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Issue transitioning from Dreamstation BiPap to ResMed 10 VAuto BiLevel
#1
Issue transitioning from Dreamstation BiPap to ResMed 10 VAuto BiLevel
Hello, am new to the forum and could really use your help.  I just purchased a new Aircurve 10 VAuto as a possible replacement to my 3 month old DS Auto BiPap which is on recall list.  Not that I have $$ to throw away, but cannot live without PAP support while I wait for repair or replacement of the DreamStation. 

My Dr stated the change from PR DS Bi-PAP to RM 10 VAuto BiLevel should be transparent... but is wasn't!  Over 3 month period, I was able to acclimate fairly well to the DS.  AHI typically under 2, normally wake up feeling rested after 7 hours sleep. 

Last night, tried out the RM unit but immediately noticed a lower inrush of air upon inhalation as compared to the DS unit... eventhough both units had same EPAP min 8 and IPAP max 18, and PS4 (The DS unit provided a noticeably stronger inrush of air).  While using the RM unit, I then fell asleep for 1/2 hr to wake abruptly... AHI 7.7 with 3.8 CA events (which i don't normally have). Switched to clinician mode and bumped up EPAP setting to 9.4 (which is pressure I've seen in DS 7-day EPAP history log), then bumped up the Trigger setting from med to high, then went back to sleep.  Woke up maybe an hour later not feeling well... this time i noticed exp. pressure 13 and in pressure 16.9.  At this point, I switched back to DS for remaining few hours of sleep.  I do plan on installing the OSCAR software tomorrow, but would like to get this unit "in the ballpark" prior to trying again.  Any suggestions to guide me there would be appreciated!
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#2
RE: Issue transitioning from Dreamstation BiPap to ResMed 10 VAuto BiLevel...
Download OSCAR (link in the above black banner)
Make sure you have an SD card in your machine (any brand, 2-32GB not bigger)
read the card and post a screenshot (F12) of your daily chart.

Note that the auto modes respond quite differently and as a result will require a different optimization. The OSCAR data provides the info on which to optimize your therapy. We will help you through this.
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#3
RE: Issue transitioning from Dreamstation BiPap to ResMed 10 VAuto BiLevel...
These are 2 completely different therapy styles. Yes both may be BPAP but that's about all that's the same. You need to approach setup on the VAuto from scratch more or less.

Not being negative, but when you're getting what's likely treatment emergent Centrals from the ResMed VAuto, I have to suspect the 3 months on the DreamStation wasn't delivering as good a therapy as you might have thought. Unless there's a bigger CA issue than you're led to believe.

Would you like to post your diagnosic sleep study detailed and redacted report? Add in at least an OSCAR from the VAuto as well.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Issue transitioning from Dreamstation BiPap to ResMed 10 VAuto BiLevel...
           
Sorry for the delayed response, was out of town several days to visit family.

- PDFs of sleep study / BiPap titration attached.

- OSCAR downloaded. 

- Dreamstation was missing SD card.  Installed one last night and recorded last night's data. Wasn't a typical night, but has full night of data.  Began with EPAP bumped from 8 to 9.5 (based on last 30 day history).  In middle of sleep I recall waking up with higher than usual IPAP/EPAP numbers, and higher AHI, so I returned back setting to 8 EPAP thinking I should of left that setting alone for sake of showing baseline. 

- As I had mentioned, first attempt at using AirCurve 10 on July 8 was not easy for me, so all I have for now is about 1 hour of OSCAR sleep data.  I believe I bumped up the EPAP setting to 9.4, since the AirCurve felt like it didn't provide as much inhalation volume as the DS. 
 
Will post OSCAR reports shortly.

Thanks!
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#5
RE: Issue transitioning from Dreamstation BiPap to ResMed 10 VAuto BiLevel...
       

Attached OSCAR report screenshots.  Thanks in advance!!!
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#6
RE: Issue transitioning from Dreamstation BiPap to ResMed 10 VAuto BiLevel...
I'm just in observation mode... Your report states you were diagnosed OSA and CSA. It appears to have been a home study. Did that include the effort belt?

If the CA and OA combo are accurate, I am inclined to believe this particular BPAP may not be right, but the CA treatment king may be called for, the ASV.

Keep an eye on your OSCAR report section called CA or clear airway. CA or really Central Apnea, will be quite consistently inconsistent. This means variable up and down frequently.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Issue transitioning from Dreamstation BiPap to ResMed 10 VAuto BiLevel...
Home study did have belt. 

My existing sleep Dr has been short with me saying she can’t talk much more because she’s running over and has to start next appointment. That appointment was last week. I did want to discuss some things with her but was cut short. 

That said, I have an appointment on Thursday to see a pulmonologist that works with sleep apnea patients. I would like to share you perspective with him but am not yet up to speed with all the charts and etc.  Could you elaborate on the consistently inconsistent point about central apnea? I did proactively grant him access to my data. 

Another thing…
Over past month and half I’ve been experiencing varying levels of night sweats that none of my other Drs have been able to figure out, not even with blood tests.  In morning always wake up feeling cold. Never running a fever. Don’t know if related to CA or not, but is not comfortable for sure (Btw- this is what I started to bring up to her when she rushed me off).  Your thoughts on that? 

Thanks again…
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#8
RE: Issue transitioning from Dreamstation BiPap to ResMed 10 VAuto BiLevel...
Those are interesting graphs, I tried to replace my auto bipap DS with an S10 for her on EPR 3 and could not get it comfortable and had three of my worse nights sleep in four years being on therapy. I tried my old DS apap to see if it was was the Resmed machine, and it was, better than the S10 fh.

You can pull out the foam on the DS devices.
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#9
RE: Issue transitioning from Dreamstation BiPap to ResMed 10 VAuto BiLevel...
On the Central Apnea, consistently inconsistent attribute is meaning they will be up and down frequently without setting changes. It'll be a roller coaster.

And how I've read the report, there's a diagnosis for both Obstructive and Central Apnea. So given that, I'd think you'll need to expect Centrals to appear. If they don't show, then great. Depending on the CA activity, there's 2 possible directions, and the first likely needs exhausted before moving on and up.

Please do yourself the favor of making a sleep therapy diary. You'll note good and bad aspects ongoing. Whatever you choose to describe, typical it'll be symptoms and complaints. On your current VAuto, your main tools are pressure and pressure support for the Obstructive, but this can and likely will, be counter to Central Apnea events. These are opposing one another on your Apnea therapy teeter-totter. Pushing one type down for better therapy also pushes the opposite side up.

The VAuto has timing controls such as trigger that may be helpful to combat the CA.

First thing, let's see usage on OSCAR and we'll go down the editing pathway from there. We'll help edit your settings via suggestions and we'll see how good it gets. If it can't get good enough for you, we move to the next stage.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Issue transitioning from Dreamstation BiPap to ResMed 10 VAuto BiLevel
I will try the vauto again Saturday night, don’t want to risk having a bad night sleep before a workday, lol. 


In meantime, my dreamstation biflex setting is at 3. I do believe that is the difference I’m feeling upon exhalation compared to the VAuto. 

Question…
Would changing biflex setting to lower number (from 3 to 2, or 1) reduce chance of CA?  
Would reducing PS from 4 to 3 reduce chance of CA?  Thanks…
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