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+--- Thread: VCOM & Bi-Level (/Thread-VCOM-Bi-Level)
RE: VCOM & Bi-Level - SeePak - 11-01-2024
Pepper, not sure about leak rates?
For me, i have the least leak using dreamware under nose nasal mask.
the F&P micro nova pillows i have been using mostly for last 2 weeks are real low as well.
the Resmed Mirage Nasal mask leaked worse for me, and that was just because i have a hump on bridge of nose.
I think the full face masks are complained about the most for leaking, due to surface area coverage, and probably cause they are used generally i think, with higher pressures.
Also, i wonder how many people realize when they are mouth breathing, this shows up as leak rate, and i have seen that on this forum quite a bit, so that would not be the mask's fault.
I just realized i had one more mask to trial i guess, my dreamware full face which i discontinued when i started mouth taping again in July this year.
Will do that and post....all results, though i can say now that ALL my masks have had some decent numbers using the VCOM , but sometimes i get the bad nights so hard to say so far.
I need to stop mouth breathing, so for me, that is the measure of performance for the VCOM.
The quietness is great too!
RE: VCOM & Bi-Level - WallyPepper - 11-14-2024
Now I am still using the VCOM, it will not come out of the loop. I find that I need one breath at full pressure to aclimate the the 'reverse pressure relief' the VCOM provides. My range is almost approaching a single pressure. I have my machine auto-titrating in a range of just 2 cm of water, and plan to drop that to 1.6 here for an experiment (dumb ResMed only moves in 0.2 cm increments, but it probably doesn't matter given the 'accuracy' of the flow measurement).
Having used these with a variety of masks now and I find that position, other than right at the mask, does not seem to affect the efficacy of the VCOM as much as someone might think. At the machine, middle of the hose, at the joint of two hoses, all seem about the same to me. Right at the mask for me is louder.
One thing I haven't tried, since I have not needed it yet. VCOM and full face/full face hybrid mask. I have two different hybrid masks, and a traditional full face that I only use if I am forced to breathe through my mouth. Only when I am ill or 100% congested as a result of the flu or seasonal allergies. I will report that when and if I need to switch masks again.
RE: VCOM & Bi-Level - SeePak - 11-14-2024
Hey Wally, thanx for your updates, here's mine....
Full Face Mask, with VCOM at back of CPAP machine..( cannot use at mask for the masks that have tube connect at top of head )
CA events came down
Exhalation time increased
Quiet operation
However, i have begun getting what i am pretty sure are Positional events WITH Neck Collar, so i had to take it off and looks ok now !? ( got another collar on order, taller by 1 inch)
For me , VCOM helped as per above observations , but not sure that i felt less fatigue/tiredness thru the day. ( dont think that was ever claimed by Dr. Noah, he said it was for comfort and that it would not make AHI worse.)
But, i have taken VCOM out for now for other testing......
RE: VCOM & Bi-Level - ChadBSr - 11-14-2024
Vcom is great but not with bipap. They're completely opposite approaches to PAP
RE: VCOM & Bi-Level - SeePak - 11-14-2024
Hi Chad what has been your experience with vcom?
RE: VCOM & Bi-Level - ChadBSr - 11-14-2024
As I increased pressure I was having more and more CSA flags. I started having events and spo2 drops immediately on sleep transition. Everyone said get used to it, it will go away, etc.
I switched from APAP to CPAP, turned EPR off, and put vcom in. I started at 4cm. The CSA issue stopped immediately. I stopped feeling like the machine was breathing for me.
I've increased pressure 0.2 each night. I'm now at 8cm
0 - .4 AHI. Just some minor flow limitation here and there. Still no CSA. I will keep going until I find the best pressure.
Vcom has been fantastic. I am convinced that Dr. Noah is right about EPAP vs IPAP.
I may even try adding a second vcom if I get CSA before I reduce flow limitation to zero.
RE: VCOM & Bi-Level - SeePak - 11-14-2024
Chad that's awesome to hear!
Thanks for sharing your results.
Repeatable results is not something that I've found possible through the years.
I'm going to look at my data and see where VCOM worked the best with which mask and least CA events.
Looking back through history I have found out that I get CA events even without epr so I've been revisiting the use of EPR as a another trial.
RE: VCOM & Bi-Level - ChadBSr - 11-14-2024
If you have high loop gain you may get them from EPR, too wide of pressure range, or just too much IPAP. Buteyko breathing can help desensitize you.
RE: VCOM & Bi-Level - WallyPepper - 11-14-2024
@ChadBSr
I have tried two VCOM's back to back in my loop and because it was a flawed test setup to begin with I need to try it again. If you are at pressures below 10 cm I am not really sure how much benefit you will get from two VCOMS. I am at 17 cm (during my lab sleep study, the tech sent me home after 1 hour as he said he had too much data to sift through). Rough estimate from memopry was pre-therapy AHI was in excess of 100, now routinely under 0.5 AHI, but I use RDI as my reference. One day I will relate what the sleep doc said about RDI and my response to him. If I sleep entirely on my side I can use 15 cm. When I tested two VCOMs I was at 6 - 9 cm still searching for the right numbers. At 15 - 17 cm I average about 0.4 AHI and about 0.9 RHI. Maybe it is time to see if two vcoms are the cat's pyjamas!
All of these settings were in my OSCAR data, and I had notes that told me when I started using the VCOM, when I switched to two VCOMS, when I stopped using the VCOM, and when I resumed using it again. For that kind of stuff OSCAR is invaluable.
And my opinion about BiPAP goes contrary to the concensus here, personally I think it was an engineer's solution to comfort, but not a biomechanical engineeer and certainly not someone who understood fluid dynamics (air is a fluid after all, just a gaseous one).
RE: VCOM & Bi-Level - ChadBSr - 11-14-2024
I'm with you. Bipap is for people who need ventilated. Obstructive apnea doesn't fit the description. I think APAP is pretty much garbage unless a very small range and I'm not really convinced on that either.