ResMed BPAP ST-A vs BPAP VAuto - S Mode Only Question

[cmpman1974]

I am trying to decide if it makes sense to return a ST-A machine since I am not using the IVAPS mode anymore. I am about 5 months into a 12 month rent to own term so I have invested some money into this already.  I got screwed bad as I was 9 of 12 months into my rent to own with a new ResMed Air Curve 10 VAuto machine in late 2022 and my old sleep doctor decided out of the blue I needed a ST-A so I had to start over with a newer, more expensive rental arrangement.   I can't just keep paying monthly rental fees to get nothing out of it at the end since docs keep changing their minds. 

I see the ST-A machine offers a plethora of modes such as IVAPS, C, BPAP S, BPAP ST, etc.   If I was to use the BPAP S mode on the ST-A, would I be losing anything compared to going back to a VAuto attangement?  One thing that jumps out is the Easybreathe function.  That doesn't seem to be on the ST-A machine even in S mode.  None of my doctors ever utilized the VAuto mode on the machine so IPAP/EPAP were always at fixed settings on the S mode of my old machine.  I did watch some videos on benefits of the VAuto BPAP mode LeftyLanky27 put out a while back, but apparently no one thought I would benefit so....From my understanding with VAuto mode, Pressure Support is locked at a level and EPAP/IPAP increases or decreases in tandem. I could start at 17/9 and the machine is forced to retain my PS of 8 so it may auto-titrate to 19/11 or 15/7 or whatever.

Transitioning to a new sleep doctor has been a nightmare so far.  I'm stuck with a machine my old sleep doc ordered and no one at the new practice seems to care/understand the dilemma.  They are treating me like I'm a new patient with no machine at all even though I told them so many times where I've come from and what decisions need to be made. I'm inclined to flip the ST-A to S mode and just use the new machine and finish my rent to own period, but also worried if I'm losing some key abilities that may benefit me in the long-term.  I don't know how much of a difference Easybreathe may be making for me.  I am currently using my old ResMed AirCurve10 VAuto machine that is 7+ years old.  I'm sure eventually that machine will wear out so I need to make a decision on how to move forward.

Any advice is appreciated.

[Jay51]

Just a word of encouragement cmpman.  I have made plenty of mistakes so far in my pap/vent therapy.  I've gotten the chance to make the same decision multiple times until I got it right.   Hopefully I have gotten the major decisions correct though.  I hope you figure this one out and make the right decision here.

[cmpman1974]

Is there ever a reason a doctor would prescribe a ResMed AirCurve 10-S unit over a ResMed AirCurve 10 VAuto machine? I'm trying to discuss with my DME supplier and I have a bad feeling I'm going to get the S version. I see zero advantages to it and cost seems comparable. Why would I want a scaled back machine that doesn't offer auto-titration if I want it in the future? I was always using S mode on my VAuto for all those years, but I do wonder if the auto-titration may be of benefit down the road?

I currently use a 17/9 pressure. I see VAuto mode allows a maximum IPAP, minimum EPAP and a set Pressure Support level (PS). If I put in a max IPAP of 20, min EPAP of 6 and PS of 8, I assume my pressures will be titrated between 14/6 to 20/12, correct? I have never tried this mode, but I am curious if the flexibility may help with some of my apnea events I still have on occasion. I'm guessing it could also be bad as well if the lower pressures generate more OSAs or pressure changes disrupt sleep more. Maybe it's a double-edged sword. Has anyone felt VAuto helped them more than straight BPAP-S therapy from a AHI perspective? If so, how?

I find it confusing why someone wouldn't at least want to be able to auto-titrate down the road if an option. It wouldn't seem like that's something insurance would need justification for as opposed to much higher more complex machines like an ST-A or ASV unit addressing specific concerns/health issues.

[Sleeprider]

Both the 10-S and Vauto offer the Easybreath algorithm which can be switched off in S mode. You are currently using S mode, so all the modes that offer backup or ventilator capability don't seem to have much value to you. If this is what is working for you, the doctor should not object. You are trading a machine worth over 4 thousand dollars for one that routinely sells under $1.5K. Are you better off just buying one through a private channel?

[cmpman1974]

It would cost me way, way more to buy private than do rent to buy through my insurance.  It's not even in the same ballpark.  

My main concern at this point is if I ever would have a need for the VAuto mode vs the regular S mode.  I have a feeling the DME will try to Rx the Air Curve 10-S machine instead of VAuto since my doc didn't specify the need.  I don't know if auto-titration on the BPAP is of benefit to me personally, but it seems silly to lose the capability if close in price.  My concern probably is not one my DME or doctor has though so I may be out of luck. I am not concerned about back-up rates or ventilator modes on the ST of ST-A machines since they are not needed as indicated. The ST-A will be going back to the DME.

[Sleeprider]

The difference between Vauto and VPAP-S is only a couple hundred. You seem to do okay with fixed pressure and the machines are identical except for auto-pressure programming.