Could I benefit from going to BiPap VAuto?

[vinhuard]

Hello,

I've been on PAP therapy since 2013.
Been lurking this forum from time to time to understand my therapy and I have the opportunity with my insurance to buy a new machine.

I'm wondering if it is time for me to move to a Aircurve 10 VAuto?  (I've seen great price online)

Here's how my last 10 years went (Thanks OSCAR!):

2013-->2016: S9 Autoset APAP   P: 10-17  EPR: 3
2017: Switched to Airsense 10 same settings.  
2018:I was still feeling groggy and early 2018, the sleep doctor said that could be cause by the pressure change from the APAP mode and switched me to CPAP at a fixed pressure of 16 with an EPR set to 1.

This past 6 months I have been feeling tired again.  I have been reading a lot of the threads on the forum and have been playing a bit with my settings to settle on APAP  P:15-20 with EPR set to 3.

Here's a screenshot of this last night:
[attachment=57857]


I did activate the user event flag:
   

Why you would ask?  I always had the impression (and more in the last 6 months) that even if my AHI is on the low side, that I'm not fully benefiting from the therapy.  Here's a zoomed section for example:
   



What do you think? 

Thank you very much and happy new year!

Vincent

[ejbpesca]

I am wondering why I have not had a BPAP machine all my 15 years of CPAP therapy. I recently have been experimenting with raising the min. pressure on my AirSense 10 in an attempt to maybe finally get proper therapy. An expert may reply shortly with some advice for you.

[Sleeprider]

Most people would benefit from the Aircurve 10 Vauto as opposed to the Airsense 10 CPAP. Examples of what we would do with the Vauto is to increase the trigger sensitivity to lower the flow threshold at which IPAP (pressure support) begins. This usually resolves a low level of CA like yours and can help stabilize the periodic breathing. A nudge of pressure support can help stimulate breathing where a CA or smaller breath (UF-2) might otherwise occur. It does not appear you need much more pressure support than you're getting with the Airsense EPR, but the delivery is smoother and more adjustable, and is available in increments of 0.2 cm, rather than the full 1-cm increments of EPR.

The decision of whether to prescribe bilevel lies with you and your doctor. If you feel therapy is leaving you fatigued or uncomfortable, that is really all that is needed for your doctor to order the Vauto in lieu of the Aircurve 10. Several members have recently upgraded to bilevel with good results, and their threads explain how they talked with the doctor. Take a look at this one. https://www.apneaboard.com/forums/Thread...ht=bilevel

[PeaceLoveAndPizza]

The Autosense is a bilevel, just one without all the nerd knobs and geek gadgets of the Airsense. You can still get pressure support (EPR) up to 3 cmH2O. Having the trigger response you can set to high or very high, would likely clear up most of the CA’s you are having. I don’t think have extra pressure support will help much as you don’t have a lot of flow limitations, but it may allow you to have a lower overall pressure. Something to ponder.

One thing in the charts to consider is the impact of leaks to arousals. The bulk of your events seem to be triggered by leaks. You get some small amount of flow limitation, which leads to pressure increase, which then triggers a leak, leading to arousals. That may be why you feel like a dogs breakfast lately. 

One thing to try if not done so already, is giving a soft cervical collar or mouth tape a go. I personally prefer the collar as it keep the airway open, but its a personal choice.

It sounds like your doctor is knowledgeable about CPAP, so you are lucky in that regard. If you are looking to get one out-of-pocket, you can often find one on facebook marketplace or craigslist. If you want insurance to cover it we can possibly help with the justification.

[vinhuard]

Thank you very much Sleeprider!

I'll order a VAuto and report back!

[vinhuard]

Most people would benefit from the Aircurve 10 Vauto as opposed to the Airsense 10 CPAP. Examples of what we would do with the Vauto is to increase the trigger sensitivity to lower the flow threshold at which IPAP (pressure support) begins. This usually resolves a low level of CA like yours and can help stabilize the periodic breathing. A nudge of pressure support can help stimulate breathing where a CA or smaller breath (UF-2) might otherwise occur.   It does not appear you need much more pressure support than you're getting with the Airsense EPR, but the delivery is smoother and more adjustable, and is available in increments of 0.2 cm, rather than the full 1-cm increments of EPR.

The decision of whether to prescribe bilevel lies with you and your doctor.  If you feel therapy is leaving you fatigued or uncomfortable, that is really all that is needed for your doctor to order the Vauto in lieu of the Aircurve 10.  Several members have recently upgraded to bilevel with good results, and their threads explain how they talked with the doctor.  

Hi Sleeprider,

I've ordered a Vauto and should get it by the end of the week if all goes well. 
Other than the "trigger" that should be set a bit higher than the default, should I configure it with the same pressure settings that I currently use?

Thanks!

[Sleeprider]

No, I think we're going to back down a bit and let your results guide us. Your current CPAP settings of 15-20 with EPR translate to EPAP min 12.0, PS 3.0, Max IPAP 20. I think you should start at Min EPAP 9.0, PS 3.0 Max IPAP 18.0, high trigger and everything else default. It should be really easy to increase EPAP min if needed, but let's start a bit lower.

[vinhuard]

Machine received and configured! Let's see tonight!  I'll report back tomorrow.

[Sleeprider]

Good luck! Have a great sleep.

[vinhuard]

Good morning!

I must say, feeling is different with the mask on!  That must be the lowered pressure.

How am I feeling this morning?

A bit "cloudy"

Anything I should adjust?


Here's a screenshot of this first night:
   

Some zoomed-in section:
[attachment=57927]
[attachment=57928]

Thank you!
Vincent