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Future BiPAP user.. Which machine to ask for?
#91
Really the only difference between a BiPAP S and the ST is the timed IPAP function. As far as I know it does not have any auto EPAP or variation in delivered PS. If it actually works for you, I'll be the first one that is amazed. I really don't think the doctor has thought this through, and it would be interesting to ask him at some point whom he has successfully treated with ST and what his measure of success is.

Do you have a pressure prescription? Sorry for may short term memory lapse if you already mentioned it.
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#92
Herb, I sincerely hope the machine they put you on really helps instead of makes you worse than your current status. I don't like these insurance and doctor baby step stage things they make patients go thru to get better. But at least you're making a little progress. IMO you're still going to end up on an ASV, but again this is my opinion.


Sleeprider since I live in Franklin county PA, we are very close to several Civil War battle locations. Gettysburg, Antietam, Manassas, Bull Run are a few. Very cool tours and things like that. And of course Washington, D.C. is about 90 min away where there's the Smithsonian and other stuff. FWIW look on Google map or equivalent and look at south central PA where I 81 crosses into Maryland. 2 miles north of that PA/MD crossing is my little hick area.

I'll let report my status change after second opinion consult this afternoon here in sketch form and in greater detail in my own thread.
Sarcasm is a hobby of mine. I am not sarcastic on serious issues, implied or otherwise.
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#93
(04-28-2017, 07:13 AM)Sleeprider Wrote: Really the only difference between a BiPAP S and the ST is the timed IPAP function.  As far as I know it does not have any auto EPAP or variation in delivered PS.  If it actually works for you, I'll be the first one that is amazed.  I really don't think the doctor has thought this through, and it would be interesting to ask him at some point whom he has successfully treated with ST and what his measure of success is.

Do you have a pressure prescription?  Sorry for may short term memory lapse if you already mentioned it.

Yes, 11/6 10bpm (at least it's not too high)


You're correct, no auto EPAP or PS variation. PAP iron lung.

It monitors breath rate, and switches from spontaneous to timed IPAP and EPAP.

There are quite a few slope/trigger adjustments to accommodate different breathing patterns.

This may be the way I can manage my 3 month stint on ST.

Of all the people I've talked to around here, the DME tech who is setting up my machine seems the only one who has a complete grasp of the machine's capabilities. Might be a lucky break.


Since the doctor's prescription only lists pressure settings, I plan to ask the Tech to work with me on the settings I've listed below. Especially the TiControl’s Ti Max and Ti Min parameters, and the rise time.

I'm hoping he has some latitude in moving from the default settings, since no specific settings were stated in the prescription.

This is also what I was referring to when I mentioned "tweaking the settings".

I don't know if the settings apply to the timed mode in addition to the spontaneous.
When I get it home, I'll try varying my breath and see how it works or maybe go over it with the tech.
 

Triggering and cycling
VAuto, S and ST modes only
The device has adjustable trigger/cycle sensitivity to optimize the sensing level according to patient conditions.
Under normal conditions, the device triggers (initiates IPAP) and cycles (terminates IPAP and changes to EPAP)
as it senses the change in patient flow. Patient breath detection is enhanced by ResMed's VSync automatic leak management.

Rise time adjustment
S, ST and T modes only
Rise Time sets the time taken for the device to reach IPAP. The greater the rise time value, the longer it takes 
for pressure to increase from EPAP to IPAP.
Patients with a high ventilatory demand may prefer a shorter rise time, while patients who are slow breathers 
may prefer a longer rise time.
Note: A prolonged rise time inhibits fast pressurization, therefore, rise time should not be set longer than Ti Max or the patient's normal inspiratory time.

TiControl - Inspiratory time control
VAuto, S and ST modes only
Unique to ResMed bilevel devices, TiControl™ allows the clinician to set minimum and maximum limits on the time the device spends in IPAP. The minimum and maximum time limits are set at either side of the patient’s ideal spontaneous inspiratory time, providing a ’window of opportunity’ for the patient to spontaneously cycle to EPAP.
The minimum time limit is set via the Ti Min parameter and the maximum time limit is set via the Ti Max parameter.
TiControl’s Ti Max and Ti Min parameters play a significant role in maximizing synchronization by effectively intervening to limit or prolong the inspiratory time when required.
This ensures synchronization even in the presence of significant mouth and/or mask leak.

The manual also has detailed illustrations showing how it works.



Concerning data collection:

Central sleep apnea detection
Central sleep apnea detection is available in VAuto, CPAP and S modes (when Easy-Breathe is
enabled) on AirCurve 10 VAuto and AirCurve 10 S devices.

NOTE the absence of ST mode in Central sleep apnea detection.

The tech said I can use the data from the machine to support my request for an ASV.

I'm hoping he didn't base his conclusion by glancing at the bold heading.

He did say he had patients who used the information, so we'll see.
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#94
Here's my report after seeing WellSpan on second opinion: Doc "I don't have any idea why you're on a BiPAP. You need to be on this other device called ASV. I also don't know why this doctor chose a setting of 15/10 when it's creating high levels of central apneas. Let me get a report from your DME showing BiPAP activity. I'll call you on Monday. We do need to do an echo test to make sure about a heart condition that can be an issue with some. If we cannot go ASV, you'll need to be on oxygen. Finally just be aware my team has experience working with other patients that need ASV machines."

Me "Assume ASV is my definite path, and the echo test didn't reveal the heart issue, can you and I request ResMed Aircurve 10 ASV and a heated tube specifically?"

Doc "If that's what you want then yes. OK until Monday then. Have a good day."

Thanks like Coffee Eat-popcorn
Sarcasm is a hobby of mine. I am not sarcastic on serious issues, implied or otherwise.
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#95
I'm liking Dave's story better than Herb's.

I use a Ti min of 2.3 on the Vauto, so I know of the tweaks of which you speak.
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#96
Herb needs to see Gettysburg battlefield and WellSpan doc. My next step is the echo test.
Sarcasm is a hobby of mine. I am not sarcastic on serious issues, implied or otherwise.
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#97
(04-28-2017, 08:23 PM)Sleeprider Wrote: I'm liking Dave's story better than Herb's.

I use a Ti min of 2.3 on the Vauto, so I know of the tweaks of which you speak.

I'm liking Dave's story better too.

Right, Vauto has a Ti setting.  Didn't think of that, DUH.



Picked up the ResMed AirCurve 10 ST today.

The tech had me test the AirFit P10 mask with the machine.

I asked about the trigger settings and Ti min & max.

He had the machine facing toward me and seemed to made a point of entering clinical mode while I paid attention.
Nudge-nudge, wink-wink.

He adjusted the settings based on my preference until I felt comfortable.

Feels waaaayyyyyy better than the PSG machine did.

Will see how it goes tonight.
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#98
(04-28-2017, 05:00 PM)SarcasticDave94 Wrote: Here's my report after seeing WellSpan on second opinion: Doc "I don't have any idea why you're on a BiPAP. You need to be on this other device called ASV. I also don't know why this doctor chose a setting of 15/10 when it's creating high levels of central apneas. Let me get a report from your DME showing BiPAP activity. I'll call you on Monday. We do need to do an echo test to make sure about a heart condition that can be an issue with some. If we cannot go ASV, you'll need to be on oxygen. Finally just be aware my team has experience working with other patients that need ASV machines."

Me "Assume ASV is my definite path, and the echo test didn't reveal the heart issue, can you and I request ResMed Aircurve 10 ASV and a heated tube specifically?"

Doc "If that's what you want then yes. OK until Monday then. Have a good day."

Thanks like Coffee Eat-popcorn

Dave that's GREAT news!

You're on your way.

Congratulations!
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#99
Yes thanks. It won't be too much longer and I can say I've got the ASV, and post pictures of it too. And yes, I'm being specific, the ResMed Aircurve 10 ASV and their heated hose.

I'm curious about one thing though. Any thoughts out there on if I should be motoring oxygen levels? If so, now's likely the time to request getting an Oximeter I'd guess. While I'm awake, as in at the various doctors' office visits, oxygen levels are typically in the 94-97 range.
Sarcasm is a hobby of mine. I am not sarcastic on serious issues, implied or otherwise.
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(04-29-2017, 06:31 AM)SarcasticDave94 Wrote: Yes thanks. It won't be too much longer and I can say I've got the ASV, and post pictures of it too. And yes, I'm being specific, the ResMed Aircurve 10 ASV and their heated hose.

I'm curious about one thing though. Any thoughts out there on if I should be motoring oxygen levels? If so, now's likely the time to request getting an Oximeter I'd guess. While I'm awake, as in at the various doctors' office visits, oxygen levels are typically in the 94-97 range.

SleepRider is the expert, but from my novice perspective, it's another window to see what's going on during the night.

While the data from the machine shows the cause, the oximeter shows the effect on your oxygen saturation.


BTW, the oximeter that attaches to the machine is astronomically expensive, but my older model CMS50F can be purchased for $50 on ebay. (Ships from China, free shipping but 2-3 weeks to arrive) It only holds 1 waveform at a time, but I download it faithfully every day so it doesn't matter to me.

It comes with version 3.5 firmware and a straight sensor plug that sticks out toward the wrist, and if you bend your wrist up during the night might be a problem. It's been OK for me, just saying. Also, you have to be careful inserting the plug because it has 5 pins that can be bent if forced. No biggie once you get the feel for plugging it in.

The newer model, $85 from Commercial Link Removed, do a search on the Walmart site.

It has a angled USB type connector on the other side of the oximeter so no problems, and newer firmware. Still only holds 1 waveform.  

Any one you go with can sync the time with the machine, so the final sleepyhead chart is the same as the $$$ one that plugs into the machine.

There is also another model ($105-$120) that holds multiple days and has bluetooth capability I think.









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