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[Equipment] Settings on Resmed st-a IVAPS
#1
Settings on Resmed st-a IVAPS
New to the group, so hopefully, I'm doing this right! 

I have a neuromuscular disorder and was on a resmed vauto bipap for about 3 years. I was informed that avaps or ivaps machines were better for NMD and because I was having episodes of gasping for breath, I asked to be switched to ivaps. NONE of the Drs or the respiratory therapists have experience with this type of machine. My initial settings had the mask blowing off my face and made me feel like I was hyperventilating. Lots of research later, I just hacked into it and started making adjustments. It's MUCH better now, and I can tolerate it when I'm awake. 

However, the second I start to fall asleep it pushes two forceful breaths. Obviously, this wakes me up. I have tried to figure out what is causing that, but can't seem to make that stop. I do know that with my particular NMD I have weak diaphragm and shallow breathing. I don't know if I just need to adjust more or what. I would LOVE to sleep with it, but I end up abandoning it for my old Bipap every night. I have asked the resp. therapist, and she doesn't know. I have barely put in 3 hours a day on this machine for about 2 weeks. I have no nighttime reporting. 

Here are my settings, if that helps. I just need to get some ideas on where to start. Thank you!

Mode iVAPS 
Height 66 inches
Target PT Rate 9 (learned with the learn target feature)
Target Va 2.0L/min (learned from resmed calculator)
MV 2.9 l/min (I can't change)
vt 326 ml (I can't change)
VT/kg 5.4ml/kg IBW (I can't change)
EPAP 4
min ps 4
max ps 15
ti max 2.0s
ti min .3s
Rise time min
trigger low
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#2
RE: Settings on Resmed st-a IVAPS
I sympathise with your doctors, as I have seen very few IVAPS users here. Nevertheless, I believe that OSCAR supports displaying its data and settings. So I would recommend that you download OSCAR (from the menu item in the black bar at the top), collect some data, and share some screenshots with us. You will need an SD card(size 4 to 32 GB, not larger), and a computer, any of Windows, Mac, or Linux), and an SD card to USB adaptor. If you have questions or problems, there are people here who will be happy to help you get started. Some of them have links in the signatures to useful topics (i don't Sad ).

Oh, yes, welcome to the Apnea Board. We have beginners, and learners, and experienced users who are willing to share their experience. All are welcome.
Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#3
RE: Settings on Resmed st-a IVAPS
Unfortunately, I don't have an SD slot on my laptop. Therefore, no report. But, even so. It would only be a few hours during the day.
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#4
RE: Settings on Resmed st-a IVAPS
mommadavis, a SD card adapter or dongle can be purchased really inexpensively, and you just need to decide if you need to use the USB, USB-C or otehr interface with your computer. Look for SD card adapter on Amazon, and I assume you have either a USB or USB-C port on your computer. Cost should be about $10.

Based on Neuromuscular disorder, you have the right machine. My impression is that your PT rate is too low and should be set closer to your normal respiration rate or at least 12. Va rate should be closer to 4 L/min based on your height and what we have seen from individuals your height, and MV or 4.6 L/min would be better. Vt looks okay, but your breath rate is too low. I would suggest trigger medium.

If you can post charts after getting a SD card adapter, it will help me to be more specific. Bonus! Here is a link to the Sleep Lab Titration Guide for your machine. https://document.resmed.com/en-us/docume...er_eng.pdf Start at Page 34.

'
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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#5
RE: Settings on Resmed st-a IVAPS
Oh, wow. I couldn't find a document like that! Very helpful! I'll be ordering the adapter from Amazon too. Thanks for the help!
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#6
RE: Settings on Resmed st-a IVAPS
The titration guide offers a number of suggestions for dealing with shortness of breath. The trigger sensitivity at "low" really perplexed me with neuromuscular disorder. Normally we want trigger to occur with less effort and spontaneous inspiratory flow, which requires at least the medium (default) trigger, and more likely high, which would cause your machine to trigger IPAP sooner and with less respiratory effort. After you've read the titration guide, check back with any questions.
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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#7
RE: Settings on Resmed st-a IVAPS
Got my SD card thingy in today. I ran the reports. First, with just my IVAPS and then I added my vauto, because I'm still using it at night.

I am attaching the report information. I'm not sure if it's the right info. I made a few adjustments after looking over the report, but would still welcome some advice-I'm not yet confident on what I am looking at. Thank you in advance for helping me.

Current settings:

Target PT rate: 12
Target Va 4.0 L
MV 5.2
VT 437
VT/kg 7.3 ml IBW
EPAP 6
Min PS 4
Max PS 20
Ti max 2.0
Ti min .3
Rise Time 300
Trigger low
cycle low

It's better, but I still think I might need more tweaking. Tonight will be my first night to try the new settings.

     
   
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#8
RE: Settings on Resmed st-a IVAPS
I use iVAPS.  I had an incredibly difficult time getting it to work back in April (see this thread) and basically completely failed at the time.  I have been meaning to go back and update because I have it working quite well now.  


Were you using vAuto or S mode on your vAuto?  Moving from S mode is easier.

What I learned is that you need to start with data from your vAuto.  Specifically, you want to know:
  • Your typical respiratory rate.  This should be your median if your RR is reasonably constant, but otherwise it is the periods where your rate is "not low".
  • Your typical median vent.  It might help to know your typical tidal volume, but Mv is more useful.
  • The EPAP that you need to prevent OAs.  If you were using S mode, that is just your EPAP setting.  If you were in vAuto mode, you could use your min EPAP, but if your median EPAP was a bit higher, you might use that or need to increase later.  
  • The IPAP that you need during periods when you are sleeping well.  This needs to be enough to maintain your oxygen saturation at "normal" levels.  Ideally that should be > 95%, but > 90% is probably okay or less if your normal is lower.   If you were using S mode, that is just your IPAP setting.  If you were in vAuto mode, it needs to be a typical (median?) pressure.  
So, the steps tat I ultimately followed are:

  1. Set Target Patient Rate.  This is the rate that you should be breathing at, your typical rate, though the ResMed titration guide suggests that this should not be lower than 15.  Your current setting of 9 seems to be way too low because it will only initiate non-spontaneous breathing at a rate of 6.

  2. Set Target Va.  There are calculators out there for this but the easiest way is to set your height and then adjust Target Va until you get that Target Mv that you want.  It is better to target Mv rather than Vt because Mv relates to Va directly while Vt requires consideration of RR.  Vt is often quoted because it is used by Philips machines, which are often used for titration studies.

    Now you can directly target your typical Mv that which you achieved with the vAuto.  You can target higher if you wish, but the machine will possibly need to drive your respiratory rate at times to achieve that.  My philosophy is that my typical Mv (which is a little below 6 outside of REM, which is when I have RR reductions) is adequate.  In fact, I have determined that I get "good enough" oximetry results provided my Mv stays above 5-ish.  So I currently have my Mv target set to 5.3. That sets my target Vt about 20% lower than my typical and my Vt/kg at 5.1 (it probably should not be below 5).

    Setting my Target Va this way means that I basically run at my min PS / IPAP most of the time and only increase when Mv drops because my RR has dropped.  I do this because the increase in PS is reasonably fast and "aggressive", so I save it for only when I need it.

  3. Set your EPAP - as described above.

  4. Set your min PS to the IPAP that you worked out as described above.  Make sure it is high enough to achieve the Mv that you want during your "normal" periods. 

  5. At this point, I set my max PS to min PS +1 - just to see how it would react.  I did quite well but noticed that the pressure was "maxing out quite a bit and also, in my case, I was still getting desaturations during REM.  So I increased my max PS by another 1.  That was enough for me at the time, but I am currently considering increasing by 1 again. (Although I might increase min PS by 1 first - I'd like to try get my O2 a little higher outside of REM too).

    The reason I have capped my max PS so tightly is because I found that if I increase my PS too much I (1) was prone to aerophagia and (2) was suppressing my respiration to the point where my spontaneous trigger rate dropped below 10 and the machine had to trigger for me.  I didn't recover from this to reset and so it ran for the whole night.  It was unpleasant. It is possible that this wlll not be such an issue for you.

  6. I have trigger and cycle both set to medium

  7. I have T rise set to 0.9 and Ti min set to 1.  I did this because I transitioned to my new machine from an AS10 Elite with EPR set to 3, so it had the EasyBreathe comfort settings used.  I found the fast rise time (0.3 sec) uncomfortable and had been told that rse time only needed to be short for COPD patients.  

  8. I have Ti max set to 2.5 sec simply because I breathe deeply as I fall asleep and that is more comfortable.
I should mention that, other than the fact that my RR decreases during REM, I still have no diagnosed condition to explain what my problem is - a source of much frustration with my current respiratory specialist.  I did, however, have a sleep study done a few weeks ago and have my follow-up in about 2 weeks.  Perhaps I will learn something then.

I have attached two charts.  One, from a few nights ago, shows how my machine is working currently.  the second, from April, shows what my RR chart looked like when my PS was too high (because I had my Va target set too high) 

I hope this helps


Attached Files Thumbnail(s)
       
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#9
RE: Settings on Resmed st-a IVAPS
Be sure to post the detail charts like StuartC did above. These charts show us much more about what is going on in your therapy and settings.
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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#10
RE: Settings on Resmed st-a IVAPS
I thought I should point out the settings on the second of the charts I posted previously - the one from April. They show in OSCAR as EPAP: 5 - 15 and IPAP 9 - 24. They were, in fact EPAP: 5, IPAP: 9 to 14.

The reason for the discrepancy is that OSCAR was reading (the default) EPAP max from the machine even though I had Auto EPAP off. To fix the issue, I turned Auto EPAP on, set Max EPAP to 5, then turned Auto EPAP off. I have a Lumis 150 ST (Aussie version of the machine with iVAPS mode) so perhaps yours does not have the same problem, but you can try that if you do.
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