Opinions Please

Pugsy wrote: ↑

Wed Nov 14, 2018 11:19 am

My best guess as for the clustering....either REM stage sleep or you were on your back.
With the timing of the clustering....I lean towards REM with maybe a secondary influence combination of being on your back too.
Either way I vote bilevel auto.

Pugsy wrote: ↑

Wed Nov 14, 2018 1:27 pm

For the regular auto adjusting bilevel (not the specialty models with back up rates and all that stuff) it depends on who is paying for it and is cost a factor.

First choice ResMed AirCurve 10 VAuto just because I have a penchant for the latest and greatest especially if insurance is paying the bulk of the cost.
Second choice if paying out of pocket would be the older big brother ResMed S9 VPAP Auto....essentially the same machine in terms of major therapy algorithms and function as the AirCurve 10 VAuto but with the cosmetic upgrade and a few minor "improvements".
Since it is now a discontinued model the price for this model has dropped in the secondary market substantially.

Pugsy wrote: ↑

Wed Nov 14, 2018 11:03 am

Obviously the machine wants to go higher and can't.

I have actually had a chance to use both the ResMed auto adjusting bilevel as well as the Respironics auto adjusting bilevel.
I prefer the ResMed bilevel myself.

It's a bit less noisy in terms of both motor noise and the breathing noise (the darth vadar sounds) and the algorithm responds a bit faster which usually means less time at the higher pressures (when they are needed which in my case is REM related).
Plus the EasyBreathe thing is better than the BiFlex relief IMHO and there are a couple of other customizable features that can be useful for fine tuning the inhale/exhale timing thing.

They need to put you on the fast track for a bilevel ...and an auto adjusting one because you only need the higher pressures for parts of the night. No sense in using higher pressures if you don't need them.

There should be more than enough proof here to satisfy Medicare.

Pugsy wrote: ↑

Sat Dec 01, 2018 3:58 pm

Tell me all your current settings with your apap...and we can get real close using the S9 VPAP.
Easy peasy...I went from a Respironics apap to the same S9 VPap auto super easy.
And you might get lucky and get by with a little less minimum pressure than you need with the apap.

Pugsy wrote: ↑

Sat Dec 01, 2018 6:12 pm

The flex setting of 1 is minimal exhale relief. Exhale relief on the VAuto is accomplished with PS.
Let's pretend you get 1 cm drop during exhale with Flex at 1...you don't but it's close.

So the apap setting of minimum 17 means 17 on inhale and a little drop to 16 during exhale....max doesn't really matter if you never reach it and with the apap of course limited to the 20 anyway.

So with the VPAP...when you use PS you add to EPAP instead of subtract from IPAP (when apap is used) to get similar settings.
You would set the minimum EPAP to 16...PS to 1 and max IPAP of 20 or higher if you ever hit 20 with the APAP...I would set it to 25 and let the machine do its thing. It won't go anywhere without a good reason to go there.
This will give you 16 exhale and 17 inhale just like the apap is giving you... the timing of the reduction might be a little different and if you find it seems a bit off...let me know as there are some additional settings available to change the timing a bit to get it better in sync with your own respiration.

Now...at some point...do play with the PS a bit just to see how you like it...
Once we see some reports we will know if you can maybe drop minimum EPAP a little and maybe add more IPAP by using more PS or not.
I love PS of 4...I can't get that with my Autoset but I can get close by using EPR at 3...which is like PS of 4.