Aircurve 11 vAuto issues

[Sphinxx729]

Hi there, I'm not the apnea patient, my dad is- he's 72 and can't do forums, so here I am. 
He was using ResMed cpap for just under a year and has been swapped to the Aircurve 11 bipap due to machine-induced CA that isn't present in either of his in-office sleep studies. 
Aircurve 11 is horrible so far. Night 1: felt suffocating, hyperventilation induced with the pressure changes; high leak , typical numbers of predominantly CA (7.1), felt exhausted the following day. Night 2: something malfunctioned, I saw the mask on his face correctly the entire night and heard the machine running but it recorded a whole 0.1 hours of sleep; night 3: the "diagnostics compete" screen is the first thing we see and it recorded 0.36 hours of sleep. Again, it was on his face the whole night. What the heck?! 
His Dr. will refer him to the supplier who has been less than helpful every time we contact them, so we're at a loss. Any suggestions are appreciated! 
To note, I'm trying to talk him into downloading Oscar, so we do not have that data as yet, and he is a card-only type of person, so the data is not uploaded via modem (though even if it were, there's not much assistance available). He's about to return to the cpap because at least that machine works, sort of. ?

[Sleeprider]

Please download the free OSCAR (Open Source CPAP Analysis Reporter) from the link at the top of the forum page or the link. We're going to need some better details on what is going on. The Aircurve 11 Vauto is a very good device, but is still intended to resolve obstructive sleep apnea and related issues. If your dad has central apnea, the correct solution is a variation of bilevel called and adaptive servo ventilator, or Resmed Aircurve 11 ASV. If his device is setup in S-Mode (fixed pressure at 14/9 (IPAP/EPAP) that is a pressure support of 5.0 cm. That may have made the CAI much worse due to washout of respiratory CO2.

To help you and your dad educate the doctor, please take a look at the Resmed Clinical Titration Protocol, and note the conditions each device is intended to treat. The Vauto or VPAP-S are bilevel devices with no backup, and the titration protocol calls for moving to ASV if centrals persist. So he is likely using the wrong machine. Feel free to share this resource with your dad's doctor, and keep in mind it is the physician that calls the shots on prescribing the right device, no an equipment rep. The information on ASV starts on page 28 and is a easy to understand read. https://www.resmed.com/us/dam/documents/...er_eng.pdf

Meanwhile, we can probably make your dad more comfortable until we can see an OSCAR chart. Go into the clinical settings and set the device to the following:
Mode: Vauto
EPAP min: 7.0
IPAP max 16.0
PS: 4.0 cm
Trigger Sensitivity: Very-High
All other settings at default (TiMin 0.3, TiMax 2.0, Cycle medium)

These settings will relieve some of the CO2 flushing by reducing PS and will enable the device to trigger IPAP with less spontaneous inspiratory flow. If dad needs ASV, this is not a substitute, but very-high trigger has proven effective in some cases of CA. FWIW, I'm 71, and that age does not preclude competence at computers, mobile devices or social media.

[Sphinxx729]

Thank you for the reply! Lots of info to take in there. He is only encountering CA with therapy- no CA in sleep studies, but yes- Oscar looks like it would be immeasurably helpful. I'll need to work on convincing him of that.

My dad also has a semi-recent brain injury, but I didn't mention that (nonetheless, prior to the incident, he still couldn't wrangle the internet well).

[Deborah K.]

If his machine is recording way less time than he is sleeping the machine is not working right. Ask the supplier to swap it out for a new machine.

[Sleeprider]

Brain injury is cause enough for a new sleep test. That can be the cause of centrals, in fact that is the very definition of primary central apnea that affects the autonomic respiratory center. Ideal study would be a split study to evaluate sleep respiration without any therapy, then titration and evaluation of appropriate bilevel options including ASV.

[Sphinxx729]

His brain injury was prior to the apnea diagnosis, he's had two split sleep studies since and they've diagnosed only OSD. (The second study was to gather his respiratory data for programming the Bipap machine, his doctor said). 
His CA seems to be therapy-induced, but it's definitely good to know he's been getting the best type of test (I was unaware there are different types of in-lab studies).  We don't know if apnea was present prior to the brain injury, but it definitely is after.