Dog Slobber - APAP to VAuto

Dog Slobber wrote: ↑

Sat Nov 09, 2019 2:09 pm

palerider wrote: ↑

Sat Nov 09, 2019 12:58 pm

Diddling with cycle is not going to help DS. He's breathing fine.

Pugsy wrote: ↑

Sat Nov 09, 2019 1:25 pm

used by a person with no history of lung issues.

Now that you mention it, I do sometimes have laboured or heavy breathing.

But, that's because of Mrs. Dog Slobber. Different Trigger setting.

because she's trying to kill you with the pillow?

Dog Slobber wrote: ↑

Sat Nov 09, 2019 2:09 pm

palerider wrote: ↑

Sat Nov 09, 2019 12:58 pm

Diddling with cycle is not going to help DS. He's breathing fine.

Pugsy wrote: ↑

Sat Nov 09, 2019 1:25 pm

used by a person with no history of lung issues.

Now that you mention it, I do sometimes have laboured or heavy breathing.

But, that's because of Mrs. Dog Slobber. Different Trigger setting.

TMI.

Day 3 of the VAuto, a no-hitter.

0.00 nights aren't much of a big deal, I routinely get 2 or 3 a month. Well see if there's a change.

I still like seeing minimal activity on the Flow Limitations graph. As predicted, the CA placeholder showed up in yesterday's graph when I had my first central.

Still having some awakenings though. Oh well.

Unrelated to the APAP->VAuto change, might be time to change the P30i pillows. I'm on my original set, since mid July, and the last couple nights they've been quite leaky. I'll try a good wash, see if they improve.

Dog Slobber wrote: ↑

Mon Nov 11, 2019 8:36 am

Day 3 of the VAuto, a no-hitter.


VAuto.png

0.00 nights aren't much of a big deal, I routinely get 2 or 3 a month. Well see if there's a change.

I still like seeing minimal activity on the Flow Limitations graph. As predicted, the CA placeholder showed up in yesterday's graph when I had my first central.

Still having some awakenings though. Oh well.

Unrelated to the APAP->VAuto change, might be time to change the P30i pillows. I'm on my original set, since mid July, and the last couple nights they've been quite leaky. I'll try a good wash, see if they improve.

too bad about the awakenings. sorta hoped you'd found the magic bullet. oh well.

but thanks about the reminder to clean my own damned pillows. been gettin' kinda leaky the last week or so.

Dog Slobber wrote: ↑

Mon Nov 11, 2019 8:36 am

Still having some awakenings though. Oh well.

Give yourself more time with the new machine and way of doing things. The awakenings might still reduce later on and maybe later you can have more solid sleep.
I can't promise it for sure but miracles can happen sometimes and sometimes it just takes looking at results long term to see minor changes.

First time I started using bilevel it took a little over 6 weeks to spot that I was averaging 30 to 45 minutes more sleep with bilevel than I was getting with apap. The reports themselves were always good enough I suppose but long term when I look at time slept I started noticing a very gradual increase.

It's still not perfect in terms of arousals but I am content knowing that I am doing the best I can do given the other health issues that are messing with my sleep and while not the total miracle I had wished for....still better than when I started.
Sometimes we just have to learn to accept those things we can't change no matter how much we wished we could.
When we can look in the mirror and say "I have done the best I can given what life has given me....so I am good" ....then it's a good day.
It's not perfect but it's the best I can do and it is what it is and I am good with it.

So is the general thinking to convert from APAP to VAuto to subtract the PS value from the min autoset value and setting that as the min EPAP value? Where the value for PS is just a direct mapping of the EPR value for the autoset machine? The max autoset value stays the same and is set for max IPAP? What happens if the autoset setting was low such as 5min-15max. What should it be set to if the PS value is 3 and the lowest the VAuto setting is 4?

What considerations for VAuto should be made for the values of the start pressure and the ramp time?

Apologies in advance if this should be it's own separate thread.

magungo wrote: ↑

Thu Nov 14, 2019 3:25 am

So is the general thinking to convert from APAP to VAuto to subtract the PS value from the min autoset value and setting that as the min EPAP value? Where the value for PS is just a direct mapping of the EPR value for the autoset machine?

No, the min pressure - EPR is the minEPAP, then PS=EPR,

magungo wrote: ↑

Thu Nov 14, 2019 3:25 am

The max autoset value stays the same and is set for max IPAP?

absent of other issues, set the maxIPAP to 25.

magungo wrote: ↑

Thu Nov 14, 2019 3:25 am

What happens if the autoset setting was low such as 5min-15max. What should it be set to if the PS value is 3 and the lowest the VAuto setting is 4?

What do you THINK? a min pressure of 5 is stupid for most people.

magungo wrote: ↑

Thu Nov 14, 2019 3:25 am

What considerations for VAuto should be made for the values of the start pressure and the ramp time?

Apologies in advance if this should be it's own separate thread.

Yes, it should.

magungo wrote: ↑

Thu Nov 14, 2019 3:25 am

So is the general thinking to convert from APAP to VAuto to subtract the PS value from the min autoset value and setting that as the min EPAP value? Where the value for PS is just a direct mapping of the EPR value for the autoset machine?

I made the same mistake when I was investigating finding settings equivalent to my APAP. (palerider: feel free to correct me if I still haven't gotten it correct)

An APAP setting of Min: 10 cm, EPR: 3 is equivalent to a BiLevel setting of EPAP:7, PS 3.

But this creates confusion, or it did for me anyway.

Think of it this way, with CPAP/APAP and EPR you set the Pressure (or Min: pressure) and subtract the EPR to get the effective pressure while exhaling.

With BiLevel, you just set the Min Exhale pressure. The PS is what is added to EPAP when inhaling. It really makes more sense to represent it this way.

Recap:
CPAP / APAP : Set pressure (or min pressure), subtract EPR value (1,2, or 3) to get effective exhale pressure, to a minimum of machine limit 4 cm.

VAuto: Set exhale to desired pressure (minimum 4), add PS (0-10) to get effective inhale pressure to a maximum of configurable Max IPAP value or machine limit of 25 cm.

What considerations for VAuto should be made for the values of the start pressure and the ramp time?

I just set my desired EPAP, 6 cm.
Ramp time: I set to 20 min, the AirCurve has no equivalent to Auto.

Apologies in advance if this should be it's own separate thread.

No problem.

As palerider suggested, it should be in its own topic. This is especially important for n00bies therapy topics as questions unrelated to their particular situation can get hijacked and morph into something completely unrelated and very frustrating to the n00b.

When this happens, Pugsy has to steer the conversation back to the OPs concerns, if people don't, she gets grumpy. Did you know she only gives one warning?

Other's who might be interested in the question might also miss it, as the question might not be related.

Me, I'm good with a little bit of divergence. My therapy is going very well and sometimes topics that change course can be beneficial.

I am wondering why anyone with an EPAP of 5 or 6 even needs a ramp time when they are on bilevel.
As for using ramp when EPAP is 4 already...waste of button pushing. Ramp is for easing a person into a higher EPAP and you can't ease up to 4 unless using the ResMed bilevel in S mode (or maybe a Devilbiss) which does allow an EPAP of 3. All other machines 4 cm is the lowest it will go. Ramp is useless button pushing and also has the negative aspect that with ResMed machines there is no event flagging going on during ramp. So all hell could be breaking loose during ramp and we wouldn't even see it happening.

Pugsy wrote: ↑

Thu Nov 14, 2019 10:10 am

I am wondering why anyone with an EPAP of 5 or 6 even needs a ramp time when they are on bilevel.
As for using ramp when EPAP is 4 already...waste of button pushing. Ramp is for easing a person into a higher EPAP and you can't ease up to 4 unless using the ResMed bilevel in S mode (or maybe a Devilbiss) which does allow an EPAP of 3. All other machines 4 cm is the lowest it will go. Ramp is useless button pushing and also has the negative aspect that with ResMed machines there is no event flagging going on during ramp. So all hell could be breaking loose during ramp and we wouldn't even see it happening.

For me, a 20 minute ramp is on the verge of being silly with an EPAP of 6 on Ramp and 8.2 during therapy.

I think my main motivation is that's how I've always done it, and I didn't want to introduce too many variables when I was first trying the VAuto.

I should start reducing my ramp down 0. But, I'll likely ween myself off (20 -> 15 -> 10 -> 5 -> 0) as I am averse to change, and like to trick myself into thinking that with gradual change I won't notice.

I really liked the Auto Ramp, so I could look at my data and know how long it took me to get to sleep. Since that's not happening anymore, no need I guess.

Dog Slobber wrote: ↑

Thu Nov 14, 2019 9:48 am

magungo wrote: ↑

Thu Nov 14, 2019 3:25 am

So is the general thinking to convert from APAP to VAuto to subtract the PS value from the min autoset value and setting that as the min EPAP value? Where the value for PS is just a direct mapping of the EPR value for the autoset machine?

I made the same mistake when I was investigating finding settings equivalent to my APAP. (palerider: feel free to correct me if I still haven't gotten it correct)

I see nothing to correct.

Posting an update

12 days ago I moved from an AirSense 10 AutoSet for Her to an AirCurve 10 VAuto.

Settings comparison:
AutoSet for Her: 11.2 - 20, EPR 3
AirCurve: EPAP: 8.2 - 25, PS 4

The settings are virtually identical with the only difference being my IPAP: 12:2 on the AirCurve, 1 cm higher than the AirSense.

My numbers have improved:
In 12 days with the AirCurve, my AHI is 0.22, I've had 5 nights of 0.0 and the Flow Limitation trace is dramatically empty.

In 107 days with the AirSense, my AHI was 0.37, with about 2 0.0 nights a month. My Flow Limitation was pretty active.

Now I don't attribute the improvement *directly* attributable to AirCurve vs AirSense. Instead, I believe the improvement to be the extra cm of IPAP. Thats the only real difference between the two.

Essentially, I'm enjoying the benefits of an extra cm of pressure, but without having to exhale against more pressure. And that extra cm does appear to manifest in better therapy. Lower AHI, considerably less Flow Limitations and more 0 event nights.

This brings me to my next point. There have been a few claims about ResMed's algorithm overshooting. Basically, supplying considerable more pressure than needed, at the expense of comfort and mask leaks.

I think my experience demonstrates this not to be the case, at least for me.

Had the ResMed algorithm overshot the appropriate pressure, then there would have been little room for the improvement. Surely, it would have overshot with the AirSense by at least that extra centimetre, to give me similar numbers as the AirCurve.

And yes, I recognize my experience is anecdotal. But, it's still more evidence (on a real world patient) than anybody who's made ResMed Overshoot claims has presented.

I'm glad you're enjoying the treatment the new machine's giving you, my friend.

Shall I come into your thread an act like an ass like your doing. Do you appreciate it actually I am better than you and will again ask you to keep your opinions to yourself and stfu if you dont have anything positive to say

RLMMG wrote: ↑

Tue Dec 24, 2019 8:17 am

Shall I come into your thread an act like an ass like your doing. Do you appreciate it actually I am better than you and will again ask you to keep your opinions to yourself and stfu if you dont have anything positive to say

Go ahead, couldn't care in the least.