Help applying prescription to ResMed AirCurve 10 VAuto

[MarionSSS]

First post so bear with me - been lurking for a couple of weeks and could use some help setting up my ResMed AirCurve 10 VAuto to the prescription settings I was given.

Here are the results of my initial study:
AHI=25, RDI=25, Lowest O2 Sat=73%, Sleep Efficiency=96%, TST=5h 50.5m, PLMs index=0, No supplemental oxygen was used

Titration study results:
Sleep Efficiency=93%, TST 5h 50.0m, PLMs index=0. No supplemental oxygen was used. Best mask trialed: medium simplus (by the way it was the only mask trialed). Pressures were stated at 4 cwp and increased to 22/18 cwp. C-Flex of 3 was used with heated humidity.
Interpretation:
Incomplete titration due to failure to capture stable REM supine. The patient failed CPAP so BiPAP was trialed per lab protocol which the patient tolerated better subjectively though central apneas were seen initially; these should resolve with regular BiPAP use at home over the first several weeks.
Recommendations:
>Treat patient with AutoBiPAP at IPAP@15-25 cwp, EPAP@11-21 cwp, Pressure support@4-8 cwp, C-Flex of 3 and heated humidity with any comfortable mask.

There was no consultation with a doctor (is that normal?). A nurse from my general practitioner's office called to tell me my sleep study results were available and that she had a prescription for me. After finding out which DMEs in my area were covered by my insurance, I selected one that was nearby and part of a national network. I had the doctor's office fax them my study results and prescription and off to the DME office I went.

When I arrived at the DME the tech there said that the above prescription was really for a Philips Respironics Auto BiPAP machine that they did not stock but could get for me. She said that they had the latest ResMed Auto BiPAP machine in stock and that it should work just as well and that the local doctors hadn't had time to familiarize themselves with it. My prescription did allow for substitutions so I decided to go with it. She set up the Aircurve for me and also fitted me with the P&K Simplus.

Went home, got everything situated and it's been nothing but misery for a week. The mask has leaked horribly especially at the high pressure prescribed. No amount of adjusting fit could stop the leak. Each night I've given up after 2-4 hours and taken the mask off. I went back to the DME today and exchanged the Simplus for the Mirage Quattro. She said that they have a lot of patients that successfully use it.

So I'm getting ready for my first night with the new mask but it has occurred to me that the ResMed Aircurve 10 VAuto may be truly a different machine than the PR Auto BiPAP. For instance, the Aircurve has multiple settings that don't seem to be addressed in the scrip. The scrip also prescribes a "C-Flex of 3" but I don't see a setting for C-Flex on the Aircurve. Maybe the terminology is different on the ResMed?

I'd appreciate whatever help you all can provide. I actually had a sleep study done 10 years ago and didn't persevere with the treatment and now I think maybe I've kind of "lost" the last ten years and I'm determined to make it work this time.

[palerider]

>Treat patient with AutoBiPAP at IPAP@15-25 cwp, EPAP@11-21 cwp, Pressure support@4-8 cwp, ... The scrip also prescribes a "C-Flex of 3" but I don't see a setting for C-Flex on the Aircurve. Maybe the terminology is different on the ResMed?

minepap =11, maxipap=25, somewhere between 4 and 8 on the ps, maybe start with 4.

there is on *flex on the resmeds.

read this first: https://maskarrayed.wordpress.com/tamin ... e-quattro/

[MarionSSS]

>Treat patient with AutoBiPAP at IPAP@15-25 cwp, EPAP@11-21 cwp, Pressure support@4-8 cwp, ... The scrip also prescribes a "C-Flex of 3" but I don't see a setting for C-Flex on the Aircurve. Maybe the terminology is different on the ResMed?

minepap =11, maxipap=25, somewhere between 4 and 8 on the ps, maybe start with 4.

there is on *flex on the resmeds.

read this first: https://maskarrayed.wordpress.com/tamin ... e-quattro/

Yep, I do have min epap set to 11, I did have max ipap set to 25 although I decided to try it at 20 for a night. PS was set 4. Was able to have my first real night of sleep with a mask on. Slept for 5.5 hours and the machine says an AHI of 2.8. Will bump ipap up to 22 and see how that goes.

Not sure what you mean by "there is on *flex on the resmeds." Is there a setting I can access?

Thanks for the link. The mirage quattro will definitely need some taming. It was nowhere near as comfortable as the simplus. Left marks on the bridge of my nose and on my chin. Definitely can crank it down much tighter than the simplus to eliminate leaks but of course you lose some comfort in doing so.

[palerider]

there is no *flex on the resmeds.

Not sure what you mean by "there is on *flex on the resmeds." Is there a setting I can access?

I apologize for the confusing typo... there is *NO* c/a/biflex on the resmeds.

generally, the mirage shouldn't be that tight, if you have annoying leaks, try some mask liners. they made the Mirage quattro work good enough for me for years.. no nose irritation.

[Sleeprider]

Not sure what you mean by "there is on *flex on the resmeds." Is there a setting I can access?

He meant there is no C-flex or A-flex on Resmed machines. Resmed uses a pressure relief called (EPR) exhalation pressure relief. It is not relevant with bilevel therapy since you are setting the pressure relief in the difference between IPAP and EPAP. With Respironics, C-flex and A-flex is a means of changing the timing of inhaltion/exhalation pressure transistions.

The differences between Resmed and Respironics are kind of interesting, and you can ignore this if you find it confusing. Resmed will always maintain the same pressure support between IPAP and EPAP. The pressures move together. While Respironics IPAP/EPAP move independently, and can vary as much as the settings allow. Your original script:

AutoBiPAP at IPAP@15-25 cwp, EPAP@11-21 cwp, Pressure support@4-8 cwp, C-Flex of 3 and heated humidity

would allow IPAP to move between 15-25 cmH2O, independently of the EPAP at 11-21. On a Respironics DS 760, it would be input as Mode: AutoB, MaxIPAP 25, MinEPAP 11, maxPS 8, minPS 4. You might also adjust humidity, heated hose and mask resistance.

Palerider gave the correct settings for Resmed unit. They are similar but not identical in how they operate on auto bilevel.

(Edit: I see he already replied while I was writing this)

[MarionSSS]

Thanks for the responses "riders!"

Should I be concerned with the difference between the two since the original scrip called for c-flex or will the resmed do just fine?

[Pugsy]

The ResMed will be just fine.
Respironics various Flex exhale relief options are comfort related and not necessarily therapy related.
I have used (and owned) both the Respironics BiPap Auto and the ResMed equivalent S9 model to the machine that you have.
The absence of Flex with the ResMed machine was really a not issue. The bulk of the exhale relief for these bilevel machines comes from the difference between inhale and exhale.
Besides...the ResMed has something called Easy Breathe technology which is pretty sweet in its own right.

The only real difference between the 2 brands is the ResMed has the single fixed pressure support and the Respironics offers a variable pressure support. From my own experience I found the way the ResMed did it a little more comfortable and I didn't really miss the variable PS.

You should do quite nicely with the Resmed unit.

Actually CFlex refers to CPAP therapy anyway.
BiFlex is what it is called on the BiPaps
http://biflex.respironics.com/
Some people don't even need or want it...it's considered a comfort feature and in this situation it is not a make it or break it needed feature.

[MarionSSS]

Thanks, Pugsy. I do like the AirCurve. Just starting to really dig into the data with sleepyhead and resscan. Need spend some time reading up on how to read the data.

[MarionSSS]

What is the PS setting for?

[Wulfman...]

What is the PS setting for?

Presumably........."Pressure Support".

From a Respironics manual:

The level of pressure support (PS) delivered is determined by the difference between the IPAP and EPAP settings (PS = IPAP - EPAP).


Den

.

[MarionSSS]

This is a ResMed machine. There is a max ipap and min epap setting. Does the pressure setting allow for some sort of variance from these?

[Wulfman...]

This is a ResMed machine. There is a max ipap and min epap setting. Does it allow for some post of variance from these?

Doesn't matter. The principle is the same.

If that doesn't answer your questions, here's a link to a Google search on "bilevel pressure support".

https://www.google.com/search?q=bilevel ... ZjCh2hCAP0


Den

.

[Pugsy]

This is a ResMed machine. There is a max ipap and min epap setting. Does the pressure setting allow for some sort of variance from these?

Pressure support is the difference between EPAP and IPAP.
With the ResMed machines Pressure support is fixed in that the difference between EPAP and IPAP is always the same with the AirCurve VAuto.

Now EPAP and IPAP can vary when in auto adjusting mode but PS is always the same.

Example....Auto Mode...Minimum EPAP of 8 cm...Pressure Support of 4 cm...that will make the machine give 8 cm on exhale and 12 cm on inhale to start the night....then as the night progresses and maybe the machine needs to go higher.
Max IPAP is where the machine could go to if needed but it is not necessarily where it will go.

So EPAP 8 and PS of 4 and Max IPAP of 25 means that the machine can roam around between 8/12 or `10/14 or 15/19 or 20/24 as it thinks it needs.
If the machine decides that more EPAP is needed then it will increase EPAP and by default IPAP will get pushed up.
If the machine decides that more IPAP is needed then it will increase IPAP and by default pull EPAP up with it.
This pertains to auto mode only.

[Guest]

that's why I didn't like the resmed s9, I couldn't set the PS down to 2.0 and it was difficult to fall asleep on. I can't remember one good night on the s9
but now on the philips asv I keep demasking at the ipap 25cm, epap 5-10cm setting, auto. and I suffer horribly from hypoxia and asthma without the oxygen when I demask. I ran out of trazodone, I'm concerned it narrows the blood vessels in the brain
I also wonder if the oxygen is not getting to my brain since it's bled in below the vent holes on the comfort gel mask and maybe the oxygen just goes out the vent holes. the comfort gel lasts a long time but it's heavy and uncomfortable

[MarionSSS]

Thanks, Pugsy for confirming for me how this all works.