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Changed from AirSense10 Autoset to AirCurve 10 VAUTO S with triple the AHI
#1
Changed from AirSense10 Autoset to AirCurve 10 VAUTO S with triple the AHI
I was diagnosed with severe sleep apnea in August 2018, my Doctor put me on the Resmed AirSense 10 Autoset with a rate of APAP min 5 max 20(cmH20). My AHI averaged about 20 and this week (Wednesday) I started on a BIPAP Resmed AirCurve 10 Vauto S with a rate of VPAP-S EPAP 5 and IPAP 20 (cmH20). the lowest my AHI has been was 57 and as high as 70. I had an increase of central apneas also. Can anyone tell me what is going on? Listed below are the charts from both machines from this week Monday through Friday.

Thanks,
John


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#2
RE: Changed from AirSense10 Autoset to AirCurve 10 VAUTO S with triple the AHI
John, there are a couple possibilities, but one will require a different bilevel machine with a backup rate, while the other will work with your Aircurve 10 Vauto with revised settings. The extremely high pressure support of 15 cm you are using (difference between IPAP and EPAP) is causing severe apnea. Your machine is not designed to provide a breath when you don't take one. Your problem is complicated by the fact your doctor is seriously incompetent (or perhaps not, we'll see). Obstructive apnea must be treated by increasing EPAP pressure, and yours is nearly at the minimum pressure your machine can generate. Your obstructive apnea seems very persistent and may be a positional apnea that may respond to use of a soft cervical collar. Take a look at the Positional Apnea section of our Optimizing Therapy wiki http://www.apneaboard.com/wiki/index.php...ng_therapy

Another possibility is you may have complex apnea with both obstructive and central events. The machine you probably need in this case, is the Resmed Aircurve 10 ASV which in ASVauto mode can automatically increase EPAP pressure to prevent obstructive apnea, and will provide anywhere from zero to 15 cm of pressure support to cause you to take a breath if you have a central apnea. In other words, the adaptive servo ventilator provides pressure support on a breath by breath basis that is as much as you need, when you need it. When you do not need pressure support, it stays out of the way.

The least expensive test is to try using a soft cervical collar with a comfortable fit that prevents your chin from tucking and does not impose pressure on your throat or the soft tissues under your chin. Finally change your pressure settings to Vauto mode, EPAP min 7.0, IPAP max 20.0, PS 4.0. You cannot tolerate the fixed S-mode at 15 cm pressure support. That is an insane setting for a machine without a backup rate.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#3
RE: Changed from AirSense10 Autoset to AirCurve 10 VAUTO S with triple the AHI
Sleeprider Chart 4 and Chart 5 is on the autoset machine or the last two on the right. I called the Doctor on Thursday after my first night on the new machine and his nurse said to try it for a couple of days and to call them back at the first of the week.
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#4
RE: Changed from AirSense10 Autoset to AirCurve 10 VAUTO S with triple the AHI
Nash, please re-read my edited post. I missed the Autoset first time through but posted a revision since. You need to change the settings on your current Aircurve 10 Vauto as follows:
Mode: Vauto
EPAP min 7.0
IPAP max 20.0
PS (pressure support) 4.0

It appears someone setup your machine in VPAP S mode improperly. All we are doing is correcting the mode and setting the PS appropriately.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Changed from AirSense10 Autoset to AirCurve 10 VAUTO S with triple the AHI
Thanks, I'll give it a try and see how it work out. Thanks  for your help.
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#6
RE: Changed from AirSense10 Autoset to AirCurve 10 VAUTO S with triple the AHI
I just was this,  I just got home, I was afraid of what I was going to find.  I opened your first chat and for the first time EVER I shouted out loud "WHY, WHY!!!!" and my wife came running because I NEVER do that.

Please ASAP change your settings to what Sleeprider recommended.

Your Duck blew this one.  (What sound does a duck make?)
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Changed from AirSense10 Autoset to AirCurve 10 VAUTO S with triple the AHI
Do you have a copy of your prescription for the Vauto it maybe that the DME messed up and misread the prescription. But please do follow the advice of Sleeprider and Bonjour
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#8
RE: Changed from AirSense10 Autoset to AirCurve 10 VAUTO S with triple the AHI
Sorry for the delay, I had spoke with my Doctor and he wanted me to come in and bring in my machine, after looking at the settings they mad an adjustment and said that the DME supplier did not put the correct settings in. Below is a copy of my first night on new settings with AHI 22.3 and my BiPap recommendations from my sleep study. at the doctors office the nurse said it was the wrong machine. Do you or anyone know what machine will accommodate these settings from my BiPap Titration recommendation?

New settings
VPAP Auto
EPAP 8(cmH20)
IPAP 25(cmH20)
PS 10


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#9
RE: Changed from AirSense10 Autoset to AirCurve 10 VAUTO S with triple the AHI
A PS of 10 is ridiculous that is why your CA's are too high. Change the PS to 3 or 4.


Please follow the earlier recommendations of sleeprider and Fred (Bonjour) the prescription is suitable for a Philips machine that has auto adjusting pressure support. Not for a Resmed machine.
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#10
RE: Changed from AirSense10 Autoset to AirCurve 10 VAUTO S with triple the AHI
In post #4 I suggested
Mode: Vauto
EPAP min 7.0
IPAP max 20.0
PS (pressure support) 4.0

Please reset your machine so you don't hurt yourself and fire your doctor. If you need PS 10, you need a machine called the Resmed Aircurve 10 ASV. The Vauto is NOT going to work with these settings.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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