SleepRes V-Com - Opinions?

Pugsy wrote: ↑

Sat Apr 15, 2023 9:48 pm

Come on folks...Jason does a lot of really good educational material and he puts it out there free for everyone.
He doesn't put it behind a pay wall.
Doing all that sort of stuff takes money.
Do you all really begrudge Jason getting some funds elsewhere to help pay his internet presence bills?

Do you think that all positive comments he makes about anything were paid for by the product and not his true thoughts?

Why is everything a big conspiracy and why so negative?

This thread was someone wondering if anyone had heard of or tried it.
How did it get derailed? How come now we are questioning Jason's motive for saying he tried something and liked it?

+1

My only comment would be Jason uses fixed pressure.

This device, because of its pressure limiter, can also influence the devices ability to detect events.

For fixed pressure, no problem, but is the ResMed auto algorithm negatively impacted.

I don't question his motives, but I do question the wisdom of inserting any device into the flow loop of a medical device between the blower and mask when doing so has not been recommended, endorsed, or approved by any manufacturer or any authoritative medical oversight body that I know of. And I question why anyone with credentials would choose to seem to do so by publicizing it. But then again, hey, it's his reputation, not mine, and it sure ain't the stupidest thingy hawked on YouTube.

I consider the device a trick to make a patient percieve that pressure has been reduced although it hasn't. Nothing more. Being fooled can be considered a comfort device, I guess, in the way zero-med pills might "help" a hypochondriac, but that doesn't make it worthy of public endorsement to hype the benefits of a sort of placebo effect.

Just my opinion as someone who hasn't, and won't, try it.

It isn't negative conspiracy theory that keeps me from trying a lucky astrology mood watch in an attempt to improve my therapy, either.

Trying to breathe in against resistance to flow has the potential to increase negative pressure in the airway in a way that narrows it, much like the IFLs caused by sinus troubles. Doesn't smell like a great idea to me.

I watched the video again with LeftyLanky. He goes out of his way to assure the viewer he won't hawk products for profit and I believe him. So I ordered a V-COM, will give my opinion after a few nights with it.

If it was medically a good idea to limit inspiratory flow, it would already be built in to the machines/masks.

Meantime, anyone who wants to spend $25 for 5 cents worth of plastic is always welcome to do so, of course, just to help prop up the economy.

Maybe, but if it helps? It will be worth it.

Dr. K's two cents:

. . . V-com is . . . geared toward inspiration, imagining that most people find discomfort breathing in with pressurized air. Nothing could be further from the truth. Many people can tolerate higher inspiratory pressures, because it feels good to finally feel like you are getting a full breath. But, breathing out against these high pressures is very uncomfortable. V-Com doesn’t address this problem . . .

https://fastasleep.substack.com/p/v-com ... adaptation

I dissagree, we can adjust pressures, and to a certain extent IPAP/EPAP with EPR or flex. Why not the flow? The V-COM is a simple peice of plastic that limits flow, making new pap users more comfortable. And couldn't it possibly make CPAP more effective in reducing AHI for certain patients? For example if two patients require 12 cm/water but one does better at 100 percent flow and the other does better at 80 percent flow, wouldn't it be nice within the machine to adjust for that just like we do for pressure? I think so, and if the V-COM is successful for a large enough population of pap users the cpap manufactures will be paying attention. And we will see flow as an adjustment on future cpap machines.

Denase wrote: ↑

Mon Apr 17, 2023 2:14 pm

I dissagree, we can adjust pressures, and to a certain extent IPAP/EPAP with EPR or flex. Why not the flow? The V-COM is a simple peice of plastic that limits flow, making new pap users more comfortable. And couldn't it possibly make CPAP more effective in reducing AHI for certain patients? For example if two patients require 12 cm/water but one does better at 100 percent flow and the other does better at 80 percent flow, wouldn't it be nice within the machine to adjust for that just like we do for pressure? I think so, and if the V-COM is successful for a large enough population of pap users the cpap manufactures will be paying attention. And we will see flow as an adjustment on future cpap machines.

Because you can't set the flow as described in your post (ie from 100 to 80).

You can set pressure, and then allow the machine to adjust the flow appropriate to meet the adjusted pressure.

Or you can set the flow, but then you have no clue what the resulting pressure will be.

But, you can't set both.

I believe the people talking about it online and in articles are often mixing up the concepts of flow and pressure. They interrelate but aren't interchangeable the way they are being discussed.

Resistance to flow is already an inherent property of masks and hoses. It is scientifically designed and accounted for in engineering, sensors, and algorithms. That's why machines ask for input on hose length, hose diameter, and mask type. Poking a stick into all that just for kicks can have dangerous unintended consequences, since the machines need to understand how to use the flow signals they sense for accurate adjustments and accurate reports:

Many machines need to sense the timing and nature of inspiration according to flow generated by the human diaphragm dropping in order for the machine to initiate pressure changes with each breath (bilevel, EPR, etc), in order for it to choose proper pressures in APAP mode according to flow-curve information (by sensing flattening, vibration, etc), and to properly report the nature of events (open-airway apnea, closed-airway apnea, hypopnea, flow limitation) after the fact. Affecting that signal path with a dumb hunk of plastic that the machine can't account for is asking for trouble on multiple levels, even if people "report" feeling fine and "report" that their machine still seems to work, as best they can tell by looking at it from the outside--and even if the seller of said hunk of plastic says, "Hey, don't worry about all that technical stuff, it's fine. Credit card, please."

When a pusher on the street says "Hey, try this, 25 bucks, it will make your life easier,' I am skeptical until I see independent verification from someone other than said pusher that possible benefits outweigh obvious risks. Real science. Not the FDA saying it probably won't kill you, not right away, anyway. "Studies" by the company that sells it obviously aren't unbiased.

The idea behind it is flawed. No manufacturer says to use it. No medical board suggests it. Not a risk I'm willing to take. But everyone has his or her own risk tolerance and judgment when playing around with his or her own medical devices.

So have at it!

I mean, chances are, it can't possibly turn out as bad as the SoClean debacle, right?

* Ominous background music and maniacal laughter start as camera goes dark. *

Stewart H from Bleep thinks it's okay. I'm not saying he's an expert, but I trust his knowledge. I'm struggling with mouth breathing and chipmunk cheeks when I tape. I'm going to try this device just to see if it helps. After six years, I'm still struggling to get a good night sleep with cpap.

Denase wrote: ↑

Mon Apr 17, 2023 12:40 pm

Maybe, but if it helps? It will be worth it.

Placebo's help too.

Denase wrote: ↑

Mon Apr 17, 2023 2:14 pm

I dissagree, we can adjust pressures, and to a certain extent IPAP/EPAP with EPR or flex. Why not the flow?

What do you think creates the pressure?
If you restrict the flow, then the pressure will *DROP* because of the venting. And it's the pressure that keeps your airway open in order to take another breath, drop that pressure too low and you won't be taking that breath until you wake up enough to open your airway, thus negating the benefit of CPAP.

Denase wrote: ↑

Mon Apr 17, 2023 2:14 pm

The V-COM is a simple peice of plastic that limits flow, making new pap users more comfortable. And couldn't it possibly make CPAP more effective in reducing AHI for certain patients?

By doing the exact opposite of what reduces AHI?
In other news today, charlatans have announced that dark is light, down is up, and they've got a gadget that lets you get around the law of gravity, for only $35 plus shipping.

I can't wait!

Denase wrote: ↑

Mon Apr 17, 2023 2:14 pm

For example if two patients require 12 cm/water but one does better at 100 percent flow and the other does better at 80 percent flow, wouldn't it be nice within the machine to adjust for that just like we do for pressure?

There's no such thing. 80% "flow" will result in reduced pressure. Pressure is the result of flow meeting resistance, reduce the flow but keep the resistance the same (the vent on your mask) and pressure will drop.

Come back when you've learned even the most basic aspect of fluid dynamics.

Denase wrote: ↑

Mon Apr 17, 2023 2:14 pm

I think

You've misused that word.

Denase wrote: ↑

Mon Apr 17, 2023 2:14 pm

so, and if the V-COM is successful for a large enough population of pap users the cpap manufactures will be paying attention. And we will see flow as an adjustment on future cpap machines.

V-COM will go the same way that provent and theravent went (after scamming quite a few people out of their money.

What do you want to wager?

It seems to me that the marketers conveniently and self-servingly ignore the lessons taught by any basic bilevel titration--that although what happens in the airway during expiration relates to apneas, it is what happens in the airway during inspiration that relates to the hypopneas, RERAs, and snores that can destroy sleep quality just as easily as apneas.

And anyone wondering whether limiting flow during inspiration increases comfort should simply breathe in through his nose while holding his own nostrils half shut. Then please send me $30. Thank you.

After all, pressurizing the airway does not change the rudiments of how human breathing works.

Boy you guys have it all wrong.

OK. You got me. I admit it. I'm a shill for the competition.

It's called "mainstream PAP therapy."