Guess which machine I will get...

[Sleeprider]

Let's differentiate breath support and pressure support. Pressure support is the crux of bilevel, and it is the difference between IPAP and EPAP. With the Autoset, you could have had up to 3-cm of pressure support because the reduction in exhale pressure is from 1 to 3 cm and is identical to bilevel pressure support, although you have to think of the machine as a bilevel and set it accordingly. With the Vauto, you get the automatic adjusting pressure and unlimited pressure support. So you can set Minimum EPAP pressure and a maximum IPAP pressure and choose any pressure support from zero to 15 cm. Pressure support relieves flow limitation and can boost breath tidal volume. It unloads the effort of inspiration and lets you "sleep like a baby".

Breath support is the ability to set a timed backup rate if you fail to take a breath. It is really for individuals with central or complex apnea, or who fail to take breaths due to hypoventilation, neuromuscular deficiencies or COPD. These machines can target breath rate, average tidal volume, and in some cases induce inspiration when there is no spontaneous effort. I don't think this is what you need, however you (like myself) may find that the lower exhale pressure and higher inhale pressure is very comfortable. Unless you have a diagnosed respiratory disorder or therapy onset central apnea, you do not need ST, ASV or iVAPS.

[Cruiser]

Let's differentiate breath support and pressure support.  Pressure support is the crux of bilevel, and it is the difference between IPAP and EPAP.  With the Autoset, you could have had up to 3-cm of pressure support because the reduction in exhale pressure is from 1 to 3 cm and is identical to bilevel pressure support, although you have to think of the machine as a bilevel and set it accordingly.  With the Vauto, you get the automatic adjusting pressure and unlimited pressure support.  So you can set Minimum EPAP pressure and a maximum IPAP pressure and choose any pressure support from zero to 15 cm.   Pressure support relieves flow limitation and can boost breath tidal volume. It unloads the effort of inspiration and lets you "sleep like a baby".  

Breath support is the ability to set a timed backup rate if you fail to take a breath.  It is really for individuals with central or complex apnea, or who fail to take breaths due to hypoventilation, neuromuscular deficiencies or COPD.  These machines can target breath rate, average tidal volume, and in some cases induce inspiration when there is no spontaneous effort.   I don't think this is what you need, however you (like myself) may find that the lower exhale pressure and higher inhale pressure is very comfortable.  Unless you have a diagnosed respiratory disorder or therapy onset central apnea, you do not need ST, ASV or iVAPS.

I suspect I may have OHS...which may explain why they had breath support turned on for the titration. 

I think I have all the info I can get prior to my meeting with the doc - I just need to see what the second sleep study revealed and advocate for myself based on those results (if required).  Right now, I just want the best sleep possible even if it costs a few grand. 

Thanks for everyone's help on this...it gives me better insight into what I need to ask the doc.  I will post again next week once I have my appointment and hopefully gain clarity on why I was titrated with bilevel/Breath Support.

[Sleeprider]

ST is indeed listed for OHS, however unless you need the backup rate, the Vauto is more comfortable for several reasons. First, the Vauto will automatically adjust pressure for obstruction, so you can enjoy lower pressure when don't need higher pressure to control obstructive apnea. The Vauto has EasyBreathe™ pressure transitions which are a wave-like pressure transition. As you transition to IPAP, pressure rises quickly and tapers as inspiration reaches its peak, then drops quickly, but eases into the lowest pressure of EPAP. The ST produces a square wave form that transitions quickly to IPAP, levels off, then drops to EPAP and levels off. Both machines are capable of the same amounts of pressure support, but the Vauto is more comfortable, and adjusts to your needs. What the Vauto does not do is to provide a timed backup trigger to IPAP.

Your charts did not include the respiratory statistics. If you turn off the pie chart (File/Preferences/Appearance), we could see inspiration/expiration time and tidal volume. There may be some information there.

[Cruiser]

ST is indeed listed for OHS, however unless you need the backup rate, the Vauto is more comfortable for several reasons.  First, the Vauto will automatically adjust pressure for obstruction, so you can enjoy lower pressure when don't need higher pressure to control obstructive apnea. The Vauto has EasyBreathe™ pressure transitions which are a wave-like pressure transition.  As you transition to IPAP, pressure rises quickly and tapers as inspiration reaches its peak, then drops quickly, but eases into the lowest pressure of EPAP.  The ST produces a square wave form that transitions quickly to IPAP, levels off, then drops to EPAP and levels off.  Both machines are capable of the same amounts of pressure support, but the Vauto is more comfortable, and adjusts to your needs.  What the Vauto does not do is to provide a timed backup trigger to IPAP.

Your charts did not include the respiratory statistics.  If you turn off the pie chart (File/Preferences/Appearance), we could see inspiration/expiration time and tidal volume.  There may be some information there.

Interesting!  I will have to see what I can dig up on this.

Here are two days of data - note, one is the same as the past posts on page 2.

       

[Sleeprider]

I wish we could get you to try that machine with settings of 7.0 minimum 15.0 maximum and EPR full-time at 3.0. Your tidal volume at 420 is good, and your respiration rate, inspiration time and expiration time are all normal. I am still certain that your most comfortable and effective option is the Aircurve 10 Vauto. I see no benefit to a ST, ASV or iVAPS.

[Gideon]

Thank you SleepRider
I too didn't see anything but I appreciate the second check.

[Cruiser]

Any concern about the  max inspiration time of over 3s, and 4s for expiration?

If I have OHS, I notice that the vAuto is not indicated. Hmmm

[SarcasticDave94]

No offense intended, but we can only go by what is known especially via info within the charts. Earlier Sleeprider has mentioned that with the current data, VAuto would be the most likely to produce very good results and comfort. Pushing for a higher machine than indicated and without fully exploring the current machine's therapy capabilities just delays when you'll start feeling better consistently.

[Cruiser]

I went back to the doctor this morning.  They have given me another 3-4 week trial with Bipap and a fixed setting of 17/13.  Apparently during my titration, this setting produced 0 AHI, while 16/12 produced a number of centrals.  I asked the doc why they had breath support turned on, and her reply was 'some of the bipaps do that.'  It almost sounded like she wasn't very familiar with Bipap in general.

The test unit I got was a Dreamstation, so I have no idea what it actually translates to.

Tomorrow night, I will pull up my first night in OSCAR to see what happened and post.

Right now, I am thinking I may just get 2 x Resmed's VAuto's.  In Ontario, I think one would be fully covered and I would buy the other at ~$1100.

[Gideon]

Remember that Centrals can be consistently inconsistent.