Newbie Needs Help - Dreamstation 1030X

[muziccity]

Thanks so much for the feedback everyone.  I hoped I would be one of the few who was an overnight success and immediately felt better, I never expected to actually be feeling worse. 

Here is what it says on the underneath of my machine: DreamST ST30 H/C DSX1030X. For the first week that I had it, it was set on ST mode. This mode makes my chest hurt and makes my heart pound. It instantly raises my blood pressure but not due to anxiety, I am extremely comfortable with this machine and the nasal pillows at this point. It also gives me an immediate headache. I was determined to stick with it but none of those issues subsided after that first week. Also every night when I would fall asleep for the first time it would wake me up and I would feel like I had stopped breathing and sort of take a deep breath of air in a panic. It's very strange and hard to describe but it happened everytime. I dont know, maybe its supposed to do that. Another side effect is when I wake up in the morning, I feel very light headed, disoriented and dizzy. I remember one day in particular it was so bad, I had trouble walking. 

So for that first week, my AHI was between 20-30 and that is why I switched it myself over to the CPAP setting. On CPAP, my AHI has dropped down to 5-10 but there's not really any settings I can tweak to improve it. The only thing I can adjust is the cmH20 and I've been experimenting between 11-18 to try to find what was working best. 

But it sounds like this machine is totally wrong for me. My concern is my doctor is gonna be like "Well you changed modes, we need to go back and stick to ST mode". The strange thing is after my first sleep study he told me I would be getting a ResMed. He showed it to me in the office, then after my second sleep study I was referred straight to the clinic and given this machine. So I never spoke with my doctor or heard the results from that 2nd study, so I don't know why they put me on this machine but I will schedule a follow up and see about it, he does seem to genuinely care but no doctor likes to be told he's wrong. 

I was reading through my medical records online and found a diagnosis that says "Idiopathic sleep related non-obstructive alveolar hypoventilation & Obstructive sleep apnea". Now, this was after my first sleep study but before my 2nd sleep study. The diagnosis after my 2nd sleep study says "Treatment-emergent central sleep apnea & sleep-related hypoxia"  The different diagnosis confuse me. I might be reading it wrong but it looks like my oxygen levels were low during the first study but normal during the second? FWIW, I did take a soma and a valium to fall asleep during the study. I have to assume that made things worse and I do not normally take those. As far as weight, they did categorize me as obese. But here's the thing, I'm 5-10 and 220 pounds which is barely obese but the crazy part is 3 months ago I was 200 and 6 months before that I was 185 which was my normal weight for 10 years. I dont know why I'm gaining weight like crazy, when I used to be able to maintain it. I know this is only making it worse for me. 

I'm degrading. These past 10 years, month after month I'm just going downhill in every way. These few paragraphs took me hours to write and read back through and there's random words in sentences that don't even belong. I'm watching myself just fall apart. Lack of concentration, loss of memory, no focus or drive. No goals or energy. I'm just tired all day. I'm extremely depressed but only due to problems caused by tiredness. I feel like I have stayed up for 4 days straight and just ran a mile. That's how I feel every minute and people don't understand. I get an appointment for a week away at 2pm and I have anxiety all week trying to figure out how I'm gonna time my sleep and naps perfectly so I can wake up at 1:30 and be able to make it to the doctors office. Someone tell me you felt this way too and it will get better.

[SarcasticDave94]

This is definitely in my opinion indicating the ST is not the right machine for you. Complain or get another doctor that will listen. I believe you need a ResMed Aircurve 10 ASV.

DSX1030 is showing as an ST:



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[sheepless]

I felt that way & it gets better. it's tempting to elaborate but for now I'll just say that in my own experience & 3 years of reading about other members, perseverance pays off. after all, the alternative leaves much to be desired.

[muziccity]

I was wondering what's the difference between ST mode and AVS. I found some interesting posts on this forum and have learned a lot from them but I would like to be super prepared when I go into my appointment on Monday. As it applies to me, how would I benefit more from AVS and why does the Dreamstation not work for me? 

I'm feeling optimistic, thanks so much for your help.

[SarcasticDave94]

1. ResMed ASV typically is more comfortable and more aggressive in attacking apnea events versus Respironics. This is by comments here on AB. It was why I chose ResMed ASV when the time came.

2. Why ASV instead? ASV is the best tool to fight central and complex apnea. Complex apnea is both Central and Obstructive events mixed. This is you. (I had excellent results with the ASV combating my complex apnea therapy needs.)

3. ST is more for those with lung disease like COPD or other such ailments. Assumed NOT you.

Get the ResMed AirCurve 10 ASV and you will not regret it. I can assist other pressure gurus in setup. ResMed has titration protocol that will get you off and running quick.

[muziccity]

So I went ahead and borrowed my dad's ResMed Airsense for a quick nap just so we can have some data to look at before my Monday appointment. I don't really know how to read it, any thoughts? I feel like it took me about an hour to fall asleep, maybe I'll use it overnight.

[Sleeprider]

Before discussing your chart, let me say you need ASV. Do not try to predict how your doctor will react when you ask for a titration study for ASV, just do it! Every day you spend on the wrong machine is another day that stresses your heart and body, and results in poor sleep. You have diagnostic and titration studies that clearly point to the need for ASV. All you need to do is ask, and obtain the heart health screening that will be part of the approval process.

Your chart with OSCAR confirms the results from your sleep study posted earlier. You have complex sleep apnea, and with CPAP pressure, most events are central and hypopnea. Even in the parts of the chart with no events, I see a fluctuating respiratory flow that suggests some periodic breathing and respiratory instability. From what I am seeing on this chart, it would appear you would get better therapy on Auto or fixed CPAP at relatively low pressure, than using your ST. This is a common result for individuals with complex apnea, however your results on CPAP will be consistently inconsistent. Sometimes good, sometimes not, because CPAP does not treat central apnea or hypopnea.

Let's talk about the different types of machines and how they relate to your problems. This document shows how each machine is adjusted to meet patient needs and describes the intended use of each machine. Please review the intended use of the ST and ASV and you will quickly see you have the wrong device https://www.resmed.com/us/dam/documents/...er_eng.pdf

1. Auto CPAP (Airsense 10 Autoset). This machine is intended to treat obstructive sleep apnea, and works by supplying enough pressure to gently expand the upper airway to prevent collapse ore restriction. The auto-CPAP uses a built in algorithm to increase or decrease pressure based on the amount of airway restriction its sensors detect. The CPAP usually provides a single channel of pressure, however the Resmed is capable of reducing pressure during exhale which resembles bilevel therapy and increases the user's comfort. This machine has no capability to apply a higher pressure in the event of a central apnea or hypopnea, or to maintain respiration rate. This machine is only useful for individuals with spontaneous respiratory effort.

2. Bilevel (BiPAP, VPAP, Aircurve 10 Vauto). This machine is also intended to treat obstructive sleep apnea and works in the same way as CPAP to prevent obstructive apnea. The machine supplies separate inhale (IPAP) and exhale (EPAP) pressures which can be used to help resolve flow limitation, and hypopnea better than single channel CPAP pressure. Like CPAP it relies on spontaneous breathing effort and does not treat central apnea.

3. Bilevel ST (Spontaneous/Timed). This is a fixed pressure bilevel machine that has the option to set a backup rate to trigger IPAP on a timed basis. This machine is mostly used for people that have obstructive or restrictive pulmonary conditions and hypoventilation. Most ST machines can reach 30 cm maximum IPAP pressure. The ST provides the same pressure all of the time and is not suited to the treatment of central apnea. A variation known as the ST-A has an intelligent "Volume Assured Pressure Support" (iVAPS or AVAPS) which can vary the amount of pressure support to maintain a target tidal volume and respiratory rate. While this may improve central apnea it is too slow to respond to events on a breath by breath basis and is mostly useful to adjust to varying degrees of pulmonary restriction or obstruction and maintain respiratory volume. Both ST and ST-A are ventilators that assist with mostly spontaneous respiration and improve hypoventilation. The drawback of ST for central apnea patients is the consistently high pressure support that would be required to resolve CA events is not tolerable.

4. Bilevel ASV (Adaptive Servo Ventilation). The ASV detects and responds to breathing abnormalities by applying just as much pressure support as is needed to correct the abnormality. As the patient breathes normally, the machine will provide low pressure support for comfort from 0 to 4 cm. When breathing volume drops, the ASV increases pressure support to restore respiratory volume. This can be a moderate amount of pressure to correct hypopnea, or more pressure in the case of central apnea. It provides the pressure when needed as needed to maintain respiratory volume. Unlike ST, the machine reduces pressure support when it is not needed, and can far surpass the pressure support provided by ST if and when it is needed.

This is an AAST article on the intended use of ASV https://www.aastweb.org/blog/what-is-asv

[muziccity]

I read that article and looked over the document, it really does make it clear that I'm on the wrong machine. I wonder why my doctor chose ST for me. The only things I can think of are:

- One diagnosis said I have alveolar hypoventilation.
- Another diagnosis said sleep-induced hypoxia.
- I have peripheral artery disease (partial blocked artery in leg)

If I do have hypoxia or hypoventilation, I'm not sure how bad they are but I did read on that article about ASV that it's not intended for those with chronic hypoxia or elevated partial pressure of carbon dioxide. Those are really the only things I can think of but I'm definitely going to ask for ASV titration. This machine is absolutely not helping me at all, if anything I'm worse. Thanks for all of your input everybody, it's much appreciated. I will let you know how it goes on Monday.

[SarcasticDave94]

FWIW I was in a similar ballpark as you when I was on a standard BPAP and needing ASV. It was a vampire sucking the life out of me.

I'm mailing you the Dr. needs to listen to my complaint baseball bat.

[Sleeprider]

The choice of ST is mostly an insurance requirement. They don’t want to pay so they make it necessary fo the doctor to try cheaper machines first. Read our wiki on justifying Advanced PAP Machines. You will get ASV after you jump through the hoops and complain loudly enough to your doctor.