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S9 VPAP ST-A OSCAR Data Question
#1
S9 VPAP ST-A OSCAR Data Question
Hello,

I recently got an S9 VPAP ST-A iVAPS on rent. I was looking to test out a bilevel machine as I suspected some issues with flow limitations while using the Resmed Airsense 10 Autoset.

I have a couple of questions that I am looking help for. First, does the machine not show Flow Limitations and Clear Airways data? I have ticked all the options for events flags in OSCAR but I can still not see FLs and CAs. I wonder if this is an issue with OSCAR compatibility or with the machine giving limited data. 

My other question is related to my therapy. I was using my Resmed Autoset with settings of 9 Min. Pressure and 11 Max. Pressure with EPR at 3. My data was fine with it but I was still waking up exhausted, and when looking at my flow rate graph the only thing I could see as possibly interfering with my therapy was what seemed to me like flow limitation. I thought I would try a bilevel machine to achieve higher pressure support.

Well last night I set the IPAP to 10 and EPAP to 5 but I did not have good sleep. When I looked at the data in OSCAR, the AHI was above ten and there were many unclassified apnea which looked like clear airway events to me. Maybe a pressure support of 5 is too high for me? I have now set it to IPAP 9 and EPAP 5. I am using it on S mode. 

Also, my tidal volume was quite low with the median value at only 220. Why could that be? My usual tidal volume is above 300 with the Resmed Autoset. My other settings on the S9 machine are: Ti Min: 0.3, Ti Max: 3.0, Rise Time: 150, Cycle: Medium, Trigger: Medium.


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#2
RE: S9 VPAP ST-A OSCAR Data Question
The ST-A is an extremely sophisticated ventilator that is normally prescribed for individuals with severe pulmonary disease and respiratory insufficiency and failure. It has the VPAP-S mode that you are using, but it is not the ideal machine to manage your flow limitations or obstructive apnea. Considering what you want from a machine the Vauto is far preferable. You are using VPAP-S mode at EPAP 5.0 and IPAP 10.0 (pressure support 5.0). This low EPAP pressure appears to be insufficient to prevent obstructive apnea.

Based on the closeup on your charts, the UA events appear obstructive and will probably clear up with higher EPAP. The inspiration peaks are slightly flattened or downward sloping which may be flow limitation, however I think your pressure is too low. My suggestion is that you raise the EPAP and IPAP pressure in increments of 1-cm until the UA events are titrated out. I don't think your machine has Easybreathe, which would be more comfortable than setting rise-time. Your inspiration times and expiration time are appropriate for normal breathing and don't suggest flow limitation, however tidal volume is relatively low. If the UA events had the appearance of central events, we would work with trigger sensitivity, but that does not appear to be the case here.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#3
RE: S9 VPAP ST-A OSCAR Data Question
This isn't a normal BPAP. This is a mini ventilator with modes like iVAPS, ResMed's version of AVAPS. This machine has backup rate.

I think this machine flags CA as Unclassified.

S mode is spontaneous only. This gives 2 static pressure, inhale and exhale, if I've got it right.

You went from APAP to ventilator. Might want to try a middle ground as in VAuto. Unless I'm mistaken, you were only needing to treat Apnea, so you've got a machine WAY more than you need. And a penalty is when you try to downgrade the machine to treat your Apnea, you get a too basic therapy when VAuto will be lots better.
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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#4
RE: S9 VPAP ST-A OSCAR Data Question
Hello, thank you both very much for the replies. So, unfortunately where I live the VAuto is not available and the only Resmed bilevel machines available are the S9 VPAP and the Lumis 100 (which I think is equivalent to the non-auto version of the Aircurve 10). 

I thought the unclassified apneas were happening due to the PS of 5, but they could very well be due to the low EPAP. However, I took about an hour and a half nap afterwards in which I adjusted the EPAP to 6 and IPAP to 10 (so that PS was at 4), and I didn't experience any UAs then, though my flow rate curves appeared irregular. Anyways, I guess I'll try a EPAP of 6 and IPAP of 11 tonight. Should I let my other settings remain the same (Ti, Trigger, Cycle etc.)?

By the way, here are a couple of images of what I thought was flow limited breathing on the Resmed Autoset. Do you think this indicates flow limitation? I usually have some periods of such breathing in my data which tend to begin and end with a short arousal. The only reason I wanted to try a bilevel device was to increase PS and see if that improved my sleep, if indeed flow limits are the problem I was having on the Autoset.


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#5
RE: S9 VPAP ST-A OSCAR Data Question
Lumis 100 has several different specific models within. None equal the US VAuto. There are Lumis 100 S, ST, ST-A etc. I'll attach a link to the Lumis PDF.

My suggestion is, no don't edit time settings.

https://www.google.com/url?sa=t&source=w...L2LU7YRruB
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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#6
RE: S9 VPAP ST-A OSCAR Data Question
Here's a screenshot image, part of my ventilator accessories PDF, this shows what ResMed calls the Lumis.

[attachment=35086]

Here's a screenshot on various modes in Lumis 100

[attachment=35089]
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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#7
RE: S9 VPAP ST-A OSCAR Data Question
Ah, I see. Thanks!

Also, here is a part of my breathing when I took the 1.5 hours nap with EPAP at 6 and IPAP at 10. I don't think the breathing looks very good here.


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#8
RE: S9 VPAP ST-A OSCAR Data Question
It appears the Lumis 100 S is just below a VAuto, static pressure versus an Auto.

I'm not the greatest at flow images, but yours do appear to be odd looking. Sharp short exhales, stepped, limited inhales.

Wait for better info than my limited amount.

Not all is negative about this Lumis or whichever BPAP you have now. Pressure support is a higher range than the AutoSet EPR of 3 Max. So you're correct if you believe high flow limitation is your issue, high adjustable PS is a good idea. It's just that the machines you have available are just below a VAuto or way over it.
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: S9 VPAP ST-A OSCAR Data Question
Right, I understand. I'll try to make do with the machine I have right now, but perhaps sometime later I can get a VAuto from the US, if bilevel solves my issue.

My only fear is that the unclassified apneas that I experienced (in the images that I attached in the first post) were actually clear airways, though Sleeprider said that they look like obstructions. If they were clear airways then perhaps I'll be stuck in a limbo so that increasing PS would induce CAs but reducing PS would cause flow limitation.

Anyways, I'll have to try to see. I'll take Sleeprider's suggestion for tonight and increase EPAP and IPAP by 1 cm each.
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#10
RE: S9 VPAP ST-A OSCAR Data Question
(08-25-2021, 12:47 PM)gadgetmaniah Wrote: If they were clear airways then perhaps I'll be stuck in a limbo so that increasing PS would induce CAs but reducing PS would cause flow limitation.

Welcome to the balancing act that is the result of using the wrong tool for the job.  At low levels it is not a problem.
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