Resmed ASV vs Dreamstation ASV

[Justanotherguy]

I bought the VAuto, I read titration should be upping EPAP until no obstructions, and increase IPAP from there. However on the opposite side I read that a lot of UARS people need a higher than minimum EPAP to keep the airways stable. What are your thoughts on that?

[Sleeprider]

As you do more posting your allowance for images will increase. Your next membership level comes at 20 posts http://www.apneaboard.com/forums/Thread-...-explained

I often use Imgur for images as it provides more flexibility when more images or off-topic material is wanted.

[Justanotherguy]

As you do more posting your allowance for images will increase. Your next membership level comes at 20 posts http://www.apneaboard.com/forums/Thread-...-explained

I often use Imgur for images as it provides more flexibility when more images or off-topic material is wanted.

Thanks, any comments on the two previous posts? VAuto titration and issue finding?

[Sleeprider]

I think your conclusions on titration strategy for the Vauto are right on. It's trial and error with an underlying methodology. We have a good UARS article and the use of bilevel in our wiki here. I'm sure you will recognize Dr. Krakow. http://www.apneaboard.com/wiki/index.php..._and_BiPAP

[Justanotherguy]

Yes I am aware of both Krakow which I had a consult with, and the Wiki which I read completely, very good material indeed.

I'm still fuzzy on the logic of titration. Just to make it easy, let's assume this case:
EPAP min 4
PS 4

Now you notice some obstructions >
EPAP min 5
PS 4

Obstructions are now gone, flow limitations still seem apparent and/or sleep is not refreshing. Do you then raise PS (to increase flow) or increase EPAP to increase possible stability of the airways? That is the part I still don't get, or able to reason which one to choose.

[Sleeprider]

EPAP can serve several functions in addition to preventing obstructive apnea, so it's common to have a higher EPAP pressure than the minimum needed for OA. EPAP maintains a stent in the airway that improves flow, particularly in the nasal and nasopharynx. It can also recruit lung volume by raising PEEP, and it overcomes a perception of claustrophobia or air starvation that can be common with pressures that are too low. A basic tenet of ventilation is that EPAP controls oxygenation, while PS influences flow and volume, but they do interact. EPAP plays an important role in many functional and comfort variables, and unfortunately is difficult to quantify. PS can help reduce inspiratory time, improve peak flow-rate increase tidal volume, and help normalize flow in a restricted airway. Sleep science is all about the numbers, AHI, RDI, Vt, Vm, Ti etc. The art of bilevel titration is to realize that the "rules" of titration are just guidelines and finding comfort and efficacy is an ongoing assessment of qualitative factors.

[Justanotherguy]

It's not science.... it's art hehe. Gotcha, I am supposed to receive my VAuto beginning next week. I guess I'll start off on 6-18 with ps 3, and titrate from there.

[Justanotherguy]

I am supposed to receive the VAuto today or tomorrow, I also got the heated line which I've never used before - any recommendations on what to set that on?
Additionally, do I start the VAuto on the following?
Epap min 8
Ipap max 25
PS 4
Trigger high (or medium?)
Cycle (default?)
Humidity/tube temperature (?)

[Sleeprider]

Your pressure settings should be a good start. I'm not sure I would suggest a maximum pressure over 18 given your history because we will ultimately use EPAP for obstruction and perhaps hypopnea, but treat flow limits that raise pressure with PS. Start with trigger and cycle on medium, and if you have centrals, we will raise trigger sensitivity to high or very high. I'd rather get a good baseline. You may want to raise Ti Max to 3.0 seconds to avoid the machine cycling when you take a longer inspiratory breath. It generally won't affect anything, but you will notice shorter cycle times during a long, low-velocity inhale.

I use manual climate settings. The heated tube remains lower than body temperature and is mainly to prevent condensation on the tube-wall. I tend to use ah humidity setting of 3 or 4 (lower in summer) and a tube temperature around 78-80.

[Justanotherguy]

I just received it and set all the settings accordingly. I also got another person go through my sleep study and he said the PLM I have could make things worse - or be related to the fatigue. I took levocetrizine, tylenol, magnesium, melatonin and valerian root before sleep yesterday and had a top 5% night at least. I only feel slightly fatigued at the moment, which is very rare. I hope I can get this as a new baseline. I can post OSCAR screenshots tomorrow - but I guess I have to remove old screens for that as I'm on the edge of the limit as of now.