased pressure support to maintain periods of low ventilation. If you want to get an idea of what your results would like like on Vauto you can switch to S mode with longer rise time (use max of 900 ms) and it will mimic vauto minus increasing EPAP which you dont really need anyways. The only way Vauto prevents hypoventilation is the same way ST does, by using a high PS every single breath (rather than just when you need it). It works but would be better if we could get away with lower PS when it isn't needed. Only ASV and iVAPS provide variable PS and only iVAPS is capable of maintaining ventilation.

With the Vauto you are going to have the same problems with timing controls. They will either work on both machines or wont work on either, they are literally the same control and if Vauto is used in S mode everything is the exact same except for variable PS. If we cant get them to work we can at least minimize Timin so that it doesnt force the breath to be held this way the machine stays relying fully on your spontaneous breathing.

The issue isn't that we dont know how to program an ST-A (basics are the same, only thing really different is target Va), it is that your breathing offers a unique challenge that I dont believe has been seen often. Sleeprider is using his experience on what works for most people(which often is using high trigger sensitivity and increasing PS is often what helps), the only reason I am disagreeing with some of it is because I think your case is more complicated. That is also why I was pushing for you to trial these machines and not just buy a Vauto, ASV, ST etc.

Speaking of which ASV doesnt really treat the hypoventilation (other than same way as Vauto or ST by setting a high PSmin but it better treats centrals and doesnt have timing controls which could potentially work better in your situation. We are far from even getting the variables tuned in right now though so I would say stay focused on the ST-A for now once we get the basics dialed in for timing you can try S mode to see if Vauto would work if that is what you want to do.

[Geer1]

Results look the same for the most part. I'm curious what the other type of breathing around 1:45 looks like.

[Mal777]

(I had already replied, but I think I forgot to hit "Post reply")  :-((

Anyway thankyou for explaining this.   It is so copmplicated that hopefully Sleeprider will chime in with his suggestions regarding my various settings

As I mentioned in my previous post, last night was quite uncomfortable (During the night I would breath fairly normally, although much faster than usual, then the machine gave 3-4 short and forceful breaths, and then would repeat cyle a minute or 2 later.)

these are settings from last night

target PT  15
Target VA  6.2
MV  8.2
VT  549
Epap auto
epap min 5
epap max 20
ps min 4
ps max 10
Ti min 1.0
Ti max 2.5
rise time 500
trigger high
Cycle  low
ramp on 15min

Suggestions please Sleeprider? and Geer?  Maybe try PS increase?

I will keep using ST-A as uncomfortable as I am finding it, in the hope it will improve.  May try S mode down the track so I can decide whether to open Vauto box (have max 10 days to decide before return is due)

Have enclosed screenshot at 1.45 as requsted also a new copy of sleep study which is much clearer and gives more details of events and arousals on S   and ST machines.

thanks so much Sleeprider and Geer

Mal

[Geer1]

That extra sleep study data is helpful.

You can see how the worst period of desaturation occurred shortly after sleep when using S mode. It was due to the centrals, mixed apneas and hypopneas hat were occurring. That is similar to what we have seen on CPAP and now on ST-A (your sleep transition central apneas). You can also see that the hypopneas later in the study were occurring in similar sleep transition situations and likely would have been central apneas except for the ST backup rate turned them into hypopneas. Vauto most likely will have the same issues S mode had during that titration (numerous central apneas/hypopneas and desats etc).

Changing either trigger sensitivity or PS tonight should tell us something useful, it is up to you which one you want to try. PS will probably give a more drastic change, I am just not sure if it will be positive or negative, the only way to figure out is to try it (and like I said earlier if you wake up feeling strange change it back for now). If you choose to adjust PS I would increase it to 5. If you choose to adjust trigger sensitivity I would set it to low and then if that feels too strange to breath with you can bump it up to medium and if needed back up to high and try PS instead.

I believe the target rate is timing that breathing at 1:45 but it looks decent enough so won't worry about that for now since I believe the higher target rate should be helping fight those centrals better.

[Sleeprider]

I wish I could see all this stuff Geer1 is talking about, but I don't. I'm still at "stay the course" and lets see if anything needs addressed. The respiration rate and volumes seem pretty good and I assume comfort may follow. I really don't like the idea of changing settings every time we look at a chart. That's my opinion, and it's your therapy. We went into this to correct respiration rate and volumes and that seems to be accomplished. I'm not ready to make changes yet.

[Geer1]

You don't see 30 BPM respiration rate and 13 LPM minute volume for over 2 hrs last night (and high respiration rate later as well)? He had the same first night too.

   

Edit: Or do you not consider that to be an issue?

Edit2: Bad math...

[Sleeprider]

I'd like to slow down the resp rate, the Mv is not so much of a concern because at that rate, the Va is not necessarily high and the machine is not pushing the rate. On what basis are you claiming you have a clue what is really going on here?

[Geer1]

No point arguing, you are clearly annoyed that someone is questioning you... MAL you are welcome to message me if you have questions or want my input, us disagreeing isn't going to help you get anywhere with this so I'll step out of Sleeprider's way...

[Mal777]

I wish I could see all this stuff Geer1 is talking about, but I don't.  I'm still at "stay the course" and lets see if anything needs addressed.  The respiration rate and volumes seem pretty good and I assume comfort may follow. I really don't like the idea of changing settings every time we look at a chart.  That's my opinion, and it's your therapy.  We went into this to correct respiration rate and volumes and that seems to be accomplished.  I'm not ready to make changes yet.

Thankyou Sleeprider. I have appreciated and respected your valuable advice over the past 3 months.  
I didn't wish to cause any disruptions on here.... I just want to feel well 

I will do as you suggest and leave things as they are for a while, and hopefully I will get more comfortable with the ST-A therapy. 

Mal