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[Pressure] Help needed with new VPAP and new to forum
#1
My background:
About 5 years ago I had a sleep study done when I lived in Houston at the Baylor College of Medicine sleep center and was told I had mild to moderate obstructive sleep apnea. At the time I did not want a CPAP and opted for a dental appliance. This worked fairly well for 3-4 years but has become less effective recently. I have decided it is time to get a VPAP machine and hopefully get better sleep. Currently feeling tired and sleep everyday.

I now live in the highlands of west Panama (Central America) and there are no Sleep Centers or Doctors who are familiar with Sleep Apnea and treatment. So I am having to go it on my own as far as pressure settings, etc.

I have just ordered a ResMed AirCurve 10 VPAP Auto with HumidAir Humidifier and the P10 and it should arrive here in about 10 days.

Since I have no Doctor, I have no instructions for setting the min/max pressures or any other settings.

If someone give me advice as to a logical starting points for the various pressure settings and any other settings on the AirCurve 10 it would be most appreciated?

I have sent in the email requesting the clinical setup manual for the AirCurve 10. I will also download Sleephead software to monitor the data.
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#2
G'day jpatfarrell, welcome to Apnea Board.

I wonder why you have chosen the Aircurve machine rather than the less expensive Airsense? If you have simple obstructive apnea (which was apparently the case if your oral appliance did the trick) then the Aircurve might be overkill.

Regardless, you will be using the machine to titrate your own therapy. The way this is often done is to set it on auto mode with a pressure range of 4 (minimum) to 20 (maximum). After a week or ten days review the results in SleepyHead or ResScan and start making adjustments from there. You might find that 4 is uncomfortably low and depriving you of air, so you could bump up the minimum a couple of points.

I'm not sure if SleepyHead handles the Aircurve machine as yet (perhaps somebody could confirm this) but the latest version of ResScan should do.
DeepBreathing
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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.
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#3
Hi jpatfarrell,
WELCOME! to the forum.!
Hang in there for more answers to your questions and much success to you as you start CPAP therapy.
trish6hundred
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#4
Hola Deepbreathing....thanks for your reply.

I know/hope that the AirCurve is an overkill but living in Panama creates many challenges for access to high quality and latest technology. Trying to return or exchange something is nearly impossible and expensive. I decided to spend more money and hopefully have everything and more in a machine the first time.

The latest version of SleepyHead does handle the Aircurve.

Reading the Clinical Manual that I received last night it appears that I will need to set several parameters including:
min EPAP, max IPAP (4-25 cm range), Pressure Support, which is difference between IPAP and EPAP pressures (0-10 cm range) and TiControl (the minimum and maximum limits on the time the device spends in IPAP before raising the pressure- range is 0.3 to 4 seconds). There are several other settings such as ramp time, etc.

From the clinical manual:
"In VAuto mode, the AutoSet algorithm automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. Pressure Support (0-10 cm range) allows you to set the difference between inspiratory and expiratory pressure and is fixed throughout the night. Min EPAP and Max IPAP settings allow you to restrict the delivered pressure ranges in which the AutoSet algorithm can operate. The EPAP and IPAP will vary across the session according to the patient’s needs. It responds to snoring, apneas and flow limitation of the patient’s flow curve. Min EPAP and Max IPAP can be adjusted to limit the upper and lower delivered pressure limits."

My understanding is that I should set the starting min and max, as you suggested, at something like 4 cm and 20 cm. The AirCurve will automatically adjust up and down during the night within this range according the the Pressure Support parameter. For example: if IPAP is automatically adjusted up to 16 cm the EPAP would be 10 cm if the Pressure Support is set at 6 cm.

I appears that the Pressure Support setting is most important because the AirCurve will automatically adjust to the IPAP pressure needed to the level needed stop AHI and the EPAP will follow according to the Pressure Support setting.

Any idea of what a Pressure Support (difference between IPAP and EPAP) number should be to start? Seems like I have read that a number like 6 or 8 is typical.

"The AirCurve needs to have set the minimum and maximum limits on the time the device spends in IPAP. The minimum and maximum time limits are set at either side of the patient’s ideal spontaneous inspiratory time, providing a ’window of opportunity’ for the patient to spontaneously cycle to EPAP. Ti Min and Ti Max parameters play a significant role in maximizing synchronization by effectively intervening to limit or prolong the inspiratory time when required."


Any idea of what typically would be appropriate settings for the min and max time limits in IPAP? Available range is 0.3 to 4 seconds.

Sorry for the long post but I need and want all the help I can get to setup this device to achieve success in shortest possible time.

thanks in advance for any advice,

Pat

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#5
Starting at 4 min and 25 max EPAP IPAP is wide open Most user find 4.0 is too low. I would suggest setting minimum at 6.0 and not using the ramp feature. To start, I would not exceed PS 3.0. The objective of your initial titration is to determine an appropriate pressure range, and excess pressure support when you don't need bilevel could confuse things. Your EPAP pressure maintains an open respiratory path to avoid snores, flow limitations, Hypopnea and obstructive apnea from occurring. If you see those kinds of events, it is an indication you need higher minimum EPAP. Pressure support improves ventilation and makes breathing easier. It clears CO2, so you don't want to over ventilate or you may cause central apneas. These are general guidelines, and you may want to read any of the titration guidelines that are available by searching on the web.

On my BiPAP auto, I use a min EPAP of 11.0 with variable pressure support of 1-4 and pressure support changes within that range. The 11.0 min EPAP is what I need to support my breathing and eliminate flow limitations, Hypopnea and obstructive apnea from occurring. A bit of pressure variation on IPAP improve ventilation. I am sensitive to excessive PS and was experiencing periodic breathing and CA with higher PS. We are all different, and respond to pressure differently, so my example is not meant for you to use, but rather as an example of how responses to pressure vary.
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#6
jpatfarrell,

I use the S9 VPAP Auto which is the prior version of the Aircurve 10 Auto. Previous to that I used the S8 VPAP Auto. Anyway what I have seen for PS setting is 4-6 cm/H2O. I think that 4 may be the most common and that is what I use. The Ti min and Ti max can generally be left at their default values of Ti max= 2.0 and Ti min= 0.3 which is where mine are (had to go double check that). At the very least, I think that is a good starting point.

If the Aircurve has an "Easy Breathe" setting, I would turn it on. I use it on my S9 and the transitions from EPAP to IPAP and vice versa are almost undetectable

Best Regards,

PaytonA
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#7
Hi PaytonA and Sleeprider,

Thanks for you detail and informative replies. I believe I have a good understanding now on reasonable starting points.

Further reading of the manual indicates the AirCurve 10 VPAP Auto can be set for "Auto" or "S" mode.

If I understand it correctly in "Auto" mode I set the min and max pressures and the Pressure Support (difference I want between the IPAP and EPAP) and the AirCurve automatically adjust the pressure up or down as needed while maintaining the Pressure Support differential setting between the two.

I appears that in "S" mode the IPAP and EPAP pressures can be set independently. I am guessing that these two pressure settings stays constant and do not vary as needed like in the "Auto" mode. Easy Breath is available only in the "S" mode.

Any idea why anyone would choose the "S" mode with fixed pressures instead of the "Auto" where the machine automatically adjusted the pressures?

Sleepyhead, why do you recommend not using the Ramp feature?

I wish my machine was here now....I ready to get started.

Thanks,

Pat
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#8
Yes, S mode is a straight bilevel PAP mode that gives one the same EPAP and IPAP all night long. Who would use their VPAP Auto in S mode? I do. It actually gives me better results than Auto mode. I do try auto mode on occasion to see if I may need to change my settings but it seems, based on my data, as if some if not many of my OAs do not have a normal precursor.

Actually, in thinking about the Ti settings, one could make a VPAP or Aircurve Auto emulate a backup rate by setting the Ti and the PS appropriately. Other than that, I do not think that it needs to be changed.

Best Regards,

PaytonA
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#9
PaytonA,

Interesting that constant pressures for EPAP and IPAP works better for you than the machine automatically adjusting to the best pressure based on the algorithms. Why is this the case? Is the pressure varying uncomfortable or noticeable?

What info do you rely on from using it in Auto mode that helps to tell you what pressure settings would be appropriate in S mode?

thanks,

Pat
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#10
(03-01-2015, 06:45 PM)jpatfarrell Wrote: If I understand it correctly in "Auto" mode I set the min and max pressures and the Pressure Support (difference I want between the IPAP and EPAP) and the AirCurve automatically adjust the pressure up or down as needed while maintaining the Pressure Support differential setting between the two.

Yes, whatever PS you set will remain constant. IPAP = EPAP + PS, so as EPAP goes up and down to manage events, the IPAP will go up and down in lock step. For this reason, start out with a low PS of 3 or less, until (or unless) you feel the need to change that. A high pressure support will cause large pressure swings between inhale and exhale which can be uncomfortable, and not needed in most cases.

Quote:Sleepyhead, why do you recommend not using the Ramp feature?

The ramp is really a comfort feature, designed to gradually raise the pressure up to your therapy pressure over a period of time. The idea is that you will be asleep before the pressure reaches a level which prevents you from falling asleep. Machines sometimes (often, always?) come from the factory with the ramp set at 45 minutes. This is far too long and means that you're losing that amount of therapy time every night - doubly so if you have to get up during the night.

If your starting pressure is low anyway, the ramp has little or no beneficial effect. If the starting pressure is higher, you might want to set a short ramp period (5 or 10 minutes, say) just to ease you in to the therapy. I disagree with those who say never to use the ramp - it's there for a purpose and (like so much else in PAP therapy) it's very much up to the individual as to what suits him or her.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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.
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