ResMed AirCurve 10 Vauto Help

[Gideon]

My comments are in Blue

I’m trying to give my best with the equipment I have. 

Sure.  Absolutely.  An ASV or another machine takes time to get so why not use what you have to make each night until then better and learn something along the way.  

A fixed pressure like CPAP mode won’t be beneficial from what I understand.. what about easy breathing?

Lets start here.  Correct, CPAP mode is likely to have less potential value than all the other options.  Frequently CPAP is the best mode for resolving Centrals

Easy Breathing is generally a good thing.  I will just say a research paper comes to mind that says people would find better final settings faster by titrating (working to find your best setting) with Easy Breathing turned on early rather than consider it an add on for later, because Easy Breathing might change how your body responds to various settings EPAP, IPAP, PS and EPR settings.   Yes, anything that deals with pressure could change what settings are determined without it. 

Without an ash machine you’re saying that I can get somewhat close to ASV therapy by lowering the pressure support and enabling the trigger setting to very high so the pressure catches the slightest inhale? 

First I will answer your question and then add a "but really you should do this instead."

"I can get somewhat close to ASV therapy by lowering the pressure support and enabling the trigger setting to very high so the pressure catches the slightest inhale?" 

Nope.  That is not it. 


And now the "... really you should do this instead."

Actually, to Ben024 and EVERYONE else wondering if an ASV is right for them, to slowly, night by night replicate the ASV to see if that is what you need you should titrate:  (Others board members: This approach is an on-the-fly developed draft, please reply with improvements.) Unless you have a backup rate/timed breathing, this cannot be done because there is no trigger from Central Apnea.

Also, you may not need an ASV because sometimes CAs go away when another PAP solution is well aligned with a person's needs.  The process below will help sort that out.

So lets get to it. 

To Titrate to see what machine you really need while assuming in advance that you need an ASV.

First methodically titrate EPAP up to find out how high it needs to be to remove Obstructive Apneas - OAs. (Just like you would an ASV, or what an ASV would sort of automatically nearly do for you.)  This needs to be done is "S" mode/Spontaneous/Manual mode, In Auto mode you need to check the charts to see at what pressures Obstructive events occurred or did not occur to reset min EPAP pressure.

• If you don't already know FOR SURE you need a minimum of a higher total IPAP (total pressure) start by setting your Min EPAP to 4 and Max to 5 and your PS to 3 (I would suggest a PS of zero) (you want PS out of the way for the moment).  If you are doing this in Auto mode use a wider range to speed the process up.
  
• Download OSCAR, each morning load data from the VAuto's SD card to see if the 4 or 5 EPAP was enough tot knock out the OAs.
  
• Each day or two post your OSCAR charts here using those "how to organize your charts" and "attachments" links from Bonjour above.  
  
• Each day raise the Min & Max EPAP numbers by 1.0 if your OA in your AHI was a disaster and by .4 each night when you are close to knocking out OA (you are ignoring CAs and Hypopnea events while you are first determining your Min-Max EPAP settings).   When your OAs disappear (1, 2 or just a few all night left is OK, stop raising EPAP and fix Min to the current Min Number and Max to 1.5 numbers higher (1.5 cmH2O higher).  The above is sound, following basic titration protocols except for using Auto Mode, but that is OK.
  

Congrats!  Time to test your PS needs, and if you really need an ASV.  (Note: PS is used to treat Hypopneas, Flow Limits, RERAs, and Snoring)

• Now that you have your "low EPAP needs" figured out (in the bullets above) each night raise PS 1.0 (1 cmH2O) 1.0 if your CA and Hypopnea are still a disaster in your AHI and by .4 each night when you are close to knocking them out, beating those nasty buggers into submission.  This is OK, a slow increase of PS in a person that has Centrals, though in most cases you will more likely need to decrease PS.
  
• If you end up needing 4-8 PS to beat down the CAs then ask Sleeprider if he thinks the VAuto is a keeper for you. This is where I have problems, higher PS where the user (Ben) has complained about Centrals.  This is why daily charts are so important.  Most people with Centrals and especially Treatment Emergent Centrals Have a lot of trouble with a PS 0f 3, let alone going higher..  Going higher in this case is rarely needed.  You stated 4-8 PS, These values are OK with Obstructive events, especially if you take into account the increase in Tidal Volume and Minute Vent that goes along with them.  
  
• If you need 10-15 PS to beat back the CAs, then yep, an ASV is calling your name.  Oh you are so smart, the charts you now have the provide the data you need to get your Doc to help you get an ASV, the daily charts in OSCAR detailing the methodical testing approach you used and how other options failed until you used low EPAP and high PS to kill the CAs.  You should not be in this range 10+ without treating a respiratory condition or other situation that requires a forced breath and this means with a backup rate.  These values in the presense of a backup rate/Timed breathing are where Centrals are treated and forced breaths occur.  Yes ASV can be treated with an "ST" machine (VAuto is not one)  and this was used before the advent of the ASV machines. 
  

The qualification for ASV calls for a successful titration of obstructive events (OAHI <=5) with remaining Centrals Unsuccessful (CAI > 5).  There is no possible way to show with a CPAP or BiLevel without backup that Centrals can be successfully managed with an ASV.  We can only show a failure.  What we want is to get an in-lab ASV titration to prove success.

What actually happens with increase PS is that the users breathing becomes more efficient, typically with increased Tidal Volume and Minute Vent, a process which is more effeciently washing the CO2 out of the blood which can significantly decrease the drive to breathe.  If the Centrals are caused from a different reason, stroke or something like that, the cause may not this mechanism and the user  may be able to handle higher PS levels, that is unless this mechanism kicks in making the centrals more complex.  

Everyone, please reply and improve.

Will, you show a very good and solid understanding of what is needed to titrate Obstructive Apnea, well done.  It took me a long time to understand centrals to the point that I was ready to render opinions on them.  

Time to Snooze.  Zzzzzzz

WillSleep


A few key links Bonjour posted above 
Soft Cervical Collar
Organize Charts
Attaching Charts
Dealing with a DME

[slowriter]

Depending on what the OPs data actually shows, would not EERS potentially be a possibility?

[Gideon]

It is a definite possibility, and I suspect actually work for many members here. The main issue with it is that it is not widely accepted.

[slowriter]

Seems easy enough to test though, at least for those with a bit of DIY spirit. Just construct the extension, with three different lengths of tubing, and see what happens.

Am surprised more people here don't seem to be experimenting with it.

[Sleeprider]

I have no problem with Will's initial suggestion of EPAP 4-5 with PS 3 and see how it goes with a focus on resolving OA. I think the result will be a lot of CA and that it will get catastrophically worse with higher PS. I'm certain Fred and I see eye to eye on this.

EasyBreathe™ is a flow shaping algorithm that gives the resmed bilevels and CPAP with EPR its characteristic wave-shape insted of a square-wave. It's definitely a good comfort feature. Pressure support without a backup trigger in the presence of central apnea is simply not going to work. See my first post here.

[holden4th]

Easybreathe is something I hadn't heard of with the Aircurve V10 auto. Is this a natural part of the algorithm or can I turn it off and on?

[slowriter]

Easybreathe is something I hadn't heard of with the Aircurve V10 auto. Is this a natural part of the algorithm or can I turn it off and on?

I'm pretty sure yes; it's just part of the vauto mode, and you can't turn it off.

[Sleeprider]

You can disable Easybreathe in S-mode but not in Vauto mode.