First night using VCOM

[Lucky7]

"V-Com displayed a very active flow limit graph"

Interesting, I saw the opposite.

That being said, not sure what I think of the device one way another.

"but also did reach out to various pioneers in the field and other people who have worked in the field for decades."

This is one of them:

https://healthcare.utah.edu/find-a-docto...t-j-farney

He trained Jason (Lefty) at U of U. Dr. Noah is a U of U alumni in Pulmonology.

[Lucky7]

"but most APAP machines have settings to adjust for general mask type"

Everything in the circuit is a resistor. So, with that being said a "general" setting for mask type is just that, a general setting (unless you are talking about the X settings on Respironics machines). You can look at pressure drop specs for various masks, and they are all over the place.

In this interview Dr. Noah discussess taking advantage of this:

https://youtu.be/wRiSTzfPsSU?feature=shared

[Andre Carignan]

Same, just received it yesterday and tried it last night. Also having more difficulty exhaling. And worst mouse leakage has worsened when using V-COM…

[Andre Carignan]

"Mouth" not mouse! Now you can stop laughing 

[OpalRose]

That's not the funniest thing I've read on this forum.

[mw1655]

I think there is a place for v-com for some users. I have long struggled with CPAP/APAP and EPR/c-flex on Resmed and Philips devices before and made the jump to Lowenstein. Overall, I found the Lowenstein with Softpap more comfortable. Even though I am compliant, I've never felt rested even after 7-8h of sleep. My AHIs are around 2-3 but I do see increases in pressures from the machine. I bought a v-com to try out and after a couple of weeks I see the benefits for me. Still need more time to adjust:

- Switching to CPAP and turning off SoftPap. I found that I was quite sensitive to the CPAP pressure. It's currently set at 6.5. I tried higher levels but they seem to be more uncomfortable
- I found that the v-com needs to be at connected at the mask and not at the machine helped massively. It is a bit noisier. I don't use a heated hose nor humidifier.
- My leaks are better managed
- My deep sleep seems to have increased

[rapwedinger]

The best explanation I saw concerning Vcom is this: it forces the CPAP to better mimic the way humans breathe.  We tend to exhale at a greater pressure than we inhale, probably because our chests work against atmospheric pressure to take a breath, while on exhalation, the chest is working with atmospheric pressure.  The CPAP machine reverses this order.  As a result, our blood oxygen levels become oversaturated, and the carbon dioxide content is driven downward.  This is essentially hyperventilating.  Your brain recognizes that the oxygen/CO2 balance is low and stops breathing to allow CO2 to increase and restore a proper O2/CO2 ratio.  

If you have a lot of CAs and you track your SPO2 levels, you'll notice that a lot of CA clusters occur immediately after your blood oxygen spikes to 97% or 98%.  That's what happens to me.  Eventually, the body adjusts to this situation, and the CAs drop in number.  A Vcom can help the situation by restoring the normal breathing cycle.

That said, I used the Vcom for the first time last night and got mixed results.  I started out on a constant pressure of 12.4cm and had a bunch of CAs.  Eventually, I switched the machine back to APAP with a range of 7 to 11cmH2O.  The CAs went away and I had a relatively good 3.5 hours for the remainder of the night.  My AHU was 15 for the night.  Still trying different things to exorcise the CAs.

   

[rapwedinger]

Flow limitation and Leak rate trend

   

[rapwedinger]

My second night using VCOM, My AHI went down to 2.2 from 15.0.  I used a nasal pillows mask (Airfit P10), which I've often had leak problems with, but last night the leaks were within acceptable parameters.  Not where I want to see them, but good nonetheless.  Flow limit 95th percentile of 0.08.  I may have found the right setup. Viva la VCOM!

   

   

[Crimson Nape]

If you feel better, then that is great. Just keep in mind that the V-COM is past all CPAP sensors, and will not provide accurate CPAP reporting.
- Red