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[Equipment] ResMed AirCurve 10 VAuto or ST
#11
RE: ResMed AirCurve 10 VAuto or ST
I don't think you don't need a vauto, it doesn't have a backup breath. The doctor may have thought this before your sleep study?
Or your doctor is mistakenly thinking the vauto has a backup breath, you need to clarify this. A machine without a backup breath may be ok in a 12 week review. I wouldn't choose one now.

At this point of time, given the pressure induced CA. It seems the sleep study showed that you need 25/16 with a backup breath when a CA hits. In all probability, these CA will resolve over 12 weeks. They correctly want a ST because you don't have a central nervous system disorder, but only a new user pressure induced CA. You haven't said what problem you have, whether it's obstructive or restrictive. In either case you need 25/16 or min epap 16 PS 9 to clear it. PS 9 indicates you have a significant need to assist you to get enough air in each breath.

I think the ASV and also I add the vauto aren't the machine for you, because both are maxed out at your pressure setting. 25/16. there is no room for them to move, so neither will auto the pressure. The ASV will give a variable backup rate for the last 5 minutes average, but can't give you the 16 (or higher if you need it later). It also has a max setting of min 6, so it can't do the min ps9
Also we don't know what other settings they used in the ST to shape your breath. They all aren't available in all machines.

If it was me, I'd choose the avaps or ivaps. (I have the resmed ivaps, I don't know how well the philips avaps work, I also have an asv) a/i vaps can go to ipap 30cm if needed and auto variable backup rate. It also still has the ST mode with fixed pressure and backup, if you prefer that. Also with the auto amount of air, it will give you what you need when you need it at the pressure you need. With sleepyhead, you will be able to fine tune the pressures.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap from machine data, or software. Set the min pressure at 'med' median pressure or 90% OR 2cm below 95% pressure. max pressure at 20cm for now. Forum will help you fine tune settings
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#12
RE: ResMed AirCurve 10 VAuto or ST
When you get your machine, which ever one the doctor, lab and you decide on. Put some charts up for opinions.
I wonder if you have some positional apnea, by tucking your chin to chest, etc. That may be also be worth looking at. It's not that unusual when high pressure is needed.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap from machine data, or software. Set the min pressure at 'med' median pressure or 90% OR 2cm below 95% pressure. max pressure at 20cm for now. Forum will help you fine tune settings
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#13
RE: ResMed AirCurve 10 VAuto or ST
Hi Sleeprider, this is a very good description of Resmed machines with Bilevel and backup rate support!
My wife is getting a pulmonary lung test next few weeks, and by reading some of the articles in this forum, I suspect my
wife is having restricted lung function due to her scoliosis spine. 
By reading this article, sound like the ST-A is the machine that she needed to assist her breathing. 
Anyway, I should get a clearer picture after the lung test and the Bilevel titration test in next few months!
I shall keep you posted!
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#14
RE: ResMed AirCurve 10 VAuto or ST
(03-29-2019, 04:55 AM)gumleafau Wrote: Hi Sleeprider, this is a very good description of Resmed machines with Bilevel and backup rate support!
My wife is getting a pulmonary lung test next few weeks, and by reading some of the articles in this forum, I suspect my
wife is having restricted lung function due to her scoliosis spine. 
By reading this article, sound like the ST-A is the machine that she needed to assist her breathing. 
Anyway, I should get a clearer picture after the lung test and the Bilevel titration test in next few months!
I shall keep you posted!

Thanks. I'm glad the information helps.  I hope you will post the results in the thread you started earlier and we can talk about the machine alternatives there http://www.apneaboard.com/forums/Thread-...p-at-Night
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#15
RE: ResMed AirCurve 10 VAuto or ST
Hi ajack, Sleeprider, all,

Important differences exist between the capabilities of ResMed ST-A versus Philips-Respironics ST-A. The ResMed AirCurve 10 ST-A can treat Central Apneas but the P-R ST-A cannot. Also, the ResMed ST-A only allows fixed (not auto-adjusting) EPAP.

Similar to an ASV, the ResMed ST-A will very quickly (within a few breaths) adjust PS all the way up to its max, if necessary, to prevent a Central Apnea. In contrast, the P-R ST-A will only adjust PS by a small amount once per minute or so, and therefore cannot treat CA.

The main differences between the AirCurve 10 ASV versus the AirCurve 10 ST-A are:
1. Different feel; the “Easy Breath” waveform of the ResMed ASV smoothly rises and smoothly falls, versus the choppy on/off feel of an S, ST or ST-A machine. (On my ST-A, I adjusted the Risetime to its longest value, 900 milliseconds, which made the pressure rise from EPAP to IPAP fairly smooth, but the fall time is not adjustable and is abrupt. I’ve gotten used to it now, but for a while I really missed the smoothness of the ResMed ASV waveform.)
2. The EPAP is manually adjustable (does not automatically adjust) on the S, ST and ST-A machines.
3. When it came time to get a new machine, this is why I chose the AirCurve 10 ST-A: it has a manually adjustable lower limit for the alveolar Minute Ventilation. (Mine is set for a minimum of 10 Liters per minute.)  When I was using a ResMed ASV, I would sometimes notice in my sleep data that sometimes my Minute Ventilation would gradually drop lower and lower until I had an arousal from sleep because too little breathing was occurring. Now I have a floor below which the ResMed ST-A will not allow my Minute Ventilation to drop below.

Take care,
— Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.  The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea.
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#16
RE: ResMed AirCurve 10 VAuto or ST
vsheline, I'm not sure I get all that you've said but it's good scoop. thanks. I have a couple questions that may or may not be off-topic for the OP, but maybe of interest.

when you say your minute ventilation dropped on asv, does that mean it wasn't handling / keeping up with central apneas? I've been under the impression asv is the so-called gold standard for treating centrals.

also, does your floor of 10L/m correspond to sleepyhead reported min, med, or 95%? 'floor' sounds like a minimum and 10 looks quite high compared to my numbers. SH reports my min as 0.00. I don't think my med (really the only minute vent. number I've paid much attention to) has been more than about 8.5. last night, for example, my med minute vent. was 8.12 and tidal volume 520. with your floor of 10L, is your tidal volume commensurately higher?

edit: now I'm thinking respiration rate is a related variable. guess I need to read up on what these things are, why they're reported and how we should interpret them. thanks for any insight (or link) anyone has to offer.
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#17
RE: ResMed AirCurve 10 VAuto or ST
(03-30-2019, 09:16 PM)sheepless Wrote: vsheline, ... when you say your minute ventilation dropped on asv, does that mean it wasn't handling / keeping up with central apneas?  I've been under the impression asv is the so-called gold standard for treating centrals.

also, does your floor of 10L/m correspond to sleepyhead reported min, med, or 95%?  'floor' sounds like a minimum and 10 looks quite high compared to my numbers.  SH reports my min as 0.00.  I don't think my med (really the only minute vent. number I've paid much attention to) has been more than about 8.5.  last night, for example, my med minute vent. was 8.12 and tidal volume 520.  with your floor of 10L, is your tidal volume commensurately higher?

Hi sheepless,

Central events are commonly fairly rapid, and ResMed ASV responds to these excellently, auto-adjusting the PS within a few seconds to maintain 90% (I forget whether it is 90% or 95%) of the average Minute Vent measured over the most recent several minutes.
 
But if MV drops gradually to 90% in five minutes or so, and again to 90% of the new lower average in the following 5 minutes, and again in the following 5 minutes, et cetera, I think the ResMed ASV algorithm will accept this as natural variation and will not intervene even when average MV may have cumulatively dropped well below what the average MV had been 20 or 30 minutes earlier.
Algorithm Details: https://www.ncbi.nlm.nih.gov/pmc/article...po=85.8333

On the ResMed ST-A, my setting of 10L/minute would correspond to a minimum allowed alveolar MV, meaning I wouldn’t expect to see a minimum less than that in SleepyHead.  If my respiration rate were 15 breaths per minute, the minimum alveolar tidal volume might be one fifteenth of that, approximately 670 mL.  (I’m a big guy, nearly 6’3”.)

Take care,
—Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.  The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea.
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#18
RE: ResMed AirCurve 10 VAuto or ST
thanks Vaughn. I think I get it now. also thanks for the link which on first skim looks to be quite informative. Halokittie, sorry for the diversion.
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