Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.
Login or Create an Account
ASV goes to 25, but your titration was nonsense. If you look at the presures where OA events were resolved, between 5 and 9 EPAP, that is going to be the range for ASV. Everything else (H, CA, flow limit) resolves with the pressure support. You need the faster response, but there is no question in my mind ASV is the ideal answer.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
02-06-2020, 11:54 AM (This post was last modified: 02-06-2020, 11:58 AM by Brando80.)
RE: 1st Night Bi-Pap, high pressures = terrible
Thanks for summarizing, that makes sense. I got an appointment today with my pulm Dr so I'm trying to get my info together. The ST-A has a backup rate, while the ASV uses PS to maintain your previous 90 sec worth of minute ventilation, which is the treatment for H, CA and flow limit, am I stating that correctly? My OA events were treated between 5-9 on the bi-vent titration not the CPAP titration. The ASV is still a bi-vent correct? It provides PS whereas a CPAP just provided epap? Just so I'm thinking correctly.
Thanks again, I need to make donation, you guys have a venmo or something? Everyone has been so helpful.
Brando
02-06-2020, 04:13 PM (This post was last modified: 02-06-2020, 04:18 PM by Brando80.)
RE: 1st Night Bi-Pap, high pressures = terrible
Saw the pulmonologist, seems pretty clueless. Told me I didn't have mixed sleep apnea and bi-pap was the treatment for both my centrals and obstructives. I told them I couldn't tolerate the 22/17 bipap and that the Resmed site, UpToDate and other sources recommend an ASV for my mixed apnea. Then when they found out I had been using ivaps warned me that I shouldn't do that. After a little bit of discussion I think the initial defensiveness wore off when thy realized I knew what I was talking about. They said I couldn't go straight to an ASV but would need another sleep study, I pushed back on this as the ASV uptitrates on it's own. Plus my ST-A was more expensive and was probably a mistake as it should have been an ST, to which I got the reply all of the ST's have an auto feature. Then they suggested I call my insurance, which stated I needed a pre determination letter first. Stinks because I probably could have gotten the ASV 1st if that was what was ordered. So now I see my options as go back to my PCP which has agreed to "do my best" lol. Love my PCP and I'm sure we could manage this. Or go see another sleep Dr and see what they say, how do I get an expert?.
As far as the machine I can just keep trying with this ST-A or try the pre-D and get an AVS. Or do another sleep study, my 4th. So there it is. I'll atach my full initial sleep study.
Also the pulm Dr did mention maybe an MRI but I'm not to keen on it. I'm considering it as CAI from the literature seems rare, maybe under diagnosed? How common do you see it from people on here?
Machine: Needing iVAPS but QUACKS refusing to help but they love testing Mask Type: Not using mask Mask Make & Model: F&P Vitera on shelf Humidifier: None/nada CPAP Pressure: 0-0 pressure set CPAP Software: Not using software
Other Comments: SCS PVC K9D** Untreated CA Asthma Dr. Donothings
No offense but your Daffy Duck amigos can't fix or want to take responsibility for your train wreck of a circumstance. I do wish you the best and that you'd come out the better for this toxic medical goof up.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
02-07-2020, 09:14 AM (This post was last modified: 02-07-2020, 09:16 AM by Brando80.)
RE: 1st Night Bi-Pap, high pressures = terrible
Had a hard time last night. I felt like the machine spent a lot of time at a higher pressure which the graph shows it did. Had a lot of air swallowing and trouble staying asleep. The changes that I made were taking the epap from 4-7 and the RR down to 10 which is what the learning tool suggested. Unlike Wednesday night which was comfortable last night I felt like the breaths were very sharp and forceful, which is probably why I swallowed so much air. I did have 3 beers in the evening which may have exacerbated things. Not sure what changes to make from here, may just stick with these settings a few days and see how they feel, or take the epap back down a little to 6? I really just want to be able to wear this thing. Going to spend some time today going through the manual. I'm working the next 4 days 13hrs/day so I was hoping to be tolerating this a little. Going to see a different pulm Dr today.
Thanks
Brando
Wow! Did you see your median tidal volume? The machine should not do this if Va is correctly set. Can you please check settings? ASV solves ths. Put in a phone call to Supplier #2 and have the run hours of your machine available. Ask them what they need to swap your ST-A for ASV. Let's try to take a shortcut. Alternatively, if you can return your machine to where you got it, Supplier #2 sells used and new machines at $1750 to $2250. Just get the ASV script.
If you become aware that the machine is running away with pressure like this, you need to either stop therapy, or take some consciously appropriate breaths to reset. That is a complete disaster. We could just go back to ST mode with lower pressure and live with the CA and H events pending getting the right machine.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Crap I missed that. I bet it changed it when I did the learning mode and I didn't catch it. I'll attach the new settings it wants to do which are RR 15, Target Va 11.4L/min, MV 13.3L/min Vt 888 VT.Kg 12.1ml/kg ibw In the hospital we generally use 6-8ml/kg IBW so that seems high to me. I actually am glad for this, I was worried that I just couldn't tolerate this thing. I'll see what the pulm Dr says today and see if they'll try for a predetermination from the insurance. Otherwise I'll just look into purchasing one. I'm renting to own this one and if I'd known this before hand and not gotten this one it would have been much easier. Should have found you guys sooner, lol. Thanks
Brando
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Just took a quick read through this and the pulmonologist appointment went exactly as I would expect it to. Your titration studies and the summaries were for you to receive an ST yet some buffoon sold you an ST-A.
Although I agree an ASV may be better I think you are better off not messing around in iVAPS mode due to the ventilation it provides and also because as you have already found it needs to be set up right otherwise you will over ventilate yourself. I would be switching back to ST mode and testing it out, if you can confirm you don't sleep well enough with it then that is extra ammo for you and doctors to use to get an ASV machine.
ST and ASV differ in that with ST your pressures remain set and the machine fights central apneas simply with backup rate. With ASV the machine is continuously changing pressure support to try and overcome flow limitations, hypopneas and apneas as well as has a backup rate to fight the centrals.
Your titration study showed that ST was capable of dealing with the obstructive and central apneas, they only kept raising the pressures because you were having hypopneas. There was little correlation with the increasing pressures to indicate that the hypopneas were improving, for some reason the 22/17 just seemed to magically be better and part of me wonders if that was because you were in a different stage of sleep (slow wave sleep has fewer breathing disturbances) or just coincidence. There was also no classification of the hypopneas and they could have been central in nature in which case higher pressure isn't going to help. Based on your two titration studies I like the looks of a 14/9 setting I would try that in ST mode if I was in your boots.
If you continue to try iVAPS mode out you need to get minute ventilation figured out. In your short periods on ST your minute vent median was 9.38 the one night but you had significant time awake so I expect that is still too high. Your first night on iVAPS your minute ventilation was 7.38 which is closer to what it probably should be.
