VCOM & Bi-Level

[WallyPepper]

I actually meant to say EPR not BiPAP. It was late and I was getting ready for bed. But it still applies, if you don't need ventilating.

When the only tool you have is a hammer, every problem looks like a nail!

[ChadBSr]

Yes, I still agree. EPR was put in for comfort and has caused more problems. If anything we actually need IPR.  KPAP looks to be the future. I'm hoping PAP therapy is temporary for me anyway. I'm following buteyko and myo therapy

[WallyPepper]

Another update:

Tried two VCOMs. Tried it one at each end of the hose, tried them back to back at either end of the hose and had some very interesting results.

1. It was almost too easy to breathe in, as in there did not seem to be any real air pushing itself during inhalation. I thought that would be a good thing. AHI numbers remained the same between days with one VCOM and days with two VCOMs.
2. When using the F&P Solo mask and two VCOMs the mask produced a very audible whistling sound on every breathe. So much so, that it actually woke me up on two nights.

I was not able to try two VCOMs on any other mask, for reasons, mostly being lazy and not wanting to switch masks. The whistling I think is the result of the mask causing the air to create a vortex. I believe this because it is impossible to line up the holes precisely and I think the offset just forces the air in the tube to swirl. So for now my experiment with two VCOMs is done.

I am still alternating between the P30i and the Solo. Not sure which one I like better. Headgear is a big advantage to the Solo, the pillows goes to the P30 hands down. I will try out the P10 starting next week some time. See how those two compare (Solo vs. P10). All of my mask testing is done with the VCOM in the loop. I have determined that there is simply no reason to not use it and with pressures higher than most people would use a pillow mask, it works great.

If any one is on the fence about the VCOM, just remember to give it a week, or month, and don't forget to turn off EPR!

[ChadBSr]

I am also experimenting with a second vcom. Tonight will be night 2. I also switched my Solo from cushion to pillow.

[ChadBSr]

I had to stack the Vcom one after the other because I use a heated hose. It definitely increases sound. You are probably right about turbulence. As an experiment I forced my old regular hose onto the first vcom, then the second vcom, then the mask. Its now quieter than with a single vcom. Its at least as quiet as no vcom and maybe even quieter. I'm at much lower pressure than you though. I'm not sure yet about the effect on therapy.

[WallyPepper]

I am also experimenting with a second vcom. Tonight will be night 2. I also switched my Solo from cushion to pillow.

No one I have seen online likes the Solo Cushion. So far they all say the pillow is the way to go. I switch back and forth between the Solo Pillow and the ResMed P30i, but tried the P10 for the first time last night. So far my initial thoughts: The large P10 is smaller than the large P30i; The headgear sucks; It is quieter than the Solo; Did I mention that the headgear sucks!

After several nights in a row using the Solo, I find that one nostril is irritated. It is consistent. Every few days I have to switch to the P30i because of the irritation. I do use a soothing gel on the nostril pillow, it only extends the non-irritation by one day. My general schedule is now 5 days with the Solo, follwed by the weekend using the P30i.

Going to try the P10 with 2 VCOMs but I want ot get used to it first. 

I also use the heated hose during the winter, so I have the VCOM attached to the mask end of the heated hose, then an 18" hose extension. All of that is covered by two hose covers, just for length, since no one makes a cover that is longer than 2 meters. I cover the hose only to provide some insulation so less heat is lost, I do not use a humidifier so I have zero concern about rainout. With two VCOMs I tried back-to-back, then the hose extention, tried one VCOM then the extension then the other VCOM, tried both VCOMs at the end of the entire contraption. With the Solo I got the whistling regardless of VCOM positioning.

One thing I can say with 100% confidence, I never could have used a pillow mask without the VCOM. I always had some sort of blowout because of my therapy pressure. Now, they just never happen. I really would like to see the KPAP stuff in the future as I am a firm believer in the methodology and think EPR and those that preach it's gospel are sent by the devil!

[ChadBSr]

After a couple nights I really don't think I see a benefit to the second vcom.  Maybe if I could increase the pressure high enough it would help, but I've hit a wall around 7-7.6 where I'm getting TECSA and trying to balance CSA and OSA.  I'm now experimenting with EERS and depending on how that goes may or may not add a vcom into that mix.  Experimenting while awake, I think I really need close to 11cm to see good breathing waveforms but at 10cm my AHI is worse than no treatment because of the TECSA.  Hopefully the EERS will let me increase to higher pressures without my brain forgetting to breathe.

I actually like the solo cushion, I just like the pillow even better except for the sore nose I'm getting as well. I will probably have to switch back to the cushion every now and then.

[WallyPepper]

@ChadBSr

Let us know how those experiments go. As you noticed I am running higher pressures than you are. I should be between 16 -17 cm straight CPAP. That makes wearing a pillow mask unsufferable without the VCOM. That is also why I wanted to try two in the loop.

I was sent home from my lab sleep study after less than an hour because the tech said he had too much data to score. I was having events at a clip of just under two pre minute. At 16 cm I range from about 0.3 to 1.5 AHI each night, depending on how well I fit the mask and if I roll around much.

[WallyPepper]

Back for a quick update.

Been using two VCOMs for just over a week. They are arranged in this order:

• S10 >> ClimateLine Hose (with heat on) >> VCOM >> 18" Hose >> VCOM >> ResMed P10 (Large & Medium pillows used)
  

The whistling is there but minimized when I fiddle with the mask fit a bit. My average AHI for the past 10 days is around 0.6; SPO2 pretty much never drops the 4% to trigger an alarm, but I still get around 10 drops a night over 3%; I have had my Samsung GW7U measure more Excellent scores than ever before, pretty much all nights but two (one was conjestion, the other was something I ate for dinner causing a bit of gastric distress). The CPAP does spend more time in the top half of my auto-titrating range.

Here is a totally subjective summary, using two VCOMs seems to make breathing in as easy as breathing during the day when I am awake. At the very least it has caused no puffy cheeks nor caused any mouth leaks. Breathing out must be near my best theraputic pressure as the numbers and how I feel in the morning do not lie. I am pretty sure there is some minimal pressure drop, but can't measure it myself. For anyone that is forced to use higher pressures I would heartily recommend a VCOM. I am a firm believer in what VCOM is capable of and actually does. I will be switching this setup next week back to the P&F Solo to see how it fairs and if the nostril irritation returns. Still believe EPR is the work of the devil!

Now I can't wait to see what 2025 brings, especially if KPAP arrives to shake up the market.