[Pressure] Change Pressure on AirCurve 10 VAuto

[mftinvermont]

Good Day everyone. I'm new to the BiPap scene, but has used a CPAP for several years.
I've been using a ResMed Airsense 10 AutoSet for a little over a year now with pressures set at Min 7 - Max 15 (cmH2O) and have enjoyed low AHI's, under 1.00-2.00 AHI's pretty consistently but I suffer from terrible mask leak no matter which mask I use. I have a very narrow upper bridge and it's deep to my chin and I have trouble getting a full face mask that does not leak in that area. I've used Moleskin pads on my Quattro FX in order to build up the area enough where it doesn't leak and it has stopped the problem, somewhat...but my Sleep Center isn't happy about that. (They feel I shouldn't have to do this to get a good mask seal). Being a mouth breather with very narrow nasal passages, nasal masks don't work and I still leak through my mouth even with a chin strap, which I found very uncomfortable.
My Doctor prescribed a AirCurve 10 BiPap machine with a straight "S" setting at EPAP 7.0 IPAP 11.0 (cmH2O) in hopes it would help the problem and it did stop the mask leak better than my AirSense 10 but my AHI's are through the roof, sometimes approaching 5.00 per night and after a week I was feeling it. Fatigue, tiredness, sleepiness and heart palpitations (I suffer from A-Fib and take Tikosyn to keep it steady).
I contacted my Sleep Center about switching to the AUTO BiPap setting on the machine and they hemmed and hawed. I'm not understanding why they would not put me on this setting first since my AirSense 10 is in Auto setting, however I'd like to try it a couple of nights to see if I could get the AHI's lower. I've set my own Auto several times with great success (with no help from my sleep center, and low AHI's) but I'm finding the Auto BiPap settings a little to complicated for me to set. Does anyone know the proper Auto BiPap settings for my prescription? Is it even possible? I purchase my own equipment and I'm on a 30 day trial from my DME.
Any help out there would be most helpful.
Thank You
Michael

[OpalRose]

Hi mftinvermont,
Welcome to Apnea Board!

I don't use a BiPap, but there are many here that do, so hang in there.....I'm sure you will be getting some responses soon.

Not sure why your Sleep Center wouldn't want to help, but sometimes they won't even consider a pressure change without a doctor's approval. Perhaps your doctor's decision has to do with your
A-Fib. You should call your doctor and ask him. If he says ok to Auto setting, then your sleep center should comply.

[mftinvermont]

Thanks for the quick reply OpalRose.

Hi mftinvermont,
Welcome to Apnea Board!

I don't use a BiPap, but there are many here that do, so hang in there.....I'm sure you will be getting some responses soon.

Not sure why your Sleep Center wouldn't want to help, but sometimes they won't even consider a pressure change without a doctor's approval. Perhaps your doctor's decision has to do with your
A-Fib. You should call your doctor and ask him. If he says ok to Auto setting, then your sleep center should comply.

[PaytonA]

You did not mention your EPR setting with the Autoset. I am assuming that you were not using it.

Actually, I would set your Max IPAP to 17 and your Min EPAP to 7 and leave your PS at 4.0 No other settings should need to be changed at the moment. I raised the top end a little to give the EPAP as much headroom as it appears to have had with the Autoset

My motto is "Simplify".

Best Regards,

PaytonA

[mftinvermont]

Thanks for the response!!!
The EPR is not set.
I will try this and I hope it works.
Michael

You did not mention your EPR setting with the Autoset. I am assuming that you were not using it.

Actually, I would set your Max IPAP to 17 and your Min EPAP to 7 and leave your PS at 4.0 No other settings should need to be changed at the moment. I raised the top end a little to give the EPAP as much headroom as it appears to have had with the Autoset

My motto is "Simplify".

Best Regards,

PaytonA

[mftinvermont]

Can anyone tell me what the PS is for? Mine is set at 4.00 but I think it could be lower.

[PaytonA]

Can anyone tell me what the PS is for? Mine is set at 4.00 but I think it could be lower.

PS stands for Pressure Support and defines the difference between IPAP and EPAP. So if your EPAP is 13 and your PS is 4 your IPAP will be 17. For Vauto machines in auto mode the IPAP = EPAP + PS will be maintained regardless of the pressure the machine chooses at any given time and the machine will keep the pressure that it chooses so that the Min EPAP and Max IPAP are always maintained.

In short, the PS is the kind of the equivalent of EPR except it can be set much higher if needed. If you are more comfortable with the EPR of 3 rather than the PS of 4, you can set the PS to 3 and it should feel about the same or you can set it to 1 or 2.

Best Regards,

PaytonA

[FFOGHORN]

There is a lot of controversy (and confusion) in this forum regarding Pressure Support and its relationship to IPAP/EPAP on the Resmed AirCurve 10 VAuto.

First of all, the machine itself "sets" nothing - not IPAP, EPAP or PS. In VAuto mode, the machine automatically adjusts pressures based on events, but it does so within the parameters entered into the machine by the clinician or the patient (if adventurous).

Also, for all those coming from Respironics machines, the Resmed machines use a different algorithm to auto-adjust the machine. Specifically, the Respironics machine allows EPAP and IPAP to move independently while Resmed "ties" the EPAP and IPAP so that they move together in VAuto mode.

So, one sets Minimum EPAP and Maximum IPAP and Pressure Support on this machine. I want to stress I am talking about VAuto mode only, which then adjusts pressures on-the-fly throughout the night. All Pressure Support does is establish the difference between EPAP and IPAP. For example, if PS is set to 4, the EPAP and IPAP waves as viewed in Sleephead or ResScan will be exactly 4 apart all night long.

To illustrate, a doctor prescribes IPAP 15, EPAP 8, Pressure Support 4. Assuming you are not using Ramp, the machine will start with EPAP 8 And IPAP 12 (remember Pressure Support will keep EPAP and IPAP 4 apart all night; the machine begins at the lowest EPAP allowed by the doctor, in this case EPAP 8). As events occur throughout the night, the machine will adjust. But, EPAP can never go below 8 and IPAP can never go above 15, unless someone changes the prescription in the machine. The machine figures out where it needs to be, based on your events. If it hits IPAP 15, then EPAP will absolutely be at 11 (15-4=11). Not to beat a dead horse, but this applies only to this machine in VAuto mode. Other machines do it differently.

Obviously, if you see a pattern where your machine is hitting your prescribed Maximum IPAP every night, you also see 5+ AHI and you feel crappy in the morning, then you should seek help in determining if your Maximum IPAP needs to be raised or if you're experiencing runaway IPAP due to some other issue.

Sleep tight, everybody!

[_cy_]

checking in .. even though I'm not the OP, I've adopted this thread as my place to place feedback on my Aircurve 10 Vauto.

it's coming up on one year usage with 1677 hours, consistently about 1.1 AHI, PS 4, exhaust 6.8, intake 12.2 .. note those are my settings which may or may not be useful for you.

it's been quite a journey learning how to set/use my Aircurve 10 Vauto. without the feedback on this forum, learning curve would have been steeper yet. hence why it's really important to post your feedback.

everyone is different but for me it was essential to understand all the settings. which can be a tall order with all the different setting on Aircurve 10 Vauto, multiplied by all the different modes. if you don't have the clinical guide, it's not hard to find instructions on how to get one.

let's start with why someone would need a bipap (bilevel) vs a cpap and what the differences are. cpap provides a continuous pressure measured in cm h2o .. which provides the splint that hold open your air path. positive pressure is great when inhaling but that pressure works against you when you exhale.

inhale brings fresh O2 into our lungs, exhale expels CO2 .. when lungs has a hard time overcoming positive pressures delivered by cpap .. your PCO2 or partial pressure of carbon dioxide could get too high. that's when bipap (bilevel) machines are necessary to provide pressure relief during exhale cycle.

now let's cover some potentially confusing terms used by Aircurve 10 Vauto. let's assume you have machine set to Vauto mode. PS or pressure support sitting determines how much pressure relief is delivered during exhale cycle. default is 4 cm h2o separating epap and ipap .. aircurve 10 has the ability to raise or lower pressure relief by changing PS settings.

actual pressure support is in-between epap and ipap. so PS setting is really to set amount of cm h2o relief aircurve 10 delivers during exhale cycle.

now let's cover EPR or expiratory pressure relief which is only available in CPAP mode on Aircurve 10. function of EPR is essentially the same as PS in Vauto mode but limited to 3 cm h2o .. note Airsense 10 autoset which is a cpap machine has EPR which delivers pressure relief limited to 3 cm h2o.

[PaytonA]

.... aircurve 10 has the ability to raise or lower pressure relief by changing PS settings.

Just to be clear.

aircurve 10 has the ability to raise or lower pressure relief by manually changing PS settings.

Best Regards,

PaytonA