Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

[Pressure] Aircurve 10 VAuto settings recommendations
#1
Executive summary of sleep studies
first sleep study 6/16/03 - recommended cpap pressure of 9. Moderate to severe obstructive sleep apnea., elevated index of 36, to 77 when on back. Moderate to sever snoring, sleep fragmented oxygen desaturation in mid 80's

Sleep study 6/17/05 - cpap/bipap. At cpap pressure of 9 c-flex of 3 no obstructiv apnea's and 11 hypopneas and AHI of 4.1 On bipap of 11/9 and 13/9 had AHI of 1.2 and -0- respectively flex of 3 as well. Oxygen satruation of 93%. hypopneas well controlled on 9 cm nasal cpap felx of 3.

Wakefull test 6/16/05 - dimly lit room, 4 opportunities to fall asleep for 20 minutes, sitting position. Did not fall asleep.
-------------------
I just upgraded from a Respironics Remstar Pro Series M Bipap machine to the Aircurve 10 Vauto.  The old machine was set by clinic to a fixed pressure of 9 and flex of 3.  A few weeks ago the humidifier started to fail so figured that it was time to upgrade.  Due to the high deductible nature of our health plan, the new machine was ordered from an online retailer at their suggestion of what would replace the old.  I looked at the old settings in the last couple of weeks to get an idea for the new and switched to the auto bipap mode to see what it would do.  I found that I slept a little better and the average pressure was 10.2.  Have not had an issue tolerating treatment since first prescribed.  Using the new P10 nasal mask vs. Swift FX and suing humidification with the new machine.

Being an old user (and gadget freak) I figured that it would be easy, the old machine did not have that many settings in the clinical mode.

I have noticed on the new machine that when breathing, it seems that the "flex" part of exhale stops short of my breathing rhythm giving the sensation that air is cut off.  Same sensation on enhale as it doem not start with initial action. I read several posts on trigger and cycle as well as Ti min and max, not as easy as I first thought.

Machine is currently set on auto options where possible, I assumed it would just do it's thing.  I like the idea of the auto pressure adjusting as it seems i need more than the old setting of 9.

Any suggestions would be appreciated.  Report attached.
   

Keith
Post Reply Post Reply
#2
Your tidal volume is down and your breath rate us up, I think you have a little bit of mouth exhale on the flow chart, but generally good. Your apnea is well controlled with your current settings. With the help and monitoring of your doctor, I would raise the pressure support till you have normal volume. This gives a general idea of what could be a goal?
[Image: c.jpg]
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
Post Reply Post Reply
#3
Keith, Download the clinic Manual from the private files area. It explains all the different settings. Most people leave the timing settings in Default. As long as your O2 levels are good don't worry about tidal volume.
Post Reply Post Reply


#4
I'm not sure about some of your terminology. You say the M-series was set at "fixed pressure of 9 and flex of 3". That does not make much sense for a BiPAP, so if we assume you mean "pressure support" rather than "Flex" we would have fixed pressures of 12/9 (IPAP/EPAP). I think your EPAP minimum pressure is just too low in spite of good results in this graph. I see no reason not to keep the current PS 4, but would encourage you to increase EPAP min to a comfortable level. Just a guess, but I think that would be closer to 6 or 7 cm-H2O. Your machine did reach those pressures, but not until near the end of the night.

As far as tidal volume, and resp rate, I have no idea what ajack is looking at in the absence of historic data. You have a few snores, virtually no flow limit and very good results. I would focus on finding a comfortable minimum EPAP pressure, and if you feel out-of-sync with the machine, we can consider increasing Ti Min settings to fix that.
Post Reply Post Reply
#5
I thought I would split into two posts, do you have a COPD, etc? This may need a change in Ti and trigger, cycle
It really should be done by your doctor, but for background, page 21,22,23,24
https://www.scribd.com/document/35340282...-Titration
If the machine is behind in timing as you breathe, or triggering too soon, you would adjust trigger.
the amount of time the pressure lasts for is Ti max, you may also have rise time, the time it takes to reach full pressure.

going by the guide
titration starts at ps4cm. a default setting for a normal lung is ps6cm and an obstructive lung is ps8, there are also default settings for the Ti, rise time, trigger and cycle
------
We don't know the history, we don't know if the machine is reading volume and breath rate correctly and is why I suggested the doctor. It seems there is mouth breathing at 01:30 where the leaks are and there seems to be no exhale on the flow chart, It was an observation and a zoom of the area would be needed to investigate and fix if desired.

we don't know the o2 number to say if it's high or low. We do know that going by the machine, that last night he is breathing 16 times a minute at 440 tidal volume to maintain the current o2 level and a minute vent of 7.6. I would ask the doctor if a rise in pressure support would increase the tidal volume and decrease the breath per minute and generally have less effort breathing and check the machine to see if it is reading it right.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
Post Reply Post Reply
#6
Suggestions much appreciated.

No COPD, blood pressure normal with meds, not on any other related medication.

5'11, 250 pounds so a bit over weight and probably the cause for apnea?  Not sure how to convert that to the chart for tidal volume with AVAPS.

I had requested the clinic manual earlier today and just received by email.  Not sure who is in charge of that bu appreciate the prompt response!  Will start studying that tonight.

My old Remstar was a bipap machine and was surprised to see it set at a FIXED pressure when i looked at the settings.  Simple setting either fixed or auto.  It was set at fixed/9.  CFlex was another simple setting 1,2,3....set at 3.  A lot has changed in technology since I received this machine.  No idea what it was set as fixed, another reason to become more involved in treatment.  My first machine in 2003 was a regular cpap, fixed pressure at 9.  Second machine in 2005 was the Bipap from Aprea Health Care, no choices given, they set the machine at fixed even though my sleep study had bipap settings as well.  I had regular check in periodically with a tech for a couple of years.  Nothing was ever changed and the sessions were of no real value, I think it was to check compliance.

Will go slow with changes.  Setting EPAP from 4 to 6 tonight to see what happens.

My plan is to use the Aircurve in Bipap auto mode.
Post Reply Post Reply


#7
Hi Keith R,
WELCOME! to the forum.!
Good luck as you continue CPAP therapy and also with the new machine.
Hang in there for more responses to your post.
trish6hundred
Post Reply Post Reply
#8
A person 5'11" in that chart would be 71" with an ideal weight of 74.5kg and be deemed to have a median tidal volume of 600, It's a rough guide for setting up someone on a bilevel machine that tries to get assured tidal volume in the lung. The machine will try and maintain around this volume with each breath.

Your chart has your median tidal volume at 440. To make up for this, you may need to breathe more often to get the needed amount of air per minute. Your breath rate was 16 per minute.
Everyone is different and you change a bit from night to night, but for example on bilevel, I'm 5'7" 67", my breath rate is 12 and my tidal volume is 560. My median pressure support varies, but a median PS of 10, rising to 16 isn't unusual for me. My machine will change my PS as I need it.

Have a look at other peoples charts here and you will see a spread of numbers. It's just that you now have the bilevel and have the means to help your respiration through pressure support and the help of your doctor..

There is no rush and everyone goes at their own pace. raising the epap may help with the few OA and H that remain. Did you find the titration guide helpful?
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
Post Reply Post Reply
#9
(11-13-2017, 06:32 PM)Keith R Wrote: Being an old user (and gadget freak) I figured that it would be easy, the old machine did not have that many settings in the clinical mode.

I have noticed on the new machine that when breathing, it seems that the "flex" part of exhale stops short of my breathing rhythm giving the sensation that air is cut off.  Same sensation on enhale as it doem not start with initial action.


I noticed similar issues when I changed from a Respironics BiPAP to a ResMed VAuto. My BiPAP had a feaure called Bi-Flex which eases that the transitions from inhale to exhale and exhale to inhale. I'm not sure if your old M-Series had that.

Anyway, after a few nights I adapted to the change and it didn't bother me any more. In fact, I like the new arrangement better.

Quote:I read several posts on trigger and cycle as well as Ti min and max, not as easy as I first thought.

I wouldn't concern myself with those settings yet.

First, learn about the settings called  maxIPAP, minEPAP, and PS; and what they do. Get those settings under control. Forget about Flex and EPR, as none of that is relevant to the VAuto.

Also, I see signs of mouth-leaking between 4:20 am and 6:00 am. You may want to try a chin strap. And make sure your mask straps are adjusted well.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply


#10
The tidal volume chart is just a guideline. There's too many factors involved to say your tidal volume should be 600 because your 5' 11".

The number one consideration should always be your oxygen levels. If these are normal than there is no need to adjust tidal volume.

You never adjust settings just to match some chart. Assuming your O2 levels are fine you should only adjust the timing settings as needed for comfort of breathing.
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  Five nights on new Aircurve Vauto alps 7 189 5 hours ago
Last Post: alps
  Please Review The Data & Give Recommendations Hojo 106 3,997 Yesterday, 08:10 PM
Last Post: Sleeprider
  CPAP setting feels different on Resmed Vauto vs Elite 10 Sleep Therapy 5 111 12-12-2017, 04:36 PM
Last Post: Sleep Therapy
  Constant Air the same even when i change settings blackhawk2737303 6 223 12-11-2017, 04:16 PM
Last Post: Sleeprider
  [Equipment] Resmed AirCurve 10 Vauto Mutka 6 124 12-10-2017, 08:31 PM
Last Post: CB91710
  First 2 weeks. Mask recommendations? Acheron2010 2 123 12-03-2017, 11:58 AM
Last Post: DKRMT
  AirCurve 10 VAuto not set to VAuto hcbrf3 9 284 11-30-2017, 02:29 AM
Last Post: yrnkrn

Forum Jump:

New Posts   Today's Posts




About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.

For any more information, please use our contact form.