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Chart Envy
#91
RE: Chart Envy
ST is more intended to treat restrictive airway and lung conditions like COPD, obesity related hypoventilation and neurological problems resulting in weakness that limits a patient's breathing (respiratory insufficiency). It is not for complex or central apnea. Read the literature on the intended use for these machine. You need ASV and for some reason, your highly respected doctor is suggesting a use for ST that is not FDA approved. https://www.resmed.com/us/dam/documents/...er_eng.pdf

Your altitude is not very impressive, and we have many users of ASV in the U.S.A. that live at elevations above 7000 feet where altitude seems to significantly influence central apnea. In my experience, elevations below 4000 feet are a non-factor. A ST machine is a dumb bilevel that uses fixed pressure to to improve ventilation in each spontaneous breath, and when a breath is not taken, provides a backup trigger to IPAP. This will make your central apnea absolutely worse. I predict you will consistently see AHI above 25 and possibly as high as 40 depending on the amount of pressure support he is suggesting. ASV provides minimal pressure support for spontaneous breathing, staying out of the way until you need a backup breath, at which point it is capable of providing up to 15 cm of pressure support to initiate a breath.

I would rather not insult your doctor, but he is on the wrong track. Decline his ST experiment and investigate why he is reluctant to use the RECOMMENDED therapy for your condition, ASV.

Calgary has some beautiful skiing, but the lower elevations are rarely able to be skied. I think you guys are getting some record snowfall down low this year. Enjoy!
Sleeprider
Apnea Board Moderator
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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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#92
RE: Chart Envy
Thanks Sleeprider for the detailed response as always and the link, very interesting.

I've swapped to my 'away' machine and will use only this one for the next while, here for another two weeks - the Tech hasn't got back to me yet so will call him tomorrow and ask for an ASV trial instead - looking at the trends the bad patches do coincide either with returning home or messing with pressures.

I want to take all possible variables out of the picture and only use my away machine and not touch pressure and see what happens when I time travel again and return again - if I see the same thing then I'll push for an ASV prescription / trial anyway as irrespective of the cause the result is a 7-10 day rocky period which I want to avoid.

Onwards......

Last 2 days sub 5 and feeling much better again, its tough this, it really is.....

Rob
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#93
RE: Chart Envy
Rob, I described the standard ST machine above but did not differentiate it from iVAPS. The iVAPS is a more intelligent version that is able to use variable pressure support to target a respiratory volume. This is closer to ASV in theory, but still intended for a different group of patient needs. The auto-adjusting EPAP pressure and adaptive pressure support of ASV will still meet you needs better, and for less cost than iVAPS.

Tom
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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#94
RE: Chart Envy
I spoke to the Respiratory Tech at Supplier No2, explained my history and numbers and asked about the two options / need for ASV and he agreed that the ST was worth a shot as it would provide a 'puff' in simple terms whenever my body does not request it and that it is a valid treatment for my type of idiopathic Complex and thought it might work for me.

I'm now sitting on two air sense 10's a Dreamstation and a Resmed portable CPAP so don't want to shell out for any more hardware until completely sure I need the ASV. Local sleep tech has found the ST so getting that as a loner for a month which will allow me to try it and see, appointment on Tuesday.

I swapped to use the 'away' machine the last few nights and therapy has been equally sh**ty as it was with the 'home' one so thats a faulty machine ruled out at least.

Going through this will confirm if I can be treated with the cheaper option ST (as Supplier 3 has low hrs ones for under $1400) and will see how a return home altitude (?) bump responds to different treatment under the trial month. I will ensure I have an appointment on my return / finish of trial.

I hope you're wrong about the results of this trial Sleeprider but fear you're not......

Rob (getting very sick of cold and snow btw)
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#95
RE: Chart Envy
I have tried both an ST and an ASV to treat my complex apnoea, and after a month trial on the ST I went with an ASV That I bought online
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#96
RE: Chart Envy
Captain Slog 20th Feb.....

Used the 'away' machine at home for 6 days to see if home machine was faulty - 6 day average 11.55

Last night was the first time with the loaner Aircurve 10 ST, set up as following

IPAP - 19
EPAP - 15
Resp Rate 11

Got off to sleep ok then bloody dog woke me at 0130 and I forgot to turn it back on and slept (mask on without it switched on) till about 7 (bugger) at which point I started messing with sensitivity setting to make it less of an 'oh sh*t' when it cycles to IPAP pressures - must say a 200ms rise time makes all the difference in comfort.

Slept for a further couple of hrs and have to say I felt well rested even with trying to suffocate myself for half the night.

I compared a 'good night' from previously and response rates seem similar - anything of note in shape of the breathing waves ? Attached both

Ti max is currently set to 2.2 secs - is this limiting my max inhale time to 2.2 secs - if so what should it be set to assuming it won't do that every breath ?

Ti min currently set to 0.3 of a sec - what's that meant to do ?

Just trying to optimize as much as possible even though the sleep doc was categoric with the don't mess with settings message - oops I slipped and fell on clinical mode !

Looked pretty good results though for stunted night one and once I softened the response it was much less scary to wear.

Help appreciated

Rob
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#97
RE: Chart Envy
Who is paying for the ASV or ST? If the doctor want's to bet a weeks salary that ST is better than ASV, go for it. Otherwise he is being a stubborn fool. ASV does everything ST does, but also automatically adjusts EPAP and adaptively applies pressure support. So your "puff" is 8-cm of pressure support for every breath with ST, but it is 2 to 12 cm with ASV...what the heck is he thinking?

[Image: 44987513-this-adorable-duck-says-quack-q...ve-it-.jpg]
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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#98
RE: Chart Envy
Lets focus away from the lovely quackery and back to the questions peeps ?

Rob
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#99
RE: Chart Envy
Rob replace the pressure line with mask pressure and zoom in on some of the hypopnoea so we can see what’s going on arround those
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RE: Chart Envy
Sleep rider - I'm paying and will claim back from health insurance pending a prescription, they should pay 90% of whatever machine is required sending diagnosis.

Jason - updated the format, charts attached

What I noticed was that my inhale rate median has dropped from about 1.8 secs previously to about 1.3 secs, my exhale has stayed about the same - is this meaningful and does it relate to the question I asked above ? If relevant then how do I get it back to where it was / should be ?

Ti max is currently set to 2.2 secs - is this limiting my max inhale time to 2.2 secs - if so what should it be set to assuming it won't do that every breath ? Ti min currently set to 0.3 of a sec - what's that meant to do ? 

It feels kind of weird with what feels like forced breathing but I seemed to get into it better last night, feel ok today rather than great - guessing it will take a week or so ?

With the majority showing up as Hypos now would this be fixed by raising the EPAP / reducing support a little ? Just asking btw, not going to mess with this without Dr approval as he was pretty specific about this and want to keep him onside as need a diagnosis to move to either ST or ASV.

Attached are the zoomed and reordered charts - comments appreciated, no idea how to read the waveforms and what good or bad looks like ?

Rob
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