VAUTO- Where to next?

[zzzZorro]

This chart from last night should show as 17/22 with a PS=5.0  (EPAP was raised from 16 to 17cm from the night before it)
[attachment=8848]
 
I am trying to decide where to go next.  I have been called “consistently inconsistent” and that has proven true.  My machine is an AirCurve10 VAUTO.  Some runs are consistently very good, but then the chart can just go off the rails.  Some of you may recognize the following statements as being yours.  I have been studying them to see if there is improvement to be had.
 
“The first step is to optimize your settings to provide a narrow range of pressure that is effective.”  (Went to EPAP 17cm)

 “A good first step is to increase the minimum pressure to equal your current average or median pressure.” (set based upon previous night’s EPAP (med) 16.70cm)

“EPAP controls OA, and PS is for comfort to make breathing easier and treat flow limitations, snoring and hypopnea.” (PS set 5cm)
 [attachment=8849]

Flow Limitation has been a challenge, even when the AHI is very good. The raised EPAP and/or the PS increase to 5.0 has provided perhaps the best FL I have seen so far. I found the following article is interesting:

Flow Limitation vs AHI https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688581/
.. an experiment in which two groups of patients diagnosed with OSA were treated with different CPAP pressures. The first group was treated with CPAP pressures targeted to eliminate flow limitation and the second group treated with CPAP pressures targeted to treat apneas, hypopneas and snores. The pressure requirements for the first group were higher than for the second group; however the first group had an increase in sleep time and more consistent improvement in maintenance of wakefulness testing [59]. These results are suggestive that titration to eliminate flow limitation would lead to improved clinical outcomes.

Any ideas?  

[Walla Walla]

Normally and Higher pressure support is recommended to get rid of flow limitations. However in the past you had a problem with clear airway events due to increased pressure support. You've been using the machine for a while now so you might try increasing the pressure support again and see if it triggers clear airway events still. If not than increasing pressure support is the way to go. But if it triggers clear airway events it may be time to consider going to an ASV if health permits.

[zzzZorro]

Normally and Higher pressure support is recommended to get rid of flow limitations. However in the past you had a problem with clear airway events due to increased pressure support.  You've been using the machine for a while now so you might try increasing the pressure support again and see if it triggers clear airway events still. If not than increasing pressure support is the way to go. But if it triggers clear airway events it may be time to consider going to an ASV if health permits.

As I understand it on a VAUTO, PS should not exceed EPAP and IPAP settings.  PS=5 is the difference between 17 and 22cm.  If it is increased to PS=6 without either Raising IPAP or Lowering EPAP first that wold not be the case.  Am I right or wrong on this assumption?

[Walla Walla]

I was looking at the chart where your PS was set at 1.8. Missed that you had tried it at PS of 5. To answer your question about the PS yes you have to raise the maximum IPAP to allow room for the pressure support. Once you reach 25cm maximum on the IPAP your limited.

[ardenum]

I run in three-s, one great day, then slightly worse, then 20 AHI on third day, then again great one, and so on, I learned to cycle between nasal and mouth every 2-3 days, it keeps my Ahi around 5 everyday, I also cycle slightly with pressure, on top of having different pressures for nasal and full face.

Not to mention this is all thanks to having alot of junk removed during UPPP and turbinectomy. Before even pressure 25 didnt break my OSA.

Maybe its time to go under the knife?

[zzzZorro]

-But if it triggers clear airway events it may be time to consider going to an ASV if health permits.

Thanks Walla.  Apologize for a poorly worded question. Meant to express as:
'Staying with the VAUTO and asking for any suggestions with adjustments to it?'
Usually under AHI 5 but bounces around- Sure insurance would not spring to replace a one year old machine.

I just set it for tonight at 16/23 PS+6 and will see what happens..

[zzzZorro]

-Maybe its time to go under the knife?

I'd rather subject myself to a third sleep study (aintagonna happen)

[Kosoku]

I found with my Vauto, that once I up'd the Trigger sensitivity to Very High, it eliminated nearly all of my CA events. Also, when I switched Cycle to Very High, it eliminated nearly all my Hypopnea events. I now have a very consistent AHI of 1-2. I just find the very high setting to be more comfortable for me as it switched instantly when I breath, however everyone is different.
Basically saying if you have not tried those settings, give them a shot. Was what made my VAUTO work wonderful for me. That and the releaf and the new FFM and tennis ball shirt.

[zzzZorro]

I found with my Vauto, that once I up'd the Trigger sensitivity to Very High, it eliminated nearly all of my CA events. Also, when I switched Cycle to Very High, it eliminated nearly all my Hypopnea events. I now have a very consistent AHI of 1-2.  I just find the very high setting to be more comfortable for me as it switched instantly when I breath, however everyone is different.
Basically saying if you have not tried those settings, give them a shot. Was what made my VAUTO work wonderful for me. That and the releaf and the new FFM and tennis ball shirt.

Thanks Kosoku for the response.  Trigger and Cycle are about the only things I have not tried. Will go there next.
Much appreciated..

[Kosoku]

I found with my Vauto, that once I up'd the Trigger sensitivity to Very High, it eliminated nearly all of my CA events. Also, when I switched Cycle to Very High, it eliminated nearly all my Hypopnea events. I now have a very consistent AHI of 1-2.  I just find the very high setting to be more comfortable for me as it switched instantly when I breath, however everyone is different.
Basically saying if you have not tried those settings, give them a shot. Was what made my VAUTO work wonderful for me. That and the releaf and the new FFM and tennis ball shirt.

Thanks Kosoku for the response.  Trigger and Cycle are about the only things I have not tried. Will go there next.
Much appreciated..

Just wondering if you had a chance to test and whether or not Trigger and Cycle settings helped?