VCOM & Bi-Level

[Jay51]

#15

07-26-2024, 10:27 AM (This post was last modified: 07-26-2024, 10:40 AM by Narcil.


Narcil posted that if your pharyngeal pressure is at say, 8; then your inhale pressure would drop to 6 and your exhale pressure would rise to 10.  A difference of either +2 or -2 based on exhaling or inhaling. 

It seems like pressure support would be good, in that it raises pressure on the inhale.   

*I provided the link to the post above:  just click on "#15" to go to the original post and thread.  

[Nightynite]

Dr. Noah calls it training wheels for cpap.


https://sleepreviewmag.com/sleep-treatme...adherence/

[eok361]

being fully aware that i'm in the minority, i have been using a v-com with great success in my therapy for over a year. i won't post a bunch of oscar screenshots to show the results. you'll just have to take my word for it. 

everything from flow limits to leaks have been drastically reduced, to the point of being non-factors. my ahi rarely goes above 1 (i don't consider that anywhere near an end-all data point...just mentioning it). 

the one thing i have read somewhere is that the fl numbers (on resmed machines) is incorrect once you place a v-com in the circuit. but i can't get any definitive reason as to why that would be. 

I could see how the perceived extra pressure during exhalation might be bothersome for some, but it doesn't bother me at all. my pressure setting isn't that high to begin with (CPAP @ 10.6). if it were above 12, i might have a different opinion of it. 

since retiring my phillips system one machine in june of last year, and having gotten an as10, i have been through many masks, settings, accessories (tapes/mouthguards, cervical collars, pillows etc) to try to get my numbers down. 

what i have now works. i do feel groggy some mornings, but that's for another thread. i merely wanted to chime in and say that the v-com does work for me. 

but i completely understand if it doesn't for others.

and i believe it's really only meant to be used in CPAP mode. not bi-level or apap with epr.

[MrIvanDrago]

Agreed. I tried it about a year ago and I thought I was using it wrong. I felt like I was suffocating.

[WallyPepper]

@eok361

My expereince is the same as you. VCOM made a huge difference in both the effectiveness and comfort of my therapy. Huge reductions in both flow limits and mask leakage. My AS10 is set to 15 cm of pressure with the VCOM in place, and the RDI (I don't use AHI) is generally around 1.0, and I am actually sleeping longer per session. 

To others who have poo-poo'ed the VCOM without really trying it, all I can say is, "Science that cannot be questioned is religon!"

BTW, I also experimented with two vcoms in the loop and it did not significanly change any numbers, so basically I put in the VCOM on two different hoses that I switch between so I don't have to move it back and forth.

I am also following the suggestions that many have glossed over, such as on ResMed change your setting to 'Full Mask' and turn EPR off as well as I increasing therapy pressure by 1 cm. 

Another side effect, my entire system is now quieter, despite increasing therapy pressure. I am nearing 1 month using VCOM.

[SeePak]

I have now read and watched a few videos for the V-com device as suggested in a few of the posts previously.

******This device is ONLY used for CPAP, no EPR, this is a huge point and consistent in all the literature if have read and watched about the VCOM. *****

Flow/velocity change characteristics during inhale is the V-COM's main selling point.
By reducing flow turbulence CPAP therapy is tolerable for a wider range of new patients. ( and apparently a lot of others as well who have been on CPAP already)
I would have definitely been one of those people, as i was initially ( 35 yrs ago ) put off by the pumping of air into my lungs, getting very claustrophobic with a mask on....

I breathe lightly and slowly usually, except i do have anxiety which is aggravated by this whole CPAP process, which causes me to take large breaths here and there and,
due to the intolerance to CO2 buildup or 'air hunger', this process ends up causing a lot of CA events , stopping of breathing, feedback loops etc. etc. rinse, repeat!

The VCOM allows this flow change to happen without adjusting the exhale pressure, so that is why you cannot just drop your pressure to simulate this device using the CPAP mode.
(i read some earlier VCOM testing posts and i dont understand why someone had problems exhaling while testing the VCOM, cause the EPAP stays the same!!)

Also saw testing where the flow limits were less, but 'all over the place'? ( could we see the oscar graph)

Also saw a tester that had OA events before testing and none with the VCOM and 0 time in apnea. That sounds good to me, but they woke up trashed or something like that.

Also comments that 'all results i have seen are negative', well there have been at least 2 people, and probably more stating in this post that it worked, so hopefully that now means there now are people being heard of with good results !?

(I think bias testing is happening here, hard to control that.)

And what looks to be common ground here on this website and with the VCOM people is that EPAP is what maintains airway . at least i think that is the concensus, correct me if i am wrong, and sorry in advance if i am wrong )

so, for me, if the feeling of air inrush is lessened AND i can have same exhaust pressure, VCOM should work for me too, however,

It seems that the higher the pressure prescription, the better the results with the VCOM. ( my therapy is only 6 to 7 cm )

The majority of people i see on this website ( seems to me ) have much higher pressures than what i am accustomed to.
They would have more chance of success i believe. ( physical size, obesity will affect performance apparently of the VCOM)

Maybe we could pass one of these around, share the expense and experience?

Also, Steven Covey wrote a book called '7 habits of highly effective people'. In it he describes a whole tribe going thru the forest cutting down trees looking for something,( i cant remember what) when suddenly the leader climbs the tallest tree and yells "Wrong Jungle"! But all the bosses say, nvever mind, we are making progress !!)

I've seen a lot of contradictory thinking even on this site, we need someone to climb that tree!!??

Any takers?

[eok361]

Maybe we could pass one of these around, share the expense and experience?

Any takers?

I'd be willing to foot the 30 bucks, if folks were interested in trying it out, on a "you try it for a week or so and pass it along" basis. 

The Aussie youtuber did a test with like 17 people to see its effect. Most of the numbers were improved, but that was a small sample size.

But i get the feeling that not too many folks here would want to try it. 30 bucks isn't exactly a bank account breaker to try something.

[SeePak]

Hey eok

what comes to mind, for me, is all the $$$$ spent on masks etc. that are suggested.
and i'm not complaining, just trying to put some levity to the griping about $30 and it dont work.

Actually, it probably/possibly does work, just have to try it longer, maybe?

also, i tried the full face mask setting while using my dreamware mask last night.
though i did not adjust pressure up, actually i put it a bit lower.

It seemed to feel maybe a little less air rushing, not sure, however...

Almost absolutely no leaks last night!

Not sure if this will be a one off, but gonna keep it for now as my setting.

Sleep was decent too.
thanx pepper !

looking into amazon for a VCOM too, ....

[Old Steve]

The guy that invented the VCOM said this is what they are working on now and that it will replace the VCOM, perhaps by 2025. .  KPAC, here is more info. 

 https://sleeplay.com/blogs/news/what-is-kairospap-a-new-sleep-apnea-treatment

[WallyPepper]

@SeePak

Even if you don't believe a single word from Dr Noah about the VCOM, at least this much is true, CPAP machines are designed and built by engineers, not doctors. The doctor says to the engineer, 'I need a specific pressure at the mask and don't let it drop', then they are done. It is the engineers that make that work. So we are stuck with technology that is over 40 years old. Since that time all that has been done is tweak for comfort and compliance, but nothing about the underlying tech has changed. A lot of people here routinely will tell you that you must use EPR or that APAP is the only way to go, because it works for them. Again, those additions added to the top of this tech were built by engineers. And no meta-analysis indicates that compliance increases with their use.

So, we get a lot of 'It's always worked this way, we don't/won't look at anything else/new/modification' that might actually make therapy better/easier to increase efficacy or compliance.

I am not saying that VCOM or KPAP is the magic bullet, it will likely be that it is not for everyone. Putting up samples of one that may have only used a device or methodology for a day or two is not a basis for drawing a conclusion of whether or not something works. Come on, people we spend more time evaluating masks. And, repeating their thoughts on every page of this thread does not make it more true. When I set out on my CPAP journey (April 2001) my machine didn't even have a timer, so it can't even tell you how long it has been run. It has three settings, Pressure, Ramp Time, Altitude Adjust and that is it. By the way I still have and use that CPAP on occasion. So when I first learned of VCOM, I came here and to the other main Apnea board to see what people thought, but did not pass judgement because I had not tried it myself. Thirty dollars was a small price to pay for an experiment I could do myself, to draw my own conclusions. I have spent way more that that on a single mask fit kit, only to put that mask aside for another equally as expensive. Is it perfect, no it certainly isn't! But in my case study of one it did make a significant difference in both sleep quality, the feeling of refreshment as well as the data itself. But I am also working on my 27th night of using VCOM. I would never have gotten these results if I gave up on it within the first week of use.

With respect to the settings I mentioned before. Full Face and no EPR, and ideally CPAP mode. That is what Dr Noah recommends, but if you do a search on this board for VCOM, you will see that most of the 'testers' have ignored that advice. They didn't want to change they way their machines are set up so the 'test' was destined to fail. Honestly even I don't follow all that advice, because I also have some positional apnea and do not need 15 cm all the time, if I sleep on my side I get through the entire night never exceeding 13 cm. So my setup is Full Face Mask and EPR off but Auto set from 12.6 to 15.6 cm.