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AirCurve 10 ST-A
#31
If you go back to ST, you normally reduce the back up rate to be under your breath rate, so I guess it would be around 14. 10 is ok and is a default rate. I know it's confusing between the two modes. If variable both on vauto and ivaps up to 25cm, isn't clearing your obstructives, I wouldn't have a guess what to use for fixed ST pressure.
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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#32
(12-26-2017, 05:56 PM)zzzZorro Wrote: Have you tried the settings from your BPAP-ST titration (ST mode, BPAP 16/6 with backup rate of 10) ?

-This is the third machine I have been on.  First was APAP then BiPAP, now iVAPS.  I have run the figures in the BiPAP but do not recall exact results.  On top of everything else the Sleepyhead crashed and stats/charts on previous two machines are kaput!  The iVAPS automatically recommended a Target Pt. Rate of 17 so probably that is the correct breath rate to be using.  Been considering going back to the ST mode and the 16/6 would probably be a good place to try it.

With other machines results were always inconsistent.  Occasionally would get significantly improved results, then they would go in the tank. That is why I have progressed to this machine that is the best/only one left that can be prescribed.  I have a hunch the cardiac adventure in March is the cause of the heavy C/As, unless of course, the C/As caused the adventure in the first place.. Thinking-about

Thanks much..


Wish all the usual disclaimers (this is not medical advice, consult with your doctor), I would go back to the settings from your BPAP-ST titration (16/6 with backup rate 10) and see how those work out.  I would also check if your doc has a "patient portal" where you can register and message him directly about your concerns.

Did your doc prescribe AVAPS mode, or was that something you switched to on your own?
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#33
Doc Wizard prescribed the iVAPS settings posted at the opening of the thread.  Then disappeared behind the curtain.  Results were ugly!

Used S/T Mode 16/6 with BR-15 last night.  Decided to try 15 BPM as it was 2 points down from the 17 BPM recommended by the iVAPS test.  Felt comfortable in use.

About 0330 I woke up doing the 'grunt-snore' thing (actually more of a grunt) on exhale that apparently was coming form the back of the palate.  Seemed like it was either the lungs having a higher pressure on the exhale beginning or the point of machine pressure support maybe being a little to high at cut off (?!) weird!

Results were even UGLIER!
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#34
Good thing this machine is safer than ASV, or I'd be really worried about you.   Dont-know

God only knows why having hundreds of apnea is healthier.
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#35
Zorro, I too obstruct on exhale. I have this when falling to sleep on my back and would be the same during back sleeping. I kept increasing the min pressure till there was enough air splint, to hold my throat open during the change over to exhale.

I doubt the ASV would clear these obstuctives either, even leaving aside the increased 5 fold death risk with low ejection. The ASV also maxes out at 25.

My guess is you have your head propped up on a pillow, chin to chest, because of the neck problems. It's probably constricting the airway. It's the only thing I can think why there is such a wide difference in range. I think the pillow, mattress, or a combination of both, that was used in the sleep study. Which had 10/4 result, showed there are other factors in these obstructive events.
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
Post Reply Post Reply



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#36
(12-27-2017, 11:43 AM)zzzZorro Wrote: Doc Wizard prescribed the iVAPS settings posted at the opening of the thread.  Then disappeared behind the curtain.  Results were ugly!

Used S/T Mode 16/6 with BR-15 last night.  Decided to try 15 BPM as it was 2 points down from the 17 BPM recommended by the iVAPS test.  Felt comfortable in use.

About 0330 I woke up doing the 'grunt-snore' thing (actually more of a grunt) on exhale that apparently was coming form the back of the palate.  Seemed like it was either the lungs having a higher pressure on the exhale beginning or the point of machine pressure support maybe being a little to high at cut off (?!) weird!

Results were even UGLIER!


1) If I were you, I would be faxing the SleepyHead report from when you were on the doc's iVAPS settings to his office and calling them  multiple times a day.  You need urgent help from your doc.

2) From what I saw in the other thread, your AHI was consistently under 10 while on CPAP 8.  If that is correct, I would consider go back to that pending further input from your doctor.  Unless something has changed since then that I am not aware of...

Again, all of this is stated with the disclaimer that I am not a sleep medicine specialist, and this is not medical advice.  It's just what I personally would do temporarily if I had no way to get access to my doctor. But access to your doctor is first and foremost. It sounds like at a minimum, you need an in-lab titration study for whatever mode he is prescribing.
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#37
If I'm following Ajack correctly I agree that this calls for an increase in EPAP pressure, for obstructive apnea, and you will need to increase the IPAP by the same amount to deal to maintain pressure support. 18/8 might reduce the ugliness...sorry for my previous comment, it's just I really feel bad for you. That looks miserable.
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#38
(12-27-2017, 04:30 PM)Sleeprider Wrote: Good thing this machine is safer than ASV, or I'd be really worried about you.   Dont-know

God only knows why having hundreds of apnea is healthier.

You can rest assured the 'Gummit [Government] knows... They have all the answers  but the're a secret!   Dielaughing  

(12-27-2017, 05:13 PM)ajack Wrote: Zorro, I too obstruct on exhale. I have this when falling to sleep on my back and would be the same during back sleeping. I kept increasing the min pressure till there was enough air splint, to hold my throat open during the change over to exhale.

I doubt the ASV would clear these obstuctives either, even leaving aside the increased 5 fold death risk with low ejection. The ASV also maxes out at 25.

My guess is you have your head propped up on a pillow, chin to chest, because of the neck problems. It's probably constricting the airway. It's the only thing I can think why there is such a wide difference in range. I think the pillow, mattress, or a combination of both, that was used in the sleep study. Which had 10/4 result, showed there are other factors in these obstructive events.

I appreciate your sharing the exhale obstruction problem.  It may help to explain what I have experienced periodically since going onto the ST-A.  Never happened on other machines.

The collar, even though it worked previously had Zero effect this time around.  Just one of those things I guess..  Neck problem allows for little head elevation;  Basically I am flat (supine) on a memory foam mattress with a soft pillow that slightly supports my neck.  EVERYTHING about the sleep lab was lousy; hard rigid mattress and a stiff pillow.  Both times comfort was lousy and I would have no idea of the effect on the titration..
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#39
(12-27-2017, 05:34 PM)Shin Ryoku Wrote: 1) If I were you, I would be faxing the SleepyHead report from when you were on the doc's iVAPS settings to his office and calling them  multiple times a day.  You need urgent help from your doc.

2) From what I saw in the other thread, your AHI was consistently under 10 while on CPAP 8.  If that is correct, I would consider go back to that pending further input from your doctor.  Unless something has changed since then that I am not aware of...

I took your advice to request access to a Patient Portal and have been waiting since 1000 am for application information to arrive (I had the secretary send it to TWO different emails) Nothing has arrived yet... The Doctor is 'off' until Tuesday, January 2nd and his nurse is 'sick' today and may be in tomorrow.  Getting an idea of what I've been saying about the Wizard of Oz??

The idea of sending the resultant sleepyhead chart of his prescription is a good idea.  Actually, a hand delivered packet prior to the last appointment where I actually met him face to face brought that about!

During the day I searched back and found a CPAP setting that produced a AHI-6.06 On September 17th with a S9 Autoset with a fixed 14 cm pressure.  I decided to go with that prior to checking the board.  IF it gives ANY real improvement over what I'm getting now I will stick with it till the appointment next month.  BTW the CPAP mode with the ST-A has no EPR available.
 
(12-27-2017, 05:37 PM)Sleeprider Wrote: If I'm following Ajack correctly I agree that this calls for an increase in EPAP pressure, for obstructive apnea, and you will need to increase the IPAP by the same amount to deal to maintain pressure support.  18/8 might reduce the ugliness...sorry for my previous comment, it's just I really feel bad for you.  That looks miserable.

I am going with the CPAP 14cm with no EPR (which should give an end EPAP pressure) tonight.  If that goes south, we'll give your 18/8 suggestion a whirl.

Please don't apologize.  The help offered here has been greatly appreciated.  Even though the guy looking back from the mirror in the morning has become a bit more 'worn-looking' over the past year I'm doing good.  I am a tough old guy that has intentions of burning the candle off at both ends before going anywhere.  I NEVER take offense when offered a suggestion to help better myself.

Thanks Again Guys Eat-popcorn
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#40
I think I suggested you go back to the CPAP pressure that yielded the best results we found earlier, until you can get titration sorted out. I have no illusions that 18/8 is going to work any better than what you have been getting on the ST, and I completely agree with your decision. You're tough enough to have made such a strong try in spite of some of the worst results I have ever seen.

Good luck, and I'm sure you will persist and get something better once they work it out in a titration lab.
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