AirCurve 10 VAuto Bipap settings help needed

Pugsy wrote: ↑

Sat Mar 02, 2019 10:18 am

Sorry for the "discussion" with ajack. I didn't mean to hijack your thread like this but he's talking about stuff that doesn't pertain to you and can't seem to understand it. Sometimes he just irritates the hell out of me and I can't keep my mouth shut.

I've had no problem at night with my P10's. But I'm starting to find I need to tape my mouth during the day, when reading ajack's posts.

If you were asking what settings to use? I didn't make an actual recommendation because there is so much that I don't know pertaining to why you had a problem with the AirSense 10 Autoset and what your current problem is with this machine and I haven't seen one report from any machine to give me any sort of idea what your pressure needs might be.

In other words...I don't know what you need and I don't understand what the problem was that you were having with whatever the AirSense 10 was doing.

Without more information....what I would do is suggest using the machine setting as it has been set up...and get a report using the software and see what is happening and what it wants to do and at the same time have you try to explain what your problem with it as it is now at these settings.
It's real hard to fix a problem without first identifying the problem. Heck, sometimes it's hard enough to fix it even when we know what it is.

You have a great machine...I would love to have it myself. I would like to try to help you make it comfortable so you can sleep with it and get the benefits it offers but there is so much missing in details that's it's hard to come up with anything but a WAG...wild ass guess...and I don't like guessing unless I have no choice at all.
I don't know what kind of results you had with the AutoSet....and I don't know what your problem was with it. I am assuming that since they gave you the bilevel that for some reason they felt you did better with more PS but if your problem was strictly inhale related and your wanting a really low IPAP...kinda hard to do a low IPAP when you are using PS of 4.

I'll remember you are female in future. I was using the he in a generic way, the op may also be female, who knows?

They normally use min and max epap with PS
EPAP + PS = IPAP
If they are calling it max ipap, as you know, it's actually a max epap setting and ps .. , the epap changes and the PS stays the same

so the setting would be
epap 5, ipap 19, ps4 and see where the machine goes when a chart is posted.

Dog Slobber wrote: ↑

Sat Mar 02, 2019 10:38 am

I've had no problem at night with my P10's. But I'm starting to find I need to tape my mouth during the day, when reading ajack's posts.

Sometimes it's not so much the taping of the mouth that is needed but mittens on the fingers or in my case...a truckload of bandaids because I tend to bite my fingers to a bloody pulp to keep me from saying what's on my mind because it's usually not very lady like.

ajack wrote: ↑

Sat Mar 02, 2019 10:42 am

I'll remember you are female in future. I was using the he in a generic way, the op may also be female, who knows?

They normally use min and max epap with PS
EPAP + PS = IPAP
If they are calling it max ipap, as you know, it's actually a max epap setting and ps .. , the epap changes and the PS stays the same

so the setting would be
epap 5, ipap 19, ps4 and see where the machine goes when a chart is posted.

I try to use the terminology that people see on their LCD screens....less chance of confusion.
I already explained what ResMed does with their fixed PS.

And without knowing what kind of problem the OP has now or in the past with things...I would NOT suggesting changing IPAP max from 9 to 15.
I don't have enough information to warrant that suggestion....it's a WAG and I don't do wags unless I have no choice and in this situation ...there are choices. The choices involve taking some time and getting more history...and I won't give up accuracy for speed and WAGs.

Hi Pugsy, no problem. I'll just skip those posts.

Below I'll post some of the info from my previous post that gives some details and first I'll explain what happened with the resmed Airsense.

Here's what happened with the airsense and why the doctor changed me to bipap:

I was grinding my teeth. I already have severe TMJ and I've lost teeth to it. I wear a lower bite guard 24/7, which corrects my bite, and the airsense was causing me to grind so hard even with the bite guard, that my top teeth were seriously aching. This is not normal for me while I'm wearing my bite guard, and I was concerned I'd traumatize and lose more teeth. The doctor recommended bipap. When I took the sleep study using bipap, at the setting of 4/8, I was not grinding my teeth.

During the sleep study I had a big problem falling asleep because of the initial IPAP pressure of 8. I had the same exact problem I describe below with that IPAP in the excerpt below from my follow up question. So to help me be able to fall asleep during the sleep study, they started me in cpap mode with a pressure of 5 and I was fine. Once I fell asleep they turned it to bipap with 4/8 and apparently I did well with no grinding or apneas.

I was told this machine could basically start me with a low IPAP and detect when I fell asleep and raise it then. But I now see that this is not true.


Here's the relevant part of my previous question which has some details about my current issue:

So it seems that it is what it is and I'm guessing that there is no other machine that does what the Resmed guy told me. So how do I adjust to this?

The good part is that when I put it on, the EPAP of 4 feels really good. I think you're right that I needed more than the airsense could give me.

The problem is that the IPAP is really bothering me. I feel like I'm hyperventilating and I get that feeling like I can't get enough air. I keep trying to take deep breaths but it doesn't give me relief. Also my ears immediately became blocked/full and began ringing.

It may help to know that when I had the resmed airsense 10, after some experimentation I found that I could start comfortably at around 5 for the IPAP. I still woke up with the ear ringing/fullness but at least I didn't feel that immediately or that sense of hyperventilation, so I could fall asleep. Also I have problems with vertigo from the inner ears, and failed cpap many years ago because it was inducing the vertigo. I only decided to try cpap again because I was told that the ability to start with a lower ipap and ramp up could help me to avoid that. In fact it did. I had to play around but when I ramped the starting and ramping pressure, I didn't get vertigo. I'm concerned about the possibility that starting at an IPAP of 8 will induce vertigo.

Also I don't think the max of 9 will be good enough. When I had the airsense, sometimes it went higher than that. It was set to a max of 20, and it was usually around 8-9 but sometimes went up as high as 12. If I understand correctly, if I change the max IPAP to 12, the EPAP will rise with it? When it rises, does that mean I'll have stronger air pressure when I exhale? If so, I'm guessing my body won't love that.

So is there a setting that will deal with some of these issues?

Pugsy, please let me know if there's anything else I can tell you that will help you get the full picture.

Thank you so much!

I think I sort of have a clearer picture now.

Yes...if IPAP goes up (assuming it wants to and can)...it will drag EPAP up with it for as long as it goes up.
Just because the AutoSet wanted to go to 12 doesn't always mean that we have to always let it go to where it might want to go.
Sometimes we have to make compromises in what we allow the machine to do when the going somewhere causes more problems than what it was trying to kill with more pressure might have caused.

You need a machine that can do cpap part of the night and then switch to auto adjusting...ResMed doesn't make it. Respironics used to offer it with their machines that offered "split night" settings. I don't know if they offer it now on their apaps and I don't think they offer it at all on their bipaps. And we can't get anywhere near 4 PS on the apap machines using Flex exhale relief. The most they will do is a 2 cm drop and that's only if you breathe forcefully.

How about trying a compromise...lower your EPAP minimum to 3...and see what it feels like comfort wise with 7 IPAP (keeping the 4 PS).
Or try various compromises with a minimum EPAP with various PS settings to see what you are comfortable with and by comfortable I mean able to fall asleep.
I have no idea why PS affects your teeth grinding...but if it does ...then it does and we deal with it but the AirCurve machine won't let you do what you were told it would do and what you want it to.

The way I am getting it...the problem right now is mainly the fact that you can't fall asleep with these settings? They aren't comfortable to you for some reason. At this point I don't know that I would worry about the max IPAP setting of 9...it might work out just fine and it might not but until you can actually get to sleep...doesn't really matter what it is. I would put that on the back burner for now. Worry about increasing it if needed and we need you to sleep and get us some data showing what the machine wants to do before we can decide if 9 cm is enough or not max IPAP.

When you were using the AutoSet were you using EPR...and if you were did you have it set to 3?

Even if the AirCurve 10 VAuto did have an auto adjusting PS...that wouldn't necessarily guarantee that it would auto adjust. The machine might not go to 4 even if it could. They just don't work that way. Just because a machine can do something doesn't always mean that it will do what it can do.

You want PS to eliminate the teeth grinding but the PS being present is causing comfort issues and you can't fall asleep...is that pretty much a short version of your problem?

Play with the trigger setting...see if that makes in difference in comfort and lessens the feeling that you are hyperventilating.
Pay special attention to if you feel like your breathing feels rushed and the machine is trying to encourage a rhythm that you aren't okay with.

Use the machine while awake and under no pressure to fall asleep...believe it or not but eventually your brain will get used to it.

Consider reducing PS to 3 and see how that feels to you especially if you also reduce EPAP to 3....that would give you 6 IPAP to start with. Might be comfortable enough for you to fall asleep.

Pugsy thank you so much for the suggestions. Yes you pretty much summed it up.

I did use the EPR setting of 3 on the Airsense but I didn't even discern much of a difference and it definitely didn't stop the grinding. I guess I needed the EPAP at a minimum of 4 to stop the grinding.

I'm not really clear on how the EPR setting of 3 compares to an EPAP pressure of 4. If I change the EPAP setting to 3, will that be equivalent to the EPR setting of 3?

Yes, EPR at 3 is pretty much the same as PS of 3. The timing might be ever so slightly different but most people won't notice the difference.
I tested it myself once just to see...used CPAP mode with EPR at 3 and bilevel mode with PS of 3 and I could barely feel a slight difference in the timing ...but I had to really strain to feel the difference.
If your minimum setting on the AutoSet wasn't at least 7...you weren't getting 3 cm drop during exhale anyway. Example...on the AutoSet you might have had the setting at 3 for EPR but if your minimum pressure was 5 or 6...you wouldn't get the full drop because the AutoSet couldn't drop below 4 cm...it can only drop a full 3 cm when the pressure is at 7 so then it has room to drop to 4.

Maybe it isn't EPAP that is the trigger for the teeth grinding. Maybe it is the PS that is the trigger...which is why I suggest trying 3 minimum EPAP with 4 PS so inhale will be 7 and maybe won't feel so much like hyperventilating.
The VAuto will do one thing your AutoSet couldn't do...give you a 3 cm minimum EPAP.

Angielynn wrote: ↑

Sat Mar 02, 2019 11:42 am

Hi Pugsy, no problem. I'll just skip those posts.

if you wish, you can put him on your foe list. then you'll never see his posts again, unless someone quotes him or you deliberately choose to read them.

good luck!

Angielynn wrote: ↑

Sat Mar 02, 2019 10:05 am

Hi Pugsy, I posted a follow-up question - it's showing on page 1 for me. I'd be grateful if we could continue our conversation. I couldn't understand anything that ajack said anyway. It's not a problem, I'm just waiting on your advice.

Pugsy says we're all a family here.

Ajack is the college professor with the mismatched socks and sweater that's not buttoned up properly, smelling of alcohol, who's insisting on talking your ear off about magnetorheological dampers and the intricacies involved in properly tuning them, when all you'd done was mention that you needed to get your oil changed in your car, and now you can't get away from him to make a mad dash to the restroom. Oh, and by the way, when Aunt Flora let Ajack look under the hood of her SUV, it never ran right again and she had to buy a new one.

For your own sanity, click on ajack's name there, then click 'add foe'.

jimbud wrote: ↑

Sat Mar 02, 2019 10:35 am

ajerk needs to check his house for a gas leak. Sorry I just had to say something.

Very perceptive.

And, maybe if more people point out their distaste to his ravings, he'll just go away.

Angielynn wrote: ↑

Sat Mar 02, 2019 11:42 am

Hi Pugsy, no problem. I'll just skip those posts.

Below I'll post some of the info from my previous post that gives some details and first I'll explain what happened with the resmed Airsense.

Here's what happened with the airsense and why the doctor changed me to bipap:

I was grinding my teeth. I already have severe TMJ and I've lost teeth to it. I wear a lower bite guard 24/7, which corrects my bite, and the airsense was causing me to grind so hard even with the bite guard, that my top teeth were seriously aching. This is not normal for me while I'm wearing my bite guard, and I was concerned I'd traumatize and lose more teeth. The doctor recommended bipap. When I took the sleep study using bipap, at the setting of 4/8, I was not grinding my teeth.

The problem with sleep studies is that you're in an alien environment, all wired up, and you're not going to sleep normally. So people very often don't get the same exact results at home.... and have to make adjustments.

Angielynn wrote: ↑

Sat Mar 02, 2019 11:42 am

During the sleep study I had a big problem falling asleep because of the initial IPAP pressure of 8. I had the same exact problem I describe below with that IPAP in the excerpt below from my follow up question. So to help me be able to fall asleep during the sleep study, they started me in cpap mode with a pressure of 5 and I was fine. Once I fell asleep they turned it to bipap with 4/8 and apparently I did well with no grinding or apneas.

I was told this machine could basically start me with a low IPAP and detect when I fell asleep and raise it then. But I now see that this is not true.

Unfortunately, no.

Your old machine, you could start with a low ipap and have that increase up to a PS of 3, at which point the EPAP would start to increase, but the VAuto won't do that.

Angielynn wrote: ↑

Sat Mar 02, 2019 11:42 am

I'm concerned about the possibility that starting at an IPAP of 8 will induce vertigo.

Vertigo is usually caused by hyperventilation, which means too much PS (Pressure support), not too much ipap...

Angielynn wrote: ↑

Sat Mar 02, 2019 11:42 am

Also I don't think the max of 9 will be good enough. When I had the airsense, sometimes it went higher than that. It was set to a max of 20, and it was usually around 8-9 but sometimes went up as high as 12. If I understand correctly, if I change the max IPAP to 12, the EPAP will rise with it? When it rises, does that mean I'll have stronger air pressure when I exhale? If so, I'm guessing my body won't love that.

Usually, it's not so much the actual EPAP that causes people to have trouble exhaling, it's the relationship between EPAP and IPAP, when you start exhaling, the pressure drops and that lets you exhale easier, no matter what the eventual EPAP is.

Pugsy wrote: ↑

Sat Mar 02, 2019 12:14 pm

How about trying a compromise...lower your EPAP minimum to 3...and see what it feels like comfort wise with 7 IPAP (keeping the 4 PS).

Point of order, minepap won't go below 4, the machine has to be in non-auto mode to get an EPAP of 3.

Angielynn wrote: ↑

Sat Mar 02, 2019 12:47 pm

Pugsy thank you so much for the suggestions. Yes you pretty much summed it up.

I did use the EPR setting of 3 on the Airsense but I didn't even discern much of a difference and it definitely didn't stop the grinding. I guess I needed the EPAP at a minimum of 4 to stop the grinding.

I'm not really clear on how the EPR setting of 3 compares to an EPAP pressure of 4. If I change the EPAP setting to 3, will that be equivalent to the EPR setting of 3?

EPR of 3 is related to a PS of 3, not an EPAP of 3. EPR creates a limited bilevel function in a cpap machine... so you have a different inhale and exhale pressure, and that's what PS is.

EPAP Expiratory Positive Airway Pressure
IPAP Inhalation Positive Airway Pressure
PS Pressure support (the difference between EPAP and IPAP
EPR Expiratory Pressure Relief (sort of the same as PS, except PS is a pressure *increase* from EPAP, and ERP is a pressure DROP from IPAP.)

I hope that didn't confuse things any.