[Pressure] TheWallofSleep's Therapy Thread

[TheWallofsleep]

I did call them, however, I understand it is not their fault. I meet with my doctor in a few weeks, then I will see if I can get a script. If insurance will not cover it, I will probably take my business back to Supplier #2.

[TheWallofsleep]

Long story short, I couldn't talk my provider into covering an ASV, but I was able to get most of a brand new VAuto covered. That's right, 0.0 hours on the clock. I have a clean SD Card, and am ready to go. I am assuming as long as I keep the machine under a seperate profile on OSCAR, there will not be any problems.
Eventually I will receive the data from the study which will have their recommended settings, but I have a feeling I will be self-titrating regardless. My Former APAP settings was 10-15cmH20. I am copying the climate settings over as is, and already disabled ramp. I do not know if the VAuto was preprogrammed by the DME in accordance to my doc or if this is the default settings, but right now I have:
Mode VAuto
Max IPAP: 9.0
Min EPAP: 5.0
PS 4.0
Ti Max 2.0s
Ti Min 0.3s
Trigger Med
Cycle Med
 
Should I run with these for a few to see the data, or should I tweak based on what I was working with on my APAP. I have a feeling the MaxIPAP/MinEPAP range will be too low right out of the gate.

[SarcasticDave94]

Yeah it seems like they're maybe doing the Avoid CA Game by making this lower pressures than what you were using. I guess best to try it as is 1 night, post OSCAR, and tell us what you liked and didn't. Keep a sharp eye on CA. On the VAuto Trigger can be edited to High. Just a maybe, run it as is to get a base number. Then make an edit. If it is totally nasty as it's set now, then do something of an edit, either trigger high or pressure edit.

I hope it goes well but BPAP and CA don't play very well together. Be ready to complain very loudly if it's a bad mix for you.

[TheWallofsleep]

Here is my first night with VAuto. The numbers look good, but I feel pretty terrible. I did not sleep for the first 2hr24 minute section, so I have excluded that from the count. The data here is only for 4hr52m, so I feel I need to maybe get a few more hours down to have a useful baseline. Tolerating the machine is not too bad either, which is something I have heard people complain about.

When posting screenshots for the AirCurve 10 VAuto, is there a different set of charts or chart order that is more useful than the default ones the CPAP users share? If so, just let me know. I am consistently appreciative of all the advice.

[SarcasticDave94]

The same OSCAR that one would show for AutoSet will be fine, just like what you've showed.

The VAuto is just a true Auto BPAP and not a very high level machine like the ASV. Due to the ASV being issued for Central or complex Apnea, different charts may be needed there.

[TheWallofsleep]

Finally, we get to start having some fun. I decided to raise the EPAP/IPAP by 1cm to see what what happen and the centrals lit up. I am assuming that was a change in the wrong direction. I may go back down by 1cm tonight to see what happens.
I do not know how much of this is inconsistent centrals, or just too high of a pressure.

[SarcasticDave94]

Well that went the wrong way, yes I'd revert back to 9/5 pressures. Since your prior chart shows CA at 1.03 vs this one of CA 8.23. That increase of 1 supposedly added 7.2 to your overall AHI. But remember one night's not a trend, but as that went badly, I'd dial it back. As your CA seem to be hyperactive compared to the others, you might want to give it a few days and try again. Remember your ResMed has fractional steps between the whole cmH2O steps. Between 9 and 10 are these fractional .2 steps, 9.0, 9.2, 9.4, 9.6, 9.8 and then 10.0. Maybe do smaller steps next time.

[TheWallofsleep]

I definitely should take more advantage of the ability to make adjustments in smaller increments. As I saw you say in a different thread about treatment with the VAuto, it is a game of teeter-totter. Since I have both OSA and somewhat prevalent CSA, I will gradually and independently work on increasing max IPAP to combat OA/HA, and then gradually lower PS to see about diminishing CA. I want to find a middle ground where I can feel the best. If anything, it will help me rule out certain changes in certain directions. From what I saw earlier, I don't think my max IPAP can ever go over 10cmH20, but ~9.2 may be beneficial.

[Gideon]

Please provide a 10 minute view that has your centrals, let's see if it is CO2 induced or ideopathic.

[Gideon]

And I should add that if it is CO2 driven it is likely that PS is the main driver, yes pressure is involved, though usually a minor player. You do want a few CA events to drive your apneic threshold down and make you less susceptible to low CO2 induced centrals.