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[Equipment] BiPAP AVAPS vs. ST
#1
BiPAP AVAPS vs. ST
Hi all,

My Dreamstation BiPAP AVAPS had to be sent back under warranty due to broken dial (electric issue) and while I wait for a replacement I am on a borrowed Dreamstation BiPAP S/T (local DMEs don't have AVAPS lying around), but my DME did have this BiPAP S/T which hadn't been used since pre-COVID, so I took it. 

From what I can tell, the main difference between AVAPS and S/T is that AVAPS is going to adapt to my tidal volume fluctuations, whereas S/T only provides timed breaths regardless of tidal volume. Is that true? Are there other important differences between AVAPS and S/T?

My doctor did say I can temporarily use the S/T, but obviously she prescribed AVAPS because that's what I need. I worry a bit about this now because my AHI the past two nights I've used the S/T is between 7 and 8. With the AVAPS it was under 5. I am pregnant and want to ensure adequate oxygenation especially now. I estimate it'll only be about a week on the S/T, so hopefully all in all not much harm.

I must say I do not feel as well rested on the S/T, and when I wake up with it on full force I feel a bit suffocated with the lack of tidal adjustment I am now accustomed to.

Thanks for any and all advice.

KA
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#2
RE: BiPAP AVAPS vs. ST
Post OSCAR screen shot (F12) of the ST, both Normal and Advanced Charts

Do the same for your AVAPS

Let's see what is going on and go from there.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#3
RE: BiPAP AVAPS vs. ST
The BiPAP AVAPS is most equivalent to the Resmed Aircurve 10 ST-A which has an iVPAPS mode, and in my opinion is superior to the Dreamstation. Anyway, the ST is simply a fixed pressure BiPAP with a timed backup rate and no capability for targeting minute vent. It is a machine that should be discontinued in my opinion because it has been so effectively replaced by the more intelligent algorithms of AVAPS and iVAPS and even ASV. A lot of them are still sold because doctors and clinicians have not kept up with the evolving technology.
Sleeprider
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#4
RE: BiPAP AVAPS vs. ST
Did not have data card in S/T but will record tonight's data and post tomorrow. Here is the last night on AVAPS. Thanks!


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#5
RE: BiPAP AVAPS vs. ST
Very good to know, Sleeprider, will keep the Resmed Aircurve 10 ST-A in mind when it's time for a new machine, and of course consult here. Thanks.
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#6
RE: BiPAP AVAPS vs. ST
The above is correct. The ST is pretty dumb compared to ST-A which has iVAPS. This stands for intelligent AVAPS and only ResMed will have this mode. Other machines that run AVAPS are in the ventilator class such as the ResMed Stellar and Astral. Philips has some AVAPS mode units, but the ones that come to mind are ventilators as well. IMO the ST-A would be a good target for a new device. I'd suppose there's some respiratory reasoning behind the AVAPS. Anyway, that's my 2 cents worth. Best wishes in successfully snagging a new unit.
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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#7
RE: BiPAP AVAPS vs. ST
Your results shows fairly significant hypopnea events. Not surprising with a dumb machine that provides this kind of therapy. We don't know why you are on AVAPS and it would help to know that information. These are pretty unique machines and not intended for central or complex apnea, but for a restrictive, pulmonary or neurological condition where adaptive pressure support to maintain minute vent is important. Do some research on the Resmed Aircurve 10 ST-A with iVAPS. It is by far the most intelligent in this category and actually targets an alveolar minute vent. If you really want to know more, request the clinical manual for that machine from the CPAP Setup Manuals link at the top of the page.
Sleeprider
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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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#8
RE: BiPAP AVAPS vs. ST
Sleeprider, thanks. Clarifying point: the data I posted is from my BiPAP AVAPS. I thought we were calling the S/T the "dumb" machine? Now I am worried that my Dreamstation BiPAP AVAPS, which I will have back in a few days (brand new replacement), is possibly the wrong machine for me? 

I am on AVAPS due to some unclassified neuromuscular disorder. I've copied the clinical interpretation of my last titration study below. Mostly this manifests as abnormally diminished MIP and MEP values, and moderate complex apnea. It may be connected to my Ehlers-Danlos Syndrome, a connective tissue disease, and accompanying neuropathies. My autonomic nervous system is most affected, but sensory and to a lesser extent, motor, are as well. I was known to have severe apnea in infancy, my parents were told that I spontaneously grew out of it, and then it wasn't until my clever cardiologist ordered a sleep study that I was diagnosed with apnea around age 31.

"CLINICAL INTERPRETATION: This overnight sleep study documents improvement in the patient’s moderate

complex sleep apnea with bilevel pressure with a backup rate (BiPAP S/T). At the final bilevel pressure of IPAP
12 cm H2O and EPAP 8 cm H2O with a backup rate of 12 breaths per minute, the patient still had an elevated
RDI due to respiratory effort-related arousals. Given her underlying myopathy/neuromuscular disorder, I would
recommend BiPAP AVAPS which, in addition to providing a backup rate, ensures that her tidal volume is
maintained."

I realize after finding this report that I was titrated on a the S/T. And it did not suffice! So, I am not happy to be on it, especially in pregnancy, right now. But it is temporary.

I regret (and apologize to bonjour, who invited me to try beta months ago) that I have not installed OSCAR 1.1 until just now. I had been finishing my PhD and this all seems complicated enough that I joke to my husband that you all should be given honorary doctorates for your depth of knowledge in the apnea domain. Now in between PhD and work so happy to spend the time trialing the software and get you some feedback (but I may just have questions).

I have to check with insurance how frequently they cover a new machine. I've only had the Dreamstation AVAPS 2 years in December. I am reading about the ResMed AirCurve 10 ST-A and it does look impressive. I'll bring it up with my sleep neurologist and have kept a note for future reference.

Thanks all. I'll post S/T data tomorrow.
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#9
RE: BiPAP AVAPS vs. ST
With complex Apnoea, I would be looking either a Resmed ST-A or the Resmed ASV if it can maintain minute vent with the neuromuscular disorder. The ST is not the machine for you it is a rather blunt tool
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#10
RE: BiPAP AVAPS vs. ST
Your chart looked very similar to ST to me because your pressure support changed very little through the night, it appears you require pressure support pretty consistently. I will offer that the Resmed Aircurve 10 ST-A with iVAPS is more responsive and would likely avoid the hypopnea we see in that chart. Being comfortable is a bit part of therapy, and the Resmed pressure delivery is better, however if you can ever get a chance to compare, don't turn it down. The Philips pressure support response appears muted compared to what you would have with the breath by breath response of the iVAPS.

You should not consider ASV as a solution. It is not intended to maintain a consistent target minute vent, but to maintain the breath rate and minute vent in someone with central apnea, rather than a neuromuscular disorder. Take a look at the Resmed Sleep Lab Titration Guide https://www.resmed.com/us/dam/documents/...er_eng.pdf It covers all the different machines and their appropriate use and how they work. You can skip ahead to the ST and ST-A section to learn more about how those should work. The forum allows you to request up to two clinician manuals. You should request the Philips Respironics BiPAP AVAPS and Resmed Aircurve 10 ST-A and compare those. I think you will find that comparison surprising, and might help you when you discuss therapy with your doctor and DME.
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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