Starting settings for switch from Airsense 10 to Aircurve 10 VAUTO to minimize Aeroph

[TexasTiger]

Just received my Aircurve 10 VAUTO plus a switch to DreamWear full mask and looking for the best initial starting settings.  Last use on AirSense 10 was 8-11 with EPR 3 attempting to minimize too much air intake (bloated and up 4-6 times a night getting rid of gas!).  Gastro Doc ran lots of tests and believes the CPAP/APAP is causing the problem and sent me back to the sleep doc for help.  I am hopeful that the Bi-Pap will solve the problem and maybe be able to get the events down (averaging 5.5 to 6 now).  Sleep doc thinks setting 8-11 with pres set 4 and not on VAUTO.  

Last sleep test was a year ago and was AHI=64, RDI=70, and centrals=5.  I changed the settings to as follows (help much appreciated):
Mode = VAUTO
Max. = 11.0
Min. = 4.0
PS = 4.0
Ti Max = 2.0s
Ti Min = .3s
Trigger & Cycle = Med.
Full Mask (Dreamwear)
No Ramp

I can settle for some events as long as I can get a full nights sleep with no wake ups.  Looking back it seems this all started a few years ago when I switched from a ResMed brick set at continuous 9.0 (high events but slept the entire night) then going to Airsense 10 with settings on Max Press 11-15.  Have tried for a few years to get the events down and never gave any thought to the possible Aerophagia.  Any help much appreciated and I will post charts after a few days on the new machine.

[ardenum]

Aerophagia means you have weak muscles in throat and at the end of the esophagus. I myself have same issues and I find that this helps:

Trigger : very high
Cycle : very high

Ti max -Ti min is where you setup the breath length that matches your natural length, which isn't 2s probably for most, I use 3.5 for Ti max, and 0.8 for Ti min. I find 0.8 to be good against any potential hypopnoe. Also if you use low pressure settings I'd recommend going S mode instead, since aerophagia wakes you up, meaning any excesive pressure will cause you to wake up. 

Also if very high trigger feels like it's pumping a balloon, set Rise time to something between 400-600ms.

When you find anything comfortable, post some charts so we can see if you are also getting properly treated while minimizing the aerophagia.

[TexasTiger]

Thanks for the reply Crowtor - poor nights sleep - Aircurve says press. 10.9 with Exp Press 7.0 - AHI=18.2 & Centrals 10.7.
For sure need to get the press down to help with the centrals & maybe lower the min press also - any thoughts on this? Others on the forum indicate that VAUTO is best to use but it looks like S mode works for you? I'm surprised you can run pressure 8-17 and not have any aerophagia issues. Thanks again for the reply.

[Sleeprider]

Tiger, I thnk using the Vauto mode would help us to find the appropriate pressures for you. You previously started with a minimum pressure of 4, and i remember advising that your CA events occurred with higher pressure and more EPR. I'm a bit surprised to see you using a Vauto since central apnea have been present with pressure support, so these results should not come as a surprise. If you want to use the Vauto to identify the best settings, then go to Vauto mode, Max IPAP 12, Min EPAP 4, PS 2.0. Set your Trigger Sensitivity to Very High, Cycle to Normal, Ti Min to 0,8 and Ti Max to 2.0. The machine will increase EPAP up to 10 to resolve obstructive apnea, however your problem is central apnea which this machine does not treat! The trigger and Ti settings are intended to help with this, but again this is not the right machine.

Your last sleep study confirmed central and complex apnea. The Vauto or any bilevel other than ASV is going to increase your centrals. I assume you were issued this machine instead of ASV because you failed CPAP and now must fail BPAP before moving to a machine with a backup rate. This complicates our advise to you because optimizing your results may slow down your progression to the machine you need. Obviously, if we want better results with fewer centrals, you should use low pressures and low pressure support settings. What really needs to happen is for you to get through this trial and move on to ASV as soon as possible. Please read the wiki on Justifying Advanced PAP Machines http://www.apneaboard.com/wiki/index.php...P_Machines

[TexasTiger]

Thanks again Sleeprider for your help.  Changed to Bi-Pap to help with the aerophagia cause the VA will not provide an ASV or give a script for one because their studies show they are not good due to possible heart implications - had to push hard just to get this new device.  Will go back to my private doctor to get the ASV authorized after proof that this one is not doing the job.

I have attached the chart from the first night - actually felt better than 75% of other nights even though the results look ugly.  VA now pushing Dreamwear so had to start with that for the first part of the night - did not work well as you can see by the leaks - went back in the middle of the night to my F20 which works very well for me.  I will change settings in VAUTO as suggested and test a few nights before posting another chart to see what other changes can be made then.  Thanks again for all your help.

[TexasTiger]

Sleeprider after looking at the suggested documents to read I agree and should let this machine fail to more quickly to move on to what I need and have been asking for over two years now.  I'm going to put the settings back to original (max 17, min 4, PS 4, Mode S, Trigger, TI, & Cycle defaults) and continue to suffer a while before going back to my non-VA docs with enough evidence to get medicare to get an ASV.  I'll periodically post some charts for comments.  Thanks for the recommendation.

[TexasTiger]

Correction to the settings for "S" mode - IPAP = 11 & EPAP = 8 (last settings used from Airsense 10) plus easybreathe on.

[Sleeprider]

Be assured we have many Veterans that use ASV that were issued from VA hospitals and doctors. There is no VA policy that prevents a patient from receiving the therapy that is medically necessary. You may be screened for left ventricular ejection fraction (must be higher than 45%) but the VA does prescribe and dispense ASV to individuals with diagnosed primary central and complex apnea that fail CPAP and BPAP. They are very good at making you jump hoops. You need to request a referral to sleep specialists with expertise in central and complex apnea if your doctor is simply one of those that is convinced CPAP is the only therapeutic device available for all apnea. The good ones do exist, and this forum has been where we heard their stories, both frustrating and successful.

[Sleeprider]

I'd like to clarify the settings you plan to use. In post #1 you said:
"Sleep doc thinks setting 8-11 with pres set 4 and not on VAUTO. "

That would translate to:
Mode: S
EPAP 8.0
IPAP 11.0 (PS 3).

That seems consistent with your most recent post. I think you should stick with the prescription in order to best persuade the doctor that ASV is an appropriate move. In S-mode please be sure to set Easybreathe to ON in the comfort settings. That should make it a bit better.

[TexasTiger]

My sleep doctor (all sleep disorders) is a psychiatrist that thinks all sleep problems can be handled through psychology and seems to feel that these problems are all in your head.  So far I have not been able to see another sleep specialist.  I see my primary care doctor next week (VA) and hope to convince her that I need another diagnosis on this problem.  Thanks for the encouragement on hopeful VA solution.