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New to Therapy - Starting on BiLevel
#1
New to Therapy - Starting on BiLevel
I just recently purchased an Aircurve 10 VAuto and am waiting on it to arrive. In the meantime, I'm wondering how I can convert my prescribed pressure to effectively begin treatment on this device. I haven't begun any therapy yet, so I don't really know what is effective for me, but the clinic that prescribed me wanted me to start on 5-15 cmH2O on an APAP with a ramp time of 45 minutes.

I see on the wiki the recommendation is to start with an IPAP of 8 and EPAP of 4 for people who haven't tried other therapies. Would this still apply to my case? Is this advice still generally considered sound?

Also, how does making adjustments generally work for people who are self-adjusting? The wiki mentions just changing the IPAP for people who are dealing with hypopneas, which is my case, so, assuming other issues don't arise while making these adjustments, would I just adjust the IPAP by 1 cmH2O every night until I begin to see normalized breathing curves?
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#2
RE: New to Therapy - Starting on BiLevel
I've not used a VAuto, but the scripted 5 would probably plug into the EPAP. Maybe the 15 would be IPAP. Then you need to fill in a PS, you might want 3 or 4 for that.

IMO the ramp of 45 minutes is going to be wasting 45 minutes therapy time. Consider making that time minimal or none, and don't lock your pressure down to a too low number if you must use it. And ResMed Ramp gets added on every time you turn therapy on. So suppose you have 3 sleep sessions, there's 135 minutes of Ramp.

Check back with the thread to see what others say though. I've not used this lower therapy level device.
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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#3
RE: New to Therapy - Starting on BiLevel
I see SarcasticDave posted a recommendation. If your machine is a bilevel auto start with the prescribed EPAP Min of 5 and set PS Min of 3 and a PS max of 15 and see where the machine tries to go. You can make additional adjustments later and you will get some suggestions here after you post your charts from OSCAR. As he suggests, either set ramp off or shorten it to 5 minutes because it acts like a fixed pressure machine on ramp and is mostly ineffective.
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#4
RE: New to Therapy - Starting on BiLevel
I don't think PS Max 15 is doable nor a great idea. But again I've not used the VAuto, I'm going by the settings that the ASV and ST-A machines have available.
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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#5
RE: New to Therapy - Starting on BiLevel
I suspect the PS Max may be limited by the IPAP Max setting but it should  not severely limit the auto response until the settings are dialed in. The settings all interact so one of the settings will be the hard limit on the IPAP Max or the EPAP Min plus the PS Max.
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#6
RE: New to Therapy - Starting on BiLevel
Welcome,

Most here would want to see your redacted Sleep Study results to help you out. It's time to prepare mask selection, SD card for the machine and download OSCAR.


""..but the clinic that prescribed me wanted me to start on 5-15 cmH2O on an APAP"

something is missing here...

the 5 is the Min Pressure
the 15 is the Max Pressure

What did they specify for the EPR value? 0,1,2 or 3? (in Vauto mode this is similar to but not same as PS which is Pressure Support)

If they indicated you have Hypopnea that is generally treated with some level of EPR (PS in the Vauto)

Certainly not maximum PS of 15!

If they said EPR = x then your Vauto settings in VPAPauto mode would be

Min EPAP = 5 (to start with for now)
Max IPAP = 15 (to start with for now)
PS = x as per their specification.

The x of PS is a constant with this machine, not a variable. It moves together with the EPAP.

Your pressures during the night might vary as follows:

EPAP 5, IPAP = EPAP + x

EPAP 6, IPAP = EPAP + x

EPAP 7, IPAP = EPAP + x

Until x = your Max IPAP of 15 and no further.

to give you an idea this is how the two move together....

   
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#7
RE: New to Therapy - Starting on BiLevel
Well how about that. This looks just a smidge simpler than my old ASV.

So EPAP is the variable and PS is static.

I mostly ran mine at EPAP 8-13, PS 3-15, and results in IPAP 11-28. These were my settings BTW and not suggested for you to try them...

Coffee
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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#8
RE: New to Therapy - Starting on BiLevel
(09-25-2021, 04:48 AM)SevereApnea Wrote: Welcome,

Most here would want to see your redacted Sleep Study results to help you out. It's time to prepare mask selection, SD card for the machine and download OSCAR.


""..but the clinic that prescribed me wanted me to start on 5-15 cmH2O on an APAP"

something is missing here...

the 5 is the Min Pressure
the 15 is the Max Pressure

What did they specify for the EPR value? 0,1,2 or 3? (in Vauto mode this is similar to but not same as PS which is Pressure Support)

If they indicated you have Hypopnea that is generally treated with some level of EPR (PS in the Vauto)

Certainly not maximum PS of 15!

If they said EPR = x then your Vauto settings in VPAPauto mode would be

Min EPAP = 5 (to start with for now)
Max IPAP = 15 (to start with for now)
PS = x as per their specification.

The x of PS is a constant with this machine, not a variable. It moves together with the EPAP.

Your pressures during the night might vary as follows:

EPAP 5, IPAP = EPAP + x

EPAP 6, IPAP = EPAP + x

EPAP 7, IPAP = EPAP + x

Until x = your Max IPAP of 15 and no further.

to give you an idea this is how the two move together....


Thanks for the response. I really appreciate the explanation.

I'm not sure where the idea that I redacted anything came from, but I've attached the graphs from my sleep study. My sleep study only showed 1 obstructive event the whole night, with an RDI of 5.7 consisting entirely of hypopneas otherwise. I also had a very high amount of "spontaneous" arousals which averaged about 33 per hour.

What I said in my OP is pretty much all the information I have regarding my prescription so I'm sorry it seems like something's missing, but if it is it's not something I'm hiding. I've attached a snippet of my prescription to show what it is they have listed, but it's pretty bare and doesn't mention much. As you can see, EPR isn't checked, and the setting section just saying 5-15 cmH2O. Everything else on the prescription is just about accessories and mask type basically.

Do you have any recommendations for adjusting settings? Would I just change IPAP like is recommended in the wiki?


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#9
RE: New to Therapy - Starting on BiLevel
Hi there again Zeliox.

thanks for posting that info! that's great.

By 'redacted' I mean that when you post your sleep study results you edit/mark out/hide your personal information, name, DoB etc.
Just a simple way to maintain privacy. I see you have done that already on the attachments, so that's fantastic.

Secondly, sorry if my post sounded like I was accusing you of anything, far from it, it just seemed like something was missing from their recommendation.

If they recommend Pressure settings they would normally also recommend EPR (expiratory pressure relief) in the ResMed machine or some sort of C-flex setting if its a Philips Respironics machine.

From your attachment it looks like they have suggested an APAP machine with pressure settings from 5 - 15, they have specified a ramp time of 45 minutes and have not checked the box for EPR or C-flex, but did enter the value of 1 / full time.

Might be an idea to get some more clarity from them about whether they want you to have this on or off.


From the snippet of the sleep study you attached, it seems you have mainly hypopneas. I assume that was your first (diagnostic) study and not titration study?
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#10
RE: New to Therapy - Starting on BiLevel
Thanks for the clarification and response SevereApnea. I was admittedly not in the best mood when I was writing my response and I probably read into some of the words you used more than I should have.

I'll be calling them on Monday for some other concerns and I'll definitely be asking them for specifics regarding the settings they recommend. I don't know if it may also be a good idea to bring up to them that I'm buying a BiLevel. They've not been the most cooperative so far sadly and I'm worried they'd just get kinda snippy that I'm not strictly following what they recommend.

I see what you're saying about the 1/ full time. I hadn't noticed that myself. So would that mean that I should set PS to 1 as a start? It seems rather low to me considering my study. I have asked them if they can retroactively score RERAs to get a better understanding of my condition, but they seem resistant to it sadly, but I'd imagine an appreciable amount of my "spontaneous" arousals are RERAs considering it's so high. From my understanding, the average person might have 5-10 an hour but mine was about 33 an hour. I also have a WatchPAT test I did last year that shows significant RDI with low AHI which I believe is indicative of UARS. I've attached that study to this post in case anyone finds it useful.

This was just an in-lab sleep study without any sort of titration. I don't currently have the means to have an in-lab titration done sadly so I'm just going to have to try and figure it out myself using OSCAR, the wiki, and hopefully some advice from people here.


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