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i was able to locate a barely used aircurve vauto 10 this weekend. i used it in CPAP mode, since that's how i've been using my airsense 10.
i probably shouldn't, but i'm curious to see if any of the bi-level settings might help me more than the CPAP mode. I've been dialing those in for over a year with excellent results, so i'll more than likely just stick with that. i am curious to see if there's something i can try to maybe make it better.
my main events are hypopneas or reras. i have a very rare instance of OA, but hardly ever a CA. i do have flow limit issues at times, but not much over .20.
on average, my ahi numbers have been below 1. i am a devout back sleeper. it's not possible for me to sleep on my side.
my current setup is:
as 10 CPAP mode, 10.8 cmh2O
v-com at machine end
vitera ff mask
caldera alt scc.
nearly flat pillow with concave well for head to rest.
no tape, no mouthpiece.
All the numbers and settings for bi-level are total greek to me.
are there any settings i could try for a night or two that might determine if bi-level is for me? i haven't had a sleep study in decades, nor will i be getting one anytime soon.
thanks for any suggestions. even if that means just stick with CPAP
Hello. I glanced through some of your Oscar data in your other threads. Just based on what I saw there, it's difficult to tell if BiLevel will help you or not. I can, however, say that eliminating leaks most likely will. In most of the screenshots you shared there was at least some level of leak. It's not always the amount that disturbs sleep, but the variability, of which there seemed to be a lot.
Feeling well rested every night is obviously the main focus, and if you already do, BiLevel probably won't give many tangible results. That being said, no harm in experimenting if you're curious. BiLevel can make a big difference for some people, especially for those that struggle with hypopneas, RERA's, or various other minor forms of flow limitation. It can also potentially help with leak since some people can get away with a lower average pressure. You'll definitely want to monitor your nightly results in OSCAR or SleepHQ as BiLevel can come with complications for some people, if you do choose to experiment.
I'm sure you already understand how BiLevel works. You have two pressures, one that you inhale with (inspiratory pressure, IPAP) and one that you exhale against (expiratory pressure, EPAP) instead of a constant, fixed pressure like CPAP. The difference between those pressures is called pressure support. Meaning if you have an IPAP of 9 and an EPAP of 5, your pressure support is 4.
You'll find both IPAP and EPAP in your clinical menu, along with the "mode" menu which you're obviously already aware of. VAuto is auto titrating, meaning it automatically adjusts your EPAP and IPAP in a certain range with a fixed pressure support in response to events your machine flags. S mode just keeps a static EPAP and IPAP throughout the night. These are the three most important settings (and really all you need to understand for now) but I'll explain the others just in case you're curious. Feel free to skip ahead to the last paragraph if you aren't.
Easy-Breathe is a Resmed algorithm designed to make the transition between breaths more natural. Over time it adapts to the speed at which you inhale and exhale, and tries to match it. Since the pressure alternates every time you breathe in and out, it can feel uncomfortable when your machine is immediately switching between pressures, like a switch. Easy-Breathe aims to smooth this out, and automatically adapts it to your individual breathing pattern.
Ti Max and Min are the maximum and minimum times you can spend inhaling, respectively. For example, if you have a TI Max of 2 seconds, you can spend a maximum of 2 seconds inhaling at your IPAP (ex: 9 cmH2O) before it switches back to your EPAP (ex: 5 cmH2O). Same concept applies to TI Min. If it's at 0.3 seconds, you can spend a minimum of 0.3 seconds inhaling.
Rise time essentially replaces Easy-Breathe and for that reason turns off if you have Easy-Breathe enabled. Instead of an algorithm, it sets a fixed time between the transition from your EPAP and IPAP. For example, if it's at 150ms the transition between finishing exhaling and beginning to inhale is super quick (only 150ms) and if it's at, say, 500ms that transition becomes much slower.
Trigger and cycle are sensitivity settings. Trigger controls how much you have to inhale before your machine begins ramping up to your IPAP pressure, and cycle controls how much have to exhale before your machine begins ramping down to your EPAP pressure. The higher the trigger sensitivity, the more sensitive your machine is to your inhalation. The higher the cycle sensitivity, the more sensitive your machine is to your exhalation.
That's it for all the settings. Like I said, you don't really need to know all that just to try it out, so if you skipped ahead it's no big deal. As for recommendations, I would use S mode with everything else on default. Just make sure Easy-Breathe is on. For pressure settings, leave your EPAP at 10.8 and try an IPAP of 14.8. The pressure you exhale against is what ultimately stabilizes your airway, and if you're still having complete obstructive events (albeit rarely) at 10.8 on CPAP, lowering it any further could very well cause them to become worse. If you have any history with aerophagia above 10.8 cmH2O on CPAP, that IPAP will... more than likely cause you to experience some. If so I'd recommend maybe starting with something like an EPAP of 9/10 and an IPAP of 13/14. I would also recommend taking your V-com out, since the entire purpose of it is to limit inspiratory flow, which is not something you want with BiLevel. If you have any other questions let me know.
thanks for the thorough explanation, coutherino. i'll give that s mode with easy breathe (sans v-com) a try to see if it eliminates some of the flow limits.
09-25-2024, 08:20 AM (This post was last modified: 09-25-2024, 08:20 AM by eok361.)
RE: acquired an aircurve vauto 10/self titrating
i don't think bi-level will work for me. i tried those settings last night (s mode with those numbers). an early test before bed seemed ok, but i was sitting.
at bed time, when i reclined, the mask almost blew off my face. i didn't have time to play with the machine at that point. i did try a quick v-auto attempt, but the same thing happened.
my mask is a f&p vitera and it's been the best i have tried after many attempts with others. all out of pocket, which is getting tiresome.
maybe this weekend i'll try more trials, but i'm kind of in the dark here regarding bi-level settings/nomenclature. for the rest of the week i'll stick with my CPAP settings.
That's probably for the best, sticking with CPAP for now. Sorry to hear it didn't work out though. If you decide to experiment again, I'm happy to help. The settings are pointless if the mask won't seal, so if you do decide to experiment again it'd be best to start at a much lower pressure.
(09-25-2024, 08:50 AM)coutherino Wrote: That's probably for the best, sticking with CPAP for now. Sorry to hear it didn't work out though. If you decide to experiment again, I'm happy to help. The settings are pointless if the mask won't seal, so if you do decide to experiment again it'd be best to start at a much lower pressure.
yep. next attempt will be at a much lower pressure. thanks
If you post an Oscar for last night we can better help you. If you don't get a chart posted today, then for tonight you could drop the Max to 15 and see how you do. Don't give up on the Vauto, especially in Vauto mode. It's a better and more versatile machine than your Autoset.
i lowered the pressure levels in vauto, but had way more events than usual, plus awful leaking. zooming and scrolling, i could see many other suspicious looking flow items that look like unflagged events.
the tidal volume increased a lot from my usual 480 to 500 @ 95%.
i think i'll just stick with the CPAP with vcom. the results were far less activity on that setting.
