ResMed AirCurve 10 VAuto or ST

[Sleeprider]

In S-mode you set the IPAP and EPAP. There is no pressure support setting, but PS is equal to IPAP minus EPAP. When you increase IPAP and leave EPAP the same you are increasing pressure support.

In Vauto mode you set a minimum EPAP and maximum IPAP and the PS. By setting the PS IPAP will always be that specified pressure higher than EPAP. In bilevel therapy, we use EPAP to resolve obstructive apnea, and increase PS for flow limitation and hypopnea.

Here is a titration protocol for S mode bilevel. Notice it increases EPAP for obstructive apnea, and increases IPAP (PS) for other events. The Auto bilevel increases EPAP automatically, but we often need to go back in and fine-tune PS.

[biyahero]

In S-mode you set the IPAP and EPAP. There is no pressure support setting, but PS is equal to IPAP minus EPAP.  When you increase IPAP and leave EPAP the same you are increasing pressure support.

In Vauto mode you set a minimum EPAP and maximum IPAP and the PS.  By setting the PS IPAP will always be that specified pressure higher than EPAP.  In bilevel therapy, we use EPAP to resolve obstructive apnea, and increase PS for flow limitation and hypopnea.

Thanks Sleeprider for that additional clarification!  I now think I fully understand that issue.
So now when I specify the "exact settings" that the VA Doctor wants to order the machine I now know that there will appear a menu choice in the VAuto Mode for PS, so I won't need to worry that my specifying a PS setting would confuse her if she wouldn't see that setting on the settings menu.

[Sleeprider]

Any clinician understands the term PS as being the difference between IPAP and EPAP. If you gave only one variable (EPAP or IPAP) and stated the pressure support setting, the settings can be easily determined. In auto bilevel we always state the PS or range of PS (Philips BiPAP can provide a range of PS while the Resmed uses a fixed PS).

[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)

[...]
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.

What I did forget to ask is what effect will the Ramp Time setting if enabled have on the auto-adjustment?
i never used Ramp Time on my AirSense 10 Autoset machine and when I got the ST machine that I haven't used and will return I observed that the Ramp Time was set to 20 Min.

So perhaps I should have Ramp Time set to OFF if it will affect the auto-adjustment of the AirCurve 10 VAuto?

[jaswilliams]

If your used to using no ramp just set the ramp to off. Ramp just delays getting to effective pressure

[biyahero]

Sleeprider pid='290621' dateline='1553975583']
  Daily SleepHead Data.pdf (Size: 754.18 KB / Downloads: 19)
  Overview.pdf (Size: 729.31 KB / Downloads: 17) 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.

Well I had a lengthy post with two SleepyHead attachments, but it seemed to disappear prior to posting, so here I go again...

My Sleep Medicine Doctor at first was irate that I had been issued an AirCurve 10 ST rather than an AirCurve 10 VAuto, since her desire, when I researched the AirCurve 10 machines and asked her which one she wanted, and also her "ResMed Cheat Sheet" said AirCurve 10 VAuto.  However after she noted that on her consult she had written that I was maxing out the pressure at 19.8 every night that she would "change to BiLevel 25/21 cwp", she now has consulted with her Sleep Lab Manager and they are unable to come to a decision about which machine I should use, so she called her ResMed Rep to consult with him about the differences in the two AirCurve 10 machines, and he has not returned her call in two weeks.

I have analyzed my data from the AirSense 10 AutoSet machine using Sleepyhead and discovered that while it does frequently end up showing 19.8 cwp on the machine's sleep report in the morning, it doesn't always do that.  I also discovered that very infrequently the machine will show 0.1 Central Events and in SleepyHead I found that of the three "Clear" events I could find, two of them occurred at 14 cwp to one at 16 cwp. So I changed the settings around April 21 on my AirSense 10 machine to be 16 - 20 rather than 12 - 20, and also I turned on Smart Start and Ramp. I have so far had no further "Clear" events.

Attached are some SleepHead Data screenshots for your review ... I'll attach my original Sleep Study later ... I don't want to risk losing this post again and have go rewrite it a third time!

So if my Sleep Medicine Doctor ends up telling me I should keep the AirCurve 10 ST machine, and I don't really need 25/21 cwp of pressure, but have no choice since that machine wouldn't have the Auto Capability and would have to be used in S Therapy Mode, do you think this will have any detrimental effects on my therapy to have excessive pressure?  I would really like your opinon on this!

Also since I don't intend to continue dragging whatever AirCurve machine I have around the world due to the increasingly intrusive and annoying airport security inspections and plan to use my recently purchase ResMed AirMini during my travels, will that have any detrimental effects on my therapy if I am using 25/21 cwp most of the time in Therapy Mode S and then when I travel I use 16 - 20 cwp auto on my AirMini?

[ajack]

You can manually titrate the S or ST mode, as sleeprider posted above. You would need the ST mode if you stopped or slowed breathing, that needed a backup breath rate per minute. The sleep study would have shown this.

The Vauto, is an auto S mode, moving the epap up and down and keeping the same effective PS, in your case being 4. example, epap 10 + PS4 = ipap 14. Now you may have the max ipap set at 25, but the machine is using what it needs.

Because you are using a small PS of 4 and if there is no indication that you need a backup breath rate. The air mini can be set at fixed 20 with whatever pressure relief is available. Check with doctor, but I don't see an issue. Your PS of 4 isn't very high, indicating that you don't need a lot of what a high PS will do.

[Sleeprider]

Biyahero, your images did not show up this time. My signature has instructions on organizing and positing attachments. I really think the answer to your question on what machine to get is obvious. You should request the Aircurve 10 Vauto. With that machine, we can make any adjustment to pressure and pressure support that you might require. The Vauto does not have a backup rate, but nothing in your previous results suggests you have a problem that would require that. My interpretation of your previously posted results are that pressure support will assist in comfort and efficacy, by reducing hypopnea and RERA. The Vauto can meet your pressure needs to avoid apnea, but having pressure support is key. In addition, the ST model does not use the "EasyBreathe ™" flow algorithm, and you will find the Vauto more comfortable. We could make the Aircurve 10 S work, but having auto-adjusting EPAP makes the process easier, and allows you to enjoy lower pressure when the machine does not detect a need for higher pressure.

[biyahero]

Biyahero, your images did not show up this time.  My signature has instructions on organizing and positing attachments.  I really think the answer to your question on what machine to get is obvious. You should request the Aircurve 10 Vauto. With that machine, we can make any adjustment to pressure and pressure support that you might require. The Vauto does not have a backup rate, but nothing in your previous results suggests you have a problem that would require that.  My interpretation of your previously posted results are that pressure support will assist in comfort and efficacy, by reducing hypopnea and RERA.  The Vauto can meet your pressure needs to avoid apnea, but having pressure support is key.  In addition, the ST model does not use the "EasyBreathe ™" flow algorithm, and you will find the Vauto more comfortable.  We could make the Aircurve 10 S work, but having auto-adjusting EPAP makes the process easier, and allows you to enjoy lower pressure when the machine does not detect a need for higher pressure.

Thanks Sleeprider!  My computer was in the shop this week hence my tardy reply.

Now finally today my Sleep Medicine Doctor, after consulting with her ResMed Rep about the comparative benefits of the two models of AirCurve, agrees that while the consult her assistant wrote would have supported the issuance of the AirCurve 10 ST, she does ... as she initially said, want me to use the AirCurve 10 VAuto.  

So Monday I will start the process of returning the unused  AirCurve 10 ST and get them to issue me an AirCurve 10 VAuto.

Rather then start a new thread for this, can you tell me how to change the settings for my AirMini to 16-20 cwp rather than 12-20 cwp that it is currently set at?  

It has Ramp turn on and starts at 5 cwp it appears and I am comfortable with my AirSense 10 AutoSet set at 16-20 cwp so with Ramp turned on so I would like to change the AirMini to those settings.


Thanks!

[Sleeprider]

The Airmini is not going to resemble a bilevel machine, however you can use EPR on that machine. The Airmini clinical manual is available from Apnea board by request. Follow directions here. https://www.apneaboard.com/adjust-cpap-p...tup-manual

It should be easy to set the Airmini to 16-20 with EPR 3, but of course this is nothing like what you will get from the Vauto.