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Problems with ResMed AirCurve 10 ST-A (ASV) Algorithm
#1
Problems with ResMed AirCurve 10 ST-A (ASV) Algorithm
The unit is reportedly designed to respond to patients attenuated voluntary breathing by automatically augmenting the breath tidal flow. That is not happening. I have central sleep apnea with a propensity for Cheyne-Stokes breathing patterns. I have self-awakened to discover breathing patterns with normal heart rhythm that were so shallow heart arrhythmia was triggered. During this described incident, I was using the ResMed AirCurve 10 ST-A (ResMed) with no alarms and no assisted breathing.  The unit’s operational settings are provided below.

Question: Has anyone found a way to enhance the ResMed’s ability to respond to acute shallow breathing caused by sleep apnea more effectively?

Unit Settings:

VARIABLE               SETTING
Mode                      IVAPS
Target PT rate         13
Target V                 12.0 L/min.
------------------------------
MV                         14.0 L/min
Vt                          1077 ml
Vt/Kg                     12.4 ml/Kg
--------------------------------
EPAP                      6.0
Min. PS                  7.8 cm/H2O
Max. PS                 12.0 cm/H2O
TI Max                   3.0 sec
Ti Min                    1.6 sec.
Rise time               600 msec.
Trigger                   Med.
Cycle                     Med.
Mask                     Full
Ramp time             Off
Ramp time down    Off
Humidity                6

I look forward to your suggestions.

Sincerely,
Robert
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#2
RE: Problems with ResMed AirCurve 10 ST-A (ASV) Algorithm
I'm not certain right now what to suggest if anything. Your CSR issue is a complication that makes things somewhat difficult.

Even so, it could be a setting within timing that might need some adjusting, I think it's possible a trigger or cycle sensitivity that needs increased.

As you're likely aware, the ST-A is very different than ASV. The ResMed ST-A and ASV are different machines for different treatments. I've used both, and I should be getting an Astral myself for COPD and Central Apnea overlap.

I'm just voicing a thought. Is it possible you need an actual ventilator like a ResMed Astral 150? It's very much like a ST-A in the settings but it's more powerful.
Dave

OSCAR
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Problems with ResMed AirCurve 10 ST-A (ASV) Algorithm
I'm not familiar with your condition or size, but the target rates for ventilation are extremely unusual. The ST-A uses iBR which should be 3-breaths per minute lower than normal respiration rate. For most people that is about 12 BPM. Your target volume is an alveolar volume, which is lung volume minus the dead-space of teh airway. For me as a 6'-2" male individual with exceptionally high pulmonary capacity, that is about 6-L/min, and your settings are double that. Your settings are setup for a giant. I would be looking at a Vt of 1/2 your target at 600 L/min max. I have no problems with your Ti-min and Ti-max but the targets are simply not human. Someone made a mistake.
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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#4
RE: Problems with ResMed AirCurve 10 ST-A (ASV) Algorithm
I didn't take note of the odd settings. That doubled target issue might be the issue itself.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Problems with ResMed AirCurve 10 ST-A (ASV) Algorithm
SarcasticDave94, and Sleeprider
Thank you for this guidance. This reply will include an understanding from your second message and a message from Sleeprider.

I will adjust the tidal volume to a human's body (smile) and increase the trigger cycle sensitivity. I suspect this will make a large difference in the units performance.

Your comment about the difference between ST-A and ASV was a real awakening for me. I thought the ResMed ST-A was an ASV until now. My discovery included reading an Apnea Board comment named RE: St vs. ASv from 04-08-2019 @2:20 PM. The article suggests ASV in Auto mode for central and mixed apneas like my condition. 

Who makes the best ASV machine for combination central and obstructive apeas? Is the REsMed Astral the best solution or are there others to consider too?

How can I get a prescription for the more advanced machine? My local doctors are only providing conventional equipment.

I look forward to your thoughts.

FijiFarmer
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#6
RE: Problems with ResMed AirCurve 10 ST-A (ASV) Algorithm
FigiFarmer, Your ST-A is a rare and valuable machine for someone that experiences pulmonary dysfunction, respiratory failure and and severe neuromuscular disorders, but it is not the machine of choice for central and complex apnea.  The Resmed Aircurve 10 ASV is what you need to find.  If I could have you and SarcasticDave swap machines, that what I would do.  As far as setting up the ASV, it's very simple to setup in ASVauto mode and to fine-tune.  If you continue to use the ST-A, I think you should get the manual from the forum and read through to understand how the settings should be setup. I have included some information from the manual below that describes some basics of how we use iVAPS. In your case, you should probably back off to ST mode which will be a fixed EPAP and IPAP with backup breaths provided where spontaneous breathing does not occur within the specified backup time.  If doing this, try EPAP 6.0, IPAP 10.0, BPM at 12 and trigger sensitivity very high.

[Image: attachment.php?aid=4210]

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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: Problems with ResMed AirCurve 10 ST-A (ASV) Algorithm
Sleeprider,

Thank you for spotting errors in process control and this guidance. After instrument adjustments you suggested, I slept through the night without an apnea that caused wakefulness.
Questions:
·       Is your suggestion to use ST with fixed EPAP and IPAP over iVAPS because the iVAPS is not precise enough to act like a ASV? I studied your attached literature but am still unclear about the difference between the ST with EPAP & IPAP, and the iVAPS. It is my understanding that they both provide pressure assisted breaths during apneas. Is the difference the tapering of pressure support offered by iVAPS?
·       I am aware of the Apnea Boards rules about promoting products. At the same time, I would like to know what type of ASV machine to look for? How can you recommend the ideal equipment that will speed my search?

On a separate topic. I am a chemist developing controlled release magnesium taurate for alleviation of tachycardia. In collaboration with two other Ph.D. level scientists, I have found that magnesium taurate is the best magnesium compound to alleviate and prevent atrial tachycardia. This new controlled release product will make my dosing of the compound less arduous. More on this if it is a relevant topic.

Sincerely,
FijiFarmer
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#8
RE: Problems with ResMed AirCurve 10 ST-A (ASV) Algorithm
Yes, change to the ST mode then change to the pressures Sleeprider mentioned.

Having used ResMed's ASV and ST-A, there's similarities but they're definitely not the same.

ASV can have EPAP range, ST-A doesn't, at least the one I used.

Both have a PS range and both have breath backup rates.

ResMed's iVAPS is their variant on ventilator mode AVAPS, this is in the ST-A not the ASV.

ASV is for Central Apnea.

ST-A can treat CA due to the backup rate, but it'll feel different, at least to me it does.

ST-A is for respiratory disease.

Just some info from a guy that used both. FWIW I don't own an ASV any longer, and it's looks like I'll be self funding the next blower because most of the sleep doctors are pretty incompetent. QUACK.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Problems with ResMed AirCurve 10 ST-A (ASV) Algorithm
Sarcastic Dave 94,
Thanks for the prompt reply and clarifications.

Allow me to gather more clarity. You are recommending the ResMed AirCurve 10 ASV not the ResMed Astral 150 Ventilator?
And – I too have had to purchase my own equipment! This next purchase will be self-funded too. The Apnea Board is my only reliable source of information on this topic.

FijiFarmer
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#10
RE: Problems with ResMed AirCurve 10 ST-A (ASV) Algorithm
FijiFarmer, if the revisions we discussed to iVAPS worked, that's great. I am not a fan of ST mode and ST-A can be used in central apnea, however it doesn't have the rapid response of ASV. As far as I know OSCAR is compatible with your machine. How about posting a detail chart? I'd really like to see what the results of those suggestions were, and only suggested ST because the previous settings were so far out of normal that I wanted to get a baseline. Let's make this work if we can. iVAPS is simply brilliant, but you do need to get in the right neighborhood for targets.
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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