Feeling Bad Over Good Scores: Help Please

[TiredOne789]

Thank you, SR and Gideon. That's what I thought. My doctor was ready to write me a script for a new A10 for Her when I saw him a couple of weeks ago. I told him I wanted to wait. (I didn't tell him I wanted to check with you guys, though.) I need to get educated on the VAuto, first, so I can guide both the doctor and DME (Lincare). Are there different varieties of the VAuto, especially ones that focus on flow limits? Can you give me some resources to review?  Will I need another sleep study? (I hope not.) I need to be prepared when I meet with my pulmonologist. I will probably need help with the settings. I don't think he can do that. I will be eternally grateful to you.

Still Tired One.

[SarcasticDave94]

As best as I know, the VAuto is a singular device as opposed to AutoSet and AutoSet for her.

A new diagnostic sleep study should not be necessary if the doc will refer to the data from prior studies and listen to your symptom and complaint lists. Maybe there's cause for BPAP titration.

I've not used a VAuto, but I'm thinking there's EPAP, pressure support, and IPAP pressure settings along with a set of timing controls. And of course the humidifier and heated hose settings if used. Time controls typically can be left at default for most unless there's evidence they need adjusted. Mainly the therapy pressure set is what should get you running, and if you've used a PAP already, some should plug in direct from an AutoSet for example. EPR would correspond to PS, Min pressure to EPAP, Max pressure to IPAP or something very similar. Certainly ask here as needed.

[TiredOne789]

Thanks, Mr. Dave. Obviously, it is my responsibility to request the correct machine.  My doctor was going to get me another A10 for Her without even looking at my sleep reports. If I request a BiPap I can't "tolerate", it will not go well. He was not thrilled that I changed my minimum pressure.

Here's all I know about BiLevel so far:  http://www.apneaboard.com/forums/Thread-...pid=366298

This link warns: "Just to clarify The VAUTO, ASV, S, and the ST are all BiLevel machines for treating different conditions, they are NOT interchangeable. They are not a choice between them to treat a single condition."     How do I select the right one for my condition? If the Aircurve 10 VAuto BiLevel has multiple capabilities, I should be okay, but I will need assurance from you folks that this will tame my flow limits.

Thank you,
Still TiredOne

[SarcasticDave94]

Unless you have a specific and specialized need like my own therapy, a VAuto should suffice as a BPAP.

PS I have predominant Central Apnea and respiratory disease. So a VAuto is the vanilla BPAP in that group.

[SevereApnea]

Tired One

I switched to Vauto in January.
It has 3 modes: CPAP with the standard EPR options up to 3. Then the Vauto mode which works like an APAP adjusting to your events and flow limitations. The pressure support goes higher than 3 and can be adjusted in 0.2 cmw should you need it. Lastly you can use it in S-mode where you fix the EPAP and the IPAP to your selected pressures.

Both Vauto and S modes have more configurable tweaks which most folk won't need. I found these created more problems for me anyway.

I found the CPAP mode to feel better but EPR of 3 felt not enough.

Saw my sleep doc this week with all my complaints. He said: its normally not as hard as this! We agreed I would try the S-mode.

Since I switched to S-mode 4 nights ago I have had no recorded FLs. None of the other side effects of CPAP that have bothered me in the last year. Last night i went 7.5 hrs straight. EPAP 5.6 IPAP 9.2 so effective PS of 3.6 is about all I need.

I am blessed that my sleep team is keen to listen and help, none of this may apply to you its my own experience. I did fund the Vauto myself knowing that if it did not work out i could sell it later.

Just more to consider.

[TiredOne789]

Thank you, SA, for the Vauto descriptions and great suggestions. They helped give me a better understanding of the Vauto's capabilities. I like the APAP description of "adjusting with events and flow limits." I am not comfortable with the A10 for Her's EPR of 3, so hope the Vauto adjustment capabilities are comfortable to me. I am going to contact my doctor and DME (sleep tech team) today, to investigate changing machines. I thought about buying, testing, and returning the A10 for Her with the additional FL capabilities, but this group seems to think the Vauto is better. My DME will not support a machine that does not come from them. 

Now to get buy-in from my doctor.  They know I'm trouble, when hear from me. 

Again, thank you.

Still TiredOne

[staceyburke]

What do you mean”support the machine”?  Do you mean a warranty?  If so all new ResMed machines have a 2 year warranty. If you mean they are going to help you with settings - good luck with that. They will only look for compliance. You can still get suppliers (masks and such) to give you all other supplies just as you would if they supplied the machine.

[SarcasticDave94]

If this helps you, I'm not too concerned about my own therapy on who supports me or not. To me, the doctor is only needed to script the machine. And for compliance. I sometimes use what the RT says to leverage the doc on the script. From there on, I'll be driving my PAP machine with input from Apnea Board chart and pressure setting gurus. It's free, it's mostly stress free, and then we talk coffee, radio, food.

Some medical pros make unprofessional remarks like you can't change PAP settings, you'll injure yourself, you might blow up a lung, we might lose money... That sort of baloney except that last. That is their real fear, that you won't be in the boat payment office visit loop. Doc the PAP isn't helping with FL or this or that... OK come in for an office visit in 3 weeks we'll probably need to test and then a consultation on changes to include EPR 3 or PS to 4 or this that and some other... Nah get to it yourself, you need ps from 3 to 4 OK edit the settings Easy Peasy.

[TiredOne789]

    Stacey Mr. Dave, 
What I mean by "support the machine" is that the DME (Lincare) say they won't help with pressure changes on any PAP machine that doesn't come from/through them. So if I buy the machine, I'm on my own, which is no problem. I'm not certain if that's a problem with Medicare, but I'm not crossing that bridge right now.

What is concerning me is why my flow limits qualify for the Vauto instead of the A10 for Her? Is there a reference document on FL range that would show my doc why a Vauto is justified. Neither he nor Lincare have access to OSCAR, so how can they judge my FLs? I can show them the reports, no problem. Also, I tried the 3 EPR on my old A10 for Her and couldn't tolerate it. If the Vauto is going to take the EPR higher, it needs to be able to adjust with my breathing pattern.   

Here's last night's OSCAR report. It's pretty good except for the flow limits.

Thank you,
Still TiredOne

[staceyburke]

I’m a little confused- EPR of 3 - you “couldn’t tolerate it”. All EPR (exhale pressure relief) does is lower the exhale pressure to make it easier to exhale.   It should make it easier to tolerate.