Back to the Vauto in CPAP/fixed pressure

[zzzZorro]

After experimenting from AutoSet to Vauto to ST-A, we are back to Vauto in CPAP fixed pressure mode.
The Doc wanted to specifically try the Vauto in the S-mode at a 14/14 cm setting to mimic the CPAP at a fixed 14 cm pressure.  14 cm on CPAP mode with no EPR has shown to perform best of anything we have tried.  The S-mode failed to come close. The first four nights I have had the new Vauto are shown.  Nights 1 and 3 had the P-10 pillow mask and c-collar, and both had heavy air leakage.  Night 2 used F-20 Air fit with no air leaks. Night 4 used a FF Quattro and c-collar with no air leaks.

Night-1 CPAP mode 13 cm/ P-10:
[attachment=4189]

Night-2 S-mode 14/14 cm/ F-20:
[attachment=4190]

Night-3 CPAP mode 14 cm/ P-10:
[attachment=4191]

Night-4 CPAP mode 14 cm/ Quattro FF:
[attachment=4192]

The best Vauto I had was December 12 was AHI-7.33 but that was not consistently good.  That was 'why' the ST-A adventure begun.
[attachment=4193]

I'm tickled with the latest CPAP 5.54 results but possibly down the road the Vauto should be reevaluated

[Sleeprider]

I wonder if there is anything to the inverse relationship of flow limitations to AHI? You seemed to be getting best results on CPAP, even back when we were trying to find a solution, and the solution may be accepting an AHI in the 5-7 range.

[zzzZorro]

I wonder if there is anything to the inverse relationship of flow limitations to AHI?

I take that to mean when one is up the other down and vice-versa. I don't understand enough about flow-limits I guess to apply that one?

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Last night was same settings as the night before (AHI-5.54) except there was no C-collar. AHI nearly trippled. Appearance is that the collar may be the key but previously that theory did not bear itself out.  I understand that night-to-night results vary but I would think from AHI 5 to 16 to be excessive.

[attachment=4204]

The S-mode (14 cm/14 cm) chart shown in the prior post did NOT use the collar.  It was double this last CPAP on AHI.  Wondering if it should a re-do with the collar?

Thanks

[Shin Ryoku]

I understand that night-to-night results vary but I would think from AHI 5 to 16 to be excessive.

I don't think one night is enough to draw conclusions about a soft cervical collar, especially when that didn't bear out in the past. It's a big AHI change, but it could be a big change due to some other factor. Worth exploring further, though.

[Sleeprider]

I can't disagree with Shin on this. It takes some discipline to create a data-set that is statistically defensible, but that is a pretty strong differential, and that was the point of my observation of your previous 5 (now 6) charts. If we can identify the variable, then we can start to draw general conclusions.

[ajack]

I was on about the collar before, with your bad neck and such. It really did and does look like other charts, where a collar has changed the day. As said observe and record till a data set throws the best solution. Changing just on one nights chart can be counter productive. A few days with the collar may be more clear.

[zzzZorro]

I understand that night-to-night results vary but I would think from AHI 5 to 16 to be excessive.

I don't think one night is enough to draw conclusions about a soft cervical collar, especially when that didn't bear out in the past.  It's a big AHI change, but it could be a big change due to some other factor.  Worth exploring further, though.

The AHI 5.54 chart did in fact follow taking a nyproxin sodium for some O-Arthritis before sleep- may have had some effect on it..

I can't disagree with Shin on this.  It takes some discipline to create a data-set that is statistically defensible, but that is a pretty strong differential, and that was the point of my observation of your previous 5 (now 6) charts.  If we can identify the variable, then we can start to draw general conclusions.

I thought I was getting a handle on it but the 3-fold bounce  changed my opinion.  As noted earlier by SR, IF  I can get consistent AHI-5 to 7s I can live with that.
 

I was on about the collar before, with your bad neck and such. It really did and does look like other charts, where a collar has changed the day. As said observe and record till a data set throws the best solution. Changing just on one nights chart can be counter productive. A few days with the collar may be more clear.

Thanks for bearing with me- much appreciated.  The collar tends to tweek my neck but is generally tolerable as long as it fills a purpose -that is why I shy away from it.

A long-tedious data gathering process but the necessity is obvious.  I plan to keep using the collar for awhile (if I can) to proof it as viable.  Will stick with the same CPAP settings/ mask set-up for at least another night or more.. see where it leads.  Then in awhile maybe revisit the S-mode to see if several sessions validate or dismiss the previous test with it.  Doc was pretty insistent on S-mode but the AHI-31+ ran me off it.   I'm thinking maybe I should probably stay away from the Vauto mode (if I can resist the temptation) as I think the algorithms will cause pressure induced apneas..   What think?

[Note] There was a Vauto -mode chart back in December that was quite good but was very inconsistent with the settings also.

[attachment=4205]

[ajack]

At this stage it seems fixed is your answer. I can't see any obvious differences on fixed pressure cpap and fixed pressure S (same epap/ipap) The only reason I would go back to S mode is for PS with breath shaping, I:E ratio etc. Or just to get some exhale reduction if needed and it doesn't mess up your chart. Because your case is so tricky, I would keep an many variables out of it as best I could.

[zzzZorro]

At this stage it seems fixed is your answer. I can't see any obvious differences on fixed pressure cpap and fixed pressure S (same epap/ipap)  The only reason I would go back to S mode is for PS with breath shaping, I:E ratio etc. Or just to get some exhale reduction if needed and it doesn't mess up your chart. Because your case is so tricky, I would keep an many variables out of it as best I could.

Good advice.  At this point I cannot see breath shaping necessity as I:E as it is with CPAP is comfortable and in sync with my natural rythm already.  Exhale reduction is a non-issue as I guess it is a hang over from when I used to scuba dive.  Perhaps eliminating those variables will simplify the experimentation..   I have the feeling the Doc wanted me to have some time on a mode other than CPAP to justify the Vauto.

[ajack]

[soapbox] CPAP fixed pressure, is the primary treatment for apnea. It is only when this titration in a lab doesn't work, that you move on to bpap. These auto machines are good, but they can lead to the conclusion that auto is better, it isn't in 99%. I think it's just cost cutting in the health system. I would think only for those that have a very wide pressure change, say 6 all night, then a half hour at 15, from positional change. Setting 15 all night is unneeded and auto is a good option. most of the charts here could easily be switched to fixed pressure. Auto titrate machines were originally meant to titrate for a fixed pressure. The respironics auto that then went to fixed pressure after a period of time, is a good example of what was intended. Handing out apap with 4-20 and waving goodbye as you go out the door is an issue and why these forums are such a help.