[Pressure] AirCurve10 vauto s- Lowering pressure

[babag1]

My pressure ramps up so high it makes my mask leak. All my numbers are great as far as AHI etc.  My mask fits me just fine until the pressure ramps so high when I am asleep. I would like to reduce the high pressure a bit and keep in touch with my sleep numbers that stay great to stop my pressure at it's highest as then it blows out my mask. I wear a Mirage Quattro full face mask. Even tried liners etc. but still it ramps so high that the leaks begin. ..My settings are Ipap 22  Epap18. Easy Breath On  TI Max 2.0s  Min 0.3s... Trigger & Cycle Med.. Ramp Time 20 Min.. Start EPap 7.9.. Essentials Plus.. Leak Alert On (only my wife can hear this beep beep in the night) as it wakes her but I still sleep like the dead.  Smart Start off.. Pressure Units cmH20    The clerks at the Health Supply office can't change these factors and to do it I have to return to some sleep center study Dr. Never knew who he was in the first place. My machine has been paid for for a few years so it is mine to cut the lawn with if I want.    Does anyone know which number to reduce just a little so I can perhaps enjoy a better sleep?  By the way, I've tried a ton of masks but they are all the same. They all leak. My insurances for all of them. No wonder insurance premiums are so high.  This is the Wife posting so don't look at my make and model of mine. My husband is blind and this is about his.....

[Sleeprider]

I think it would be great if you would get the #Sleepyhead software. We could probably identify parameters that would both eliminate your discomfort, and produce satisfactory therapy at lower pressure. Most of us change our pressure settings and know how to optimize based on the therapy data results. Apparently you are using VPAP-S mode (fixed pressure) on a Vauto. What a waste of a machine that can raise pressure when you need it, and stay much calmer at other times.

By pressing the control knob and home button at the same time as shown in this tutorial, you can access settings. https://www.apneaboard.com/resmed-airsen...setup-info My recommendation is that you switch to Vauto mode so that your machine auto-adjusts. You need to set EPAP min to a pressure that stops most of your obstructive apnea. Since your machine is automatic, I will suggest a starting pressure of 12.0 cm (EPAP min 12.0). Set the maximum pressure to 22.0 and pressure support (PS) to 4.0. This will give you automatic pressure between 16/12 and 22/18. No other settings need to be changed, and you can keep Ramp starting at 7.6 for 20 minutes or Auto, Ti min 0.3, Ti max 2.0 and trigger/cycle at med. We can learn from these settings if you can tolerate a lower pressure, and if we look closer by using Sleepyhead, we can see why you require (or not) such high fixed pressures. This will give you immediate relief as the maximum pressure is your current settings, but there is a good chance you will not spend much time at that pressure.

If you have the VPAP-S not the auto, then in S-mode, you can change EPAP and IPAP to any lower value, but maintain the 4-cm pressure support. For example, if you may want to try 20/16, 19/15, 18/14 etc. (I always express settings as IPAP/EPAP).

[Gideon]

I suspect you are operating in "S" mode with the ResMed Aircurve VAuto 
Ramp on 20 minutes starting at 7.9
EPAP 18
IPAP 22
PS 4

Staying in "S" mode you could drop both EPAP and IPAP by 1 to see at which pressure your problem stops

or you could find a mask that works for you at the higher pressures.  Keep in mind that the bigger the mask the harder it is to stop leaks for 2 basic reasons.  !st the mask has more seal area from which to leak, 2nd the larger masks are applying that pressure over a greater area thus applying more force to lift the mask.

Why are you in "S" mode?  Is there a reason you are not using "Auto" mode?

Auto Mode would keep you at lower pressure until you need it.  
For settings I would suggest 
Ramp OFF
Min EPAP 8
Max IPAP 22
PS 4

Then I would observe what it does overnight with SleepyHeads detailed charts observing what is driving the higher pressures and then managing appropriately.

Posting detailed charts will get you much better advice as well since we would be coming from knowledge instead of guesses.  

Fred

[babag1]

I am not too computer savvy (78) although I have belonged to this website forum for some time.  This machine is connected to MyAir with I look at the values almost every day to see how we slept the night before. All are good. I even stop into my hospital's health supply store and the gals that are there can scan everything from our machines and last week they were good except my husband's complaint (ha, mine also as he is a deep sleeper and I can hear a snowflake falling.) They look at his charts and just give him another mask. I think at least 6 by now. 

You have seen the settings I indicated on the thread. Can you tell me exactly which one(s) to change to reduce the high pressure slightly? I want to do it slowly to see if it helps along with watching all of his AHI's etc. 

I really do thank you. 

[babag1]

Fred-Wait, you did tell me to Change the Ipap to 21 and the Epap to 17 (ea. down just one and I can do that).  I don't know why the Mode says "S", that is what they just gave him. 

When you said reduce Ipap by one, It was 22 so I would reduce that by 1 making it 21
When you said reduce Epap by one, It was 18 so I would reduce that by 1 making it 17
I can also turn the Ramp Off (don't know why the girl turned it On last week when he got the new mask)

You Quoted Ramp OFF
Min EPAP 8
Max IPAP 22
PS 4 ARE THESE THE NEW FIGURES YOU SUGGESTED TO BE CHANGED OR THE ONES REDUCED BY "1"?

I have don't know what ("PS 4" means). I never saw a PS on that machine to change it.

[Gideon]

Both Sleeprider and myself feel it is more likely to get a greater amount of relief by going into Auto mode.

If you can post on this forum you have enough computer savvy to use Sleepyhead.  

"S" mode is manual mode.  It works by setting pressures high enough to prevent events from happening.  Auto mode will likely spend much of the time near the pressure you start at.  

Consider asking your doctor to prescribe VAuto mode with either the settings Myself or SleepRider suggested then have your clinic make the changes.

Fred

[babag1]

Fred-The doctor, whoever he was, never saw him. He must have an office in China. He just reads the Sleep Center reports and prescribes them to our MD. 

The model is AirCurve 10 VAUTO.  Doesn't this mean it Auto?  "prescribe VAuto mode" you said. 

[Gideon]

PS is Pressure support, 4 is pretty common setting an is what you are currently using It is the difference between EPAP and IPAP


You Quoted 
For Auto Mode
Ramp OFF
Min EPAP 8
Max IPAP 22
PS 4 

These settings will start at EPAP 8, IPAP 12 and only increase as needed.  Will likely be a MUCH greater degree of relief than stepping down in "S" or manual mode.




I the current mode, "S" or manual mode
When you said reduce Ipap by one, It was 22 so I would reduce that by 1 making it 21

When you said reduce Epap by one, It was 18 so I would reduce that by 1 making it 17

and then repeat as necessary.

Fred

[Gideon]

Fred-The doctor, whoever he was, never saw him. He must have an office in China. He just reads the Sleep Center reports and prescribes them to our MD. 

The model is AirCurve 10 VAUTO.  Doesn't this mean it Auto?  "prescribe VAuto mode" you said. 

Talk to your MD  Ask him to Prescribe Auto Mode 
Ramp off
Min EPAP 8 (matches the Ramp to start)
Max IPAP 22 (matches the highest setting that you currently use
PS 4 Pressure Support (means to maintain a difference of 4 between EPAP and IPAP)


Sleeprider suggested Min EPAP 12 to start at a higher pressure than my suggestion because he thinks that would be a good pressure to manage most of your obstructive events and continue to use the ramp for comfort getting started.  Again this too is a very valid approach.

Fred

[babag1]

Ok, Fred and Sleeprider-

Changing the ResMed AirCurve 10 Vauto from EPap 18 down to EPap 12 per Sleeprider.
Leaving the Ramp alone at 20 minutes per Sleeprider.

Sounds like both Agree. I hope so. Should be an interesting night. Will look at his AHI etc. in the am.

-babag