AirSense AutoSet or AirCurve Vauto for OSA?

[ejbpesca]

On my 18th annual visit, my pulmonologist refused to prescribe me an AirCurve Vauto. Both my doctor and respiratory therapist claim a bilevel is only to be prescribed for OSA when lung disease like COPD is present.

What do you think about using a bilevel for simple OSA treatment?

[LSAT]

VAUTO is not needed for basic OSA. Why do you think it's better?

[ejbpesca]

I have read many testimonials from those with basic OSA claiming that switching to bilevel from APAP has improved therapy. I wonder if bilevel may be better by lessening flow limitations as seen on N2 waveforms.

I have been experimenting for six weeks with an AirCurve in Vauto mode using PS 3 as opposed to EPR 3 I use on my AirSense. N2 waveforms have improved, and sleep has been more restorative, but I wonder if the effect of PS 3 is harmful.

[LSAT]

I have read many testimonials from those with basic OSA claiming that switching to bilevel from APAP has improved therapy. I wonder if bilevel may be better by lessening flow limitations as seen on N2 waveforms.

I have been experimenting for six weeks with an AirCurve in Vauto mode using PS 3 as opposed to EPR 3 I use on my AirSense. N2 waveforms have improved, and sleep has been more restorative, but I wonder if the effect of PS 3 is harmful.

Why don't you listen yo your doctors?

[ejbpesca]

After 18 years of APAP use and 18 annual visits to this doctor, I question whether the doctor is aware of benefits a bilevel machine might deliver. The doctor considers all bilevel machines to be ventilators for lung disease. Other doctors prescribe bilevel machines for basic OSA, but those doctors are not available to me. I would get a second doctor's opinion if it were available.

Another reason not to "listen" to the doctor is the many testimonies I've read from those with basic OSA who get better results from a bilevel, specifically the AirCurve Vauto, as opposed to their AirSense APAP.

[Sleepzilla]

Your doctor is clearly misinformed regarding basic OSA therapy options. IMHO this pretty much makes anything else he says suspect too, at least until it's independently verified elsewhere.

ResMed's Therapy Handbook resource for clinicians is quite clear regarding the appropriateness and efficacy of bilevel PAP therapy for treating OSA in patients that can't tolerate or don't respond to traditional CPAP/APAP therapy.

May consider bilevel if one of the following is true:
• There are continued obstructive respiratory events at 15 cm H20.
• If the patient is uncomfortable or intolerant of high CPAP.
• The patient has a history of ventilatory insufficiency.

Signs that a patient may be intolerant of high pressure settings include:
• Discomfort with properly fitted mask, often removing mask during sleep
• Arousals or microarousals
• Lack of progress to REM sleep cycle
• Bloated feeling or sensation of swallowing air
• History of failed CPAP
• Nasal congestion
• Difficulty exhaling despite EPR feature
• Complaints of smothering or chest wall discomfort

AirCurve S/VAuto: Therapy modes considered for the treatment of obstructive sleep apnea (OSA) and to help those struggling to adhere to PAP therapy (i.e., noncompliant patients).

VAuto algorithm — How it works:
• Adjusts treatment pressure as a function of three parameters: inspiratory flow limitation, snore and obstructive apnea.
• PS remains fixed throughout the night.
• Min EPAP and Max IPAP settings allow delivered pressure ranges to be restricted.

The same ResMed Therapy Handbook is also clear that the AirCurve ST and ST-A bilevel machines (which are quite different than the AirCurve S and VAuto machines discussed above) are the only therapy machines indicated for treatment of respiratory disease.

A simple Google search for "treatment of OSA with bilevel bipap" reveals myriad resources, publications, and credible medical papers that all support bilevel PAP as a commonly accepted OSA therapy option.

[ejbpesca]

Thank you for the reply SleepZ. I am experimenting with the ResMed Vauto and have no clinician help since they believe the Vauto is only for lung disease, which they believe I do not have. I am guessing at the settings for the Vauto.