Please help. I must quickly, accept or reject an unfamiliar VAuto by 3PM PDT, Sun 5/5

[2SleepBetta]

An AirCurve 10 VAuto just came in the mail after lunch. I've requested the clinicians' manual, read the operator manual and tried the slightly used (66 hr) device on S mode for a few minutes, but as an Airsense 10 Autoset user I don't know enough to evaluate it or to set it up for tonight. Please help with advice how to test it and adjust it for my use 

I got it despite discouragement by my pulmonologist against getting a BiPAP and (of course) against doing my own settings. This Board's experts and members have helped a lot, informing and supporting a reduction from about a 60 RDI in September 2015 to my 6 month AHI of 0.1 and, last week, to 0.0---BUT still with a lot of Flow Limitation still and Snore, and with lots of motion coinciding with the snores and their accompanying flow spikes (or machine or S/H misinterpretations of other disturbances as snores, such as one sees during awake periods and upon first starting the blower sessions). All that said, together with the Board's wiki about UARS by Dr. Krakow (sp?), explains why I pushed ahead to buy the VAuto out of pocket now, the choice Sleeprider kindly suggested might be appropriate for my situation (with no guarantees, and that's perfectly understandable).

The Autoset has long been set 10.4-15.2, EPR 3, with a 1-year pressure of 12.4, leak of 8, AHI of 0.4. Absent other instruction, it seems appropriate to use the machine for a time in exactly the same way as the Autoset if I can get it set right and keep on with present results for a few days. How to do that? VAuto mode? S mode (when I tried it seemed to switch to the max and min pressures only, switching with each breath and seeming tolerable)? Should I change to S mode after I'm ready to tackle the FL I got the machine for? Then there are the Trigger min and max, the Easy Breathe and PS settings to learn. I assume one can dig all this out of the clinician manual when it comes, but not in time to do much testing before Sunday afternoon. 'Need to be sure the machine is fine (as it seems) and set it up initially.


I'd appreciate guidance.


2SB

[ardenum]

you're just panicking, i dont know what you mean by 'accepting' the device but go ahead and accept it. It offers way more then your autoset. If you want to run it as cpap then just change s mode to cpap in the settings. You still have your autoset so just use it until you can settup the vauto, theres no rush.

[ajack]

You do seem very concerned. I had a quick look at one of your charts. I think your doctor is right. I couldn't see a need for bpap. I would have raised min pressure more, towards the 95%.

[ardenum]

You do seem very concerned. I had a quick look at one of your charts. I think your doctor is right. I couldn't see a need for bpap. I  would have raised min pressure more, towards the 95%.

Are we playing sabotage now? It's already been identified in the previous thread and now when he actually got the device and you're planting seeds of fear. The doctors concern was that the patient was taking the matter into their own hands, not 'wasting' money. There's no danger to switching to VAuto, in fact it will only provide benefit in the long run.

[ajack]

Not at all, I'm giving an opinion. You say you need to make a decision. If you have already made your mind up, why ask? It won't hurt to swap to bpap.

[2SleepBetta]

Grateful for the comments above, the central request remains: "...as an Airsense 10 Autoset user I don't know enough to evaluate it or to set it up for tonight. Please help with advice how to test it and adjust it for my use."

As to "accepting",  finalization of the purchase Sunday afternoon hinges on whether the unit conforms to how it was advertised (as new). If it does conform to my offer to buy  --in all but the few hours of use as seems to be true--the seller will be paid; otherwise, he won't be paid if I lodge by Sunday a legitimate complaint and then return the device or agree on some adjustment of the deal.

Not in a panic, I'm just aware I am not informed having only experienced the Autoset while knowing that my time to decide is short. I'd like to at least know how to test its key features and, also, how to set it sensibly for my first night to see how that goes.

SleepRider got right on sending me the clinicians' manual where I see, for example, that one can blunder into settings of time elements that conflict with each other. The VAuto is much more sophisticated and complex than the Autoset, having several more variable adjustments. I have some idea of just how ignorant I am about all this new level of treatment capability.

With regard to raising the lower APAP limit, I have experimented a lot with that and, of course, have learned to raise it high enough to give the pressure build up a running or elevated start to prevent airway collapse, OSA having always been my main concern. On the other hand, a few bellys full of air or/and a chattering esophageal sphincter have spoken loudly against higher low side pressures.

I've noticed that the most frequent apneic event is a single hypopnea and that the lower envelope of my flow rate curve (ignoring the spikes I mentioned) tends to be quite "scalloped"--whatever that sign means. That undulating envelope is more pronounced when even low value FL are present and it gets much worse with larger FL. So much to know and so many years of poor sleep history I don't really know what a good night of it is--just know it is much improved and that I appreciate it.


2SB

[ajack]

For tonight I would have auto and epap8, ipap20 ps 4.
This will give inhale 12cm, exhale 8cm. the machine will raise the epap for any OA/H.
They are a good machine. Don't change anything else from the default settings

[Gideon]

10.4 -15.2 EPR 3

Mode VAuto
Min EPAP 7.4
Max IPAP 15.2
PS 3

That matches your AutoSet. Assuming default timing

[Gideon]

I'm on my phone.
Start with the suggestions settings I made above. You are coming to the VAuto after tweaking your AutoSet for a period of time.

Especially when one sees very specific settings, one should be cautious about big changes. They are likely there for a reason.

Start with the settings used on the previous machine and review the results.

As long as you avoid very high PS, the difference between inhale and exhale
Or manual mode "S" mode (spontaneous) with wide separation of the 2 pressures (high Pressure Support)

S mode is CPAP mode for BiLevel, you set specific pressures for both inhale and exhale.

Post results with the settings I suggested. And go from there.

Despite all the fear mongering you have had the VAuto is a good and safe machine.

[2SleepBetta]

]bonjour wrote


10.4 -15.2 EPR 3
Mode VAuto
Min EPAP 7.4
Max IPAP 15.2
PS 3

That matches your AutoSet. Assuming default timing
*********************************************************************************
Thankyou ajack, crowtor and bonjour,

Tonight I will go with bonjour's recommendation attempting to emulate the Autoset with its long-satisfactory settings. I will post results.

Not seeing advice here when I last looked, I started to totally wing it last night--messing with stuff intuitively (stupidly?) and then thinking better of that I sensibly hit Restore Defaults. I did change the restored "20?, 4? and PS" defaults to Max IPAP 15.2, Min EPAP 10.6, PS 4.6--don't ask why but I wanted to edge up the lower pressure 0.2 and use the VPAP PS, >3EPR, against the FL. (Strangely, SH shows the correct settings near the top of the left sidebar and erroneous rounded ones lower down.)

Below I show the results from those settings and, poorly thought out as those settings were, I see a lot of promise that the VAuto will help with FL and Snore. I also include a typical night of Autoset results with AHI 0.0, but showing middling amounts of FL and Snore which occur along with that score and up to, say, 0.5. As mentioned in OP, I think that Dr. Krakow is likely to be correct about the impact significant FL and snore have on some (all?) people's sleep. I hope to sleep better, not just score well, as now before getting the VAuto.

Without revisiting some of my posted graphs, I believe last night's FR, FL and Snore graphs were (before LL began) far smoother than usual. More and more I ponder whether much of what is reported as Snore, if not FL, isn't really some breathing anomaly related to movement, grunting, breath holding and gasping or such. I'd bet the period before FL starts, both before going to sleep initially and after the pee break, are awake periods for me and that a sudden increase in FL shows I began sleep. Related to that and breathing anomalies, there is almost always a large snore indication when I begin the session and start the second part. The motion graphs showed a lot more action in most of the second half of the session than in the first last night.

Last night I do not clearly recall awakening when and after the LL began, but did have a sense my (Silipos Gel-E-Roll) mouth seal was slipping and leaking again, as it was when I got up and as it has been doing more and more. It needs to be replaced having been used and washed too many times.

I was surprised to see the straight-line pressure levels, thinking I'd see variations, the "mountains profile", as with the Autoset. Is it because of wrong settings? I saw the mask pressure consistently and uniformly  rising to and then falling to the set levels. SpO2 oscillated rapidly from 95-98% during the LL period (and some before) and there were a lot of pulse rate spikes too in the latest half to one third of the session. Motion and TV surges, I suppose, are reflected in those swings?

Note that I cut nearly 12 hours out of the SH graphic. SH correctly showed a split session beginning with my turning on the unit minutes after receiving it near 4pm and then getting settled and hosed up so late at 4am. That explains the near 4pm starting time SH shows at left.

Again, thank you for your help ajack, crowtor and bonjour,

2SB


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