[Equipment] BiPAP AVAPS vs. ST

[KuriApollo]

Here is last night's ST data. AHI went down from previous 2 nights. As Sleeprider suggested, maybe it's not much worse than my AVAPS.
Ignore the Breathing Not Detected -- I had machine running before I used it to get out a cologne smell from the DME office.
To clarify, I have no intention of switching to ST. This is just a loaner while I wait for my AVAPS to be replaced.

[sawinglogz]

Well, it looks like they've switched you to fixed bi-level on this machine. I don't remember whether BiPAP S/T will auto-titrate at all (or whether that's contraindicated by your condition)?

Second, I notice that you're running an old version of OSCAR -- please update OSCAR to version 1.1.1! (It handles AVAPS much better.)

[Sleeprider]

Your therapy is on fixed bilevel with EPAP 9.0 and IPAP 20.0 (PS 11.0), and without the backup breaths of ST mode. It is not working very well.  Here is the titration guidance for BiPAP. With all of the obstructive apnea and hypopnea, you need to increase the minimum EPAP pressure, which would yield fixed pressure of 21/10.0.  I find it hard to believe this is acceptable therapy, so I'm also including the Resmed titration protocol for ST, which is a bit more sophisticated.

[SarcasticDave94]

I think I'll start volunteering to hit docs with a dope slap hammer for doing this. If my doc did this to me, he may be in hospital and me in jail.

In all seriousness, I hope you get off that ancient tech ST ASAP.

[KuriApollo]

Many thanks for the heads up on the new version, sawinglogz. I've updated OSCAR and now the machine settings correctly (I trust?) display. As promised, the DME coordinator DID set backup rate, and it's actually in ST mode, not fixed bilevel as the last attachments I posted from outdated OSCAR state. I guess OSCAR 1.1.1 handles S/T data better, too, but it did warn me upon import that:

"Your Philips Respironics DreamStation BiPAP S/T 30 generated data that OSCAR has never seen before...." so I have messaged developer just in case. Might this be because I used same SD card from AVAPS and it's confused by data from second machine?

Sleeprider -- do things look any better with these charts?

Dave -- I thank you, and no worries. The S/T is just a loaner. My new AVAPS will ship Monday.

Thanks all, 
KA

[SarcasticDave94]

Glad to hear you'll be back on an AVAPS soon. Even though the charts show somewhat low events, it just looks messy. A great weekend to you.

[Sleeprider]

KuriAppolo, I need to ask how you feel on this therapy. Do you feel like the breath rate syncs well with your needs?  If I have this right, your machine has several modes, including S, T and S/T.  That means spontaneous, timed and spontaneous/timed. Your machine appears to be on ;FIXED Time of 10 breaths per minute which may be similar to the Timed mode in Resmed below.   If in your settings you see "fixed", you might want to change that to ST which would allow you to take some spontaneous breaths.  I have quite a bit of uncertainty here because I don't have a copy of the clinical manual for your particular machine but have put in a request for the Respironics BiPAP AVAPS setup manual.  I have the Resmed ST-A manual, and these are the available modes for that machine:

S (Spontaneous) mode
In S mode, you may set two treatment pressures-–one for inspiration (IPAP) and one for expiration
(EPAP). The device senses when the patient is inhaling and exhaling and supplies the pressures
accordingly. The difference between IPAP and EPAP levels helps determine the tidal volume.

ST (Spontaneous/Timed) mode
In ST mode, the device augments any breath initiated by the patient, but will also supply additional
breaths should the patient breath rate fall below the set Backup Rate.

T (Timed) mode
In T mode, a fixed breath rate and a fixed inspiration/expiration time are supplied regardless of
patient effort.

PAC (Pressure Assist Control) mode
The inspiration time is preset in the PAC mode. There is no spontaneous/flow cycling. The
inspiration can be triggered by the patient when respiratory rate is above a preset value, or time
triggered breath will be delivered at the set Backup Rate.

[sawinglogz]

KuriApollo, thanks you for the sample data. Your data is getting imported correctly, but we had never encountered the mask resist lock on an S/T before, so we hadn't tested that bit yet. Now we have, and the next version won't fuss about it.

A few things I noticed:

1. This loaner S/T machine has mask resist turned on, and locked (see above). Your AVAPS had no mask resist enabled. I don't know if that's causing you any problems in practice, others may know.

2. Your tidal volume on the S/T looks terrible. It really should not be crashing like that, which is presumably why your doctor has you on an AVAPS normally.

3. In answer to Sleeprider's query, yes, the S/T on the DreamStation acts like the S/T mode on Resmed. In this case "fixed" means that the backup rate is fixed rather than adaptive. But S/T mode will also switch to IPAP pressure when it detects you initiating a breath (unlike T mode).

4. I'd be curious to see your respiratory rate graph. It looks like you're getting mostly machine-initiated breaths, and when you start breathing faster than 10 bpm on your own, it looks really shallow.

5. You can fix your fonts by going to OSCAR > Preferences... > Appearance and for the "Application" font selecting ".SF NS Text", which will make it use the system font as it should. (There was an old bug in OSCAR that would sometimes reset your font to the first font in alphabetical order, which tends to be Abadi MT Condensed Extra Bold if you have Microsoft Office installed. And once the old version had done that, we had no good way of correcting it in the fixed version.)

@Sleeprider, the service manual for the AVAPS is out there if you google for it, and it includes the setup instructions.

[KuriApollo]

sawinglogz: Thank you for that interpretation and for confirming correct data import. I am attaching respiratory rate graph from same night.

I don't know what mask resist means but will look into it and if needed request that DME change it since it's locked.

sleeprider: Thank you. I feel even more tired on this therapy (I didn't think it was possible to feel more tired on top of my chronic disease baseline and first trimester pregnancy exhaustion). I generally fall asleep quickly and easily and typically stay asleep, but when I do wake up I feel like the S/T is suffocating me by not adapting to my breaths the way AVAPS does. In that event, I have re-initiated ramp (20 min probably not necessary, I should halve that) and fallen back asleep. So, no, when I am conscious, I do not feel that the S/T breath rate syncs well with my needs. And it clearly does not maintain my tidal volume very well, which maybe accounts for the breathlessness feeling if/when I awake. I assume my inability to maintain tidal volume on my own is due to the respiratory muscle weakness demonstrated in repeated spirometry studies, which have impressed pediatric and adult pulmonologists alike since first studied in my adolescence. 

Data in OSCAR says it's in S/T mode, but when I check the machine itself I do not see mode listed under provider settings at all, so I can't confirm. If it is in fact on S/T mode, I thought spontaneous breaths would be accommodated. Yet, I am not sure how S mode differs from auto-titration, which I am pretty sure S/T models do not do.

To be sure, my sample size is low for how it feels to be on the S/T therapy, I usually sleep through it the same as on AVAPS.

[Sleeprider]

Please get the Resmed Aircurve 10 ST-A with iVAPS. Why would you not get a therapy with smart breath rate and intelligent alveolar minute vent support? You should have the best therapy on the market. Just because your medical team has no clue is not an excuse. Ask for it!