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BiPAP Dreamstation pressure drops
#21
RE: BiPAP Dreamstation pressure drops
I would guess that who ever was dispensing the ST thought it was an auto machine and was trying to set a range of values and got confused. Do you have a copy of your prescription ? As these settings are clearly wrong
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#22
RE: BiPAP Dreamstation pressure drops
Thanks JasW. I completely agree. It would be common to setup a Vauto with a range of 4-14, but what is missing is the PS 5 that was used before. This was reckless, ignorant and dangerous on the part of a medical equipment organization that should know better. It's bad enough to be easily actionable.
Sleeprider
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#23
RE: BiPAP Dreamstation pressure drops
I've been titrated 3 times; a brief history follows, 20 or so pages of detail available if you want to see them:


12/31/2017: Initial concern arose during recovery from bypass surgery; while on telemetry in ICU they noted apnea.
3/29/2018: Home sleep study: "abnormal with moderate elevated respiratory event index of 23.3 per hour, obstructive events associated with severe oxygen desaturations to as low as 66%".
4/22/2018: In-hospital titration; recommended CPAP at 8cm H2O (cwp).
4/29/2018: Dreamstation CPAP, 8cwp.
2/19/2020: In-lab titration after Neurology MD recommended BiPAP following confirmed ALS Dx. Impression: Obstructive sleep apnea. Recommendation: BiPAP at 10/6 cwp.
3/4/20: Dreamstation Auto BiPAP fixed Bilevel at 10/6cwp.
3/11/20: raised to 12/8, (ALS clinic Respiratory Therapist (RT)) in response to weakening diaphragm
3/18/20: raised to 13/8 (ALS clinic) still weakening
5/5/20: after I complained about the passive nature of the Dreamstation, I asked for a Resmed VAUTO, but received an ST, set to 14/4cwp. Don't (yet) know where in the chain my request got downgraded, hoping to find out today. Have asked for a copy of the Rx.
5/6/2020: results were unsatisfactory, felt like my lungs were going to explode. 
5/7/2020: Respiratory tech reached by phone, advised using Ramp to delay onset of high-pressure pain, saying that would allow me to get to sleep. I ignored him; he clearly either had no idea how to program the ST, or he didn't want to tell me. I reprogrammed ST to (eventual) 11/4cwp (amazing what a difference 3cwp makes), fiddled with triggering and cycling to make it comfortable. Overnight result satisfactory, wakening SpO2 96%. Doesn't look like I can achieve the ideal (for me) profile on the ST that Easy Breathe provides on the VAUTO, but this is better than the Dreamstation.

I sent a summary transcript of this thread to my normal RT, who only works part-time, and (thanks to HIPAA and a crude messaging system at the hospital) is hard to reach even when she's there. I'm awaiting her response, and have already apologized for making my own changes to her settings, but expect to have a serious talk with these folks today.

Thanks to all for your help and good wishes.
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#24
RE: BiPAP Dreamstation pressure drops
Regarding the issue of the ST, they probably think ST is an upgrade over a VAuto. At one time maybe that was true. I'm thinking though that you're probably needing something with an actual backup rate, which I don't think even the ST has. ST-A or ASV may be a better choice, but certainly ST is not doing you any good IMO.
Dave

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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.
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#25
RE: BiPAP Dreamstation pressure drops
As I said before, if you could be provided any machine to help you to maintain your respiratory volume and rate, the ST-A with iVAPS is the ideal choice. This machine targets an alveolar ventilation rate and uses adaptive pressure support an intelligent breathing rate (iBR) backup to keep you breathing at the volume an pace you need, even if you become too weak to do this yourself. This is the most intelligent and modern non-invasive ventilator in common use and is light-years ahead of ST with its fixed pressures and timed backup.

The Resmed Aircurve 10 Vauto is an auto bilevel machine that is more responsive to obstructive apnea than the Philips, and uses a more comfortable delivery of bilevel pressure (Easybreathe). This machine has no intelligence for maintaining your respiration volume or pace and has not backup provision.

The Resmed Aircurve 10 ST can be made to work for your, but we need to make some changes to the settings from what your RT provided. Based on your bilevel experience, I think you should start with EPAP pressure at 8.0, IPAP 13.0 and 12 BPM backup rate. If Easybreathe is on the machine use that. This will give you pressure similar to the Dreamstation BiPAP, but with a backup rate in case you do not spontaneously initiate a breath, and improved pressure delivery. We can certainly fine-tune the ST to meet your needs, but as mentioned previously, it does not have an intellegent algorithm to adjust pressure support to meet a ventlaton target.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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.
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#26
RE: BiPAP Dreamstation pressure drops
I cobbled together some settings that were OK by morning last night. I'm trying to add a short rest after exhalation without much luck, but everything else feels good, and I'm definitely getting more air than the Dreamstation was providing, and sleeping well. I'll put my settings up here tomorrow, but i/e is 11/4, with some waveshaping tweaks.

I verified today that the Rx was for the ST, with the 4/14 cwps. DME rep said they could fix the problem remotely, since there was a modem in the box. I couldn't get over to her that software has limitations. No response from the clinic yet, which means I'll be using this for the weekend at least, and probably forever.

As near as I can tell, EasyBreathe is not available on the ST.
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#27
RE: BiPAP Dreamstation pressure drops
(05-08-2020, 01:58 PM)Sleeprider Wrote: I think you should start with EPAP pressure at 8.0, IPAP 13.0 and 12 BPM backup rate.

What's the benefit of the higher EPAP?
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#28
RE: BiPAP Dreamstation pressure drops
I didn't think Easybreathe was on the ST. The inspiration time can be affected by changing rise-time from the default 300 ms. Sounds like you found some peace with this, but it is still not the ideal therapy that is available with the ST-A. That would be worth discssing with the doctor. Keep track of the changes made by monitoring OSCAR charts, and we can let you know what they are doing. 14/4 is a huge amount of pressure support and replaces all spontaneous respiratory effort. I think the goal should be to encourage spontaneous (self-initiated) respiratory effort as long as possible, while protecting ventilation volume. That is what we get with ST-A. This is a longer-term view. Insurance will cover ST-A at the same rate as ST, but it is such a better technology, and even includes the ST algorithim if your doctor wants to use that. The ST-A is the ventilator that will see you through as long as you don't need invasive ventilation. Hope that was not too blunt. It does everything ST does and more.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
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#29
RE: BiPAP Dreamstation pressure drops
If I were asked, I'd tell the provider to stuff their ST. But that's me.

Here's your machine back. I'll get the ST-A or I start questioning your professional credibility and shop elsewhere.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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.
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#30
RE: BiPAP Dreamstation pressure drops
The respiratory therapist from my ALS clinic called this afternoon and told me the settings she'd like me to use:

Parameter    Value
Mode        ST
IPAP        10
EPAP        4
Resp. rate    12
Ti Max        2.5
Ti min        1.5
Rise time    350
Trigger        Med
Cycle        Low
Mask        Full face
Humidity        5

I made the changes, and tested them with a short nap. They felt fine to me. She said to try them for a few days, and if I felt I wanted more air, raise IPAP but by no more than 1. Try again. etc., but leave all else the same. Fine with me.
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