V Auto settings IPAP EPAP PS

[Dusk2Dawn]

Hello  all,

   I’m using a RESMED  Air Curve 10 V auto, and a few questions on settings, hope someone has some insight.          [[ eph ….. events /hr ]]

    When using  therapy mode  (s)  from the Dr.,   the screen shows a bar graph  with both the  IPAP of 14  and  EPAP 11 showing , and  the PS  [ whatever that is … covers that range   PS = 3  in this case ] so the bar graph shows from 11  to 14   and  PS = 3  being used.  

  When I enter the  VAuto  mode, I set the  Max  IPAP to 13  and   min EPAP to  10.2  values,  but  PS  shows  0.6  ( I could change the PS if I wanted to.. but that was not mentioned in the ApneaBoard settings  guide, section 1 ).    

  Now  when I lie down to sleep, the  bar graph shows  10.2  and 10.8 , but when I check in the morning it shows  11.2 - 11    [ may add I’m getting   < 1  eph  and better #’s  than the Dr.  settings !  ]

My questions are…  
1.  what is  PS  stand for, what is it for,  and should I change it for  V Auto mode ?
 2.  If  bar graph shows   11.2 -11.8  in the morning with the mask on  , does the  Resmed ever reach the IPAP setting of 13 I entered ?  
3.  In V Auto  mode   does the  Resmed  sense  the level I need  for IPAP  and  EPAP  and  adjusts them  between  those 2 levels for best results ?

[Sleeprider]

Welcome to Apnea Board. PS is "pressure support" and is the difference between inhale positive pressure and exhale pressure (IPAP-EPAP=PS). The PS setting is only available in Vauto mode, where you set a minimum EPAP pressure and maximum IPAP pressure and use the PS setting to set the difference. For example, you could try Vauto mode with EPAP min 9.0, IPAP max 16.0 and PS 4.0 if you want higher PS or 3.0 which would closely match your current therapy and give you auto-pressure adjustment.

Ignore the bar graphs on your unit display. Download the free OSCAR software which will show you a graph of all important pressures, respiratory rates, flow limits, events and much more through the night. It will help us to help you to optimize your therapy. There is much much more to be seen with Oscar, but you will need to have a SD card (2.0 to 32.0 GB) in the slot on the left side of your machine.

In Vauto mode, the machine will detect your breathing and can identify flow limitation, snoring and other precursors to events and will proactively raise or lower pressure as needed. IPAP and EPAP move together and always maintain the set PS.

Please download OSCAR and we will help you optimize the settings to make therapy effective and comfortable. The links in my signature also point to our wiki articles on therapy optimization and other common issues and questions.

[Gideon]

Welcome to the forum.  I'll try to answer your questions but I do encourage you to download OSCAR and post the nightly charts.  There is much we can see at a glance of those charts that we would never see with a verbal description.

Your machine is a ResMed AirCurve 10 VAuto.  This is considered to be a BiLevel machine.
You are in Mode "S" or Spontaneous which means you initiate your breathing "spontaneously" without help from the VAuto. You can think of this a "Manual" mode.
In "S" mode you have two basic settings, EPAP and IPAP, both of which are fixed and will NOT change over the night. 
PS or Pressure Support is simply the difference between IPAP and EPAP pressures.


VAuto mode.
Settings 
Min EPAP. the lowest pressure that the machine will use, also the starting pressure.
Max IPAP. the highest pressure the machine will use. You may or may not reach this pressure
PS. This is a fixed setting.  It is added to the current EPAP to determine the current IPAP.  It is still the difference between EPAP and IPAP

Jumping to your 3rd question.
Sort of.  ResMed devices, VAuto included, respond to obstructive events to increase pressure, in this case, the active EPAP pressure.  The first 'event' it detects is the Flow Limit, the smallest of the obstructive events and when detected increases the active EPAP pressure.  The algorithm also responds to hypopneas and obstructive apneas.  The theory is that by responding to the flow limits your machine can increase pressure and thus prevent future obstructive events.  After a period of time with no events, including flow limits the pressure will decrease. IPAP follows EPAP by the amount of the PS always being only that much higher.
So the machine doesn't know or sense what your needs are but instead just reacts to events.  

Question 2.
apparently, the machine did not 'need' to increase pressure to head off very much.  With more 'events' it would have maxed out.

Should you use VAuto mode?  We tend to favor an Auto mode. BUT I'd like to see at least detailed summary data on your doctor's settings before recommending a change.  Detailed OSCAR charts would be better.  What I want to check out is the specific makeup of the events that occurred with your doctor's settings.  I am thinking that the added events are mostly central as that seems to follow what you describe.  But I could be wrong and the answer would impact my setting suggestions.