[Equipment] Central Apnea

[sawinglogz]

Could you post a screenshot where you've scrolled the left panel down further so that we can see all of your "Machine Settings"?

[Sleeprider]

I have to ask, how willing are you to radically change your settings? Your machine is capable of targeting minute ventilation and using adaptive pressure support to maintain it. I know we can significantly cut these hypopnea and apnea using iVAPS mode. This is nothing like what you are currently using, however it is far preferable to use ASV. As long as you have failed efficacy on this machine, how is it your doctor has done nothing about it? Have you looked for a different practitioner that will actually treat you?

[SarcasticDave94]

In my opinion, we might get the ST-A to be close to the ASV in iVAPS mode where you'd have a static EPAP like now, but a PS range and backup rate.

Backup rate and Tidal Volume would need determined, but changing to iVAPS mode, EPAP 8 to keeping it at 10 maybe (would have to adjust and trial and error), PS 3-15 or something similar to this might be a little to a lot better. No Ramp due to CA.

Dr. DoNothing needs to be made aware NOW this therapy as it is needs to be counted as a big terrible Trainwreck failure! Demand a change.

[gbbarrie]

Goodness that looks like it feels awful...

I can see for myself that the machine is completely limited to a fixed pressure and it looks like you have the ramp on. Do you need that in order to get used to the higher pressures? If not, it's probably going to be suggested that you turn it off, because during that 20 minutes, you aren't at the full therapy pressure and if you are having events, the machine doesn't mark them.

Other than that, I'm going to leave those members familiar with the Resmed VPAPs to help with settings.

When I go to bed I always watch the late news before turning the light off which is 30 mins - so I feel the ramp when it reaches maximum and my mask fully inflates ( and sometimes leaks ) so I can adjust it before settling down, it is not something I requested it is just how they set it up.

[gbbarrie]

I have to ask, how willing are you to radically change your settings?  Your machine is capable of targeting minute ventilation and using adaptive pressure support to maintain it.  I know we can significantly cut these hypopnea and apnea using iVAPS mode. This is nothing like what you are currently using, however it is far preferable to use ASV.  As long as you have failed  efficacy on this machine, how is it your doctor has done nothing about it?  Have you looked for a different practitioner that will actually treat you?

Well this is a loan machine and I am not sure if they will be happy with me making adjustments to it - however they are approachable so I will give them a call and see if they will sanction me making adjustments myself. My sleep specialist I haven`t seen in months I had an appointment Dec 15th with a blood test in pulmonary but then saw one of her junior Drs because he said ( she was travelling ).

[gbbarrie]

sawinglogz pid='430599' dateline='1642360087']Could you post a screenshot where you've scrolled the left panel down further so that we can see all of your "Machine Settings"?

[Ratchick]

You should be able to turn the ramp off yourself even without going into the clinical menu. It's just a comfort issue so it's up to you. It's not so much of an issue when you go to bed and you're watching the news for a while, but if you stop the machine in the night to pee or something, it then runs for another x minutes of ramp while you are (hopefully) already sleeping. So if you did want to try without it, it should be a problem.

[Sleeprider]

Well this is a loan machine and I am not sure if they will be happy with me making adjustments to it - however they are approachable so I will give them a call and see if they will sanction me making adjustments myself. My sleep specialist I haven`t seen in months I had an appointment Dec 15th with a blood test in pulmonary but then saw one of her junior Drs because he said ( she was travelling ).

Gbarrie, it's easier to ask for forgiveness than permission.  They have put you on a machine that simply does not work and your health is suffering.  If you have any conversation with them, that should be it.  You need a different therapy device, and it is your doctor's job to figure it out.  What you do to defend your health by optimizing the settings available on that machine is not something you should need permission to do.  Ask when they are scheduling your ASV titration, or swap your machine for ASV.  Let's hope it is soon.

[Dormeo]

Gbarrie, in every conversation with them, reiterate that you are having severe apnea even with the treatment they have recommended for you.

Sleeprider, what settings would you recommend on the current machine? If you provide the information, then if Gbarrie feels he must talk with the clinic before making changes, he can tell them precisely what he is going to do.

Gbarrie, I'm still curious to know the answer to these questions: Do you have some way of knowing that these hypopneas are central in nature (rather than obstructive)? For example, did you have a bunch of central hypopneas flagged in your sleep study? Anything else you can tell us about how your doctor arrived at the diagnosis of central apnea?

[Sleeprider]

My recommendation would be to use default initial iVAPS settings. We don't know the patent height  or ideal body weight which need to be considered.  The target breath rate appears to be about 16 BPM. We don't have ideal body weight for the Alveolar volume setting, but based on current minute vent results it appears to be between 350 and 400 mL.  We would start with EPAP 5.0 cm and use the PS range of 4.0 to 20.0 as suggested in the protocol.  Results will indicate obstructive apnea as UA which would indicate a need to raise EPAP.  Titration with iVAPS is ideally conducted while using a recording oximeter as described below.

NOTE: this therapy is not ideal for central and complex apnea, and Gbbarrie has been improperly dispensed a ST/ST-A machine.  First and foremost, I'd like to see that error corrected ASAP.