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AirCurve 10 ST-A
Last night was first night on the ST-A machine.  Felt pretty good until I put the SD card in SleepyHead, then it got scary. (193 UA's longest 52 sec.)

Current settings:
Target Pt Rate-10
Target Va- 5.2L/min
EPAP- 10.0
MinPS- 3.0
Max PS- 10.0
TiMax- 2.0s
TiMin- 0.3s
Rise time- Min.
Trig- Med.
Cycle- Med


When I looked at the charts the DME had not set the clock.  When I tried it said 'Date and time cannot be set in the past'.  Moved the date forward a year and still says the same thing for time and also won't allow the date to be set back.  How do I go about resetting the time and date?  Read manual an see the warning to set it FIRST before running it so guess it is going to have to be reset somehow and it will delete last nights recording?

Thanks for any help.

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There was a very recent thread on setting time/date. Look within the last 30.
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With EPAP 10, IPAP 20 in what I assume is ST mode, the results are far from satisfactory. I would encourage you to consider obtaining a recording oximeter and see what the effect of this really and whether you should argue for supplemental oxygen.  This is pretty awful and If I made a suggestion it would only be a guess.  Did you get a copy of the sleep report and results for different pressure? I can only suggest you hang in there at least a few days and see if it settles out. As you know your CPAP results were much better, and I would go back to that if this continues, and until you can talk to the doctor.

[Image: jNzog8P.png]

[Image: KrrzIJz.png]
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Sleeprider; was set in iVAPS mode. Sorry!
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This looks familiar to the extent that we saw similar, but less severe problems recently by member Josephdfco in this thread http://www.apneaboard.com/forums/Thread-...ilating-me

He eventually took it out of IVAPS mode and used ST to achieve results consistently less than 2 AHI. It would help a lot to know all the details about your current settings, including backup rate. None of us has particularly good familiarity with AVAPS, and like Joe, you might do better with ST mode. Who knows? I assume the settings you are using now came from some kind of recommendation. Is this your doctor's prescribed settings?
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There was an ST titration but not a ST-A.

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(12-22-2017, 01:26 PM)Sleeprider Wrote: It would help a lot to know all the details about your current settings, including backup rate.  None of us has particularly good familiarity with AVAPS, and like Joe, you might do better with ST mode.  Who knows?  I assume the settings you are using now came from some kind of recommendation.  Is this your doctor's prescribed settings?

Yes, sir. Was from the Doctor himself.  Being the last day before Christmas break not sure if anyone there is going to return calls.  I have a recording oximeter and in any previous checks it was always good. The settings at the beginning of the thread have the settings I took off the machine; was there any that I missed?

(I figured out the date/time reset)

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It seems you were not specifically titrated for the SV / AVAPS. I went back and found where you posted the settings:

Current settings:
Target Pt Rate-10
Target Va- 5.2L/min
EPAP- 10.0
MinPS- 3.0
Max PS- 10.0
TiMax- 2.0s
TiMin- 0.3s
Rise time- Min.
Trig- Med.
Cycle- Med

I will offer my opinions on these settings based on titration protocol and other information you and I have discussed over the past several months. These are opinions and I don't claim any expertise in this (see page 36):
1. Your target Pt rate is too low at 10. The titration protocol default rate is 15 and you typically have about 16-18 breaths per minute based on past and current spontaneous results.
2. Your target alveolar ventilation rate should be equal to 6-mL per Kg ideal body weight.
3. EPAP 10 is a critical titration parameter. You are currently seeing lots of unresponsive UA which are likely obstructive. The titration protocol would have you increase EPAP until these are diminished.
4. PSmin 3.0 is a comfort feature. We found your spontaneous breathing was best at a low PS, so 3 or lower is correct. At this point PSmin is not to critiVcal, but eventually you might try alternatives to see if it makes the machine less active in providing backup breaths.
5. PSmax is too low at 10. The default recommendation by Resed is 20 cm. I would increase the PSmax to 15 because the machine is rarely effective in causing a breath during an apnea event, and we have to assume many of these are central, and 10 just isn't getting you to breath. 10 cm PS was enough to make you breath between 13:19:30 and 13:20:30, but still caused a hypopnea. Either PS was insufficient, or the Va was too low. Of all the issues with your therapy this one is probably key. The machine will only use the pressure it needs to meet the respiratory rate and volume targets, so setting higher should not be a problem.
6. Timax and Timin are fine.
7. Trigger sensitivity should be high to trigger IPAP with less spontaneous effort.
8. Cycle can be left at medium for exhale.

The last comment I have is that I don't see how this IVAPS technology could have any different risk factor for you than ASV...it simply has not been studied. The principles of operation are very similar, except the ASV targets the respiration rate and tidal volume as well as auto-adjusting EPAP to stabilize the airway, while AVAPS targets mainly alveolar volume and respiration rate. Finally, a titration study using this NIV could determine whether apena are central or obstructive, and make better decisions than we can using Sleephead. It seems like if you are to get ideal settings, that kind of information would be useful.
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IVAPS vs ASV; From my studying I would agree even to surmise they have it backwards, but "you gotta do what you gotta do with what you got".

I know you took a lot of time to skull-out this for me and it is truly appreciated.

Thank You Sleeprider Thanks
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Thanks for the PM. This finished up being a lot longer post than I thought it would be. It still isn't clearly explained, but ask if you want something more. 

This may help till you see your doctor. I'm pleb, but I'll tell you what I think, to take onboard. Put a "i guess' in front of every sentence and 'as you know', for saying something obvious. Smile
If anyone thinks I've got something out of place, please jump in.

As sleeprider said, I would go back and get titrated on the unit. You have to make sure the lab tech does this level of titration. It really is a specialist thing and you are a hard case, even though resmed say it can be set up out of the box. I can only point to the out of the box info available. 

The main thing I'm seeing is you aren't getting enough pressure during an episode. I think the one you showed is obstructive, because of the deep rapid breaths at the end of it. During the event, there is little flow and the PS is maxed out. The other thing that indicates it's obstructive is the very low minute vent, even though you can see the PS:10 being used. 

Was it you who had neck problems? If it is, you still need to get your chin up and head back, as much as comfortable. If you could, I'd still try a nap with a soft foam cervical collar on and make sure I'm not closing the airway unnecessarily. That would be my first guess, to what is going on. 

Have you got your st-a manual? anything I say is going to be based on the resmed s9 manual or philips and you should confirm it to be right for the resmed 10.

The rise time min would be 1 and 150 on resmed. The default on the st-a is 150 and is the quickest rise setting. https://onlinestore.resmed.com/images/pr...017278.pdf

you need to dial in the Va, page 31 you adjust the Va to get the iVAPS working. 
you put in your height
you set your RR at your actual RR rate. so going by sleepyhead, I would set 'target pt rate' at 12. going by an older chart without back up that I posted, it would be 15 https://imgur.com/a/qAfzc so somewhere between 12 and 15 would be a guess.
you can adjust the RR as you go and the 'Learn Targets' will do it all automatically.

I'd also use your median minute vent of 6.75 or 7 off of sleepyhead charts posted here, as a guide, as well as the ml/kg
The ml/kg could be between 6 and 8. Respironics would suggest initially 8ml/kg , as one possibility on their vaps, along with their tidal volume and height values.. 

epap 10 ? What was your pressure on apap to sort out the obstructive events? this is you at cpap 13 and full of obstructives, so I can't see epap 10 PS 3 working for you. The machine doesn't adjust the epap, like on the asv and vauto. it's a single pressure that is done manually. So the first job I'd do, is to go back through your charts. Till you find a cpap pressure, where the OA were treated and use that as an EPAP
I think I have commented on the high pressure you have needed on the vauto. If your doctor says, I think you are going to use the available higher pressure of the ST-A of 30cm, because you were maxing out the vauto 25cm. Has the doctor cleared you for 30cm. There are also other machines that go higher, if needed when you are being titrated.

min ps 3 for now, I think it could be adjusted later.
You can go to ST mode if you think it's best. It's going to be hard when the numbers you were given don't work and is another reason to go back to the doctor.
As you know, the ST IPAP/PS is always set at the maximum you need. The ST-A will ramp up pressure more slowly that an ASV. so the difference in modes need to be taken into account. The iVAPS raise pressure on each breath cycle, it takes 3-4 breath cycles to get up to max. (I work it out to 15-20 sec at RR 12, before it is fully treated. I think it will flag, even when adjusted properly, but it should be better than the 1 minute apnea going untreated, that you posted.)   The ST has the max pressure/ipap at what could be between your sleepyhead 95% and max pressure. As you know. You need to trial ipap to find out that pressure. It will do that pressure all the time, for when it is needed. The ASV raises pressure multiple times during the breath cycle and is very quick at resolving apnea and PB and CA.

If you want to set it up in ST mode, you need a max PS/IPAP. 
You can titrate the ST or the iVAPS mode should be able to show you what the ST IPAP should be, as you use it.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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