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[Equipment] ResMed AirCurve10 VAuto blockage
#1
Good Morning,

I have a ResMed AirCurve10 VAuto that I have been using a short time.  I was diagnosed in late 2018 with some issues related to weight gain which with the help of some really good doctors, we have resolved most.

I was put on a Phillip Ventilator until recently and have now graduated to the ResMed device.  Settings are as follows:

Max IPAP: 23  Ti Max: 2  Trigger Sensitivity: Med  Ramp Time: 10 minutes
Min EPAP: 15  Ti Min: .3  Cycle Sensitivity: Med
Start EPAP: 10  Pressure: 7.0  Ramp: Enabled

The results for the last two days show 0 apnea and 0 hypopnia.  I am on it 4 hours per night.

I'm tolerating it well and have no leaks in the pillows.

After I get relaxed and am mostly asleep, the device will block and not allow me to breathe in until I force an exhale which makes it start working again.  It is so abrupt that it wakes me up.  This is happening about every 2 to 4 mintues.  I started with PS at 5 and now have increase it to 7.3.  

Since I'm new to this device, I would like some advise as to where to look to solve this issue...

Please advise....
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#2
Welcome to the forum.  The Resmed Aircurve 10 Vauto is one of the finest bilevel machines available and produces a lot more data than you're currently looking at.   You can download the free SleepyHead program, install it on a PC or Mac computer and see the details from your SD card graphed out. There are links in my signature that show how to organize charts, and that gives you some idea of the graphics power of the software.

You appear to be using the Vauto in fixed pressure mode at 23/15 which is a pressure support of 8.0 cm.  That should be enough pressure support to do most of your respiratory effort provided you spontaneously initiate breaths.  Give your results, it seems you have no central or obstructive apnea or other events.  Your session time at 4-hours is very short, and I suspect you should be using this machine whenever you sleep or you would not be ventilated.  Certainly with those high pressures and pressure support, not using the machine during sleep could be a big problem.  So the remaining question is, are you comfortable? Are there other issues you would like to discuss?  It is possible that you may tolerate lower pressures in Vauto mode, and the machine will automatically increase pressure if you need it.  Given your history of using a ventilator, the main criteria would be to maintain the 8-cm of pressure support.  As you lose weight, your dependence on the Vauto and your pressures may change to allow lower pressures, however you should not expect to grow (or shrink as the case may be), out of the need for PAP therapy.

The description of having exhale blocked should be fairly easy to fix.  The CYCLE setting controls how easily the machine cycles  from IPAP to EPAP (inhale to exhale). Setting that to high or very high will make the machine cycle to exhale much sooner and easier.  Click on the graphic below from the clinician manual to enlarge it.  You can obtain a copy of the clinician manual from the CPAP Setup Manuals link at the top of this page.


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#3
You appear to be using the Vauto in fixed pressure mode at 23/15 which is a pressure support of 8.0 cm.  That should be enough pressure support to do most of your respiratory effort provided you spontaneously initiate breaths.  Give your results, it seems you have no central or obstructive apnea or other events.  Your session time at 4-hours is very short, and I suspect you should be using this machine whenever you sleep or you would not be ventilated.  Certainly with those high pressures and pressure support, not using the machine during sleep could be a big problem.  So the remaining question is, are you comfortable? Are there other issues you would like to discuss?  It is possible that you may tolerate lower pressures in Vauto mode, and the machine will automatically increase pressure if you need it.  Given your history of using a ventilator, the main criteria would be to maintain the 8-cm of pressure support.  As you lose weight, your dependence on the Vauto and your pressures may change to allow lower pressures, however you should not expect to grow (or shrink as the case may be), out of the need for PAP therapy.


The description of having exhale blocked should be fairly easy to fix.  The CYCLE setting controls how easily the machine cycles  from IPAP to EPAP (inhale to exhale). Setting that to high or very high will make the machine cycle to exhale much sooner and easier.  Click on the graphic below from the clinician manual to enlarge it.  You can obtain a copy of the clinician manual from the CPAP Setup Manuals link at the top of this page.

The Phillip vent settings:

AVAPS Rate: 10 cmH2o
Tidal Volume: 400 ml
Max Pressure: 40 cmH2O
Pressure Support Max: 30 cmH2O
Pressure Min: 4.0 cmH2O
EPAP Max: 14 cmH2O
EPAP Min: 4.0 cmH2O
Breath Rate: Auto
Trigger Type: Auto
Rise Time: 1
Ramp: Off

I did have the ResMed set on 4/14 and it was comfortable.  I could never get used to the Phillips for more than about 2 hours because once it started ramping up it never adjusted to my breathing.  The ResMed even at the 15/23 is comfortable and I do sleep really well.  I do get dry mouth though.  Possibly setting the pressures down might alleviate the dry mouth?  Since I am trying to adjust the ResMed, I would like to be on it for 6-7 hours if I can get it adjusted properly.  I like it much better than the Phillips.

How does the Ti Max/Min compare to the Tidal Volume on the Phillips?

I will change the setting on the CYCLE control and see if that does the trick...

Any advice is appreciated...
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#4
I'm just a little surprised you're not using Vauto mode instead of VPAP-S mode which is fixed. Your machine can replicate the performance of your AVAPS except for triggering a breath and the amount of pressure support. If you were in Vauto mode, you could start with EPAP min 4.0, PS 8.0 and IPAP max 25.0. This would give you the current 8 cm pressure support at variable pressure that would rise in the event of flow limitation or pending obstructive apnea events. We would learn a lot from that, including your actual minimum pressure need and whether higher or lower pressure support may be appropriate.

In addition SleepyHead will report your tidal volume, minute vent and other important respiratory data on a continual graphed basis, as well as reported statistics. It is obvious you had much lower EPAP pressure, but what we need to know from your old ventilator is the median or average EPAP pressure that you required, rather than the minimum.
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#5
I'll look and report back.
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#6
Ok, I've uploaded three JPG showing the settings, last night's results and the three day results with the previous settings.

Questions:

With the device set to auto and the new pressures, the Apnea Index shows 5 compared to 0 for the previous two days.  Are the new setting showing things more accurately?

I did not have any blockages, so new setting corrected that issue.

Any advise on adjustments would be appreciated...

ALSO,

I loaded the SleepyHead software but when I tried to open it, all I got was a blank screen after loading the device info.  OS is Windows 10 Enterprise.  Video driver issues?  The version I downloaded shows a beta copy?


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#7
No. The problem with the new settings was that EPAP was too low and you had obstructive apnea as a result. Looking at the previous results, EPAP was 10 to 15 cm, and IPAP was 15 to 20 (median-95%). The machine loitered at too low of an EPAP pressure and left you with obstructive apnea. It looks like your EPAP minimum pressure needs to be at least 8.0 and perhaps 10.0 to prevent the OA events.

Your previous results were much better, and I may have misinterpreted the settings you posted. It appears that you may have been in Auto mode, and pressure support was set to about 5.0. With the new settings you doubled the time of use which is a good thing. Your tidal volume averaged 400 mL and minute vent was 6.6 (median), compared to previous results of 1040 and 10.8. In other words you were much more ventilated. If you get Sleepyhead running, we can get a better look at the settings and mode.

These comparisons would be a lot easier to make in Sleepyhead. I think it will work for you if you go to the folder C:\Program Filesx86\Sleepyhead , and execute the Sleepyhead BrokenGL.exe file. I'm certain your computer just does not support the Open GL graphics and this will work. If it does, you can create a shortcut by right-clicking on the brokenGL exe and making a desktop shortcut.

Pending more information, I think go back to previous settings except cycle sensitivity. I will say the median tidal volume and minute vent seem a bit too high for most people in that previous result, while a range of 400 to 600 tends to be much more normal. Given that you were a ventilation patient, I had hoped we kept the same pressure support settings while letting the machine pick the correct pressure range. This was a miss. Other than that, can you compare how this felt from a comfort point of view, compared to previous settings?
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#8
I'll follow your instructions boss and let you know...

You seen really knowledgeable, are you an RT?  Engineer?  

I'll try the OpenGL fix.
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#9
The OpenGL fix works.

I've attached the settings that you suggested.  Let me know if it looks good for tonight...


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#10
Any chance you can run Sleepyhead detail graphs from before and after the change. Instructions on organizing the charts are in my signature.

As far as Sleepyhead troubleshooting, I am on the Dev-team and work alongside people much brighter than myself in the effort to produce the next version of the software.
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