ResMed AirCurve 10 VAuto or ST

[biyahero]

Set your local time and try to avoid the temptation to change that when traveling, especially if you cross the date-line.  Minor time changes of a few hours are manageable, but larger changes can really mess up the data.

You're going to be amazed how much more comfortable the Vauto is for your sleep!

That's great news!

I'm really looking forward to actually getting it after all the issues I had to get it!

Most of the time I will be using it in a location where the time and date are different than the location where I will be issued the machine, so I'll set the time and date to what it is in that location (where I will use it 90% of the time), even though that will be incorrect for the time/date where I am getting the machine from and where I am initializing it. 

In the long run it is probably better that the machine doesn't change the date and time automatically since when I travel it probably would end up mangling the date and time did change automatically.

[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.

Sleeprider I got finally the VAuto a couple of days ago and it was set as I requested:
EPAP min 12.0
IPAP max 25.0
PS 4.0

Here is the first report from OSCAR using my AirCurve 10 VAuto.  

I notice that there are a two Clear Airway Events.  Previously with my AirSense 10 Autoset with settings from 12.0 to 20.0 
I had found there over a period of several months there were only three Clear Airway events and all of them occured when the pressure was between 14 cwp and 16 cwp.  So I changed the settings on the Airsense to to be 16.0 to 20.0 and there didn't seem to be any more of those type of events... well maybe there was one more recently.

So are these something I should be concerned about, or not important?

The settings of the AirCurve 10 VAuto as I received it were:

Therapy
    Mode:                VAuto
    Max IPAP:           25.0
    Min EPAP:           12.0
    PS:                      4.0
    T1 Max:               2.0 s
    T1 Min:               0.3 s
    Trigger:                Med
    Cycle:                  Med
    Mask:                   Full Face
Comfort
    Ramp Time:        45 Min  - I changed this to 5 Min
    Start EPAP:           5.0
    Humidity Level:    4
Accessories
    Tube:                    SlimLine
    AB Filter:              No
Options
    Essentials:            On
    Leak Alert:           Off
    Smart Start:         Off  - I changed this to On
    Reminders:           These are all Off
Configuration
    Language:            English
    Date:
    Time:
    Pressure Units:    cmH2O
    Temp. Units:        F
    Restore Defaults:
    Erase Data
    About
        Device
        SW  SX567-6401
        Run Hours:    0
        CX Number
        CX036-009-013-026-1
        01-100-101
        Internal Modem
        SW SX558-0505
        SN: 23192100631
        Provider: AT&T
        Type: 4G
        Service: -13.4
        Signal:  -97 dBm
        Humidifier
        SW SX 5X556-0204 

One thing I noticed about OSCAR is it always says the Humidity Level is Manual, but really since I am using the ClimateLine Air Hose when that is plugged in the humidity settings say "Auto" rather than Manual but Oscar fails to recognize that.

[attachment=13887]

[Sleeprider]

CA events are only a problem when they are frequent and clustered. CPAP machines and bilevel with backup have no means to treat or prevent CA events, which can occur from things as benign as moving in bed, transitions in sleep stage and just pausing your breathing for 10 seconds. This is a perfect result.

We don't have any data to compare your prior auto CPAP use. In the chart you provided, the pressure is almost fixed, which means you probably have room to lower the minimum pressure if you want. You can lower minimum pressure until you see obstructive events, or you find the auto-pressure fluctuations are not comfortable. Your tidal volume and respiratory stats are great. If you are comfortable there is really nothing at all here we would change. Essentially zero events, flow limits, leaks or snores. Wow!

[biyahero]

[...]

It looks like you have made all the right arguments for the Vauto.  One feature the ST lacks that is in most other VPAP models is the "Easybreathe ™" algorithm. This is the flow shaping that makes the VPAP S, Vauto and ASV have the wave-shaped pressure transitions between EPAP and IPAP.  The ST on the other hand has a square wave without pressure transitions, so basically provides EPAP pressure and switches IPAP on and off abruptly.  The comfort difference is very notable.  [...]

In one of your earlier posts quoted above you mentioned the enhanced comfort of the "Easybreathe ™" algorithm.... this is one of the things that I noticed right away when I started using the VAuto.  When I take a breath I can feel the pressure increasing, and when it is time to exhale I can feel the pressure decrease!  This is much more comfortable than my Airsense 10 AutoSet machine which am I correct that when set to Min Pressure 16 Max Pressure 20 would always maintain at least 16 cwp even when I was exhaling? Absolutely this is very noticable!

So far the results with my VAuto do not seem to support the theory that I needed more pressure, since unlike the Autoset  machine which would briefly get up to 19.8 most nights, the VAuto does not get up to 19.8 or above and seems to stary around 17 cwp.  However the comfort level of the VAuto is remarkably better than was the Airsense 10 Autoset! Also I don't need to have the mask as tight to prevent leaks.

One thing that kind of shocked or at least surprised me is the content of the "Sleep Report" on the VAuto machine (on the machine itself).  It just shows the time used in the last sleep session, and two smiling faces for Mask Leak and Humidifier, and no Pressure data, AHI or the other data shown on the Sleep Report Screen of the AutoSet machine, which I used to check upon arising each morning.

I am attaching here one of the latest OSCAR reports that the AirSense 10 Autosense machine produced before I got the VAuto for comparison with the report from the VAuto machine.

[attachment=13935]

In that report, the Pressure Frequently got to 19.8, hence my Sleep Doctor's assessment that I might need more pressure, but the VAuto doesn't seem ... so far anyway ... to get to that high of a pressure but the comfort of the VAuto is remarkably better!

Now in your latest post you suggested that I could perhaps even go lower if I wanted to try it.  

When I got the machine it was set by the Medical Supply facility which supplied it to the settings I had suggested to the VA Doctor based on discussions here in the forum as to what might be comparable to the settings I had been using on my AirSense machine. The AirSense 10 Machine was originally set by the Sleep Doctor to 12 cwp - 20 cwp but that I changed it myself to 16 cwp - 20 cwp ... perhaps unnecessarily because I had noticed I had three Clear Airway events over a period of months, all of which occurred when the pressure was 14 -15 cwp.

Now the Sleep Doctor at my latest session in her consult specifically said I needed the AirCurve VAuto with (the default settings I think) ... she put "Needs AirCurve 10Vauto Max IPAP 25 cwp min EPAP 4cwp PS 4 cwp" which I heard her thinking aloud as she was typing this I could see she was thinking about what to put for min EPAP and I heard her say something about I'll just put default.  


So in response to those proposed settings, you mentioned in an earlier post that:

She is making the case to let the machine self-titrate, something the ST cannot do. The Aircurve 10 Vauto will reach effective therapeutic pressure quickly, but will ultimately do better when the EPAP minimum pressure is raised closer to your needs. I have no problem with the sleep doctor specifying a set of operating conditions that can only be met by the Vauto, and then making adjustments once you have it.

Having said that, the Medical Supply company that issued the VAuto machine to me went with the message I had sent to the VA Doctor who kept harping on exact settings that "to simplify matters )I said) just set all defaults except Max IPAP 25, Min EPAP 12, PS 4" rather than what the Sleep Doctor had written in her latest consult, which the VA Doctor or the Medical Supply company did not have access to, and actually the Sleep Doctor herself had not yet written the latest consult when I sent those suggested settings to the VA Doctor.

So having said all that, based on the OSCAR Sleep Report from the VAuto in my last message, which you mentioned seems to be fine, do you see any point in now reducing the Min EPAP to the default of 4 as the Sleep Doctor had written to let the machine self-titrate or I'll be better off leaving it at Min EPAP of 12 where it is set now?

Thanks so much for your continued help and advice!!

[biyahero]

Set your local time and try to avoid the temptation to change that when traveling, especially if you cross the date-line.  Minor time changes of a few hours are manageable, but larger changes can really mess up the data.

You're going to be amazed how much more comfortable the Vauto is for your sleep!

Yes!  I am really amazed at how much more comfortable the VAuto is!

I set the time and date to be GMT +8 when I received the machine and so now no more split sleep periods, where it use to change to a new day at 06:00 AM in the GMT +8 time zone which was noon in the GMT -10 time zone that my AirSense 10 AutoSet was set for, and claim I used the machine :30 only if I got up at 06:30.

Another bonus of this new machine is that it has a 4G modem unlike the CDMA modem of my previous Airsense 10 machine, so it can transmit data wherever I am and get software updates which my old machine could not do since there were no CDMA providers in my time zone.

Now when I am in the GMT +8 time zone the sleep periods are actual time as in 22:00 to 08:00 and when I am in the 
GMT -10 time zone the machine just interprets 22:00 to 08:00 as 16:00 to 03:00 and so the noon changeover issue does not exist if my date/time calculations are correct.

I registered my new VAuto with myair.resmed.com and I can view some details... I think primarily what they refer to as "Compliance Data" to see that you use it regularly, but not as many details as with OSCAR if course.

The VA Pulmonologist says that the Medical Equipment Provider will have registered the machine since they sold it, and if he were to go to the ResMed site and enter the serial number it would produce a message that this serial number is already in use, so he can't see detailed data about the sleep sessions or settings, and he doesn't have the equipment to obtain the data from the SD Card as my Sleep Doctor does.  

So the good part of that is he agreed that I don't have to see him periodically and I can continue seeing my current Sleep Doctor at least until the VA gets the appropriate equipment and capabilities to read the SD Cards, which would be my preference anyway to keep seeing my current Sleep Doctor.

Otherwise he claims that to get detailed data I would have to request the Medical Equipment Provider to print it out for me and get it from them.  Is this true that only the original supplier of the machine can use the serial number to get detailed data produced by the machine?

Of course in our case I guess we don't need that since we have OSCAR.

One other question occurs to me about OSCAR ... does it matter if the machine is turned off or not when you remove and replace the SD Card?  I seems to act the same whether I unplug the power or not when I remove and replace the card.

[Sleeprider]

Please don't switch the Vauto to the default settings. I can only guess, but a minimum EPAP of 12, and PS of 4 look like they might work out. Maximum pressure won't matter as long as it goes high enough.

You can remove the card anytime, as long as you are not in therapy mode. Being plugged in or even in cooling mode is fine.

[biyahero]

Please don't switch the Vauto to the default settings.  I can only guess, but a minimum EPAP of 12, and PS of 4 look like they might work out.  Maximum pressure won't matter as long as it goes high enough.

You can remove the card anytime, as long as you are not in therapy mode. Being plugged in or even in cooling mode is fine.

Thanks Sleeprider.  I'll leave it as it is for now then.  

Thanks for the info on removing and inserting the card. I have always just left my machine plugged in all the time, but now it occurs to me ... do most people only plug it in when they are going to use it, and is it likely that leaving it plugged in all te time would make it wear out faster or not?

[SarcasticDave94]

Just my opinion, leaving your VAUTO plugged in is fine. If there were any extra wear, which I doubt, it would be negligible.

[biyahero]

CA events are only a problem when they are frequent and clustered.  CPAP machines and bilevel with backup have no means to treat or prevent CA events, which can occur from things as benign as moving in bed, transitions in sleep stage and just pausing your breathing for 10 seconds.  This is a perfect result.

We don't have any data to compare your prior auto CPAP use.  In the chart you provided, the pressure is almost fixed, which means you probably have room to lower the minimum pressure if you want.  You can lower minimum pressure until you see obstructive events, or you find the auto-pressure fluctuations are not comfortable.  Your tidal volume and respiratory stats are great.  If you are comfortable there is really nothing at all here we would change. Essentially zero events, flow limits, leaks or snores. Wow!

What you said is very encouraging! I fell pretty comfortable with these settings.

I have noticed that my results vary from day to day...well they did with the old machine as well, but occasionally with the VAuto I do have frequent and clustered CA Events (or maybe you wouldn't classify them as that) but in any case some days like last night there were none or almost none, and other days there are several.  For comparison purposes I will post the worst and the best recent reports to see what you think of them.  I did notice last night when there were several, that the flow rate increased significantly at the time these CA events occurred.  Does this perhaps occur because the machine senses these events and increases the flow rate because of them?

[attachment=14263]

Aside from these sporadic events, the current settings seem to be OK. Most of the time since I got the VAuto my AHI has remained between 1.0 and 2.0 and August 6 the AHI was only 0.22!

[attachment=14260]

August 1 it was 4.24 and had bunch of CA events. Also on that night the max pressure did go up to 21.93 whereas most of the time it seems to stay around 17 to 18.

[attachment=14258]

The last time I used the AirSense 10 the AHI was 0.86, and seldom but occasionally with that machine I would have CA events ... it seems not as many as with my VAuto however. 

Sometimes with the AirSense 10 I Autoset I would also have a night with a big AHI, but then the next night it would be OK again, just as is happening with the VAuto.

So do these results seem to be OK to you with the settings I am using? 

Should I be concerned about these occasional CA events ... some nights none or one, other nights quite a few ...or do these seem OK to you? 

I do perhaps change my sleep position, move in bed, have a transition in my sleep stage and or just pause my breathing as you mentioned earlier. Sometimes I get up only once or twice in the night to go to the bathroom, other times as many as 5 times.

Thanks for your help and advice!

[Sleeprider]

I think your results are very good, with departures in the normal range. We all have some nights that are more restless than others. If every night looked like August 1 or worse, we would do something about the centrals, perhaps titrating downward on PS, but as your results are very good overall, I don't see the need. Feel free to experiment within small ranges (i.e. change PS to 3.8, 3.6, 3.4) and see if it makes a difference for you, but if you make changes give them enough time to average out and show you if there is a trend.