Flow limitations and other questions

[Walla Walla]

After you've completed your 90 days and met with your Doctor there's no more requirement for compliance reports to medicare. Your going to have to buy the VAUTO out of your own pocket though. I bought my VAUTO out of my own pocket and I'm happy I did.

[sleepless badger]

Hi All:
I have purchased a nearly new Resmed Vauto (only 6 run hours).  Have replaced hose and filter as well as washed humidifier chamber.
I was hoping for some guidance as to beginning settings.
I am currently using the following on my Airsense 10 for her:. Min: 12.4, Max: 16.4 with EPR at 2.   I have set the Vauto to Epap: 10 with Max. Ipap at 17. 
What pressure support do you recommend (it came with it set at 4) and what should I do with Ti min/Max, trigger and cycle?
I do know that when I tried EPR at 3, I felt like there wasn't enough air when I tried to inhale (time lag?) and it seemed as if I was having to work hard to breathe.
I am hoping that Walla Walla and Sleeprider will have words of wisdom for me ?.
Thanks,
Sleepless badger

[Walla Walla]

If you were using 12.4 as the minimum on the airsense 10 than you want to set the EPAP at 10.4 on the VAUTO. I would start with 4cm pressure support. As far as the Ti min/max, trigger and cycle I usually leave in the default setting. You might want to use the higher setting on the trigger though so the machine will respond quicker when you inhale.

[sleepless badger]

Thanks for the quick response,Walla Walla!
I have set the minimum Epap to 12.4 with pressure support at 4.  
How do I know what the default settings are for Ti, trigger and cycle?  
 I have the clinical manual, but am not sure I understand this section.  Per my latest sleepyhead download, my median inspiration time is 2.8 - 95 percent at 3.98 Max at 7.24.  Expiration median: 2.46, 95 percent 3.46 Max 6.22.
I can post the chart if that is better.

[Walla Walla]

The default settings are TI Max 2.0, TI Min 0.3, Trig Med, Cycle Med. You might want to try the trigger at high instead of medium and see if that helps.

[sleepless badger]

Thanks so much for the help!  I will be back with questions no doubt after I have gotten brave enough to try it all out!
Sleepless badger

[Sleeprider]

Thanks for the quick response,Walla Walla!
I have set the minimum Epap to 12.4 with pressure support at 4.  
How do I know what the default settings are for Ti, trigger and cycle?  
 I have the clinical manual, but am not sure I understand this section.  Per my latest sleepyhead download, my median inspiration time is 2.8 - 95 percent at 3.98 Max at 7.24.  Expiration median: 2.46, 95 percent 3.46 Max 6.22.
I can post the chart if that is better.

sleepless I think you should reduce the EPAP min to 9.0 and try PS 4.0 and IPAP max at 16.0. Your original charts showed no OA and your EPAP was at 10.4. I think you will be more comfortable at lower pressures and what we want to titrations or optimize is PS. A PS of 4 should relieve the hypopnea, but I don’t think you will need the aePAzp over 12 and strongly recommend you start lower and let the machine add the pressure if needed.

[sleepless badger]

Sleeprider:  Thanks for the suggestions.   I have adjusted Epap min. to the 9.0 as you have suggested, leaving PS at 4.0 until I have some data to work with.  I have been trying out different Ti Max as well as trigger and cycle levels while awake.   Don't know how that will translate to actual sleep breathing. 
Will post some charts once I have data for further assistance in getting the Vauto adapted to me.
Thank you!
Sleepless badger

[Sleeprider]

Good luck. Please excuse all the typos and weirdness in my posts. I'm having computer problems and using a touchscreen keyboard that results in a lot of errors.

[sleepless badger]

Hello All:
I wanted to post some results from my switch to the Resmed 10 Vauto.  As suggested by Sleeprider, I set the minimum EPAP at 9.0 with maximum Ipap at 16 - 4 cm of PS.  You can see from the following screenshots that my flow limitation graph has calmed down considerably.  I seem to have traded some of my hypopneas for OA at Centrals - although when I look at a blown up picture of a number of the centrals, I don't think they are real as many occur after a period of deep breaths.   I have enclosed one blow-up of several minutes during a random night - my breath shapes are significantly more rounded that I ever was able to achieve on the Airsense 10 auto.
I am sleeping well most nights - I have only had 6 nights on the Vauto so far.  I am hoping that I can keep that up and remain consistently at or under the 1.0 AHI mark.  I do notice that when I get over 2.0 AHI I often don't feel as well the next day (headache etc).  - Had a night like that on Friday - but was traveling and think that was a factor.  
Any suggestions regarding results?  or just keep at it?
I am liking this Vauto very much!!
Thank you so much, Sleeprider and Walla Walla for your assistance!!
Sleepless badger
[attachment=8900]
First night on Vauto.
[attachment=8901]
Second night.
[attachment=8902]
Last night.
[attachment=8903]
2 minute segment - random part of the night.