ResMed AirCurve 10 Vauto Help

[Ben024]

Hello all, this is my first thread on apneaboard and would like to ask some questions about the AirCurve 10 vauto. I used the machine last night in hopes to resolve some of my central’s. I started in CPAP MODE and set pressure on 6.5

It doesn’t say CPAP auto it just says CPAP so I’m assuming it only goes up to set pressure. The other two modes are S and Vauto. When I have Vauto set the pressure lingers after my inhale if that makes sense so it sort of triggers central’s. In S mode I’m clueless. Ive been reading about low pressures being better for central’s but not sure what to set machine to anything helps thanks

[slowriter]

I think it would help people help you if you could post some background data to help understand why you're asking these questions.

For example, your sleep study results?

How about previous examples (on CPAP) of the "central" problem you note?

FWIW, I see no reason not to use the VAuto mode. It's flexible enough to be configured however you need it.

[Gideon]

Welcome to the forum, we can and will help you.

Download OSCAR and post your Daily charts.  Look in the Organization link in my signature for which charts to include, some are more important than others.

Specifically what to do depends on what kind of events you have and the quantity and when they occur and what is occurring around them.

The ROT is that for Central events we need to lower pressure and the differential in pressure that occurs both algorithmically and from the difference between EPAP and IPAP pressure that occurs on every breath.  This assumes that the cause of centrals is from the increased washing out of CO2 from the blood that frequently occurs when CPAP is initiated.

It would help us if you post (redacted) full copies of your sleep studies, not just the summaries.

[Sleeprider]

The Vauto is not capable of treating central apnea. A higher level bielvel device like the Aircurve 10 ASV is needed to perform the functions mentioned by Bonjour. With the Vauto, CPAP pressure is a fixed single pressure, but EPR (exhale pressure relief) is availablle to provide up to 3-cm of pressure reduction during exhale. VPAP S means a fixed bilevel pressure with separate IPAP and EPAP pressures, where the difference between IPAP - EPAP = Pressure Support (PS). Vauto has a minimum EPAP pressure and fixed PS, and will vary pressure up to the maximum pressure set. (EPAP - PS = IPAP).

In general, fixed low pressure works best for central apnea. Using bilevel pressure without a backup that triggers IPAP pressure just makes CA worse. The ASV has the backup that triggers IPAP and adaptively adjusts the pressure to ensure your minute vent remains stable.

[Ben024]

Thank you everyone for replying so quickly. I’m trying to give my best with the equipment I have. 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? A fixed pressure like CPAP mode won’t be beneficial from what I understand.. what about easy breathing? Or the auto feature with a low pressure support and high trigger? Or shouldn’t I even bother

[slowriter]

You really need to post your data.

[Sleeprider]

Ben, if you have predominately central apnea, the ASV is your best option. The Vauto cannot treat CA because it relies on spontaneous respiratory effort to trigger IPAP, regardless of sensitivity. At this point, we really don't know what you're dealing with in terms of severity or past results. The Aircurve 10 Vauto is a fantastic machine for obstructive apnea as well as treating hypopnea and flow limitation.

[WillSleep]

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.  

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.    

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.) 

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.)

• 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 (you want PS out of the way for the moment).  
  
• 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).  
  

Congrats!  Time to test your PS needs, and if you really need an ASV. 

• 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.  
  
• 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.
  
• 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.    
  

 

Everyone, please reply and improve.

Time to Snooze.  Zzzzzzz

WillSleep


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

[Gideon]

Will, I would rather see you work out your theory in a separate thread, not another users thread

If Ben were to follow your directions it is extremely likely that his Central Apnea would become profoundly worse. The issue is that you are counting on a signal from his body that has essentially been turned off, the signal to breathe.

No CPAP or BiLevel without backup, without timed breathing, or a full on ventilator can compensate for the lack of single to breathe.

By titrating PS as you have, especially with a susceptible user like Ben, you have greatly increased the efficiency of his breathing resulting in the increased washout of CO2 from his blood which decreases the drive to breathe causing severe Central Sleep Apnea.

[WillSleep]

If Ben were to follow your directions it is extremely likely that his Central Apnea would become profoundly worse.

Hi Bonjour, 

Thanks for replying!

I disagree with your conclusions.   Because if he followed the steps I laid out he would start at very low pressures and post his results every day or so here where, from what I have seen in other threads, he would see what is happening at each step of his titration and adjust, you and others would coach him at each step of his titration and he would never enter the danger zones you are describing.

The initial plan / framework above is just that .. a starting place and roadmap based on common tritation methods in the Clinical Tritation guides/manuals.  There is an old "No battle plan survives contact with the enemy."     Each day he studies and posts his OSCAR he and those coaching him will respond to facts being learned in those OSCAR reports and soon be completely ignoring and forgetting about what I wrote above, .. unless it actually ends up better for him than anything else he or we come up with. 

A few key thoughts on my mind:

• He asked for help starting with his current machine and we don't REALLY yet know he needs a different machine. We should try to help him.
  
• Many people have CA / UA events disappear when treatment is better designed at lower pressures using more traditional machines than an ASV.  Hopefully he will find an earlier better solution than needing an ASV.
   
• Without more facts ideas we have are all conjecture.   The first step and next step is as you said above.  Posting redacted reports, installing OSCAR and posting OSCAR reports.   These links you posted. 
  

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


WillSleep