Aircurve 10 VAuto - (optimizing advice and questions)

[Stubert]

Hi,

Finally got my hands on the Aircurve 10 VAUTO, after 1,5 year trying out the Löwenstein Prisma Smart Max, Prisma 25S and Airsense 11.

Best night in a long time. I wanted it because of the options of manually setting Trigger, Ti Max/min, cycle etc.

Hit the sweetspot almost after first night/settings and would like your advice on how to adjust to:

1. How to best raise tidal to around 600 (+epap or more PS?)

2. How to avoid arousals and reras?

I am so happy for the result and feel it is NOW time to get better!

[PeaceLoveAndPizza]

Why do you think you need a tidal volume of 600? Your numbers look fine.

There is no magic to avoiding arousals/RERAs. You have very few in the posted chart, so I would not suggest any changes at this time.

Give it more time, a few days to weeks, then post another chart if you are having any concerns or issues. For now you did a great job finding settings to give you excellent results.

[Sleeprider]

It's usually not a useful exercise to increase tidal volume because your respiration rate will naturally compensate (slow-down) to leave minute vent the same. So while you can use more pressure support to force a higher tidal volume, it usually makes no difference in your average respired air, and can cause more sleep disruption or centrals. I really don't like to use a bilevel to supplement respiratory effort beyond what is needed, and have seen generally poor results in members that have jacked up the pressure support way above needed levels, i.e. 6-+ cm. That said, I have no problem with anyone trying PS at 4.0.

[Stubert]

PeaceLoveAndPizza:

I read that tidal volume should be 6-8ml/kg multiply your ideal body weight. From my height of 190cm my ideal weight is around 85-90kg. Multiply that with 7ml/kg equals a tidal volume between 595-630.

I get the point Sleeprider reefeers to, that it might be more important to look at the respiration rate and minute vent, which looks good, eventhough tidal volume is 520.

I will try and keep settings there, but might try and set Cycle to high and PS of 4, but keep changing one setting at the time.

Thanks to the both of you!

[Stubert]

I am running epap 11 + PS 4 on Aircurve 10 vAuto.
Still have a lot of arousals.
Is increasing epap or ipap the most "normal" way to treat the arousals?
The flowrate is decreasing a little and last breath, before arousal, is flattened on top.
I see several awakenings and respiratory instability after these arousals in general, but not that much in this example.

[OpalRose]

Stubert,

I moved your most recent post and merged with the thread that started with the use of the VAuto BiLevel, as you are inquiring about the same issue.  

Please, going forward, use this thread for your therapy questions and posting graphs.  

Thanks!  

Hopefully, you are happy with your newest machine.  Your numbers look wonderful and I see no reason to adjust anything.  
Don't worry so much over a few arousals.  This is normal for most of us.  What's most important now is how you feel.

[MrIvanDrago]

I went down this road a while back with tidal volume and my size being 'appropriate'. I tried raising pressures, etc. and my tidal volume 'Med' got to about 620; however, my sleep was terrible even though the numbers looked good. I now have more manageable pressures and my tidal volume sits anywhere from 480-500. I was told to look at the 95% number for tidal volume as well, which aligns with most calculators out there. 

Some people are more shallow breathers than others, and like others have said, the body compensates for minute vent. Just my thoughts as I was chasing the same with tidal volume and found it to be a waste of time and sleep.

[Sleeprider]

Stubert, I don't see any need for setting changes on your Vauto. Your event rate is exceptional, and there are no flow limits to address. The zoomed image shows no respiratory event predicate for the one-breath blip. There is not a respiratory or setting issue to fix here.