Dog Slobber - APAP to VAuto

[palerider]

Zonker is nice, so I don't have to be (that's my story, and I'm stickin to it!)

now, wait just a doggone minute, here. i don't think it's POSSIBLE for my niceness to make up for your nastiness!



besides, you've been here 3x longer than i have.

work,work,work....

WORK HARDER!!!

[palerider]

Early on, zonker referred to me as a "wise member" - I'll always love and cherish him for that.

And congrats on the perfecct game Dog Slobber!!!

that must've been back during my self medicating with wine phase!

You mean "now". ?

[zonker]

Zonker is nice, so I don't have to be (that's my story, and I'm stickin to it!)

now, wait just a doggone minute, here. i don't think it's POSSIBLE for my niceness to make up for your nastiness!



besides, you've been here 3x longer than i have.

work,work,work....

WORK HARDER!!!

<sigh> yes, dear. i'm doing it. dear.

boy, i'm very glad that dog slobber is a nice human being and doesn't mind us tracking up his thread!

[palerider]

Zonker is nice, so I don't have to be (that's my story, and I'm stickin to it!)

now, wait just a doggone minute, here. i don't think it's POSSIBLE for my niceness to make up for your nastiness!



besides, you've been here 3x longer than i have.

work,work,work....

WORK HARDER!!!

<sigh> yes, dear. i'm doing it. dear.

boy, i'm very glad that dog slobber is a nice human being and doesn't mind us tracking up his thread!

indeed.

[Dog Slobber]

I'm the proud new owner of a ResMed AirCurve 10 VAuto.

Hoping to get some advice on converting the settings on my AirSense 10 AutoSet for Her to the equivalent VAuto settings , and then some tweaking to try to improve the experience.

I have the clinician guide and have read through it.

Therapy Summary:

• Untreated AHI: 59
• Device: AirSense 10 AutoSet for Her
• Mode: APAP - Soft Response
• Pressure: 11.2 - 20
• EPR: 3
• Mask: ResMed AirFit P30i Nasal Pillows
• Ramp: Auto - 9 cm
  
  My therapy is going great AHI typically about 0.24. I feel terrific during the day, no drowsiness or naps. My only complaint is waking up during the night. This started with CPAP therapy, and while greatly improved, hasn't gone away.

OSCAR data:

AHI_012.png

Stats_Nov_2019.png

Trends.png

My initial VAuto Settings (based on APAP: 11.2-20, EPR: 3, Ramp: Auto 9cm) :
PS: 3
Min EPAP: 8.2
Max IPAP: 25
Ramp: 10 Minutes
Start EPAP: 6

I'll be leaving all the breathing waveform parameters at their defaults and after a few days start tweaking. I understand there is no equivalent for Auto Ramp and Soft Response.


Any other advice or suggestions appreciated!

[Pugsy]

You have the settings pretty much matching up.
I did the same thing not long ago. I got my grubby little paws on an AirCurve VAuto but it wasn't my first bilevel. I have had various other bilevels over the years to play with.
I wasn't unhappy with the AirSense 10 for Her....just got a chance to get another bilevel and I had learned a long time ago that I really like PS of 4. Now I know PS of 4 is not all that different from EPR at 3 but there is a little difference and I just like it better.

I was also hoping it would help me reduce the number of wake ups.....I knew it was a long shot miracle because I have always known that my wake ups aren't related to cpap or mask or apnea. Those other things that mess with our sleep are in play for me. I was hoping that maybe...just maybe...a little sounder sleep would happen so that the pain stuff wouldn't wake me up so much. Didn't happen like I wished...oh well.

Try increasing PS to 4 and see how you like it. Leave all the other comfort settings alone for now.
See if a change in PS helps or hurts or does nothing. You've got the ability....give it a try.

[ragtopcircus]

I also made the switch recently, though I was using Autoset mode on my For Her. I gave my For Her to ... Her.

For me, the defaults were fine for Trigger, Cycle, and Ti-min, but I had to increase Ti-max. I can easily bump up against the 2.0s default if my nose is congested. The Spontaneous Cycle % will tell you if you need to tweak those numbers.

PS 4 feels the most natural to me. As Pugsy said, 3 to 4 makes more difference than you would think. I’m currently trying PS 5 because of nasal congestion, but the jury is still out on that. 4 seems to be a good starting point for many.

Even with Ramp off, the Vauto builds pressure more gradually than a Dreamstation. Maybe 10 seconds or so? I haven’t timed it. That’s really all the ramp I want, and then some.

[Dog Slobber]

Try increasing PS to 4 and see how you like it. Leave all the other comfort settings alone for now.
See if a change in PS helps or hurts or does nothing. You've got the ability....give it a try.

I'm actually really looking forward to trying out increased Pressure Support.

Like you, I'm hoping that the BiLevel helps stop the wake-ups. Fortunately, I don't have other non-CPAP related issues contributing to my wake-ups.

The other reason I'm looking forward to increased PS; a year and a half ago I had a Septoplasty and T. reduction. The surgery helped dramatically, but wasn't 100% successful. Putting my mask (with Nasal Pillows) on actually helps my breathing (inhale) a lot, but I sometimes have a little difficulty exhaling.

Increased PS, sounds like the ideal solution.

I'm going to switch over to the VAuto on the weekend.

Just to get things right, when I increase my PS from 3 to 4, I should also drop my EPAP by the equivalent amount?
ie:
APAP: Min pressure 11.2, EPR: 3
Equivalent BiLevel: EPAP 8.2, PS: 3

Then with increased PS.
EPAP 7.2, PS: 4
...
EPAP 6.2, PS: 5

[ragtopcircus]

EPAP is what splints the airway open to prevent obstructive apnea. I’m pretty well dialed in at EPAP 10 for that, so I just leave EPAP alone and let IPAP go where it goes as I adjust PS. Ymmv.

[Pugsy]

You could drop your minimum EPAP but I didn't because EPAP does the bulk of the holding the airway open and preventing collapsing and in my case I really couldn't do that anyway.
For Her settings were 7 with EPR 3 so essentially 7 inhale and 4 exhale. I couldn't go any lower on exhale and get my 4 PS so I opted to just increase minimum EPAP to 8. So I am using 8 inhale and 4 exhale (at least at the beginning of the night).
Max IPAP I just leave at 20 cm...it rarely ever goes anywhere near there that max now but on the off chance something weird happens in REM I have it available. Last year I dropped 25 pounds and with that drop I have noticed that my pressure needs seemed to have decreased a bit on the high end. I used to see 15 or above fairly regularly...now it is extremely rare.

Your choice how you get the 4 PS but just watch things if you opt to reduce EPAP to keep IPAP the same and still get 4 PS.
It might allow some apnea events to happen...and it might not because you would have more IPAP to help out things.
All depends on how close to your bottom line for prevention your EPAP on the for Her model happens to be. If not very close probably won't make any difference but if you are at the bare minimum for optimizing things...your airway might collapse a little more or try to.
EPAP does the bulk of the work but IPAP does do some work and can help out more than people might think.

[ragtopcircus]

Yeah, the “truisms” are only a simplified approximation of what is really happening.

For that matter, IPAP isn’t really IPAP either. In Vauto mode with easybreathe, the pressure support ramps up slowly. It may not reach the nominal IPAP until very near the end of your breath (if at all). You can end it at any time by just stopping inhalation.

You can see what I mean be selecting sleep report while the machine is running. There are 3 screens for that, btw. The 2nd and third are more informative. You can also stay in Clinician mode (for a while) with the machine running. That means you can change pressure support and other parameters on the fly and immediately feel the effect, and watch it on the sleep report.

[babydinosnoreless]

Wow my aircurve does a whole lot of things I didn't even know about. I bumped my min pressure and tried ps3 (hated it) but other than that it is all the settings it came with. Maybe I should be more adventurous

[palerider]

My initial VAuto Settings (based on APAP: 11.2-20, EPR: 3, Ramp: Auto 9cm) :
PS: 3
Min EPAP: 8.2
Max IPAP: 25
Ramp: 10 Minutes
Start EPAP: 6

I'll be leaving all the breathing waveform parameters at their defaults and after a few days start tweaking. I understand there is no equivalent for Auto Ramp and Soft Response.


Any other advice or suggestions appreciated!

Like pugsy says, you've got it set up like your previous machine... Now you can experiment with more PS to see if you like that.

[palerider]

Just to get things right, when I increase my PS from 3 to 4, I should also drop my EPAP by the equivalent amount?
ie:
APAP: Min pressure 11.2, EPR: 3
Equivalent BiLevel: EPAP 8.2, PS: 3

Then with increased PS.
EPAP 7.2, PS: 4
...
EPAP 6.2, PS: 5

*No*...

The bilevel is simpler in that respect than the Autoset... You have to change the min pressure on the Autoset because EPR changes the effective minimum pressure.

On a vauto, PS doesn't affect the minimum pressure (epap), so you can change it independently.

[Dog Slobber]

Just to get things right, when I increase my PS from 3 to 4, I should also drop my EPAP by the equivalent amount?
ie:
APAP: Min pressure 11.2, EPR: 3
Equivalent BiLevel: EPAP 8.2, PS: 3

Then with increased PS.
EPAP 7.2, PS: 4
...
EPAP 6.2, PS: 5

*No*...

The bilevel is simpler in that respect than the Autoset... You have to change the min pressure on the Autoset because EPR changes the effective minimum pressure.

On a vauto, PS doesn't affect the minimum pressure (epap), so you can change it independently.

OK,

So setting my my VAuto to EPAP 8.2, PS 3 was to initially create an experience similar my APAP (11.2 EPR 3) Which effectively gave me a pressure on exhale of 8.2.

On the VAuto we just set the EPAP to be the effective pressure we want on exhale.

Basically, we establish a minimum expiration pressure that manages our events and keep it at that, increasing PS, will never drop below that.