Dog Slobber - APAP to VAuto

Hi,

A local ResMed AirCurve 10 VAuto is available on a Buy/Sell forum for what appears to be a very good price.

I don't think I have a need for a BiLevel device, but wondering if there are any advantages to buying it to see if it performs better or is more comfortable than my current AirSense 10 AutoSet for Her. I also have an identical backup machine.

Some details:

• Sleep Study - AHI 59
• AirSense 10 AutoSet for Her
• Pressure 9.6-12.0, EPR 3, my AHI hovers around 1.
• I deliberately cap my maximum at 12, as I was experiencing bloating. This reduces bloating and takes care of almost all of my Obstructive Apneas and Hypopneas
• Almost all apneas I now get are Centrals. I'm not convinced they are real as usually get them if I awaken and the breathing pattern immediately prior is often erratic.
• I had a Septoplasty/Turbinate reduction about 4 months ago and therapy has been good since then. But by breathing still isn't fully restored.
• 100% compliance since the Septoplasty, consistently getting about 8 hours sleep, feeling great in the day.

My only real therapy concern is waking up once or twice a night and sometimes struggling to get back to sleep. Though, I might be getting past this.

Attached is last nights SleepyHead graph, a typical night, with a close-up of one of the CAs.

I've been managing my own therapy using information leaned here and am comfortable with the AutoSet configuration.

I'm wondering if:
There's any potential benefit for me in VAuto or S mode.
Is it much more complicated to optimize and dial-in all the extra configuration items.
Can it be set to perform the same to my AutoSet, if none of the AirCurve features are needed.

Any opinions appreciated on the AirCurve or graphs appreciated.

Have you tried lowering the EPR a notch? Your minute ventilation seems pretty darn high.

The zoomed in CA/central....obviously not real and probably post arousal (from unknown cause for the arousal) SWJ and can be ignored.
Other than the fact it points to some sort of arousal which we don't want...it's not an issue.

I don't know if anything the AirCurve might offer that is different from your apap mode would benefit you since you are using a tight range due to aerophagia issues and apparently doing well on paper anyway.

EPR is very similar to PS on the bilevel machines...so close that it is really hard to "feel" any difference.
I have tried....EPR of 3 and PS of 3 which is essentially the same thing. The difference I experienced in terms of timing and how I felt...so tiny I really had to strain hard to sense any difference.
Now the timing is ever so slightly different...timing of the transition from inhale and exhale and back to inhale.
I think PS is just a little smoother but it's a really small feeling difference that I get.
For all practical purposes for most people...EPR of 3 is going to function and feel like PS of 3.
Now if you were to go to PS of 4 or 5....obviously there is a difference and you might like that difference and it might do well for you.
I prefer PS of 4 over PS of 3 in general. I use EPR of 3 on my machine because that's all I have available...if it could go to EPR of 4...I would like it even more.

Yes, you can set the AirCurve 10 VAuto and have it mimic apap mode on your current machine as long as you don't go to the for Her auto mode which is a totally different algorithm.
Easy to do on the VAuto
Minimum EPAP 6.6
PS of 3
Max IPAP 12
You would have 9.6 in inhale when starting the night and 6.6 on exhale and the highest IPAP will go is 12.

It will feel like your current apap settings of 9.6 min and 12 max with EPR at 3.
You start out the night with inhale at 9.6 and exhale of 6.6 and then the machine goes up to 12 if needed.

The VAuto has EasyBreathe technology...the apap doesn't...is it enough of a difference that you will notice and make any difference...I don't know.

S mode...that's a fixed bilevel mode...would be like using cpap mode on your apap except you can have a bigger difference between inhale and exhale.
VAuto mode...you can also have a bigger difference between inhale and exhale if you wish.
Would that bigger difference benefit you...dunno.

If the VAuto is cheap enough...get it and try it and if you like it...sell your other back up apap...or be a cpap hoarder like me with more than 2 machines.
If you hate the VAuto (can't imagine anyone hating it though) sell it on the forum for what you paid for it.
They sell fast...just ask LSAT.

raisedfist wrote: ↑

Thu Jan 10, 2019 11:53 am

Have you tried lowering the EPR a notch? Your minute ventilation seems pretty darn high.

TY for the response raisedfist.

When I first got my device I tried lowering EPR, at the time I didn't like less than 3 because I had trouble breathing against the pressure. Now that I'm more accustomed to it I'll consider lowering it again.

Regarding Minute Ventilation. I've never paid much attention to most of the ventilation or breathing oriented graphs.

I scanned through my Sleepy Head graphs looking at my Minute Vent values. Since moving to my minimum to 9.6 cm, my Minute Vent is consistently in the 9.x litre range, sometimes higher. When my minimum pressure was lower so too was my Minute Vent, not a lot in the 7.5 - 8.5 litres per minute range.

I'm unsure what the relationship is with Minute Ventilation is.

Pugsy wrote: ↑

Thu Jan 10, 2019 12:23 pm

The zoomed in CA/central....obviously not real and probably post arousal (from unknown cause for the arousal) SWJ and can be ignored.
Other than the fact it points to some sort of arousal which we don't want...it's not an issue.
.
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..SNIP..
.
.
They sell fast...just ask LSAT.

Thank you for your thorough response, if my nighttime arousals keep it up, I'll see if I can pin down the reason.

Based on your advise, I think I'll pass on experimenting with the AirCurve, given that PS: 3 and EPR: 3 feels very similar and since I'm not prescribed for a BiLevel I don't think it would be in my best interests to get accustomed to a higher value only to go have to give it up when it comes time for a new machine in the future. VAutos being more expensive and not as available in the second-hand market just re-enforces traditional APAP should continue to do me just fine.

Dog Slobber

When I first got my device I tried lowering EPR, at the time I didn't like less than 3 because I had trouble breathing against the pressure. Now that I'm more accustomed to it I'll consider lowering it again.

Regarding Minute Ventilation. I've never paid much attention to most of the ventilation or breathing oriented graphs.

I scanned through my Sleepy Head graphs looking at my Minute Vent values. Since moving to my minimum to 9.6 cm, my Minute Vent is consistently in the 9.x litre range, sometimes higher. When my minimum pressure was lower so too was my Minute Vent, not a lot in the 7.5 - 8.5 litres per minute range.

I'm unsure what the relationship is with Minute Ventilation is.

There is no real reason for you to pay attention to any of the ventilation statistics, given that you are using an APAP. It just happened to stick out to me, since you're using EPR 3. Not sure if there is any connection, but I don't see the harm in reducing EPR and see if it helps with the arousals, or honestly, what it does if anything.

Your therapy is very well optimized, so as long as it's comfortable I don't see any real reason to shell out money for another machine when the one you have works great. If the APAP isn't comfortable, then regardless of EPR/PS, the VAuto adds a lot of comfort settings that the APAP does not have, as Pugsy detailed.

raisedfist wrote: ↑

Thu Jan 10, 2019 3:51 pm

There is no real reason for you to pay attention to any of the ventilation statistics, given that you are using an APAP. It just happened to stick out to me, since you're using EPR 3. Not sure if there is any connection, but I don't see the harm in reducing EPR and see if it helps with the arousals, or honestly, what it does if anything.

Your therapy is very well optimized, so as long as it's comfortable I don't see any real reason to shell out money for another machine when the one you have works great. If the APAP isn't comfortable, then regardless of EPR/PS, the VAuto adds a lot of comfort settings that the APAP does not have, as Pugsy detailed.

I have an appointment with my Sleep Dr. this Tuesday, she is very supportive of my APAP self-management. I'm going to stick with my current config until I see her, don't want a bad set of numbers just before seeing her.

Then I'll try reducing EPR and possibly Soft Response.

FWIW....I pretty much totally ignore all that volume, vent, RR, etc stuff because there's such a wide range of normals. Height, weight, sex, altitude, age, etc.
I stick with the basics..
Now if I had some sort of known lung or respiratory issue then I might pay more attention but I wouldn't be relying on the machine for any of that stuff...I would have real lung function studies done. These machines weren't designed for that.
Only the higher end machines which have some specific settings available for people who have problems are really designed for that stuff.
If I had a compromised respiratory system...I am betting I would know it long before I saw anything whacky on the statistics and that's assuming the statistics are accurate. Without ResScan to confirm it...I can't be sure it is even accurate.

Oh yeah I wasn't indicating that because Mv could be high, therefore head to the doctor stat! More just that EPR *may* have some effect, and with some certainty Vt and Mv should decrease with less EPR/PS. And maybe that will help. Maybe it won't.

Dog Slobber wrote: ↑

Thu Jan 10, 2019 4:02 pm

Then I'll try reducing EPR and possibly Soft Response.

please let us know how the soft response works for you, if you try it.

Dog Slobber wrote: ↑

Thu Jan 10, 2019 11:28 am

Hi,

A local ResMed AirCurve 10 VAuto is available on a Buy/Sell forum for what appears to be a very good price.

I don't think I have a need for a BiLevel device, but wondering if there are any advantages to buying it to see if it performs better or is more comfortable than my current AirSense 10 AutoSet for Her. I also have an identical backup machine.
...
I'm wondering if:
There's any potential benefit for me in VAuto or S mode.
Is it much more complicated to optimize and dial-in all the extra configuration items.
Can it be set to perform the same to my AutoSet, if none of the AirCurve features are needed.

If it's a great deal on a VAuto, I'd say "grab it". That's exactly why I have a VPAP Auto (the S9 version of what you're looking at), I was looking for an Autoset, and came across a great deal on the VPAP Auto, I'm glad I did.

It's basically an Autoset, with more abilities. Where an Autoset is effectively two machines,(Elite and Autoset) the VAuto is, effectively, FOUR.. Elite, Autoset, S and VAuto.

S won't help you, since S is like an Elite, (plain CPAP) except with greater pressure support.

VAuto mode *may* help, if there's some benefit to a little tweaking, (like there was with me). basically, you can adjust how sensitive the machine is to your breathing, I'd notice, while looking at some of my apneas, that it looked like I was *trying* to breathe as my throat was closing up, I'd see these little inhale bumps in the flow, but the machine wasn't saying "oh, inhale, I'll bump the pressure", so I adjusted the Trigger setting, making it more sensitive (very high), so the machine would raise pressure when I'd start to inhale.. and that brought my AHI down further. I also noticed that it looked like it was cutting off my inhalations sometimes, so I adjusted the TiMax setting to let me inhale longer when I wanted to in my sleep... I don't know that helped anything, but ... why not

Basically, you get more *options* with the VAuto.

No, it's not more complicated, as long as you don't start tweaking with some of the added settings, for most people, they can be left at their defaults.

Yes, it can behave exactly like the Autoset. but not the Autoset For Her.

Personally, I think the VAuto is the *best* machine for people that don't have special needs.

palerider wrote: ↑

Thu Jan 10, 2019 8:37 pm

Personally, I think the VAuto is the *best* machine for people that don't have special needs.

I want a VAuto for Her.
I like the special algorithm and the fact that the pressure minimum increases and stays increased if I meet criteria...I see it work fairly often and kinda like seeing that the machine is actually being even more proactive.
But I sure miss PS of 4 or 5....
So I want both....the special algorithm and more PS...then I would have the "perfect" (at least for me) machine.

Dog Slobber....just how good of a deal did you find? Price and hours of use?
I was real tempted to tell you to buy it...try it and then let me buy it from you....
until just a little bit ago...
My truck blew up on the interstate...spent 2 hours sitting on the side of the road getting my doors blown off by the assholes who wouldn't even move over when they could.
I have no idea what is wrong with it but I know it won't be cheap. Nothing on that truck ever is.
I had to have it towed...ugh.
I need a drink.

Pugsy wrote: ↑

Thu Jan 10, 2019 10:12 pm

palerider wrote: ↑

Thu Jan 10, 2019 8:37 pm

Personally, I think the VAuto is the *best* machine for people that don't have special needs.

I want a VAuto for Her.
I like the special algorithm and the fact that the pressure minimum increases and stays increased if I meet criteria...I see it work fairly often and kinda like seeing that the machine is actually being even more proactive.
But I sure miss PS of 4 or 5....
So I want both....the special algorithm and more PS...then I would have the "perfect" (at least for me) machine.

I think that auto raised minimum should be available in all auto machines... and, remember from session to session...

Then we wouldn't need doctors, at least not the ones that send people home with a machine set to 4-20, (or the new "I don't know anything" setting, 5-15)

Pugsy wrote: ↑

Thu Jan 10, 2019 10:12 pm

My truck blew up on the interstate...spent 2 hours sitting on the side of the road getting my doors blown off by the assholes who wouldn't even move over when they could.
I have no idea what is wrong with it but I know it won't be cheap. Nothing on that truck ever is.
I had to have it towed...ugh.
I need a drink.

Oh NO!!!

zonker wrote: ↑

Thu Jan 10, 2019 6:31 pm

please let us know how the soft response works for you, if you try it.

Absolutely.

Pugsy wrote: ↑

Thu Jan 10, 2019 10:12 pm

Dog Slobber....just how good of a deal did you find? Price and hours of use?

Don't have an exact figure yet, I'm pretty sure I can get it for under $500 CAD, ( ~$375 US). Not sure abut the hours yet. I'm going to have to describe to him how to check for run time.

All he knew was about 2 years old.

palerider wrote: ↑

Thu Jan 10, 2019 8:37 pm

.
[SNIP]
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Personally, I think the VAuto is the *best* machine for people that don't have special needs.

Thanks for this. Depending on hours, I think I'll throw him an offer and see what happens.

Well i just found out it has about 11,000 hours on it.

This gives me pause. It could run for another 10K, or stop tomorrow. Heck maybe it's not working properly now.

Any suggestions on what i should offer, or just steer clear?