Using Vcom : do i adjust my EPR?

[theredheadsaid]

So ive been on CPAP since last summer, and found i do pretty well with EPR at 1. (My pressure is between 10-12). 
So, since the VCOM kind of acts the same as lowering the EPR (from what i understand), should i then raise my EPR back to 1?
I got the VCOM today, and tried it out quickly. It feels HARDER to exhale with it on! 
Just to test, i put EPR up to 3, and still feels hard.
I was testing it on dreamwear nasal, i’ll try it tonight with full face and see what that feels like.

[Nightynite]

It’s so new there’s probably not a lot of info. for users yet with settings. I bought one a few days ago and waiting on delivery. Experimenting is all you can do I would think. Good luck and please report back on how you’re doing with it and what you had to do.

[cdplatt]

V-com is supposed to lower inspiratory pressure below expiratory pressure supposedly to increase comfort, reduce noise, leaks, etc. It should not act the same as lowering EPR, but it isn't clear how the device will interact with EPR  You should not have to adjust EPR back up.  If the thing is making it more difficult to exhale, it seems to me it's not living up to its hype.  It should be increasing the comfort while inhaling while maintaining exhale pressure.

[Crimson Nape]

That's counter to any CPAP that I'm aware of. Normally, you want your Inspiratory Pressure (IPAP) to be higher than your Expiratory Pressure (EPAP). That is how a Bi-level or an ASV operates.

- Red

[theredheadsaid]

UPDATE: i tried sleeping with the VCOM last night. I left my EPR where it had been (1). I felt like i couldnt exhale well but i thought i’d try itZ i woke up an hour later. I looked at my machine, and in one hour i had 2.2 apneas. My number is rarely above .5.
This was with a nasal mask. I’m curious to see if it would be any different with a full face, so i’ll test that before giving up. But, it doesnt look gpod.

[gainerfull]

Although the sleep res site says it works with bipap (and EPR acts like bipap) you may try it with EPR turned off. That's at least what I gathered after watching Lefty's review on youtube:

https://www.youtube.com/watch?v=_DImKq7xaGs

[Nightynite]

theredheadsaid,

Thanks for the feedback and taking one for the team. I suspect this device is being marketed to the untreated just like a good percentage of their sales information says. So the new people to cpap may adjust easier since they have no history with apap/cpap. Since your now a veteran of cpap and enjoy easy breathing, installing an obstructive device in your hose is going to change all of that and require adjusting not only to your settings but probably on how you breathe. Thanks again for your update.

[gainerfull]

That's counter to any CPAP that I'm aware of.  Normally, you want your Inspiratory Pressure (IPAP) to be higher than your Expiratory Pressure (EPAP).  That is how a Bi-level or an ASV operates.  

- Red

They address this in their whitepaper:

"For 30 years, much focus in treating obstructive sleep apnea (OSA) with positive airway pressure
(PAP) therapy has been increasing inspiratory PAP (IPAP) to maintain therapy and reducing
expiratory PAP (EPAP) for comfort. First, bilevel PAP devices, then expiratory PAP (EPAP)
reduction algorithms, and later mask resistance compensation algorithms were introduced, but
this concept of IPAP > EPAP has not improved adherence and review of the literature suggests
that this focus on IPAP may be misguided. Reducing EPAP decreases both pharyngeal cross-
sectional area and wall stiffness which increases inspiratory resistance and effort, potentially
increasing arousals and work of breathing (Analogous to drinking through a thinner straw with
more collapsible walls). Our hypothesis was that reducing IPAP below EPAP (similar to early PAP
devices) may improve comfort and decrease adverse effects. Since no current PAP device can
reduce IPAP below EPAP, we developed the V̇-Com™ as a novel way to reduce IPAP and test our hypothesis."

https://sleepres.com/wp-content/uploads/...ev-2.0.pdf

Note: I have no vested interest in this device and have ordered one for myself with low expectations but curious to try it out to see if it benefits my therapy.

[Gideon]

Keep in mind that EPR has tremendous therapeutic value in treating hypopneas, RERAS, and flow limits.

[Gideon]

Titration 101

EPAP to maintain, splint, the airway
IPAP (difference between EPAP and IPAP ) to treat Hypopneas RERAS, and Flow Limits

This is not what I read in their documentation (see Reds post above)