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Bilevel VAuto
#1
Hi, Thanks for adding me. I have a Resmed S10 Aircurve VAuto bilevel machine. So they changed my pressure because 18/14 was killing me...swallowing air all night. So yesterday they switched me to APAP 6-16...My question is...Cant I have Auto Bilevel pressure? Why would they have me get an expensive Bilevel machine and then do APAP at constant pressure (not an exhale/inhale). I am so frustrated with my dr and the communication with Apria. I am almost ready to just change it myself...but then I will have the apria police after me...I don't think my drs office understands the capability of the new machine...I also think 6 is low when I was at 18/14 before!!! Scream!! Any advice?

By the way...my overall AHI was 44, but when on my back 69% of the sleep study my AHI was 71.
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#2
They just changed the mode that your machine is operating in or did they change you to a different machine? I believe that the aircurve 10 vauto has 3 modes; Bilevel auto, Bilevel (S mode), and straight CPAP.
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#3
Hi Lisamarieknits,
WELCOME! to the forum.!
Hang in there for more answers to your questions.
Much success to you as you continue your CPAP therapy and getting it fine tuned to meet your needs.
trish6hundred
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#4
Hi Lisamarie,

GOOD NEWS -- there are no Apria police! Wink And it is not illegal to change your pressure settings.

It sounds like you still have your VPAP Auto machine but that the pressures got changed so it behaves like an APAP (which can be done on this machine). If so, you could change the settings to auto bilevel.

But what were the exact settings on your machine before they changed it? 18/14 sounds like straight bilevel settings, (18 IPAP, 14 EPAP?), not auto bilevel settings. If your machine had been in auto mode you would have had a Max IPAP and Min EPAP and a PS (pressure support) setting.

Bilevel can actually be very helpful when aerophagia is a problem but it can take some time and patience to get all the settings right. I'm wondering if you could have benefitted from more pressure support than you had previously. Maybe clarify what all the settings were before, so we could use that as a starting point.

How were you doing at the previous settings other than the aerophagia? What was your AHI while using the machine?



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#5
(10-30-2015, 06:49 AM)Lisamarieknits Wrote: I have a Resmed S10 Aircurve VAuto bilevel machine. So they changed my pressure because 18/14 was killing me...swallowing air all night.

When you say 18/14 do you mean an auto-CPAP pressure range of 14 to 18. Or do you mean a bi-level CPAP setting of 18 IPAP and 14 EPAP.

(IPAP is the inhale pressure, EPAP is the exhale pressure).

There are two treatment options for for aerophagia (swallowing of air). One is bilevel therapy, the other is lowering the pressure. An auto-adjusting bi-level machine allows you the best of both of these options.

Quote:So yesterday they switched me to APAP 6-16...My question is...Cant I have Auto Bilevel pressure?

Yes, but it takes three numbers to specify those settings. For example if you look at my settings on the left side of this screen, you see three numbers.

Max IPAP of 13.6 means this is as high as my IPAP pressure can go.
Min EPAP of 6.6 means this is as low as my EPAP pressure can go.
PS (pressure support) of 4.4 means my IPAP pressure is always 4.4 greater than my EPAP pressure.

So, this is the way it goes for me. I start the night at an EPAP pressure of 6.6 and a IPAP pressure of 11. As the night progresses these numbers go up and down staying apart by 4.4. But the largest they ever get is a EPAP of 9.2 and IPAP of 13.6.

The reason for these settings is as follows. I was titrated at 13, but at that pressure I swallow air. So they put me on bi-level of 13 IPAP and 8 EPAP. This elevated my CA index, so they lowered it to 11 IPAP and 8 EPAP.

After that I bought a VPAP Auto so I could, when needed, have my pressure raised above 11. Keeping it at 11 fixes the aerophagia, but it might disturb my sleep because I need a higher pressure to keep my airway open. I can't lower my PS below 4.4 because it elevates my CA index and that could be disturbing my sleep.

I also had to switch to a full face mask to stop leaks. These things I did with the VPAP Auto and the mask were done by me, on my own, because it was beyond the knowledge scope of my doctor and DME. I have since switched to a new doctor who I keep informed of what I'm doing and why. I also switched DME's, but I depend on them for nothing more than mask selection, and they have done alright there. The doctor, though, is clueless about ResScan and so can look at nothing more than the crappy ResScan summaries. I just tell her what I see in the data, she advises me on what to look for, but I'm pretty much on my own when it comes to these decisions.

Sleepster
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#6
(10-30-2015, 11:02 AM)PaytonA Wrote: They just changed the mode that your machine is operating in or did they change you to a different machine? I believe that the aircurve 10 vauto has 3 modes; Bilevel auto, Bilevel (S mode), and straight CPAP.

it feels like they changed it to an APAP with no bilevel

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#7
(10-30-2015, 04:01 PM)kaiasgram Wrote: Hi Lisamarie,

GOOD NEWS -- there are no Apria police! Wink And it is not illegal to change your pressure settings.

It sounds like you still have your VPAP Auto machine but that the pressures got changed so it behaves like an APAP (which can be done on this machine). If so, you could change the settings to auto bilevel.

But what were the exact settings on your machine before they changed it? 18/14 sounds like straight bilevel settings, (18 IPAP, 14 EPAP?), not auto bilevel settings. If your machine had been in auto mode you would have had a Max IPAP and Min EPAP and a PS (pressure support) setting.

Bilevel can actually be very helpful when aerophagia is a problem but it can take some time and patience to get all the settings right. I'm wondering if you could have benefitted from more pressure support than you had previously. Maybe clarify what all the settings were before, so we could use that as a starting point.

How were you doing at the previous settings other than the aerophagia? What was your AHI while using the machine?
My AHI would range from under 1 to about 5 with the previous setting. I do not think they had the Auto on other than when i first turned on...just a straight 18/14...the last setting was switched to straight apap 6 to 16...which is weird, because 6 is very low. I was thinking of trying a high end of 16 and then something higher than 6...but I would love to set it for Auto bilevel just not sure how to do that.

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#8
Ok, so I just set the IPAP at 16, the EPAP at 8 and then the PS at 4...I left the Ti numbers alone. What should those be set to? right now Ti max is 2.0 and Ti min is 0.3. trigger and Cycle are set at medium...should this all work ok I hope?

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#9
This shows how to access the clinical menu:

http://www.apneaboard.com/resmed-airsens...setup-info

If you want to try bilevel auto, you can set it up in the clinical menu. This is where I would start in your situation -- since you were previously at 18/14, I wonder how much of the time you actually need that much pressure. So I might set Max IPAP at 18, and PS at 4, and then set Min EPAP down around 9. This would allow a 6 cm range for your machine to work with in auto mode. These would be the possible pressures:

18/14
17/13
16/12
15/11
14/10
13/9

You may still need 18/14 at times during the night, but perhaps not all the time -- and if your pressure is allowed to go lower when you don't need so much pressure, it might solve the aerophagia problem while still providing adequate pressure when you need it. Give it a week or so with these settings, look at the data, and then fine-tune some more if necessary.

And of course you can post some SleepyHead screenshots once you get started in auto mode and get feedback. Others will have different ideas about where to start and how to tweak, so go with whatever makes the most sense to you.
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#10
You posted while I was typing.Smile We're thinking pretty much along the same lines.
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