VCOM & Bi-Level

[eok361]

With respect to the settings I mentioned before. Full Face and no EPR, and ideally CPAP mode. That is what Dr Noah recommends, but if you do a search on this board for VCOM, you will see that most of the 'testers' have ignored that advice. They didn't want to change they way their machines are set up so the 'test' was destined to fail. Honestly even I don't follow all that advice, because I also have some positional apnea and do not need 15 cm all the time, if I sleep on my side I get through the entire night never exceeding 13 cm. So my setup is Full Face Mask and EPR off but Auto set from 12.6 to 15.6 cm.

Wally,

it's nice to see you were willing to at least give the v-com a try. and your results pretty much mirror mine. 

if i added up all the money i've lost trying different masks/collars/tapes/pillows/mouthguards, etc, i could have bought dozens of v-coms. lol

i believe the v-com folks have stated that their algorithm could be written into current resmed machines, but that rm has no interest. i think that's why they are developing their own hardware. i'm curious to see how that goes. i might be interested when it becomes available.

and they repeatedly state to run in CPAP mode, with no EPR.

[Phaleronic]

I have it again, lost the first one, I will try it tonight-turning off FLEX and setting mask type to FFM which is what I use anyway

[SeePak]

Phaleronic, something to consider maybe?.....

I saw a video where an Aussie points out operating differences between Resmed and phillips and another manufacturer (Lowenstein?)

He suggests, i cant confirm, that...

Flex and softpap differ from EPR, in that the inspiration pressure recovery begins BEFORE exhalation is complete.

In my understanding of this, that will eliminate OA events that could have been caused by exhalation pressure , due to flex, softpap or EPR , being BELOW point of OA event.

Comment?

I'm thinking this could be good/bad or indifferent for you, trying the VCOM, cause you already have a full face mask which provides that cushion that we like that possibly absorbs, smoothens, dissipates, pressure changes and

you have a exhalation pressure reduction control, in flex , that could still allow you to use the VCOM and see some advantage, if only in comfort.

Looking forward to your results!

and thanx for trying!!

[WallyPepper]

@eok361

How goes the Vcom experiment?

In my case I have used it every night since I got it and for me (case study of one) it is working exactly as they advertise. It took me a single, maybe two if I am being picky to get used to the difference in EP vs IP but when I got the new APAP it was the same for using EPR. I am still not convinced that EPR serves any other purpose other than comfort setting checked!

I still fool around with my settings some, as I am actively losing weight, with the help of a GLP-1. So I am about to drop the pressure a bit. I am 27 lbs lighter than when I aquired the new CPAP.

In my case the only issue I have is when I try to use the ResMed heated hose, I don't know where to put the Vcom so that it is not on my head. I solved it by extending the heated hose with an 18" hose extender. I just got a Solo pillow mask fit kit so that alone might solve the problem. That is, if I like the Solo mask.

Just a side note, I don't know if you ever noticed this, but you can actually hear the Vcom working. If you listen carefully, in a really quiet room, at the end of an exhale you can hear what sounds like whirring. It is not there when the Vcom is not in the path, and it is only audible at the end of your exhalation. Just an observation.

[SeePak]

Hey pepper

I've been trying out the vcom with a few different masks and a few different spots I bought a hose not heated that goes from the CPAP machine to the mask so I can try any mask and where I'm at right now is I'm using the new Nova micro pillow mask by F&P and I have the vcom back at the small hose that comes off the mask.

I had a few real good nights and I've had some of my regular Crazy Nights so as advertised it doesn't make it worse, the vcom, unless you install it incorrectly  at an elbow right at the mask.

I have had a few real crazy nights lately that really just don't make sense as far as the events that I got and I starting to wonder that the vcom in my testing with my exact scenario does not work properly at all times when installed at the back of the CPAP machine.

And the back of the machine was not the original way that the vcom was intended to be used anyway so that's a bit of a crapshoot to stick it there but others might be getting some mileage by using it that way

 and the way it's helped me so far is that it's definitely quieter and I'm trying to stop mouth breathing however I can't be sure yet that it's happening or helping so I'll continue on since it doesn't seem like it makes things worse.

Glad to see there are those of us still giving it a try so that we can share results and possibly help others if they're willing to try it.

I have not noticed the sound you describe but it makes sense knowing how the vcom works.

The vcom throttles Peak inspirational flows which is the Comfort portion and this effect happens more with higher pressures and the bigger the breath.
During exhale the pressure will have a chance to build back up on the CPAP side of the vcom and the only flow through the vcom would be the Mask exhaust flow so therefore the exhale pressure support from the machine does not get affected.

[WallyPepper]

I had a few real good nights and I've had some of my regular Crazy Nights so as advertised it doesn't make it worse, the vcom, unless you install it incorrectly  at an elbow right at the mask.

I have had a few real crazy nights lately that really just don't make sense as far as the events that I got and I starting to wonder that the vcom in my testing with my exact scenario does not work properly at all times when installed at the back of the CPAP machine.

Every once in a while I am also having what can be described as an out of ordinary night (maybe CRAZY is a better word). I am trying to pin down what I do before bed as my routine is not always the same. For example, did I have an ice cream bar for dessert or cookies at 7 pm, cookies are worse, by the way. Did I drink something other than water with my bedtime medications. Is my nose slightly conjested, etc. Haven't found the repeatable pattern yet, but can't place blame on the Vcom, because before it, I still encountered those 'crazy' nights.

My setup with a heated hose is S10 >> ResMed Climateline Hose >> Vcom >> 18" universal hose >> Mask
Regular setup is S10 >> 45° swiveling elbow >> Vcom >> 6' universal hose >> Mask

I don't remember where the 45° elbow came from, I also have 90° elbows but decided against that because of the drastic change in air direction just before the Vcom.

I don't see much difference in the actual results with different masks, I have tried masks from ResMed, Philips and BMC, now I have the Solo to try out. One of my other issues is that I still haven't settled on a size, I get equally good night sleep with both the Large and Medium P30i, terrible sleep with the Dreamwear pillows in any size, good night sleep with the Dreamwear cushion in either large and medium. I only use the BMC mask (all are full face) when I am fully conjested. I don't normally breathe through my mouth, but I want to train myself to not ever do it and at the moment I also use tape to prevent those two to four times a night that I would expell air through my mouth. It is working for me (again, case study of one).

[SeePak]

hey pepper, will add more later wonderin

do you use the mask setting that your mask is suggested  ie. pillows for pillows

I know you were mentioning about using the full face setting as Noah had said, and that could be a source of issues, not sure, but i was trying it and i think i had some crazy around that time !

will check when i get back.....

[SeePak]

eok361

KPAP next spring, as u mentioned it is coming.

Just thought,  i am due for new machine, was trying to get prescription for aircurve vauto as per this site recommendations etc., no go with doc, then began thinking, maybe just get a APAP maybe resmed 11 ladies , see if the auto would make a diff. ( all the years i have never had auto cpap)

Looking back on this post and seeing your comment about Noah and the new machine,

I'm gonna wait !!

Unless insurance wont cover it !?  yeesh, may need prescription from sleep doc, will see...

[WallyPepper]

hey pepper, will add more later wonderin

do you use the mask setting that your mask is suggested  ie. pillows for pillows

I know you were mentioning about using the full face setting as Noah had said, and that could be a source of issues, not sure, but i was trying it and i think i had some crazy around that time !

will check when i get back.....

I only use full face setting, too much speculation about what the setting actually adjust, but I do know the leak rates of cushions are more than full face and pillows are more than cushions. This is per both ResMed and Philips documentation. The setting changes are likely so minimal to almost be insignificant for our use with the Vcom. So not the cause of the anomalies that only happen once in a while.

One thing I did notice, was when I was taking a statin my sleep got worse each consecutive night I took them. I think that was due to increasing muscle pain that left me uncomfortable every night. No more statins, pain is gone, and I am sleeping better.

[WallyPepper]

eok361

KPAP next spring, as u mentioned it is coming.

Just thought,  i am due for new machine, was trying to get prescription for aircurve vauto as per this site recommendations etc., no go with doc, then began thinking, maybe just get a APAP maybe resmed 11 ladies , see if the auto would make a diff. ( all the years i have never had auto cpap)

Looking back on this post and seeing your comment about Noah and the new machine,

I'm gonna wait !!

Unless insurance wont cover it !?  yeesh, may need prescription from sleep doc, will see...

I was one the same machine for 23 years, this is my first machine that auto-titrates and it is the first machine that actually has data. My old machine only had four settings; pressure, ramp pressure, ramp time, altitude adjustment. It did not even record the hours used. It is so much more fun playing with OSCAR and seeing what really affects the numbers in meaningful ways. My Sleep doctor just lets me tell him what I am doing and then he says keep doing it, absolutely no intervention and no judgement from him.