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[CPAP] BIPAP to AIRMINI
#1
BIPAP to AIRMINI
Currently using ResMed Air Curve 10 ST with pressures 14/10/10, diagnosed with both Obstructive and CA.  Need a travel machine.  Although a step backwards, for travel can the the ResMed AirMini be used for short duration?  How would it be set up?  Thanks
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#2
RE: BIPAP to AIRMINI
I guess it may be OK, but it's pretty sure to not be optimal. You say CA but you're on an ST, so you're probably not on the correct machine anyway. Unless you have respiratory disease, or a few other symptoms, ST isn't correct, but definitely not at all the proper machine for Central Apnea.
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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#3
RE: BIPAP to AIRMINI
Good observation - I'm pushing an ASV.

Sleep test numbers: total of 111 apneas consisting of 27 obstructive apneas, 1 mixed apneas, and 83 central apneas. A total of 140 hypopneas were scored. The apnea index was 20.06 per hour and the hypopnea index was 25.30 per hour, resulting in an overall AHI of 45.36. AHI during rem was 8.9 and AHI while supine was 46.07.

Looks like I should be on an ASV.

To my AIRMINI - worth the hassle, or go without any support?

Thank you
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#4
RE: BIPAP to AIRMINI
To go with AirMini or without is totally up to you, but I think I'd rather you have something to help rather than not.

You may find something close to a static CPAP pressure on the AirMini in the range of 6-10 may be OK. Centrals would not like too much variance unless on that ASV. And with that high of CA at 83 on the test, and at about 7.5 times the rate of Obstructive Apnea, ASV will be a perfect replacement for the wrong ST you're on currently. Let us know when you get that one too. It's an easy setup.
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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#5
RE: BIPAP to AIRMINI
Thank you
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#6
RE: BIPAP to AIRMINI
I have done a lot of travel with my Airsense / Aircurve 10 machine, and never had a problem with the size. The Airmini form factor is better for camping or motorcycling where space is limited, but it's not a show-stopper. My suggestion is to download OSCAR and post up a couple charts so we can see where you are on the ST. We might ask you to use a single pressure CPAP mode to see what life might be like on an Airmini. My guess is that CPAP mode will fail, but better to find out now than to spend $900 on a CPAP you can't use.
Sleeprider
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____________________________________________
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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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#7
RE: BIPAP to AIRMINI
Will do - thanks
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#8
RE: BIPAP to AIRMINI
I'm setting up an SD card for new data loads to Oscar. I've drafted a request to my doc for an ASV machine, whuch I'll send in a few. Below is one of my sleep studies (two performed0... anything here that argues for the prescribed ST machine?

Study start time was 09:16:25 PM. Diagnostic recording time was 8h 32.5m with a total sleep time of 5h 32.0m resulting in a sleep efficiency of 64.78%%. Sleep latency from the start of the study was 19 minutes and the latency from sleep to REM was 116 minutes. In total,78 arousals were scored for an arousal index of 14.1.

Respiratory:

There were a total of 111 apneas consisting of 27 obstructive apneas, 1 mixed apneas, and 83 central apneas. A total of 140 hypopneas were scored. The apnea index was 20.06 per hour and the hypopnea index was 25.30 per hour resulting in an overall AHI of 45.36. AHI during rem was 8.9 and AHI while supine was 46.07.

33% of the events were central in nature.

Oximetry:

There was a mean oxygen saturation of 93.0%. The minimum oxygen saturation in NREM was 85.0 % and in REM was 85.0. The patient spent 11.7 minutes of TST with SaO2 <88%.

Titration:

BiPAP was tried from 10/5 to 20/14cm H2O. Back up rate was tried from 10bpm.

PAP Titration: The PAP titration was initiated with BiPAP 10/5 cm of water and the pressure which was slowly titrated up in an attempt to eliminate sleep disordered breathing and snoring. BiPAP was increased to 14/8 Cm before switching to BiPAP ST. The BiPAP was titrated between 14/8 cm back up rate 12 BPM to 20/14 cm back up rate 10 BPM. Lowest best tolerated pressure was 16/10 cm back up rate 12 BPM. At this pressure the patient was observed in the supine but not REM sleep stage.The apnea hypopnea index improved to 16.7 per hour and O2 nadir 85%. The average O2 saturation was 91%. He spent 11.7 min of sleep time below 88% O2 saturation. Snoring was resolved. There were no significant periodic limb movements. The patient utilized medium airfit F20 mask with heated humidification. The PAP was well-tolerated and there were minimal air leaks. Supplemental oxygen was not required.

Impression:

1. Primary central sleep apnea

Recommendations:

No definitive pressure can be extrapolated from the titration, however since he had mostly obstructive hypopneas on the best tolerated pressure, consider BiPAP ST 16/12 cm back up rate 12 BPM. Otherwise consider ASV titration.
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#9
RE: BIPAP to AIRMINI
After several painful tries on the BiPAP ST set at 16/12 and 12 back up rate, I found that I could tolerate a 14/10 and 10 back up setting. I am motivated to better understand what I’m facing and how to maximize treatment.

Of note, maybe related to this discussion, both of my sleep studies were conducted prior to a December Hybrid Maze procedure performed to mitigate a long term Afib condition. While the pre-Maze procedure sleep study heart rates ranged from 91 to 113 BPM, the post-Maze procedure heart rate averages 61 BPM at rest. I was in Afib during the sleep studies, I have been in sinus rhythm since receipt of the BiPAP device and start of therapy.

Some observations after reviewing the two sleep studies:

• My 9/25/21 sleep study stated (partially completed, not enough hours of sleep): “Recommendation: Dedicated BiPAP/BiPAP ST, and ASV titrations.”

• My 10/25/21 study stated: “No definitive pressure can be extrapolated from the titration. Since he had mostly obstructive hypopneas on the best tolerated pressure, consider BiPAP ST 16/12 with 12 back up rate.

• While the 9/25 study recommended an ASV titration, the 10/25 study did not follow that guidance. But the 10/25 study did also point to an ASV solution, “Otherwise, consider ASV titration.”

• Two sleep studies, both point to an ASV titration and therapy that was not evaluated.

• Both studies identified more than 100 apneas with Central Apnea a primary issue, with O2 saturation fluctuating from acceptable levels to less than 88% O2 saturation.

Employing my 14/10 setting, the ResMed 'MyAir' app scored my January 2, 2022, therapy at 95 points out of 100. While I am sleeping better, I am not achieving the intended therapy outcome. I still awake tired and find myself dozing off during the day. The ResMed dashboard also indicates more than 20 events each hour. Are those likely central apnea events that are impacting my therapy?

During the ResMed ST therapy described above, I also wore a ring SpO2 oxygen monitor. The SpO2 report indicates 54 drops over 4%, 119 drops over 3%, average pulse rate of 59, lowest SpO2 of 79%, and average SpO2 score of 93%.

Should I instead be on an ASV ResMed machine?
• ResMed states that the AirCurve 10 ST device is indicated for the treatment of obstructive sleep apnea (OSA) and the AirCurve 10 ASV device is indicated for patients with obstructive sleep apnea (OSA), central and/or mixed apneas, or periodic breathing.

• An ASV titration and possible solution is common to both sleep studies.

This review prompts me to request a prescription for a ResMed AirCurve 10 AVS machine. Also, my understanding is that the machine can be used itself to titrate optimum settings.
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#10
RE: BIPAP to AIRMINI
I guess we haven't really had the ASV discussion with you. Anytime someone presents here on the forum with complex sleep apnea syndrome (CSAS) and a ST machine, we offer our condolences and assume you would be better served with ASV. A prescription for ASV is the desired outcome and a logical choice. Most doctors want to see a titration on ASV to demonstrate efficacy before prescribing, and most will verify your heart function does not fall into a risk group with left ventricular ejection fraction less than 45% (LVEF<45%). In my experience, it is very difficult to persuade doctors to even consider ASV if they have no prior experience with that device. Sometimes it is worth asking the question straight-away, "Do you have patients using ASV for treatment of CSAS?" If the answer is no, just ask for a referral to someone that does, because that doctor is not going to get there. If the answer is yes, then go ahead with your case for ASV and jump through whatever hoops the doc has to get you there.

The irony of the situation is that the ASV only has 4 settings; EPAP min, EPAP max, PS min and PS max, and the default settings on a Resmed Aircurve 10 ASV work great for more than 98% of them. There is nothing to be gained from a clinical titration because the machine does everything automatically and nearly always works. We have a large number of members that purchased their first ASV machine out-of-pocket, just to get to effective therapy in a reasonable time and cost. They can then use the data to show efficacy, medical necessity and benefits. Considering the cost of a clinical test is about the same as buying ASV, it just seems ridiculous how many tests are prescribed, but then again, that is how incomes are made.

I will link to the Resmed Sleep Lab Titration Guide. Your job is to compare the intended uses of ASV (page 28) with ST (page 37) and understand basically how they work and are titrated. It's easier than you think. https://document.resmed.com/en-us/docume...er_eng.pdf You will see the default ASV titration settings discussed above, and the decision tree if ASVauto mode is not used. If you want to be pointed to where to buy one out-of-pocket, for about $1100, let me know.
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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