Using Vcom : do i adjust my EPR?

[enjoysleep59]

Thanks for this post. I'll make the necessary changes and follow up with the group. My 6-mount 95% pressure has been 11.6 cm H2O. Following your guidance, I'll set the RM10 to 10.6 w/o EPR and see how a 7-day chart looks at the end of the test.

[Sleepy Quixote]

@Crimson Nape

Red,

Per your instructions - 

"Record your 95 Percentile EPAP pressure that is working for you.
Set your machine to the static pressure CPAP mode
Set the pressure to 1 cm below the pressure from step 1.
EPR to Off
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?"

My conclusions - 

Followed the instructions as stated. My CPAP pressure was 7.6 due to my 95% APAP averaging 8.6

Ran the trial for 7 days

During the 7 days my Flow Limits 99.5% average was around .18 vs an average of .06 for APAP running an EPR of 3

Aerophagia increased, GERD increased despite forcing my self to sleep on left side with a wedge pillow for inclination.

Leak rate increased, found leakage more difficult to manage and more disruptive. 99.5% average around 8.00 vs high 4s with outliers removed for APAP with EPR.

Notable Eustachian Tube discomfort extending through the day, not experienced since I enabled EPR months ago.

Overall breathing discomfort increased compared to using APAP with EPR enabled.

I accidentally left EPR enabled the first night of the trial and can say it is definitely not a good idea to run EPR while using the V-Com judging by the next mornings numbers.

The only minor improvement noticed was a slight reduction in the number of central apnea experienced. Average of 3 or so vs an average of 5 or so using APAP with EPR. Clear Airway events (non central) were about the same. Not enough of a difference for me to consider changing systems due to all of the other disadvantages. For someone who experiences a significant number of centrals the weight of choice may be different.

[Crimson Nape]

Thank you! I didn't mean for you to suffer just to meet my request. It would seem that this device may be a last-ditch effort on addressing CAs before having to buy an ASV.

Thank you once again for your effort.
- Red

[Sleepy Quixote]

Hey Red,

You are very welcome!

No suffering, just diminished efficacy which was worth it. I had been experimenting with the V-Com for reducing centrals but had little success due to not understanding how they meant for it to be applied. Your analysis of their info and correct interpretation of application made it worth while for me to give it a spin again. I did it for all of us, including my self.

I'm retired so I can afford to fiddle with things and experiment with little need to worry about negative employment outcomes. If the experiment were to have proved to be too negative I would have stopped it, so no worries.

You and all the other regulars put in untold hours of effort to benefit the many, it was the least I could do to contribute and pay it forward.

SQ

[PamFR]

I've read through all this (and another V-com thread from a couple of months ago), and I'm fascinated that my experience is so different. 

After 4.5 months APAP for mostly OSA, I was averaging 2-4 bad nights a week, where bad = 3-6 hours of actual sleep (or as close as I can tell from a couple of trackers) and AHI 3-6. Desperate to try anything that might work, I happened upon VCom. That was 19 nights ago.

Immediately upon using V-Com:

• Zero nights under 6 hours of actual sleep. 
  During this period I would have had 5-9 nights of short sleep.
  
• AHI went down to 1-3.
  
• Pressure used slightly lower (more like 11 than 12, within my APAP range of 8-13.
  
• All amazingly good whether wearing (mostly) pillows+Somnifix or (occasionally) Evora full face.
  
• ==> So I could drive again, expand my work schedule, work and parent like a smart person, etc.
  

The only bad night I had was last night (which gave me time to read your posts!). I woke up after 1.5 hours sleep with the worst aerophagia ever, ever, ever. Took 45 min of yoga twists and squats until the pain went away. 
Then I saw: I had forgotten to put the Vcom on! Maybe I'm addicted to it now?!!


Oddly, I've tried VCom with EPR=2 and no EPR, and it makes no difference, although I feel most comfortable with EPR on. 

This is so different from your experiences, and so dramatically positive for me.
Fascinating.

-Pam

[Lucky7]

So, I'm the "new guy" here and haven't tried the device (but that's the plan), but I will say this:

There are multiple video's from the inventor of the V-COM online, Dr. William Noah. He has a huge practice with thousands of referrals a year apparently. And, apparently has been at this for 37 years.

The video's are, shall way see, rather illuminating.

Cheers everyone.

[barney999]

All the comments in this thread, which is the biggest on Vcom that I found, are from 2023.  I didn't find any 2024 Vcom thread.

Can anyone provide updates to their 2023 experiences, or perhaps those who've tried it/used it in 2024 can provide their experience?

I'm most interested in knowing if Vcom would allow me to not have to tape my mouth while still maintaining my low AHI, but I'm also interested in how it worked or didn't work for others in general.

[enjoysleep59]

I've been using the V-Com for over six months now, maybe longer. I have the ResMed Air Sense 10 with a heated tube and the ResMed AirFit F30 full face. I have used it with a ResMed P30i nasal pillow mask, and it does help but I tend to open my mouth anyway when I'm sleeping. So, for me, I still have to tape when using the P30i. I saw a product in one of the news feeds that looked interesting, but I have not tried it. It web page is mouthshield dot com.

As far as the V-Com is concerned, I find it much better with it than without it. I am currently running my pressure at 11.8 cm of water with the EPR set to 1 and I'm usually 1.5 and under on the AHI. I've had nights in the 0.45 ranges with 7 to 8 hours of sleep. So, I can't complain.

[Tsunami64]

I am returning to CPAP therapy after more than 5 years absence and am having difficulty adjusting including swallowing so much air that I am very uncomfortable all day. My prescribed pressures are much higher this time around due to a significant weight gain. I tried the VCOM hoping to alleviate swallowed air and could barely breathe out against it. I do have a naturally weak expiratory flow to begin with. I lowered my EPR from 1 to 3, set to APAP, and still had trouble exhaling. The product worked as advertised in that I did not feel a huge flow going into my mouth and inhalation was easier but exhalation was harder. I felt like I woke up with the same abdominal distention.  Very interested to follow as more members try this device.

[Phaleronic]

I just picked one up and I've watched a few videos about the device on youtube (LL and Nick)-they both state you shouldn't use EPR/FLex with it, but I really like cflex+ so I'll give it a shot tonight Good thread y'all