AirCurve 10 VAUTO vs MY Machine

[ragtopcircus]

If you want to mimic your current PR fixed-pressure settings in Resmed Vauto mode:

EPAP min = 14.5
IPAP max = 18.5
Pressure Support = 4
Trigger = Medium
Cycle = Medium

[3rdMarDiv]

Note that in S mode, with the pressure set at 18/9, that means Pressure Support was 9. That is a pretty big change from 18/14 (Pressure Support 4). No wonder AHI jumped up! That actually is a big deal, and it makes sense. It's not a matter of Resmed reporting events differently; it's a clear indication that 18/9 is, as Sleeprider called it, a "disaster".

The PS of 9 was very noticeable. The IPAP of 18 felt near identical, if even a bit stronger, than what I have been used to on my PR machine. The EPAP of 9 was like nothing and was very noticeable in it's lack of notability..LOL

I'm also dealing with bummer of a cold with coughing, runny nose, etc. Between that, a new machine, a big change in noise level and my wife waking up...Well, you get the idea.

For tonight I will go with your recommendation of staying with the 18.5/14.5, Med and Med. In a few days I likely go to SR's settings of 20/12.

You guys are great

[Sleeprider]

Pleasne note that my recommendations are based on Vauto mode, not a fixed IPAP /EPAP pressure. The ideal was to use variable pressure to see what you actually needed. If you use my settings in S-mode they will fail. I hope I did not over-estimate your understanding of the difference Vauto is a fixed pressure support and variable IPAP/EPAP. S-mode is fixed IPAP/EPAP. If you still don't know the difference, let's talk before you make any setting changes.

[3rdMarDiv]

Pleasne note that my recommendations are based on Vauto mode, not a fixed IPAP /EPAP pressure.  The ideal was to use variable pressure to see what you actually needed.  If you use my settings in S-mode they will fail.  I hope I did not over-estimate your understanding of the difference   Vauto is a fixed pressure support and variable IPAP/EPAP. S-mode is fixed IPAP/EPAP.  If you still don't know the difference, let's talk before you make any setting changes.

Oh no my friend...I got what you were and are saying.

What I am saying is that the fewer the changes right now the better.

That, for me, just bringing in new equipment is a big deal. First getting acclimated to the V10 as far as it's nomenclature and operation has to be accomplished.

The sound difference threw me off unexpectedly and that had to be dealt with.

By the way, I have learned that the sound it makes is dependent on the users breathing patterns. Longer, deeper breaths causes the machine to produce more noise. Calm, normal, smooth, even breaths will produce nice, perfectly acceptable, sounds.

I changed the EPAP to 12 which produced a shorter exhale and a much quieter machine. I set the machine at 18/12 which really made a difference.

   

Now, after you look at the above screenshot, do you feel that 18.6 / 12 is an acceptable setting..?

I want to use the machines capabilities and not just swap one machine for another with identical functionality eg., 18/14 in S Mode for both.

A question I have, which is also the reason I am trying the V10, is the V10 kinda like a smart machine.

I have read about this machine numerous times and the main highlight that attracted me is that it says it can deliver the lowest pressure needed to still achieve the best results.

It sounds also to me like it will develop a personalized algorithm that accomplishes that goal..?

That it will also, by its self, supply additional support/pressure when I encounter OA and CA's..?

By the way..When I had OA's last night (see 0330) the machine got louder and woke my wife who pushed on me to get me back to prone.

So with that said, is your suggestion of 20/12 saying that even though I set IPAP at 20 that it doesn't mean that I will be always be receiving 20 cmH2O of pressure?

Are you saying that I am giving the machine the option to supply 20 cmH20 if it deems it necessary?

If that is the case the I don't have a problem going to 20 cmH20 as that will likely wake me up due to mask failure and I can move from supine back to prone.

I want to avoid the 20 cmH20 setting happening regularly for no reason.

[Sleeprider]

Looks like a successful night on the Vauto. your chart on the other hand is less useful without showing pressure. We want to see Events, Flow, Pressure or Mask Pressure, Flow Limits and Leaks. You are operating in the range of 16/12 to 18/14, so this clearly gives you some variation, and limits pressure variation to about 2-cm, which is good for minimizing sleep disruption. If we could see the pressure response, it would give us a better understanding of what is going on, but his appears to be good therapy. As always, your comfort and qualitative judgement are equally important. Is this an acceptable setting? Of course, however my original intention was to evaluate a wider range of possibilities and narrow in on what works best. This works great and it is logical to make smaller changes.

The Vauto algorithm is not personalized, but it works well for most people. Pressure support is fixed at what you sent, and EPAP can rise and fall within the limits of settings, based on presence or absence of flow limitation, and some other events. Since PS is fixed, IPAP goes along for the ride as EPAP changes.

You indicate the machine got louder when it approached you maximum pressure setting. I might argue that your positional apnea may have been part of what disturbed her sleep. The machine is very quiet, and can be made completely silent. I keep mine in a nightstand drawer with the tubing and power coming through a 2-inch hole in the back. Variable pressure may cause some changes in sound level and pitch, but I'd be surprised if it is actually louder than your Dreamstation ST30.

A maximum pressure of 20 would not likely make any material change in what you experienced at 18/12. The machine approached the maximum setting but did not quite get there. Unless we saw the pressure bumping along the maximum with some frequency, i think you found an effective maximum pressure. The only question is whether a lower minimum pressure would be more comfortable. You only have one hypopnea and very low flow limitation so your pressure support is good at 4.0 and I would not change that. The big difference between your Dreamstation and the Vauto is the way that pressure is delivered with EasyBreathe. How was your sense of comfort?

[slowriter]

The machine is very quiet, and can be made completely silent. I keep mine in a nightstand drawer with the tubing and power coming through a 2-inch hole in the back. 

I was going to say this also. I have a vauto, and neither my wife nor I ever notice any noise from it. The only noise I get is the airflow through the mask.

One way to titrate the vauto, which I think is what sleeprider is recommending, is to set it on vauto mode, and then use the information from OSCAR to dial in the settings so that the pressure swings are minimal.

You can't do this if you don't use the vauto mode.

[3rdMarDiv]

Well, I believe that since the machine had sat for over 10 months that it was just cranky the first night as last night it was smooth and even sound. Just a slight up and down motor change about or equal to my PR Dreamstation. My wife had no problem with it at all nor did I. I went to sleep and stayed asleep.

Happy Days...  

[3rdMarDiv]

A maximum pressure of 20 would not likely make any material change in what you experienced at 18/12. The machine approached the maximum setting but did not quite get there.  Unless we saw the pressure bumping along the maximum with some frequency, i think you found an effective maximum pressure. The only question is whether a lower minimum pressure would be more comfortable. You only have one hypopnea and very low flow limitation so your pressure support is good at 4.0 and I would not change that.   The big difference between your Dreamstation and the Vauto is the way that pressure is delivered with EasyBreathe.  How was your sense of comfort?

Thanks so much for all the feedback. I really appreciate it..!

I like your suggestion about the lowering EPAP and will try at 10. I will put the IPAP at 19 since it was at 18.6 and I'd prefer a round number.

As far as comfort goes I see a big difference and feel like I'm just breathing naturally. It really feels like I am not even on CPAP as I do on the PR machine. Big difference..!

This was last night:
   

Onward and upward,

[Sleeprider]

[3rdMarDiv]

My original intention was to evaluate a wider range of possibilities and narrow in on what works best.

Changed to 19/10

A maximum pressure of 20 would not likely make any material change in what you experienced at 18/12.

At 19/10 we will find that out for certain.

Looks like a successful night on the Vauto. your chart on the other hand is less useful without showing pressure. We want to see Events, Flow, Pressure or Mask Pressure, Flow Limits and Leaks.

Here they are:
   
   
   

Cont.