Using Vcom : do i adjust my EPR?

[Crimson Nape]

I scoured the V-comm site and the best I can find is their device adds about 1 cm to the set pressure.  This is the complete inverse of EPR (EPA???).  If this is the case, then In order to test this without having to buy one of these, I'm asking someone to try my idea.  

My idea:

1. Record your 95 Percentile EPAP pressure that is working for you.
   
2. Set your machine to the static pressure CPAP mode
   
3. Set the pressure to 1 cm below the pressure from step 1.
   
4. EPR to Off
   
5. Try these settings and see how you feel and how your events are effected.
   

In theory, this should reduce your IPAP pressure to 1 cm below your optimum EPAP pressure.

Thoughts? Any guinea pigs?

- Red

[Sleepy Quixote]

@Crimson Nape,

Exactly, everything I've read about the V-Com is that it should help those with centrals, due to the ability (necessity of) to turn off EPR. I'm prone to centrals so I gave it a weeks trial, what I found for me, it did reduce my few true central events but degraded my flow limit management and degraded overall sleep quality, wasn't willing to keep testing because I'd have to start fiddling with settings again to try to dial it in. Went back to my old tried and true, sleep with my head under the covers creating a pocket of co2 rich air around my head. My pressures are fairly low and running EPR I can definitely feel some of the warm air initially on inspiration indicating it's being drawn in despite the positive pressure in the nasal pillows. Also can put my hand over the vent of the mask and feel the reversal of flow initially on inspiration, providing just enough re-breathed air to mitigate central propagation. Any time I wake up during the night I intentionally do not re-cover my head and sure enough within an hour I get a few centrals.

My experience with the V-Com:
Helped centrals
Reduced noise a little?
Reduced Flow Limitation management effectiveness (for my settings)
Increased expiratory effort
Degraded overall sleep quality looking at my flow rate wave form and simply how I felt in the morning.
As others noted, might be better for someone newer to CPAP because they'll be adjusting settings to dial in anyway, I just wanted to get back to comfortable sleep.

[Sleepy Quixote]

@Crimson Nape,

You got the test procedure in there as I was writing the appraisal so did not see it till after I replied to your early thoughts.

I'll use your test in a week or so. I'm currently wrapping up my post V-Com test period of 6 days with and six days without. Then want a week to chill on testing and just sleep.

I copied your instructions into another doc so I wont have to go searching for it later.

Where shall we post results from your test structure?

I'm willing to give it another shot, would like to get my head out...      from under the covers. ;\

[Crimson Nape]

Since it basically is dealing with initial setup, I would recommend keeping here. That way, someone getting one of those little puppies will have these posts as a guideline. . . or not.

- Red

[Sleepy Quixote]

[Sleepy Quixote]

@Crimson Nape

One question before kicking off the V-Com test next week. During my initial test I added an 18 inch extension to move the V-Com away from the top vent of my Rm P30i due to noise in the headgear, it created some odd venturi that made the noise INSIDE the headgear unbearable, the headgear runs right by my ears, I have bad tinnitus and this sound in the headgear caused the tinnitus to go through the roof. Both Lankylefty and Niko (I know, I know, good for some info... eh) both acknowledged that the V-Com increased noise for top mount headgear mask folks and recommended an extension to move the V-Com away from the junction at the top of the head. I bought an 18 inch extension tube, it did resolve the sound/noise issue but broke the V-Com rule that the V-Com must be installed AT the mask vent not further away. Is this a waste of time? I wont be able to tolerate it connected at the vent as V-Com recommends. Another note is before the test commences I need a different extension, possibly shorter, that has a different diameter on each end, the one I purchased was same on both ends that fit the smaller diameter of the V-Com which forced me to push the larger diameter end of the V-Com into my climate line, which almost distended it to the point of no return. Was able to soak the end of the climate line in very hot water then cool it to get it back to size, don't want to risk it again. Will happily buy an adapter for the test, Niko claims (I know) a short stub [it looked about 6 inches] resolves the noise problem without compromising the V-Com guidelines, I just cant find one anywhere. I'm hoping you know the diameters needed off the top of your head and can point me to where to buy a shorty like that. If you don't know the diameters, I can get them for you, the main problem is, I couldn't find a super short tube anywhere with same diameter on each end let alone different for each end.  

Thanks

[Crimson Nape]

One of the few standards in the CPAP arena is the hose fitting diameter.  A standard size has a 22mm ID.  This means that you need to find an extension that has a 22mm ID on one end and 22mm OD on the other.

Now that I answered your question, please don't go spending any money on one of my "hair-brained" ideas.  It didn't occur to me that certain masks don't play well with this device.  

Thanks for considering trying it.

- Red

UPDATE: A quick search turned up this little item at Supplier #26. Do a search for, "SP-FT".

[Sleepy Quixote]

@Crimson Nape,

No worries, your "hairbrained idea" is actually probably close to what the manufactures envisioned but were unable to communicate (considering all the confusion and options). I'm all in for experimenting to find more pathways to efficacy, I'm signing up because it would be great for me to continue good therapy aaaaand ditch the EERS. It would be great if we had another option for those who have central apnea and no way to mitigate them without compromising OSA therapy with the cookie cutter APAP therapy assigned. I'm looking for the "short" extension needed for my own purposes. 

[Sleepy Quixote]

@Crimson Nape,

Got the info needed, cool adapter pack coming for a whole 9 bucks, exactly what I needed for this experiment and probably several more, thanks for the dimensions. As far as I'm concerned, if the data we get from this "hairbrained idea" can help untold numbers, or even one, its worth it. This V-Com thing has so many hoping for so much and due to communication delivering so little, if we can add yet one more viable tool to the CPAP tool kit that benefits those outside the cookie cutter PAP world all the better. From what I read, I believe their data, the problem is real world application, that is the problem ApneaBoard deals with every day all day, real world application of the theoretical, magical PAP, and helps people make it work for them in real life. I really believe this thing can help some of us. I want to give it the best shot. I fit the profile, mild to moderate apnea complicated with CA. Got the OA, H, Rera, and CA, (centrals and clear), all dependent on environment and therapeutic settings. I'm not looking to debunk the thing, I'm looking to validate it, not as the miracle they are pushing as, but as the viable tool I believe it is by looking at their data.

[Sleepy Quixote]

@Crimson Nape,

Just don't know how to construct the experiment in a valid reproducible way, because I don't know this beyond my little tiny world. You do. Lets make this experiment real, tell me what is needed for control, I'll give you any baseline data necessary and will document all that's needed to make this the real deal. I'm dialed in pretty tight right now therapy wise, low leak rates, low flow limitations, low AHI but with recurrent (minor/occasional) centrals controlled by basic EERS.

For me personally, what is important here is figuring out if this device can help, and if it can, who do we suggest it to, and how do we suggest people apply it.

I'm retired, if I have a sucky day because last nights experiment didn't go as expected my family doesn't suffer because I lost my job. My wife, the chickens and ducks may not agree, but that's between you and me. 

Let's do this.

Yes?