Aircurve Vauto - Want to change rise time/easy breathe but keep auto benefits

[Sugarvenom]

Hello all!

I recently got a Resmed Aircurve 10 Vauto, and have been trying to titrate on it to no avail. I don't have any real data to provide as I haven't managed to sleep with it at all yet.

My problem seems to be air hunger, I'm constantly gasping for air, which I understand the main solution for is to up the min pressure (or PS, to a point) until starting IPAP is high enough to make the air hunger stop. So I've been doing that, but I'm currently at min EPAP 7, PS 5, still air hungry but starting to experience discomfort at the pressure.

I've noticed that the problem seems to be exactly how the air is delivered. Early in the inhale, there's not enough air and I'm air hungry. Right at the end, there's suddenly enough and I take a "gulp" of air into my upper chest. This is accompanied by the feeling of the nasal pillows flaring, so I realised that maybe what the problem is, is the pressure is ramping up during each breath and only actually provides enough air near the end. And of course, now it's providing too much air at the end, but still not quite enough in the beginning and middle.

If I could get it to provide the pressure from the end earlier in the breath, I reckon I could finally find the solution I need to get to sleep. But it looks like settings like "Rise Time" and "Easy Breathe" (to try turning that off) are not available in Vauto mode. I'd really like to stick to Vauto because judging by my WatchPAT test, my AHI/RDI skyrocket a bit in REM, so I'd like the machine to have the flexibility to adjust when it has to, at least until I'm sure I don't need it.

Is there a solution available for this? I wondered if a larger mask might make the pressures work better for me, but I'm also an easily disturbed side sleeper so I was hoping to stay as minimalistic as possible. I'm open to trying whatever might help though.

Thanks!

[Sleeprider]

As you note, to enable rise time, you must switch to S mode and turn off Easybreathe. It would help to look at some charts in Oscar and see if we can identify why you're having these problems. Tutorials on organizing charts and attaching files and images are in my signature links. Your description suggests a need for higher EPAP minimum pressure, but the charts should offer more clarity.

[Sugarvenom]

No problem. My laptop screen means not all of the categories are showing unfortunately, let me know if you need more.

I've included two screenshots from last night, when I was on a slightly lower pressure. Mostly my breathing was even but I've grabbed a cap of an example of when it wasn't. Plus an example from today, when pressure was higher. Hopefully that's helpful.

[Sleeprider]

I see a 22 minute and 11 minute session where you never slept, but hyperventilated with a median tidal volume of 940 mL. Breath rate and timing are near normal, and it appears you increased pressure from 5.0 to 6.2. I think the big problem here is anxiety with using the VPAP. I actually suspect the pressure support should be turned down to 4.0 cm and that your sense of air-hunger comes from over-ventilation. It might help to spend some quality time sitting in a comfortable place while watching TV or reading and just using the machine to get used to it. I'd like to hear your thoughts on what is a barrier to using the machine. It might be helpful to see a chart with the mask pressure chart so we can see how the delivery of air actually has a pretty good rise-time. If you do try using the machine while relaxing, you may want to try S-mode with Easybreathe off and rise time set to 0.3 at pressure of 11 IPAP, 6 EPAP and see what that feels like.

Were these settings recommended by your doctor?

[Sugarvenom]

Have attached an image from roughly the same time last night. (If I put it at the exact same time, everything is all over the place. It seems steady much of the rest of the night like at the left hand part of the chart.)

I have tried each time to use calming techniques to slow my breathing, because at first I figured, maybe this is just because my bed is like a mountain and I'm breathing slightly fast from throwing myself up onto it before I start therapy. But slowing and calming my breathing seems to just result in me feeling increasingly short of breath until I have to take a deep sigh and go back to gasping.

I seem to need much less pressure while upright (I noticed this when I put my mask on and stayed sitting up for a little bit last night), so I don't know if that may influence things while I'm sitting around. I was pondering doing it just to get used to the mask to help me sleep, so it works for me as an idea anyway  I will try those settings and see how it goes. Thank you so much!

ETA: Whoops - And no, they weren't recommended by a doctor. Unfortunately with the health system being slow (and having got slower) I've waited over a year for treatment and am still looking at much longer to go, so I did a WatchPAT test and then purchased a device privately. That's part of why I prefer the Auto setting. Adjustments I've made to the defaults have been based on advice on forums such as this one, and SDB servers etc. I'm hoping to get a doctor soon but I guess we'll see.

[DorMindo]

Seems you changed the firmware of your device. Your profile shows you are using a climateline tube. Another possibility to explain why you see no difference raising the pressure is that the temperature of the tube and/or the humidity level that you are using is not comfortable, maybe too hot/high, it can cause a suffocating/claustrophobic feeling.

[Sugarvenom]

I found I was getting a dry throat at lower humidity, but I will try lowering the temp (I had noticed it felt quite warm so you might be onto something there).

I'm still trying out the S mode. At the settings recommended in this thread, I found it felt basically impossible to breathe. I tweaked it (very slightly) both up and down, and down seemed better, so I continued to tweak very slowly down until I could breathe easily (7.2 IPAP, dropped the EPAP to 5 because PS of 1.2 seemed low?). I then spent much of the day like that, and even managed to sleep for an hour that night before some kind of event woke me up, and a sensation of heat, pressure, and wakefulness meant I had to take the mask off and try to get to sleep in ways I'm more used to. I'll attach images of last night, with the flow rate etc before after and during the event that woke me. I did try the settings I found worked for S mode, along with my newfound confidence in the CPAP, in Vauto mode (to see if the settings were the problem originally), but I found I couldn't breathe.

Today I tried the same settings (S mode, 7.2 IPAP 5 EPAP), and I'm back to air hunger. I'm not sure if it's exertion (I was bouncing about a bit before I started today) that starts me off needing more air and then I feel like I can't make up the deficit on the setting I'm at, or if my respiration is just varying, but it's a bit frustrating. I tried all the techniques from yesterday to bring my breathing back to how was working for me before. I do meditate, so I tried to bring in my ability to relax from that, but it just left me feeling like I was suffocating.

I really appreciate all the ideas and help. It feels good to have been able to get to relax and to sleep on the device, it really gives me a boost just to know that it's possible.

[Sleeprider]

In this latest graph you have reduced pressure support (PS) from 5.0 to about 2.2. I think I had suggested 4.0, so that would be EPAP 5.0 IPAP 9.0 for PS 4.0.

[Sugarvenom]

Yes, I did start with PS 4 as suggested. But like I said, I couldn't breathe at the higher IPAP. By the time I could breathe naturally, I was low enough in IPAP that I don't think PS 4 is possible? I reduced the EPAP to one I knew was comfortable for me and would keep the PS from diminishing as far as if I'd left the EPAP at 6. I didn't realise that PS was as important to maintain unfortunately.

After having difficulty finding consistency being able to breathe with 7.2 IPAP, I tried again today and seem to be able to breathe well both on S mode and Vauto with 6 IPAP. (Not sure how I missed that before on Vauto, but like you mentioned it's possible I just haven't been used to the machine and was anxious.)

Should I be aiming higher than this to maintain PS 4 as you're recommending? At the moment I have it at PS 2/EPAP 4, to get the PS the closest I can to your recommendation while still having the starting IPAP at the setting that seems to allow me to breathe naturally, but I can try changing this.

[Sleeprider]

As far as I can tell you are titrating pressure to what feels comfortable to you. Whatever you come up with is good by me as long as it meets your needs and lets you start getting a full night of therapy.