New AutoSet For Her or VAuto for Wanda?

[RayBee]

I am asking this on behalf of my friend. We'll call her Wanda - not her real name.

Wanda is not tech savvy, so getting her on this forum isn't going to happen. She is just now dipping a toe into the murky waters of a smartphone.

You may have read some of my posts already regarding her PR Dreamstation Auto CPAP (DSX500H11C) and my getting her a REMstar. The Dreamstation consistently gave her sinus infections and massive debilitating headaches before the recall was announced. So far she is doing good on the REMstar.

Her Dreamstation is 4 years old, and her DME is Sutter in Stockton - she does like her sleep doc there. However, they don't seem too sympathetic to her needs. They said they would be able to replace her machine now, if it was 5 years old. I pointed her in the direction of requesting the ResMed AutoSet 10 For Her. They agreed, but in another year. For now, they wanted her to put a HEPA filter inline with the hose and try her Dreamstation. With instructions to discontinue use if any symptoms crop up again. This didn't happen, the Dreamstation wasn't turning on (power supply error message), but that's another story I won't go into here.

Wanda is still using the REMstar and feels great. Her settings are 8 cmH2O with EPR (C-Flex) of 3. We also set up a 5 minute ramp beginning at 5 cmH2O. When we were setting up the REMstar and doing some testing for her comfort, she was very sensitive to the pressure when exhaling to the point of near panic attack. "I can't breathe out. The pressure is too high." So that's why we settled on 8 cmH2O and an EPR of 3. An EPR of 2 wasn't going to cut it either.

The more I thought about the setup experience, the more I thought that a VAuto might be better for her. Certainly the AutoSet for Her with an EPR of 3 would work, but I thought the VAuto would offer more flexibility for her over the next 5 years. That's the catch. She will be locked in to whatever replacement model she gets for the next 5 years. So if her therapy needs change, or her comfort requirements change, the VAuto would offer more flexibility with Bi-Level settings rather than the poor-man's attempt at Bi-Level using EPR. I've read here on AB that EPR can cause its own problems and is not a good substitute for Bi-Level.

So my question is... Should Wanda push for the VAuto instead of the AutoSet For Her? The VAuto can be dumbed down to CPAP mode if necessary. Sutter will pay for the machine, but she will be locked in for the next 5 years. We still don't have any clear direction from Sutter as far as when they are willing to move forward with a new machine. The only thing we know is that it will be a ResMed, and followup appointments are always 6-weeks out.

[Gideon]

Without question the VAuto is a more flexible, more capable, more expensive machine. Because of the recall it may actually be somewhat more available.

The question is does she need it?. A BiLevel, VAuto, can go for more pressure and more pressure support (EPR) and it is incremental in less than 1 cmw units. There are additional settings that she may or may not need.

[SarcasticDave94]

Maybe the VAuto could be better for comfort. PS is more flexible than EPR of 1-3. Just my thoughts.

[RayBee]

Thanks for the comments.

Does she need a VAuto? Probably not "need", but more comfortable? Probably. More versatile? Definitely. She was pretty freaked out with an EPR less than 3.

Another unknown is whether or not her sleep doc will want to do another sleep study in the near future. She's at least 4 years out with the one that landed her the PR Dreamstation. I told her to not be surprised if they order one before issuing the new machine.

I'll talk to her about the differences and see if she thinks it will be worth the hassle to go down the VAuto rabbit hole.

[cathyf]

My experience is that the vauto with PS of 3 is totally different -- and much more effective -- that the autoset with EPR of 3. (And yes, I was comparing the same setups
autoset -- min=7, max=15, EPR=3
vauto -- min EPAP=4, max IPAP=15, PS=3.0

There are several other settings on the vauto, which I don't understand, and I left on their defaults. Those settings must make the difference.

(In fact PS of 4 is better than PS of 3 for me. PS of 3 is almost as good as 4, and definitely better than EPR of 3.)