Dog Slobber - APAP to VAuto

[Dog Slobber]

Waiting for a dog slobber picture to go with this conversation.

Body_snatchers.jpg (513.18 KiB) Viewed 578 times

[babydinosnoreless]

Epic!

[Dog Slobber]

Had my first night with my AirCurve 10 Vauto, and pleased to announce I had a very good night.

My AutoSet for Her therapy settings were:
APAP: 11.2 - 20, EPR 3

Equivalent BiLevel settings would have been:
Min EPAP: 8.2
Max IPAP: 25
PS: 3

Pugsy suggested I try Pressure Support at 4. I know better than to brush her off, I've heard reports of her alien minions. PS 4 it is!

The VAuto experience didn't feel different that the AutoSet. Perhaps a bit easier, but maybe that's just a bit of a placebo effect. Regarding my nightly awakenings. I'm not sure that I did have an unwelcomed wake up. I did awake well before my 8:00AM alarm. But I know better than to put to much stock into a single night.

Let's see how tonight goes.

Last night's VAuto OSCAR report (on top), compared to the previous night's AutoSet for Her (bottom):

VAuto-APAP.png

Some observations:
AHI: 0.13, one event, that's typical.

But one major difference, the inactivity on my Flow Limitation graph. Wow, I have absolutely never seen so little activity. I don't mean to brag, but would you look at that graph! Cripes, those air passages are so open, you can fly the Millennium Falcon down there.

I think I get it now. With BiLevel, my Exhale pressure is about the same as it was on APAP. But because of the increased pressure support, I'm benefiting from more pressure on inhale, without really feeling the pressure difference. This increased pressure difference explains less Flow Limitation.

I do find it odd that the OSCAR event flags don't have a placeholder for Central Apneas. I've checked the configuration and it should display them. Perhaps, like CSR events, they won't show up till you get your first one. I know the device is aware of them as the Sleep Report has reported 0 Centrals.

For kicks, I zoomed in on the single OA flagged. I'm not even sure it was real as the timing is about the time frame as I was starting to awaken.

VPAP_event.png

Looking at it, there is some volatility before it flat-lined, and none after. Doesn't look real.

Finally the screen provided Sleep Report.

VAuto_SR.jpg

Nothing much here, but I don't know what:
Vt, RR, MV, Ti, I:E and Spont Cyc represent, nor their significance.

I'll dig around.

My only preference so far with the AutoSet for Her is, AutoRamp. I like the AutoRamp. For me it was a reliable indicator of when I fell asleep. Not a biggie.

If anyone has any thoughts, please chime in.

[palerider]

I'm so sorry that you're a new victim of the patented super overshoot technology now... You can see what it's done to your sleep.

Yes, more PS can certainly help with hypos and FLs, and snores.

Nothing much here, but I don't know what:
Vt, RR, MV, Ti, I:E and Spont Cyc represent, nor their significance.

Vt should be your tidal volume.
RR, respiration rate
MV, minute vent.
Ti is time of inspiration, so you're well under the 2 second default cutoff, on average.
I:E is your inspiration vs expiration ratio, the only time that's worth looking at is if you're on therapy for lung diseases.
Spont cycle is how often you cycle the machine, vs it cycling itself, remember, "cycle" is when the machine goes from ipap to epap, higher is better.

[Pugsy]

Centrals/Clear Apneas won't show up on the OSCAR events graph until you have one. After that they will show up all the time even if you don't have any.

[zonker]

Had my first night with my AirCurve 10 Vauto, and pleased to announce I had a very good night.
<snip>
If anyone has any thoughts, please chime in.

my thought is "damn, i'm glad this guy is part of this forum.". why? because when you bring information, you BRING it. i've always found anything other than a simple apap hard to understand. but i could actually follow what you wrote. good job!

what i notice is how steady your pressure is under the vauto when compared to your pressure in apap. i can't remember if it was you or djams that exclaimed how steady mine were. if it was you, hope the benefit is there for you, bro.

i know you will as a matter of course, but hope to see more data going forward. (i hate that phrase!) still keen to see if this helps your wake ups.

all in all, good work, lad!

[Pugsy]

My point about suggesting PS of 4 (or even a bit higher if you want to experiment) is that it's an option or a variable that you have at your disposal that you didn't have before.
No rush to try it though...just something for a down the road "something to do" kind of thing just for the educational experience to see what it is like...see if you even like it. You may not even like it but then again you might be like me and just love that little extra push.

Some people like to try new stuff....some don't. Either way is fine as long as the person is happy.
I always learn something when I try anything new. Sometimes all I learn is what a bad idea that might have been but I always learn something. Nothing is ever a waste when we learn something.

[slowriter]

Had my first night with my AirCurve 10 Vauto, and pleased to announce I had a very good night.

....

If anyone has any thoughts, please chime in.

Results look good, and yes, like you say, they demonstrate the positive impact on FL that comes with additional PS.

The only thing I notice that I wonder about: your I:E ratio seems maybe a little low; or at least lower than "normal"? I don't know if it's anything to worry about (perhaps others with more experience can comment), but it could suggest possibly changing the cycle setting (like, from high to medium; I don't know how you have it set now)?

[palerider]

The only thing I notice that I wonder about: your I:E ratio seems maybe a little low; or at least lower than "normal"? I don't know if it's anything to worry about (perhaps others with more experience can comment), but it could suggest possibly changing the cycle setting (like, from high to medium; I don't know how you have it set now)?

*NO*

I:E is meaningless for people that don't have lung issues.

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

[Dog Slobber]

I'm so sorry that you're a new victim of the patented super overshoot technology now... You can see what it's done to your sleep.

Lov'n the patented Super Overshoot Technology.

Vt should be your tidal volume.
RR, respiration rate
MV, minute vent.
Ti is time of inspiration, so you're well under the 2 second default cutoff, on average.
I:E is your inspiration vs expiration ratio, the only time that's worth looking at is if you're on therapy for lung diseases.
Spont cycle is how often you cycle the machine, vs it cycling itself, remember, "cycle" is when the machine goes from ipap to epap, higher is better.

Thanks for this. Great start to reduce my learning curve.

Centrals/Clear Apneas won't show up on the OSCAR events graph until you have one. After that they will show up all the time even if you don't have any.

Than't what I was hoping for.

what i notice is how steady your pressure is under the vauto when compared to your pressure in apap. i can't remember if it was you or djams that exclaimed how steady mine were. if it was you, hope the benefit is there for you, bro.

i know you will as a matter of course, but hope to see more data going forward. (i hate that phrase!) still keen to see if this helps your wake ups.

Yup, it was me. On the night where you posted your first AHI 0.0, I too had one, I commented how similar how traces were.

I like to keep a real "Narrow" range, and by Narrow, I don't mean tight values between minimum pressure and maximum pressure. I mean tight values between minimum pressure and where the machine typically goes.

I'll definitely be monitoring wake-ups.

My point about suggesting PS of 4 (or even a bit higher if you want to experiment) is that it's an option or a variable that you have at your disposal that you didn't have before.
No rush to try it though...just something for a down the road "something to do" kind of thing just for the educational experience to see what it is like...see if you even like it. You may not even like it but then again you might be like me and just love that little extra push.

Some people like to try new stuff....some don't. Either way is fine as long as the person is happy.
I always learn something when I try anything new. Sometimes all I learn is what a bad idea that might have been but I always learn something. Nothing is ever a waste when we learn something.

I am actually thrilled that you suggested and that I tried it.

For some reason seeing that dramatic reduction in FLs, that I attribute to the higher PS, has really made me feel positive about the who experience.

It also re-enforced what PS does.

Keeping away the aliens wa just icing.

The only thing I notice that I wonder about: your I:E ratio seems maybe a little low; or at least lower than "normal"? I don't know if it's anything to worry about (perhaps others with more experience can comment), but it could suggest possibly changing the cycle setting (like, from high to medium; I don't know how you have it set now)?

With the exception of PS, I left all the BiLevel settings at default:

• Ti Max 2.0s
• Ti Min 0.3s
• Trigger Med
• Cycle Med

[Pugsy]

I see no reason to mess with the default comfort or breathing settings.
I agree with PR....I:E ratio on these machines doesn't really mean much and are really there for people with some serious lung issues and on the high end specialty machines designed for people with serious lung issues.
Someone with that sort of lung issue would long ago have had other problems and the limited I:E ratio is NOT suitable as a diagnostic tool and having some sort of lung issue wouldn't be a surprise.
It's pretty much a meaningless data point on this model bilevel used by a person with no history of lung issues.

[Dog Slobber]

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

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.

[palerider]

The only thing I notice that I wonder about: your I:E ratio seems maybe a little low; or at least lower than "normal"? I don't know if it's anything to worry about (perhaps others with more experience can comment), but it could suggest possibly changing the cycle setting (like, from high to medium; I don't know how you have it set now)?

With the exception of PS, I left all the BiLevel settings at default:

• Ti Max 2.0s
• Ti Min 0.3s
• Trigger Med
• Cycle Med

Which was the right thing to do.

changing cycle won't have an appreciable effect on how long you maintain inhalation, anyway.

[palerider]

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

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.

Well, THAT is an entirely different issue *cough*

[Pugsy]

Mrs Dog Slobber's headaches must be abating.