ResMed AirCurve 10 VAuto or ST

[biyahero]

• [...]
  
• To treat obstructive apnea and hypopnea, and a standard Auto CPAP is insufficient the treatment of choice is the Aircurve 10 Vauto (has higher pressure and greater Pressure Support (PS) (similar to EPR) available
  
  
• To treat central apnea, the only appropriate therapy would be the Aircurve 10 ASV
  
  
• To treat obstructive or pulmonary restriction including hypoventilation, would be the Aircurve 10 ST
  

So if I were to have an AirCurve 10 VAuto am I understanding correctly that I would be able to set the pressure to

Mode: AutoSet
    Max Pressure:    25.0
    Min Pressure:     12.0

Similarly to my current AirSense 10 AutoSet which is set to:
Mode: AutoSet
    Max Pressure:    20.0
    Min Pressure:     12.0

But if I were to have an AirCurve 10 ST,  I would have some sort of fixed pressure and a backup rate which would try to 
force me to breathe if I didn't breathe enough times per minute to meet the backup rate criteria?

I have requested the Clinician manuals for both those machines, and will be able to figure out more once I get those, but I am trying to get a head start since my VA Doctor announced this morning that she is confused after I sent her an edited version (attached) of part of the titration guide from Resmed posted by Sleeprider, featuring an annotated chart of the differences in those two machines, and said she has to talk to the"pulmonary people" and my Sleep Doctor is unavailable until April 9th.

[color=#000000]On a related note if the mask leaks more, will that affect the pressure used by the Autoset?  For example if he mask doesn't leak at all, and the pressure is a certain amount, and then a new mask leaks enough that one night it displays a red face in the sleep report, and then the next night after tightening it up it still shows a green face but says it had a 35 L/min leak rate during the previous sleep period, would that affect the pressure that would be shown in the sleep report and perhaps make the displayed pressure lower than when there is no leak?[/color

[biyahero]

Well I just got the Combined Clinician Manual for the ResMed AirCurve 10 VAuto, AirCurve 10 S and AirCurve 10 ST, and in comparing it with the Clinician Manual for the AirSense 10 Autoset I see that the settings on the AirCurve are not for Minimum and Maximum Pressure like on the AirSense 10.

AirSense 10 AutoSet
Mode: AutoSet

    Max Pressure:    20.0
    Min Pressure:     12.0

but are (at least in the "S" mode as displayed in the manual)
IPAP and EPAP rather than Max and Min Pressure as it is with the AirSense 10 AutoSet.

Now if you were to select VAuto Mode rather than S mode as shown in the manual, I'm not clear if the 
same options of IPAP and EPAP would still be what is displayed or not?

[img]blob:http://www.apneaboard.com/603d9901-303d-4cff-8e5d-c2c05db5c953[/img]

Now what my Sleep Medicine Doctor had written on the Clinical Visit Report was""Will change to Bilevel 25/21cwp which the VA will provide." without actually specifying a machine name.... although later she did clarify to me she wanted for me the Aircurve VAuto since that could go up to 25 cwp as opposed to only 20 cwp that the Airsense 10 Autoset could do, and which I was maxing out every night at 19.8 0r 19.9. I did tell the VA Doctor that is what she wanted AirCurve VAuto, but because of the lack of specific machine name in the Clinical Visit Report, the VA Doctor to ordered: 

"Positive Airway Pressure (PAP) Therapy (Choose ONE) 

Fixed Bilevel (BiPAP) Therapy Machine: Resmed Aircurve 10 Bilevel S/T with HumidAir and ClimateLine 
Air # 37307 

Pressure: bilevel 25/21 cwp" 

Now the VA Doctor says she is receptive to changing the machine to the AirCurve 10 VAuto but says she needs to know the exact settings it needs to be set for.  My Sleep Medicine Doctor will be available after April 9th to consult about this, but to get a head start on this, how do you think the "Pressure: bilevel 25/21 cwp" would translate into IPAP and EPAP settings, and PS Settings?

[Sleeprider]

Well I just got the Combined Clinician Manual for the ResMed AirCurve 10 VAuto, AirCurve 10 S and AirCurve 10 ST, and in comparing it with the Clinician Manual for the AirSense 10 Autoset I see that the settings on the AirCurve are not for Minimum and Maximum Pressure like on the AirSense 10.

Max Pressure:    20.0
Min Pressure:     12.0 but are (at least in the "S" mode as displayed in the manual) IPAP and EPAP rather than Max and Min Pressure as it is with the AirSense 10 AutoSet.

Now if you were to select VAuto Mode rather than S mode as shown in the manual, I'm not clear if the same options of IPAP and EPAP would still be what is displayed or not?

blob:http://www.apneaboard.com/603d9901-303d-4cff-8e5d-c2c05db5c953

Now what my Sleep Medicine Doctor had written on the Clinical Visit Report was""Will change to Bilevel 25/21cwp which the VA will provide." without actually specifying a machine name.... although later she did clarify to me she wanted for me the Aircurve VAuto since that could go up to 25 cwp as opposed to only 20 cwp that the Airsense 10 Autoset could do, and which I was out every night at 19.8 0r 19.9. I did tell the VA Doctor that is what she wanted AirCurve VAuto, but because of the lack of specific machine name in the Clinical Visit Report, the VA Doctor to ordered: 

"Positive Airway Pressure (PAP) Therapy (Choose ONE) 
Therapy Machine: Resmed Aircurve 10 Bilevel S/T with HumidAir and ClimateLine Air #37307 

Pressure: bilevel 25/21 cwp" 

Now the VA Doctor says she is receptive to changing the machine to the AirCurve 10 VAuto but says she needs to know the exact settings it needs to be set for.  My Sleep Medicine Doctor will be available after April 9th to consult about this, but to get a head start on this, how do you think the Pressure: bilevel 25/21 cwp" would translate into IPAP and EPAP settings, and PS Settings?

I think the Aircurve 10 Vauto is your better solution since you don't have an apparent need for a backup rate. The ST can be run in CPAP, VPAP-S or VPAP ST (spontaneous-timed) modes.  So for you, it would be a fixed bilevel, while the Vauto will automatically adjusts the EPAP pressure while maintaining the pressure support throughout the range.

Your question regarding an appropriate pressure setting on an Aircurve 10 Vauto, with a range from 12 to 25 is as follows:
EPAP min 12.0
IPAP max 25.0
PS 4.0

This will give a starting pressure of 16/12 and will auto-adjust to 25/21.  These are starting settings, and we would increase PS if flow limitations, or hypopnea remain present and increase EPAP min for continued OA.  Remember that the Airsense 10 uses EPR and your current EPAP pressure may be up to 3-cm lower than the CPAP pressure you are currently using. If your current Airsense 10 settings are 12 to 20 cm pressure, and you use EPR at 3, your actual pressure range is only 12/9 to 20/17.

This thread was started by Halokittie and it would be better if you would start your own therapy thread, where we can look at your data and progress and make specific recommendations to you, rather than adding onto another member's thread about machine models.

[biyahero]

I got out the AirCurve 10 ST I was issued and wrote down the settings the provider had set, which are:

My originally issued Aircurve 10 ST Settings as issued:
Therapy
The Choices here are: CPAP
S (Selected)
ST
T

Therapy as set on the ST Machine
Mode S (Selected)
IPAP 25.0 (Will not be present in VAuto Mode)
EPAP 21.0 (Will not be present in VAuto Mode)
Ti Max 2.0s
Ti Min 0.3s
Rise Time Min (Will not be present in VAuto Mode)
Trigger Med
Cycle Med
Mask Full Face
Comfort
Ramp Time 20 min
Start EPEP 4
Humidity Level 3
Accessories
Tube SlimLine - ClimateLineAir tubing is automatically detected when connected
AB Filter No
Ext. Humidifier No
Options
Essentials On
Leak Alert On
SmartStart Off
Reminders -> Not set
Configuration
Language English
Date
Time
Pressure Units cmH2O
Temp Units °F
Restore Defaults ——>
Erase Data ——>
About
Device
SW SX567-0306
Run Hrs 0
CX Number CX036-012=013-026-100-100-101
Humidifier SW556-0204
Internal Modem SW SX558-0505
SN Displayed but I didn’t display in this note
Provider Displayed but I didn’t display in this note
Type 4G
Service -12,3
Signal - 98dBm

Now if I were to have a AirCurve 10 VAuto, I believe from reading the Clinical Manual (Chart on Pages 14 and 15) that if the machine were set to VAuto Mode rather than to S Mode as the original AirCurve 10 ST machine was set, I would see some different choices as shown below:

1. I would no longer see a field for IPAP
2. I would no longer see a field for EPAP
3. I would no longer see a field for Rise Time
4. I would see a new field for Max IPAP - Sets the maximum IPAP inspiratory pressure delivered by the device
5. I would see a new field for Min EPAP - Sets the minimum EPAP expiratory pressure delivered by the device
6. I would see a new field for Pressure Support (PS) - Difference between Max IPAP and Min IPAP - Adjust for patient comfort

If the IPAP and EPAP settings are really what the Sleep Medicine Doctor had in mind when she wrote
"Will change to Bilevel 25/21cwp which the VA will provide.", then I guess the provider could set the Max IPAP on the replacement AirCurve 10 VAuto to 25 and the Min EPAP to 21 and the PS would automatically be set to 4?

Do those settings seem reasonable?

The reason I ask is the latest from the VA is that "I spoke to Respiratory and they told me I need to get the precise settings for the AirCurve 10 VAuto. I left a message at the Sleep Lab ... for Dr. XXXX. As soon as I hear back from them I will let you know." So I want to help provide them with the "precise settings" to cause the machine to be dispensed.

The other issue is that when I pulled out the ST machine to record the settings, I was really happy to note that the cellular communication worked on 4G. My AirSense 10 Autoset never worked on cellular and only had CDMA which is not available where I am most of the time. I do note that on Page 37 of the Clinician Manual in the Specifications it says:

Wireless module
Technology used:
CDMA (USA only)
4G (USA and Canada only)

Now it is unclear to me and seems unlikely that a given unit would have both CDMA and 4G so I am hoping to find what ResMed stock number would include 4G and Not CDMA which won't work and having 4G would eliminate my needing to drag my machine around the world to the Doctor when I go there. The ST machine I got said it was
REF: 37307 but also on the box it said 37056 AirCurve ST, 37296 ClimateLine Air, and 37299 Humidair Standard Tub,
so I believe 37307 is a package reference number for that combination which happens to include the 4G modem.

I know I have seen somewhere a very long list of such numbers as 37307 for each model of ResMed Machine and I believe that perhaps each of those numbers is for a distinct package that would include certain things... like my 37307 package also included an SD Card, which my Airsense 10 AutoSet (which I believe had a REF number of 37207) did not, nor did the AirSense 10 package have a ClimateLine Air Hose.

Does anyone know if there is away to determine what exactly those Reference Numbers include in order to be able to ask them to order the correct reference number which would include everything the REF 37307 did except it would include an AirCurve 10 Vauto rather than an AirCurve 10 ST?

[biyahero]

I think the Aircurve 10 Vauto is your better solution since you don't have an apparent need for a backup rate. The ST can be run in CPAP, VPAP-S or VPAP ST (spontaneous-timed) modes.  So for you, it would be a fixed bilevel, while the Vauto will automatically adjusts the EPAP pressure while maintaining the pressure support throughout the range.

Your question regarding an appropriate pressure setting on an Aircurve 10 Vauto, with a range from 12 to 25 is as follows:
EPAP min 12.0
IPAP max 25.0
PS 4.0

This will give a starting pressure of 16/12 and will auto-adjust to 25/21.  These are starting settings, and we would increase PS if flow limitations, or hypopnea remain present and increase EPAP min for continued OA.  Remember that the Airsense 10 uses EPR and your current EPAP pressure may be up to 3-cm lower than the CPAP pressure you are currently using. If your current Airsense 10 settings are 12 to 20 cm pressure, and you use EPR at 3, your actual pressure range is only 12/9 to 20/17.  

This thread was started by Halokittie and it would be better if you would start your own therapy thread, where we can look at your data and progress and make specific recommendations to you, rather than adding onto another member's thread about machine models.

Thanks Sleeprider... I hadn't noticed your reply until I already posted my last post... seemingly didn't get notified of a new post.  I'll start a new thread.

Thanks for the information above.

Is there a way to move my last post from this thread to the new thread I will start?

[biyahero]

SuperSleeper said in a previous thread:

I think the Aircurve 10 Vauto is your better solution since you don't have an apparent need for a backup rate. The ST can be run in CPAP, VPAP-S or VPAP ST (spontaneous-timed) modes.  So for you, it would be a fixed bilevel, while the Vauto will automatically adjusts the EPAP pressure while maintaining the pressure support throughout the range.

Your question regarding an appropriate pressure setting on an Aircurve 10 Vauto, with a range from 12 to 25 is as follows:
EPAP min 12.0
IPAP max 25.0
PS 4.0

This will give a starting pressure of 16/12 and will auto-adjust to 25/21.  These are starting settings, and we would increase PS if flow limitations, or hypopnea remain present and increase EPAP min for continued OA.  Remember that the Airsense 10 uses EPR and your current EPAP pressure may be up to 3-cm lower than the CPAP pressure you are currently using. If your current Airsense 10 settings are 12 to 20 cm pressure, and you use EPR at 3, your actual pressure range is only 12/9 to 20/17. 
=================
Thank you Sleeprider for that data, which makes everything a lot clearer that it was!

To clarify my understanding even more....

Since my Sleep Doctor in her notes said "Will change to Bilevel 25/21cwp...." then she is referring to the IPAP Max Value and EPAP Min value after the auto-adjustment period would be complete and the IPAP has reached 25.0, assuming PS is set at 4.0?

So if I were to use those settings above in red then when I started therapy it would begin at
IPAP 16  (EPAP Min + PS 4)?
EPAP 12

and slowly auto-adjust to

IPAP 25
EPAP 21

With the AirCurve 10 VAuto, would the settings for IPAP Max and EPAP Min always increase all the way to
IPAP 25
EPAP 21

or if no hypopnea events or a small number of events were sensed, might it not go all the way to IPAP 25, much as my current AirSense 10 Autoset doesn't always go to 19.8 .... occasionally it only shows 15.3 on the Sleep Report in the morning .... I check it every day ... or will the AirCurve 10 VAuto always end up at the IPAP Max setting of 25 at he conclusion of the sleep period? 

Whatever value the IPAP Max would end up at (assuming if it might not go all the way to 25), the EPAP Min would always maintain the same PS 4.0 relationship to IPAP? So for example if IPAP were to stop at 23 then EPAP would stop at 19?

As for my current Airsense 10 AutoSet settings, EPR is turned off.

Thanks....

[Sleeprider]

The Vauto can also be run in S mode at a fixed pressure of 25/21. It's up to you if you want to, or can use lower pressures and the auto-adjustment. I have not seen your charts or titration study results, so my suggestion on auto pressure may have started too low. For that matter, ou can use CPAP mode and any pressure up to 25 without any pressure support or EPR.

[biyahero]

The Vauto can also be run in S mode at a fixed pressure of 25/21.  It's up to you if you want to, or can use lower pressures and the auto-adjustment.  I have not seen your charts or titration study results, so my suggestion on auto pressure may have started too low.  For that matter, ou can use CPAP mode and any pressure up to 25 without any pressure support or EPR.

Thanks Sleeprider.  I hope by replying to this post with the subject [Split] which it seems you added that means that this is a new thread as you suggested I do rather than mixing my questions in with Halokittie's thread!

I do see in the combined Clinician Manual for the AirCurve VAuto, S, and ST that if I had a VAuto I could run it in S Mode at a fixed pressure of 25/21.  In fact that is how the Medical Supply had the AirCurve ST which they issued me set up... to run in S Mode with  fixed pressure.

I don't think I want to do that... if I did I could just keep the ST machine I suppose. 

I don't think my Sleep Medicine Doctor wants me running it in S mode either as a fixed pressure machine... that is why she told me she wants me to have a AirCurve VAuto.

I do see from the Clinician Manual chart on Pages 14 and 15 that once I have the VAuto machine, if I set it to run in VAuto mode rather than S Mode, then I should see the following differences in the settings from the S Mode settings:

1.  I would no longer see a field for IPAP
2.  I would no longer see a field for EPAP
3.  I would no longer see a field for Rise Time
4.  I would see a new field for Max IPAP 
5.  I would see a new field for Min EPAP 
6.  I would see a new field for Pressure Support (PS) 

I also see on Page 4 of the Clinician Manual that with regard to the VAuto Mode it says:

Min EPAP and Max IPAP settings allow you to restrict the delivered pressure ranges in which the AutoSet algorithm can operate. 

The EPAP and IPAP will vary across the session according to the patient’s needs. It responds to snoring, apneas and flow limitation of the patient’s flow curve. 

Please correct me if I am wrong, but I think that means that the EPAP and IPAP will not necessarily go to the Max IPAP value that has been set, but the AutoSet algorithm will determine what IPAP to use and EPAP used will always be maintained at the differential from the IPAP used of the PS setting chosen.
 
For example if the algorithm decided to deliver an IPAP of 23 (based on the patient's needs) rather than the Max IPAP setting of 25, then the EPAP would be 19 (assuming the PS was set at 4), rather than the setting of Min EPAP 21 (which would be used IF the IPAP had increased to the Value of 25)?

Now in a previous message you said:

Your question regarding an appropriate pressure setting on an Aircurve 10 Vauto, with a range from 12 to 25 is as follows:
EPAP min 12.0
IPAP max 25.0
PS 4.0

This will give a starting pressure of 16/12 and will auto-adjust to 25/21.  These are starting settings, and we would increase PS if flow limitations, or hypopnea remain present and increase EPAP min for continued OA.  Remember that the Airsense 10 uses EPR and your current EPAP pressure may be up to 3-cm lower than the CPAP pressure you are currently using. If your current Airsense 10 settings are 12 to 20 cm pressure, and you use EPR at 3, your actual pressure range is only 12/9 to 20/17. 

Starting at 16/12 and auto-adjusting to 25/21 if the AutoSet algorithm would call for it sounds OK to me.

Will Therapy automatically start at EPR Min + PS and then vary according to the AutoSet algorithm up to IPAP Max, 
or does Ramp Time need to be turned on in order for it to work this way?

Sorry to have so many questions, and thank you so much for your continued help and explanations!!

[Sleeprider]

When you open up the clinical menu settings (home key + control knob), you will be able to setup the machine
Mode: Vauto
IPAP max: 25
EPAP min: 12 (or your choice)
PS: 4.0 (this is the difference in pressure from IPAP to EPAP)

In Vauto mode there is no EPR. We can set the Ti min and Ti max and Trigger and Cycle sensitivity later, but for now leave them at defaults. With the settings above you will start at 16/12 pressure and the machine will auto-adjust as needed up to 24/20. For some reason, the Vauto does not quite reach 25 cm pressure in auto mode. These settings should be reasonably comfortable to get started, and we can fine-tune once we see some charts. As you figured out, the machine will increase pressure only as high as your needs dictate; it will not go to maximum pressure unless that is needed, and it may even stay near the minimum pressure settings. On the Vauto, PS is a constant. We are initially using 4.0 cm. Again, we may find a different pressure support is better for your needs, but this is the conventional starting point. PS will always be added to EPAP to provide the IPAP pressure. EPAP will automatically move upward if you have obstructive apnea or flow limitation. If those conditions don't occur, the pressure will stay low. As I said, we can optimize once we see the results.

[biyahero]

When you open up the clinical menu settings (home key + control knob), you will be able to setup the machine
Mode: Vauto
IPAP max: 25
EPAP min: 12 (or your choice)
PS: 4.0 (this is the difference in pressure from IPAP to EPAP)

In Vauto mode there is no EPR. We can set the Ti min and Ti max and Trigger and Cycle sensitivity later, but for now leave them at defaults.  With the settings above you will start at 16/12 pressure and the machine will auto-adjust as needed up to 24/20. For some reason, the Vauto does not quite reach 25 cm pressure in auto mode. These settings should be reasonably comfortable to get started, and we can fine-tune once we see some charts.  As you figured out, the machine will increase pressure only as high as your needs dictate; it will not go to maximum pressure unless that is needed, and it may even stay near the minimum pressure settings.  On the Vauto, PS is a constant. We are initially using 4.0 cm. Again, we may find a different pressure support is better for your needs, but this is the conventional starting point. PS will always be added to EPAP to provide the IPAP pressure.  EPAP will automatically move upward if you have obstructive apnea or flow limitation.  If those conditions don't occur, the pressure will stay low.  As I said, we can optimize once we see the results.

Thank you Sleeprider for clarifying that is how it works! That's perfect.

The only other question about the settings I am not clear on (and since the VA Doctor has said they need "Exact Settings" for the VAuto machine) is will there be an actual menu choice for PS on the setup, or that is just automatically established in the background based on the IPAP max and EPAP min settings that you have selected?

Another issue about the machine that you may or may not know about is that of cellular connectivity. My AirSense 10 AutoSet machine never had any cellular connectivity because it had only a CDMA modem and there is no provider that works with CDMA in the area where I use the machine.

So I was thrilled when I opened up the AirCurve 10 ST to record the settings that the provider had set it for when they issued it to me, to discover than I had a strong 4G cellular connection!

Now in the Clinician Manual in the Specification section for the Aircurve 10 combined models it states:
Wireless module 
Technology used: 
CDMA (USA only) 
4G (USA and Canada only) 

So do you know if there are distinct versions of the AirCurve 10 VAuto, some of which have CDMA modems and others have 4G modems, or could it be that the modem in all USA AirCurve 10 VAuto devices have both capabilities?

If there are different versions perhaps I would need to make sure the Doctor includes some statement similar to 
"4G Capable Wireless Module" on a Prescription or on the order they will make?

Thanks again for your invaluable continued help!