Anyone use ST (or ASV) + my first few nights experience w/ST

SimbaLion · Post by **SimbaLion** » Sun Nov 15, 2015 10:54 am

Recap: long time apnea, 60-70+ AHI "naturally," 20-30 with Airsense 10 auto CPAP, with some centrals, and this stayed constant for 4 months -- moved over to Aircurve ST. Picked it up last week.

Thoughts/Experience so far: Man, it's quite different from CPAP. I had used the CPAP for about 4 months now, and I had gotten so used to the sensation that when it started blowing, I didn't really even feel it anymore. But with the ST, the pressure is at 14/4 backup rate of 8, which is much higher than my avg on the CPAP (9 or so). It is much louder (at least for me, but apparently still pretty silent for anyone around me) and the the inhalation/exhalation action can only be described as "violent" and "unnatural." The cliff between the two is just so sudden... The good news is, I can still fall asleep (although it definitely takes longer than before), and hopefully it'll get easier. The bad news is...my AHI on the first few nights have ranged from 9-13. This is probably not as low as I had expected...

Questions for ST/ASV users:

- Is autoramp on the ST helpful? They set it at 45 minutes for me because it's tougher to adjust to the large pressure swings, but I swear, when I wake up at night (to use the bathroom), I feel like it's much more natural/easier to breathe BEFORE I stop the machine and go to the bathroom than when I come back and start the machine again (which I assume starts the auto-ramp all over again). Is the ramp algorithm wonky? Or is that 1 minute gap enough to make me forget how it the machine feels?

- My AHI is still higher than I thought it'd be...anyone know if it stays like that, would the ASV lower it more? What is the sensation of breathing like on the ASV vs the ST? I'm still not sure I understand the differences between the two in terms of how they work...is the ASV as "violent?"

- Any other thoughts?

LSAT · Post by **LSAT** » Sun Nov 15, 2015 11:10 am

You could just turn off the ramp or adjust the ramp pressures

Madalot · Post by **Madalot** » Sun Nov 15, 2015 1:28 pm

I'm using S/T on the Trilogy. I'm 18-23/10. I do not use any ramping so I start out at 18/10. My backup rate is 7. I know that people do an eyebrow raise when they see 7 as a backup rate, but any faster and I feel FORCED to inhale before I'm ready and would describe it much like you do --

SimbaLion wrote:and the the inhalation/exhalation action can only be described as "violent" and "unnatural."

During my last sleep study, the tech raised my backup to 9 through the night and I knew it. One of the first things I asked him in the morning was if he raised my backup rate.

Is it possible that you need a slower backup rate?

SimbaLion · Post by **SimbaLion** » Sun Nov 15, 2015 2:14 pm

Both interesting suggestions -- I'll try turning off the ramp. I'll also notice the inhalation rate -- it's not really so much that it's too fast (at least I don't think it is...although not sure)...it's just very *different* than a CPAP and definitely not how I breathe normally even remotely, so it's a very foreign feeling. It literally feels like someone jammed one of those old fashioned bellows into my mouth and started rhythmically pumping...

Madalot · Post by **Madalot** » Sun Nov 15, 2015 3:13 pm

SimbaLion wrote:Both interesting suggestions -- I'll try turning off the ramp. I'll also notice the inhalation rate -- it's not really so much that it's too fast (at least I don't think it is...although not sure)...it's just very *different* than a CPAP and definitely not how I breathe normally even remotely, so it's a very foreign feeling. It literally feels like someone jammed one of those old fashioned bellows into my mouth and started rhythmically pumping...

Yes. It makes sense. It took me a LONG time to adjust to the Trilogy. I remember some nights it just being so awful, just like you describe. It's very regular for me now.

SimbaLion · Post by **SimbaLion** » Sun Nov 15, 2015 3:46 pm

Madalot, curious what led you to the ST mode of the Trilogy (and why a trilogy instead of a much lower priced Resmed/Philips ST-type bipap)?

Were you ever on ASV mode?

Madalot · Post by **Madalot** » Sun Nov 15, 2015 3:54 pm

SimbaLion wrote:Madalot, curious what led you to the ST mode of the Trilogy (and why a trilogy instead of a much lower priced Resmed/Philips ST-type bipap)?

Were you ever on ASV mode?

I'm not a regular apnea patient. While I'm pretty sure I have sleep apnea, the more prominent condition is a rare Muscular Dystrophy, causing diaphragm paralysis when sleeping. I'm not sure why I was never put on an ASV before the Trilogy. I know that my breathing is too shallow to trigger the bipaps and the decision was made to go straight to the Trilogy. I think my DME was a little money hungry and my doctor approved it, so there you go.

Funkdoobiest · Post by **Funkdoobiest** » Mon Nov 16, 2015 10:12 pm

I recently failed a bi-pap study and then did a asv study. Both were on Respironics. I absolutely hated the bi-pap as it seemed too controlling and it seemed like expiration kicked in before I was done with my inspiration. The ASV was much better but still made me breathe much faster than normal. Many people say the resmed is even more controlling. I am hooing that there is just an adjustment period because the asv wasnt great and that is the last thing to try.

Uncle Flapp · Post by **Uncle Flapp** » Mon Nov 16, 2015 10:27 pm

Funkdoobiest wrote:I am hooing that there is just an adjustment period because the asv wasnt great and that is the last thing to try.

There is an adjustment period. It took me about a month before I could sleep more than an hour or two at a time. Now I barely notice the machine.

- Flappy

SimbaLion · Post by **SimbaLion** » Mon Nov 16, 2015 11:36 pm

Tried turning off ramp -- didn't feel much different to be honest, so I turned it back on. I think I'm just getting used to it because I slept pretty much through the whole night. Maybe woke up once but I didn't think the inhale/exhale was as violent anymore. So, the good news is that I seem to adapting quickly to this...

AHI is still 10, though. I'm not sure what the "next step" is if this doesn't do the trick?

Rundgren · Post by **Rundgren** » Tue Nov 17, 2015 1:24 am

I have never used CPAP, but just had a titration study done yesterday first with a CPAP and then an ASV and that's what I experienced with the ASV, "violent and unnatural" and like the bellows thing you described. I barely slept at all with it (but did sleep with the regular CPAP), and I even took Zaleplon for the study.

SimbaLion · Post by **SimbaLion** » Tue Nov 17, 2015 2:09 am

Rundgren, pretty rough, eh? I felt like that during my sleep study with bipap titration, but I guess I'm a more "robust" sleeper as I did fall asleep.

The good news is that even though I felt like "there's NO WAY anyone can sleep feeling like this" just a few days ago, I adapted pretty quickly. Can't promise that you will do the same, but it's just something to work on.

Rundgren · Post by **Rundgren** » Tue Nov 17, 2015 3:32 am

Yeah, that's good news SimbaLion. Hopefully, if the doctor does end up prescribing an ASV, I will also be able to quickly adjust to it like you have.

metsfan302 · Post by **metsfan302** » Tue Nov 17, 2015 6:08 am

I used my ASV last night for the first time, its going to take some getting use too. But it dropped my AHI a shit ton,. u can look at my older threads for info not going to clog your thread with my info/ story but yea..... AMAZING!!!

Hang in there, I went from like 300+ centrals a night on cpap to none last night on ASV

klv329 · Post by **klv329** » Tue Nov 17, 2015 11:32 pm

Funkdoobiest wrote:I recently failed a bi-pap study and then did a asv study. Both were on Respironics. I absolutely hated the bi-pap as it seemed too controlling and it seemed like expiration kicked in before I was done with my inspiration. The ASV was much better but still made me breathe much faster than normal. Many people say the resmed is even more controlling. I am hooing that there is just an adjustment period because the asv wasnt great and that is the last thing to try.

the respironics 960 has an "auto" back up BPM (breaths per minute, i think) and then setting for BPM from 4 to 30 with Ti (inhalation time, I think). Not sure what the "auto" keys off of -- tidal volume? The timed BPM is very controlling if set too fast from what little i tried of it. the resmed I think just has auto equivalent, but maybe a very slow backup rate -- if i hold my breath it slowly starts slow breathing, I think?

the ASVs sense an event maybe based in part on volume and BPM history and react with quick pressure elevations within parameters that you can set.

What does the ST do in practice? Does it just increase and decrease air flow to keep you breathing at a specified rate without regard to a brief history? does it also have a specified target volume or inhalation time or expiration time? What adjustments are available on the ST? quite the mystery to me. Any pressure graphs that people have posted that you have seen?

Anyone use ST (or ASV) + my first few nights experience w/ST

Anyone use ST (or ASV) + my first few nights experience w/ST

Re: Anyone use ST (or ASV) + my first few nights experience w/ST

Re: Anyone use ST (or ASV) + my first few nights experience w/ST

Re: Anyone use ST (or ASV) + my first few nights experience w/ST

Re: Anyone use ST (or ASV) + my first few nights experience w/ST

Re: Anyone use ST (or ASV) + my first few nights experience w/ST

Re: Anyone use ST (or ASV) + my first few nights experience w/ST

Re: Anyone use ST (or ASV) + my first few nights experience w/ST

Re: Anyone use ST (or ASV) + my first few nights experience w/ST

Re: Anyone use ST (or ASV) + my first few nights experience w/ST

Re: Anyone use ST (or ASV) + my first few nights experience w/ST

Re: Anyone use ST (or ASV) + my first few nights experience w/ST

Re: Anyone use ST (or ASV) + my first few nights experience w/ST

Re: Anyone use ST (or ASV) + my first few nights experience w/ST

Re: Anyone use ST (or ASV) + my first few nights experience w/ST

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