VCOM User Feedback: Positives and Negatives

[@Freecpapadvice]

Have you tried VCOM yet? If so, please share your experience with it. Interested in purchasing V-COM? Purchase here: bit.ly/38yPlXk and use discount code: 20LANKY Have a PAP Analysis with me at: axgsleepdiagnostics.com. Don't forget to pick up some Mask Bright on Amazon!

[@IamSpider_0.1]

Just ordered one.

[@craigr7151]

I'm a newbie to cpap and been using vcom for about a week. I cant tell a huge difference however will note that central apneas have reduced. Im also still in process of dialing in pressure so may have bigger impact once i get that sorted

[@randycastle5947]

That link is not working (from Australia)

[@DennisYoung007]

Got my V-Com yesterday and tried it out last night. For some reason with the V-Com in place my Resmed AirFit F30 QuietAir elbow is making very loud air noises on inhaling and when I remove the V-Com the air noises go away and back to normal. I'm using the Resmed AirSense 10 AutoSet, CPAP mode, 12.2 pressure, EPR 2, AirFit F30 mask (I'm a mouth breather). I tried a different new QuietAir elbow with same results of loud air noises on the inhale with V-Com installed. Very quiet without the V-Com installed. I tried turning EPR off and still same loud air noises. I thought this V-Com made the system more quiet? Is there anyone having the same issue with making more noises?

[@BrianJGreenwood]

Just ordered mine...GREAT video. Should I be turning off EPR when using V-Com?

[@clintpotts8983]

Three-week usage results: I've now been working with the V-COM device for about three weeks. It was a little rough at first. Placing the device on the AirSense 10 between the PAP and the hose seemed to work best for my configuration and limited the noise. While I found inhalation to be fairly routine, I found exhalation to be restricted. Lanky demonstrates the proper breathing technique in his video, so I gave this a try. At first, I found it hard to do. Nobody likes to have to think about exhaling, and it is hard to think about that while sleeping. The pressure sometimes became too much and I'd pull the V-COM out of the loop and return to pure hose/mask. However, the V-COM solves a huge problem for me and that is what forced me to keep trying it. Reading my OSCAR data, when I go into REM sleep, something is shifting in my mask use that causes my machine to ramp up to a much higher pressure (ASV). This added pressure and noise would force me to wake up and interrupt my fledgling dream before I could get to the good part. I don't like the idea of being forced to wake up right when I'm getting into REM, so I'd then put the V-COM back in the loop to "tame my machine." It tames my machine very well and for some reason, in that part of the night, the exhalation issues were tolerable and I'd sleep until morning. Building on the wee morning success, I got used to the "proper" breathing technique and started using the V-COM the whole night. Yay me! I've now settled on my default equipment for normal nights (no illness or sinus issues). I'm using the Philips DreamWear Nasal Pillow mask with the hose at the top of my head. I also bought a chin strap to keep my jaw shut to prevent mouth leaks. I use the V-COM in line at the machine. When in this configuration, there is very little wind noise, and my breathing patterns are nearly perfect all night long. I've been getting less than 1 event/hour. Last night was .1 events/hour. I think I can live with that! I also purchased the 5" Pillow Cube pillow and have been using that for the last 3 nights. So far, it has been comfortable and my neck/shoulder pain has been reduced a lot. Yay me! I've yet to fall asleep and just wake up when my alarm goes off because there is always something that wakes me up (usually wind noise with a small leak) but I'm sleeping for at least 90% of the night. That's a huge improvement. So... the V-COM seems to regulate the output pressure of my machine and keep it constant. Oh! Another adjustment I made was to kill the ramping feature of my PAP machine. That was killing me! The low pressure was being killed by the V-COM and I wasn't getting air. I now have 0 ramp time set and I just start at full. That gave me my needed air and I can fall asleep. So my review is positive. V-COM is solving more problems than it creates and I can't argue with my OSCAR report. Thanks for the recommendation and your research.

[@carlvonfuckwits2934]

Turn your epr to 3 if it's not on that. I tend to go a little up in pressure as well.

[@wallyfirkins1664]

Thank you Lefty. As I said before, I gave the one I purchased to my friend who loves it and he bought another for a relative. It solved his leaking and araphasia (SP). I have AirCurve 10ST and I am still disappointed that the V-Com won't work for Bi Level. Thank you very much for your channel!

[@corndoghatfire]

Tried the vcom last week. I found that the inhale was the issue for me. Felt like sucking a thick milkshake through a small straw... No issues with the exhale. I'm going to increase the pressure and give it another try. Fixed pressure at 13.2

[@hubertj041]

How did it go with increasing your pressure?

[@corndoghatfire]

@Doug & Eamonn Hubert/Hot Dogs & Gin I increased to 14.2. Second night was much better. I'm back down to 13.2 now with the vcom, and sleeping great. The oscar data doesn't look perfect, but I'm feeling great when I wake up.

[@SuePeifer]

Thanks, Jason, for all you do for us PAP people. I just ordered the Vcom and am anxious to try it. My CPAP therapy was great 10 years ago when I first started. In the past 3-4 years, things have changed. My DME has not been helpful in getting my pressure setting to be optimal - as long as my numbers are mostly 'within the normal range, they say everything is fine and just want to sell me supplies. My sleep doctor only looks at 2 weeks of data within the prior month of my once a year checkup - he doesn't have time to thoroughly analyze my data. So clearly I am on my own. I'm very thankful for you and OSCAR and my new ResMed AirSense 11 (did not like the replacement Deamstation 2 machine at all). From reading the comments, it appears some people are not listening to what you have said, such as: --Vcom should only be used for CPAP (a single pressure setting) and not for APAP (a pressure range) --APAP is good for 'dialing in" your pressure setting but not good long term especially if the range is big, too much wasted time getting to the pressure you need --CPAP (a single pressure setting) is best long term as long as you don't need a bi-pap machine. This is what I understand anyway. I do think many, maybe most, people do not understand the difference between APAP and CPAP - people just are not detailed these days (drives me crazy). I didn't understand the difference for quite some time. Maybe people need a list.

[@Freecpapadvice]

Pressure changes are usually needed after a few years. May just be a pressure requirement change.

[@davidrowe1254]

Got the V-Com and have been playing with the pressures to regulate the feeling of not getting enough air. Have not had a problem with breathing out just breathing in. As per your sugesstion I bumped the pressure up over several nights - up too much the second night and not enough the third night - changed a little lower the forth night and seems good. Less mouth leaks for sure and the added benefit of not having to over tighten my full face mask to prevent those leaks - thanks for the help and advice Jason.

[@jackrandom4893]

How are your AHIs?

[@earlmacleod5939]

P30i Mask with top port: First night with V-com I increased the starting pressure by 2cm to be ease inhalation - went well. Second night I increased starting pressure by 2 more cm and V-com started making a noise so loud it annoyed my wife and myself, we couldn't fall asleep. The noise was similar to the sound of a partially opened steam or water valve. I was hoping this device would allow higher running pressure, which Mr. Lefty indicates I need (but too much air aphasia, can't tolerate). V-com goes back and Bi-level machine will be reconsidered.

[@NiWhomPing]

Would have been good to mention vcom every couple of weeks for new people just finding your channel. First I heard of it was saw your video with the good Dr after months. As soon as I saw your interview with him I bought one and vcom is good.

[@cruiser4116]

Lanky, I've used the V-Com for 5 days after having continuing problems with an excessive number of Large Leaks using a N20 mask. Mouth taping is not an option for me. So far, I have had only 2 LL, one of 6 seconds and the other 2 seconds since using the V-Com. My largest AHI is 1.54 and largest number of OAs was 3 with less than 15 seconds duration for any OAs. I am a true believer who is sleeping much better. Thank you Lanky and SleepRes for finding a solution to my leaks!!

[@Freecpapadvice]

I'll be coming out with another solution to mouth leaking that doesn't involve tape. Testing it now.

[@trina2150]

Oh the anticipation!

[@LavarBurtonfromStarWars]

I still don’t understand the utility of this device. Is it for short term use to acclimate new cpap users who are not getting the hang of it? (The “training wheels” slogan I’ve read). Is it a permanent addition to therapy? Adding a restriction to the flow and telling the end user to boost their pressure 1 or 2 doesn’t pass my sniff test. If there’s a person who’s really tracking their sleep and analyzing their data, I can see it as another tool in the box. Your first video makes it sound like the answer to all cpap mysteries. I still question if the data recorded by the cpap machine for Oscar analysis can be accurate with a device changing treatment parameters downstream with no correction data. I suspect the diameter of the holes needs to be calibrated to the pressure of the therapy, otherwise how can it provide consistent results between 10 cm h2o vs 18 com h2o? I don’t see how the average end user can blindly buy this and slap it on their machine and let ‘er rip. I do think it could work if you have it in for a titration study, or if you’re a super user and really understand how to interpret Oscar data (assuming it doesn’t impact the data collection).

[@GuyScharf]

I use a ResMed AirCurve 10 VAuto set to 6.6/10.8,/PS 4.2, trigger very high, plus EERS for the length of the Brevida hose. My AHI averages about 0.6. Overall, treatment seems fairly good and the mask is comfortable. (EERS and high trigger are used to prevent central apneas; PS to address aerophagia.) When I add a V-COM between the CPAP hose and the Whisper Swivel (which provides the standard mask leak with the EERS setup), I find inhalation to be harder; I've not noticed any problem with exhalation. If V-Com helps with CA and aerophagia, it's an interesting alternative. But I think I would have to start over again in tuning in treatment settings. Not sure I want to do that, since what I have is working.

[@robjgarc]

I ended up stopping using the V-Com; my issues were mouth leak and aerophagia and the V-Com worked great to fix that. I use a mask with the airflow coming from the top of the headgear and so I had to get a short hose to reduce the noise. I feel like if you are a back or side sleeper that doesn't move much throught the night, this set up will work great. I, however, roll around all night and often end up on my stomach. This set up causes the top of my headgear to shift around and wake me up from mask leak and from the tubing getting stuck between the pillow and headboard. I tried hanging the hose directly over where I sleep and that didn't work. Curiously, this doesn't happen with the short hose removed and the V-Com connected to the top of the headgear. Something about the short tube is causing this problem. I was able to remedy mouth leak with a halo chinstrap, but then I found out that the dental appliance that I had been previously using for sleep apnea also stopped mouth leak and so I'm using that. Gear used: Resmed Airsense 11 to heated hose to V-Com to 18" humidifier hose to Resmed N30i. Hope this helps anyone.

[@jeffreydurborow4386]

Ordered a VCom yesterday after noticing it was back in stock. I use a Resmed AS-10 autoset with EPR. Mask is Airtouch N20. EPR was set at 3, but I reduced it to 2 after watching your videos on the subject. I liked the EPR, but I can get used to not having it if it helps. Anyway, I remember you said on a previous video that one should turn EPR off when using the VCom. Is that correct? Are there any other set up changes to make? I usually run about 11-13 cm H2O. My AHIs are good (0.5-1.5), but my mouth leaks like a mother. Gotta fix this dry mouth. I hate the tape and use a chin strap, but it leaks anyway. Thanks for all your videos. I usually laugh out loud at some point. You are doing a public service, keep it up!!

[@cebruthius]

5:34 Reliable conclusions cannot be made from this comparison because the setting before VCOM was 15 cmH2O with EPR at 3 (!) and after VCOM all of a sudden the pressure is fixed at 10 with EPR off.

[@cebruthius]

2:42 You forgot the lady who had the entrainment valves pop open every time she inhaled because the restrictor didn't permit the machine to maintain sufficient pressure to keep them closed.

[@Freecpapadvice]

I think I asked what pressure and what FFM that was and didn't get an answer back. They say don't use below 10, though I don't remember seeing that in the white paper. I can test this out though.

[@cebruthius]

@@Freecpapadvice Lots of people are pressures lower than 10 so better include a warning

[@fishboy491]

I tried it and it made me feel air starved. I will try upping my pressure and try it again.

[@Freecpapadvice]

Definitely increase by 1 or 2cmH20.

[@cebruthius]

@@Freecpapadvice The whole paradigm put fort by Dr. Noah is that this should not be necessary since EPAP stays the same. My brain splode now.

[@fishboy491]

@@Freecpapadvice wow. That worked.

[@Freecpapadvice]

@@fishboy491 💪🏼. Nice!

[@jimt7292]

Thank you, Lanky. I just ordered it. Cheers!

[@timhanley9992]

Got a VCOM a week ago. Having the best events readings that I have had for the past year. I am however getting a little water in my mask when my RES MED 10 is set on auto humidify.; Going to play around with that manually to see if this problem resolves. Thanks for making me aware of this device Lanky Lefty

[@jackrandom4893]

Are you using a full face mask or nose piece?

[@timhanley9992]

@@jackrandom4893 I am using a full face mask over mouth and nose. It wasn’t massive water but some

[@nytess2]

My first night with it was a game changer...no headache in the morning and felt like I got real sleep :)

[@BrendaMalone]

Is this just for CPAP and not APAP, right? Because EPR on APAP does this automatically, right?

[@larryweightman4763]

just ordered one, I will give it a shot once it arrives.

[@robhemsley9181]

How do I get one of these delivered to the Uk ?

[@micolo123]

Not available in Australia :(

[@johnssaito8027]

With an increased resistance to exhalation, is hypercarbia and compensatory respiratory acidosis a possible side effect? If so, would that not "confuse" algorithms since users may exhibit increased respiratory rates to compensate for the acidosis. Just wondering, but I have ordered one and will give it a shot.

[@cebruthius]

Any of these things can happen. Because the relationship between EPAP and IPAP is such that a sort of "negative PS" effect occurs, which imposes breathing resistance and may induce hypercarbia. In full face masks, a secondary effect that can cause hypercarbia can occur: stunted venting of the mask. I've already seen someone report here in the comments that the pressure was so low upon inspiration that the entrainment valves open with a popping sound. That means exhaled air is rebreathed.

[@dublinbu]

I tried it with an airsense 11 and respironics dreamwear full-face (started with brevida nasal pillow, but was leaking from my mouth and I hate taping). I felt air starved and it was noisy, so I ended up struggling to rip it out of the hose about an hour in. Immediately got quieter and felt relief. I know you've told others to increase pressure... how do I do that? Mine was set by the DME provider and I'm not sure how to change it...or if I want to.

[@NotMyActualName_]

You need to tell cpap supplies to stop undercutting your discount code. They have a 30% discount code right on their front page.

[@jskim2510]

Yeah real shame

[@rickw5024]

I tried it and tried to use it, so much noise and it increased the pressure so much my ears felt pressure like I was deep in a pool. FWIW it's not worth $30 , 5 is max, there are no moving parts and it's 5 cents worth of plastic. I use an airsense 11, with eps turned on the valves pop open every time I inhaled as well. With it off the pressure was too much. with the Vcom inline I just I find inhalation to hard and feel I'm needing more air.

[@mikebrock1965]

I struggle to inhale with the VCOM. No problem exhaling. It feels like ramp is on. Do I need to increase the pressure?

[@cebruthius]

That sounds logical because the VCOM creates an inverted pressure support effect, which causes increased work of breathing both during inhale and exhale.

[@Freecpapadvice]

Yes. Stated by manufacturer and I found this to be true as well.

[@aguycalledshane]

I got one of these. I get a little less chipmunk cheeks, but it's kinda loud, and I feel like I'm not getting quite enough air. I can probably increase my pressure a little, hopefully it won't make it louder. I've only used it for two nights so far. I plugged the data into OSCAR and it looks better, but I don't really know what I'm looking at. Gonna go watch an OSCAR video to see if it helps.

[@clintpotts8983]

I installed my first V-COM yesterday. When my unit was still ramping up, I was encountering the same feeling that it was more difficult to exhale and without knowledge of how to fix it (in the dark, no less) I simply removed it and went back to my mask and tape. Is the fix to learn how to breathe as discussed, or is a change of pressure better? Thank you!

[@HappyCupsInc]

I ordered one, but had to pay twice as much and have to wait 3 weeks for delivery because I’m in Canada. Hopefully it’s worth it

[@jasontrewin123]

It works, i went to 17 versus 16, without v-comm it was rough.

[@adrianrylatt6324]

I have started to use the VCOM about 3 weeks ago. I bought it to help with dry mouth. If I use my Phillips Dream Station 2, my dry mouth problem is greatly reduced. On my ResMed 11 there is no difference. I still get dry mouth. Both machines are set up the same.

[@davej3487]

I am on a Airsence 10 Autoset with 22,000 hours. Ramp off. EPR off. Set to standard. Humidity at 3. Heated tube set at 73F. I had my pressures set at 6.2 to 15 before the V-Com trial and at 8.2 to 15 for the trial. Night one, 4/26/23, I seemed to wake up needing air at least 4 times. Readout said 6.6 incidents, normal is 0.2 to 1.2. Night two, last night, woke to PAIN in my chest. Took the V-Com out and got 5 more hours of uninterrupted sleep. Tonight I will set the pressures at 9.2 to 15 and see. I will upload my data to HQ-Sleep tomorrow. Bad thing is I ordered this V-com from Cpapsupplies and it cost me $26 with the 20Lanky discount. They took 16 days to get the order to me from South Carolina to the Seattle WA area.

[@Freecpapadvice]

APAP needs to go off. Set for one pressure. What that is I don’t know, but APAP is horrible.

[@NinjaTamina]

Do you know where I can find it in Canada? CPAPsupplies doesn't ship to Canada.

[@4heitjer]

Ordered it and used it next night, breathing felt harder and no visible change for me. I took it back out. Maybe its because my pressure is 9 only. I was amazed that this was just a flow restrictor. A few holes to reduce the flow area. If I would have known that I would have just printed one.

[@Freecpapadvice]

Did you see the thumbnail?

[@ALbino998]

Here's what's probably a dumb question but something I've been wondering for a while: you always talk about being a puffer fish, lips blowing out, constantly leaking, having to tape your mouth every night, etc, so shouldn't you guys just be using a full face mask? I use a nasal mask and don't have any of those problems, my leak rate is practically zero, and really only occurs when I push my face into the pillow causing the mask to bend to the side. If I had a leak rate anywhere near what you guys have I would just pivot to a full face mask and call it a day. I can't imagine taping every night or whatever when you could just use a different mask and never worry about it again.

[@jackrandom4893]

Yeah. He keeps mentioning this. I want to know if this can be used with a facemask since the air from the machine is more dispersed vs directly into the nose.

[@MeepyManX]

I’ve tried a few full face masks and just can’t stand them, nasal masks are the only ones that I can seem to fall asleep with, also I have a full bushy beard. Been waking up with dry mouth, trying out the vcom tonight so this video could be just for people like me.

[@ALbino998]

@@MeepyManX Using tape around your mouth to get a seal with a full beard seems much more difficult to me than just pulling a full face mask slightly tighter. I only have a goatee and taping would be really difficult for me, not to mention incredibly inconvenient to do every night and undo every morning. Do I think a nasal mask is more comfortable and easier to use? Sure, of course, it should be everybody's first option, but all of these workarounds using chin straps, tape, neck braces, etc, just seem like wasting time and energy when you could just spend a week or two using the FFM until you're used to it.

[@bdonnici]

My leak rate is higher with the full face, along with the cheek puffing, squeaks and whistles.

[@marcus_ohreallyus]

I have my vcom and tested it for a bit...haven't used it for a full night's sleep yet. I noticed mouth leaking was less likely to happen, but I'm wondering if that would change over a period of several hours. Do you think that instead of doing a full mouth tape, I could get by with a partial taping?

[@Manzion1102]

Is there anywhere to buy this outside of U.S ? I live in Denmark

[@samstinkeringaround8961]

So I bought the vcom ….. it sounds like a big air leak ?? Is it supposed to be like that. I can’t put it on the other end of the hose I have a heated tube.

[@michaelcasper2613]

Thanks, very helpful

[@andrewbarnes605]

Hi Jason -- you don't recommend using a VCOM with a bilevel because, as I understand your explanation, the rise time on a bilevel is adjustable. I'm confused by this -- can one adjust rise time to cause EPAP < IPAP, as VCOM does? Could one set a bilevel machine (e.g., ResMed AirCurve 10 VAuto, as I have) in VAuto mode with EPAP = IPAP and no PS, and adjust the other VAuto bilevel settings to provide the same result as a VCOM? I hope you see this and can clear up my lack of understanding on this . . . thanks for your always great information, Andy

[@DLL969]

Does anyone know how you can purchase this in Australia?

[@CowboyTrucking61]

Off topic question, sorry. Just got back my replacement Phillips Dreamstation. I had to buy a Resmed ASV cause I got tired of waiting for the replacement to get back. My question, why are the dreamstaion readings always higher than the Redmed machine. Also the Dreamstation is for sell if anybody wants one. Its just like brand new, I used it this afternoon for about 3 hours, so low mileage on it, lol....

[@cebruthius]

It's a DSX900? I'm interested

[@stefanxlindstrom]

Anyone know where I can get one in Europe?

[@shuikai272]

It's interesting how this is improving efficacy and tolerability in those with complex OSA, aerophagia, etc. I know a lot about sleep disordered breathing but I actually know a lot less about CPAP, because basically I've never been able to actually sleep with it for more than a couple minutes without waking up gasping for air. At this point I can actually wear the mask and breathe through my mouth (my nose is basically plugged from narrowness in the structure), but unless the pressure is around 15-20 once I relax my throat and breathe with the CPAP my airway will basically just collapse, but at pressures 15-20 the aerophagia and other things is just kind of too much. Though I can relax my throat and breathe. As far as I recall when reading up on these things, I believe when it comes to complex OSA there is some kind of connection with nasal dysfunction. I wonder if the V-COM might assist to some degree in scenarios where the structure of the airway is leading to some of these problems. But I don't really know too much when it comes to things pertaining to CPAP. So far my attention has been more on the surgery side.

[@EsmereldaPea]

Have you considered trying nasal cones? My doc suggested them but I haven't tried them yet. I had a septoplasty and it didn't help.

[@kbh95207]

I swear you have a more unbiased approach to all the CPAP related information you give. Less salty than Uncle Niko and even less saltier than the different CPAP forums.

[@Freecpapadvice]

"I appreciate that" - Lanky "Salt Lick" Lefty

[@kbh95207]

@@Freecpapadvice 🤣🤣🤣

[@veryberry39]

I don't even bother watching that other guy anymore. All he seems to like to do is give opinions on drama. Not that Jason hasn't, but I don't know, he doesn't make random posts about political shit either.

[@dc3901]

Does it work with ASV? Thank you.

[@cebruthius]

The page from the manufacturer says not to use it with ASV. To be honest I'd love to try it just for giggles, because I'm pretty sure the ASV will go wonky with this thing in the circuit.

[@PJBee]

Used it for the first time last night lots of mouth leaks. I did get 9 hours of sleep

[@dandifusco1868]

Guys, i hear great results for nasal users but does it help leaks with ffm?

[@peepers4763]

Long term CPAP user tries V-Com. I struggled with V-Com’s pressure reduction, felt like a struggle to get air in. 11 cmH2O is continuous is comfortable inhalation minimum. Is there other benefit to V-Com than reducing pressure?

[@Freecpapadvice]

The most common benefits are reduction of aerophagia and leaking out of the mouth, most notable is the cheeks puffing out. EPAP is maintained but IPAP is slightly lowered. This allows you to increase the pressure and still be comfortable with it. You should increase by 1-2cmH20 when using VCOM. If you're not having any of those problems then there is no benefit to using VCOM.

[@peepers4763]

@@Freecpapadvice that is what I needed to understand. I’ve learned a lot from watching your videos.

[@cebruthius]

5:12 Patient is using EPR at level 3. Maybe turn that down a bit?

[@Freecpapadvice]

I see the EPR on this. He had periodic breathing no matter what we did. We did try with and without in an effort to remove the central apneas.

[@cebruthius]

@@Freecpapadvice I can see how this intervention benefits someone with an unstable blood gas control loop. Ideally the manufacturers would come up with something like "negative EPR" because that would be a better way to have the same effect than a foreign body in the circuit the machine doesn't account for in the flow data recording.

[@gardenman3]

does this work with a Resmed airc urve 10 asv?

[@Freecpapadvice]

No

[@Zero3K6]

@@Freecpapadvice What about if it is set to BiPAP mode?

[@joeshmoe7899]

How works with ASV?

[@cebruthius]

It doesn't, as declared by the manufacturer on their site.

[@bobosterday3350]

Okay I’m sold on V-com but now really confused on my pressure and EPR! My pressure is 6-12 and EPR of 3. Do I turn ramp off and go to steady pressure of 12 and turn EPR off? Please answer.

[@jonitalia6748]

What worked for you?

[@discontinuity7526]

I think it causes CO2 retention. I've been using it for a couple weeks. It helps with aerophagia and mouth leak but I've been getting more sluggish by the day using it. Look up CO2 narcosis. At a constant pressure of 15 with the V-COM. The white paper says "Reducing EPAP increases risk of rebreathing" that seems wrong to me from what you've taught us about EPR especially at higher pressures. Lower EPAP allows the person to blow off CO2.

[@semiephemeral9]

had the same though, ie it might make some people retain CO2 have to think about that some more.

[@alfreddiaz9610]

So I have an air pressure set around 9 I do have to wear a device that pulls my jaw close cuz my mouth opens up in my mask with the V-Com in your opinion do you think that would take care of the mouth leaks

[@screamtoasigh9984]

Mouth tape.

[@HappyCupsInc]

What do you use to keep your mouth closed?

[@veryberry39]

I have to use tape AND a chin strap, and my mouth STILL falls open sometimes. I have no idea what else to try there. XD

[@guaripolo69]

First night with it. Dry mouth basically gone however my ahi shot up to 13.6. hopefully tonight will be better.

[@laubru010]

Help! I am waking up with HUGE belching. I am bloated at times to where I look 9 months prego!! Kept thinking this bloating (farting) was gut related. So uncomfortable! Ive worn my CPAP faithfully all night every night for 25 years. Resmed N10. Nose mask. No dry mouth but dry eyes sometimes. What should be my first step of change?

[@vt7814]

I have it but after I tried I prefer without it. I feel suffocating with it.

[@Freecpapadvice]

Are you on CPAP, or an APAP range? If CPAP, did you increase your pressure by 1-2 cmH20?

[@cebruthius]

@@Freecpapadvice I don't understand, why is this official policy now?

[@cebruthius]

@@Randy_589 Who is we? Sleepres staff? Kami Harold?

[@cebruthius]

3:20 Flow data cannot be trusted since the restrictor interferes with the machine making undistorted measurements. Just ask anyone from ResMed or Philips.

[@Freecpapadvice]

Last time I asked Philips a question was 1. Will I get my new PDx units by April 30th? YES (revised.....maybe July 30th) Other time was: 2. Will this foam cause cancer? NO Yeah...I'm good. I may try some stuff with this....but I see people with and without it and subjectively they feel much better and the flow rates look similar.

[@cebruthius]

@@Freecpapadvice Ask ResMed then.

[@tomcowsert8962]

@@Freecpapadvice That foam gave me cancer! Bastards!

[@GlasanGhost]

This is also my concern, any further data on this?

[@danaparish1644]

I’ve tried the VCom with a Resmed F20 Mask and am bothered by the “popping” sound that comes from flutter valves in the quick release on the F20 mask. I sometimes have that at the beginning of CPAP therapy, but it goes away in a few minutes (after ramp up), but this popping continued for well over an hour. I couldn’t stand the noise and took off the VCom. Any suggestions on how to eliminate the flutter valve “popping.”

[@billsharp2351]

I am using the V-Com , same mask and have also tried using the Evora full face mask. I get that reinflation popping sounds as you described! Did you ever get any help with this issue? It makes the V-Com unusable for me.

[@danaparish1644]

@@billsharp2351 Not a single word on what to do about it…

[@kichki777]

Does vcom works for uars ?

[@cebruthius]

I am a UARS survivor. I can guarantee you it doesn't bring any benefit.

[@kichki777]

@@cebruthius how do you manage ? Machine mask etc...

[@cebruthius]

@@kichki777 I use a DSX900 AutoSV with Resmed F30i.

[@kichki777]

@@cebruthius is your lpwer jaw recessed ? Do you sleep on your back side or stomach?

[@cebruthius]

@@kichki777 Yes, retrognathia. I used to be a side sleeper but now I can sleep in any position.

[@billsharp2351]

I got the V-Com and gave it a try. Am using the Resmed Airsense 11 and the Resmed Airtouch F20 full face mask. Seem to always have had trouble with air leaks during the night disrupting sleep. As soon as I installed the V-Com things got much much better. Far less leak problems and sleeping through the night. I though that I had finally found the answer to my problems. BUT after about 5 days of using the V-Com I started having a new problem that I hadn't noticed until then. I am only using pressure of 8. Nearly every time I inhale the mask makes that kind of pop as it does when you first turn on the CPAP and it inflates and seals when you first pressurize the mask. It does this quite allot, and disrupts sleep. When I remove the V-Com this "Reinflation" pop stops. I just don't understand it! Has anyone experienced this symptom with the V-Com?

[@Freecpapadvice]

Yes. You need to increase by 1-2cmH2O anyway. Increase to 10cmH2O. This will keep the anti asphyxiation valve from popping.

[@jackrandom4893]

Can I wear this with a facemask?

[@cebruthius]

1:40 That's exactly what I predicted based on the "negative PS" effect that is created.

[@guaripolo69]

grabbed one, just 25 bucks to try it, not bad! hopefully helps me! i use a full mask, but have terrible mouth leak

[@davidpeterzell789]

Jason -- Instead of buying one of those compact travel CPAP machines, I bring my large, clumsy BiPAP with me when I travel all over the place. That's a big deal because I limit myself to just what fits in my backpack/carry-on luggage. Do you think the V-COM might make it easier for someone like me to use one of those travel CPAPs? (Me: BiPAP-S, EPAP: 10 cmH20, IPAP 15 CMH20, PS 4.00 cmH20). (Could make another AXG appt...) (Note: no baby turtles were harmed/crushed in the making of this comment).

[@cebruthius]

No, that would not work since the VCOM creates negative PS imposing increased breathing resistance. Apparently you need breathing assistance to the amount of 4 cmH2O PS.

[@veryberry39]

I don't have any knowledge to give on your actual question, but did you know that medical devices don't count toward your carryon limit? If you're just stuffing it in a backpack so you have less to carry, then keep doing what you're doing! But just in case you weren't aware, you can absolutely carry your machine on separately!

[@davidpeterzell789]

@@veryberry39 Thanks veryberry39, that's in important point. I'm definitely aware of guidelines like these. But yes, I usually manage put the device into my backpack, and barring that, I begrudgingly carry it on separately. I'm simply interested in the possibility of reducing the size and weight of the PAP device I carry with me. I like to put everything I take with me into that one carry-on backpack. And so I was wondering if V-COM might enable me to use the smaller machine.

[@davidpeterzell789]

@@cebruthius Thx for your response

[@cebruthius]

@@davidpeterzell789 I use a DS1 BiPAp AutoSV myself :)

[@Spencer1609751]

Isn't there a rule for Pulmonologist to see all patients new and established? Kinda lost right now!

[@doughudgens9275]

Not really. About a month ago, Jason talked about how he used to do a class for new CPAP users monthly. But insurance changed and the companies didn’t pay for it anymore, so that’s why he does individual counseling through his company. You are kinda on your own unfortunately. I’ve learned a lot from Jason and Nick (CPAP review) videos. I would recommend some binge watching of KZbin.

[@Spencer1609751]

@Doug Hudgens cool thank you. The only reason I asked is that I had pneumonia last month spent 3 days in the hospital, and blood work can back as having High Red Cell count.

[@alfreddiaz9610]

So I have an air pressure setting at around 9:

[@JC-pb4db]

I crave that full exhale feeling. First time I heard you can’t/shouldn’t do that on CPAP. Guess I will struggle with that one…

[@cebruthius]

I use a BiPAP. Breathing feels so free it's awesome.

[@JC-pb4db]

@@cebruthius I have a bunch of central apneas, but provider says I won’t qualify (insurance won’t cover it) for a titration study or bi-pap since I am under 5 with a cpap.

[@cebruthius]

@@JC-pb4db Sometimes centrals aren't "really central" but triggered by a preceding flow resistance (e.g. RERA) event causing an arousal.

[@Freecpapadvice]

LIAR!!! Nah....I'm just kidding. 😉

[@Freecpapadvice]

99% of the time this is what the "centrals" are.

[@cebruthius]

Someone posted a topic on Apneaboard. "First night using VCOM I did a lot of research before using this and it didn't go as planned. I feel like I'm going to [croak] today"

[@veryberry39]

I'm really tempted, but even with the site's 25% discount (sorry man, I'm poor), it only takes it down to like $22.50...and you're not allowed to return it if it doesn't work for you (which, frankly, is kinda contradictory to their "if you're not 100% satisfied" claim. How would I know if I'm satisfied if I'm not allowed to use it first? I digress). I'd drop the cash if there was no risk involved, but I'd be mad as hell if I spent that much on a small piece of plastic, and it either didn't work or made things worse! (I am not fishing for freebies, just combo crying and boosting your algorithm. :P )

[@dwightmoore8018]

Over the past few years, I've watched Dozens of Jason's helpful videos. I just ordered the V-COM because I figure, even if it turns out to be a piece of crap, I'm still coming out money ahead because of the knowledge I've gained from him. Besides, even if I don't leave my house, I manage to spend more than $22.50 a day and I have no idea where it goes! ;-)

[@markstevenson3880]

NEGATIVE COMMENT : In Australia we have to import from US and the PRICE is $68 on Amazon. But then again the Hurricane Drier is $670...... yeh Australians really like getting screwed.

[@mainetomass99]

Tried it. Didn’t like it. Regardless of the increase in pressure to compensate for the device’s performance, I just felt air starved. That was with up to a 3-4 increase.

[@MickAltmyer]

I've been using the VCOM since March 24th. It's quiet, comfortable, and effective as Jason has explained. Now that I've listened to the podcast featuring Dr. William H. Noah, MD, the inventor, I find his research (most impressive) and better understand his logic for creating this device. It makes sense. The white paper is loaded with good information as well. TheLankyLefty 27 has made both links available below. Jason has been helping me get my breathing and events under control since mid March. Pressure has been increased with and without VCOM from 13 to 19 - several days of each - and I find that last night's pressure of 16 using the VCOM on CPAP and EPR turned off made a comfortable and effective therapy night. My hypopnea's are down 6.03 and 95% leak rate down 28.8. Overall, I can see the logic of decreasing IPAP and increasing EPAP. Getting my head around this 180 degree change in thinking is taking some time but I'm getting there. I appreciate Jason sharing what he's learned about the VCOM and sharing the the podcast where Dr. Noah offers reasons why.

[@cebruthius]

You say "Overall, I can see the logic of increasing IPAP and decreasing EPAP" but the restrictor does the exact opposite.

[@MickAltmyer]

@@cebruthius Good catch - my typing error. I meant to say "Overall, I can see the logic of decreasing IPAP and increasing EPAP." From the "white paper" it says, "The V̇-Com™ is a known addition of resistance to reduce IPAP for improved comfort while preserving EPAP, which does not appear to affect therapy adversely based on data presented below..." see graphs in the "white paper."

[@cebruthius]

@@MickAltmyer Personally I'm verrry skeptical about "to reduce IPAP for improved comfort while preserving EPAP" because that results in inverted PS causing increase work of breathing. I've already seen some people report air hunger which supports that hypothesis. Personally I very much prefer IPAP > EPAP as delivered by my DSX900 AutoSV. Personally I find the data in the white paper very thin.

[@krazzzz2000]

I've had mine for a few days and just can't stand it. I feel like I'm suffocating and also the incoming air temp seems a lot warmer. It's not cool and refreshing like my CPAP is without it.

[@cebruthius]

@@krazzzz2000 That's probably because you're rebreathing your exhaled air.

[@cebruthius]

My theory is that the restrictor imposes an amplitude compressor effect (see amplitude compression in signal theory) which will make hypopneas "magically disappear" in the perception of the device, leading to "better numbers." The proof of the pudding is in the sleeping though, and we'll find out soon enough if the honeymoon period is over. The TECSA use case is interesting though, because of the imposed breathing resistance and increased rebreathing of exhaled CO2. Don't cheat by using examples with EPR 3 before VCOM and EPR 0 after, like you did in this video.

[@Freecpapadvice]

Who had EPR 3? Also, not concerned with the numbers reported by the PAP device either. That number is worthless. Data is manually reviewed.

[@400_billion_suns]

@@Freecpapadvice He does have a point about the machine’s data. The thing you have to remember is that the machine can only measure pressure and flow *upstream* of the VCOM. VCOM is a restrictor, which means it will have a “numbing” effect on the machine’s ability to see fast transient flow rate and pressure changes on the mask side of the restriction. If you want a simple example to visualize this: imagine you have a garden hose with no nozzle. It’s flowing water out freely. If you suddenly block the end of the hose with your hand, the hose will pressurize and you will feel a big pressure difference within the hose. Now put a nozzle on the hose that creates a small, high pressure stream. Try blocking that off. Do you feel any difference at all in the hose? No, because it’s already pressurized and that restriction has made the whole system upstream of the nozzle less sensitive to pressure and flow differences downstream. Again, I’m not saying this product has no benefit. I can totally believe that it helps. I just hope you understand that these CPAP machines are calibrated to specific hose sizes and the expected restriction to measure the data they report, and once you put other stuff in that flow path, you can no longer trust the accuracy of the data you see in OSCAR. Specifically: mask pressure will be reported higher than reality; precise breathing waveforms will be smoothed out (their sharp peaks and valleys attenuated), and due to this creating more pressure and outflow through the mask vents, it may not record overall flow rates as accurately anymore, either. The only way you can measure this stuff accurately once VCOM is in the hose would be to tap in new sensors after VCOM, near the mask.

[@cebruthius]

@@Freecpapadvice See my other comment about timetamp 5:34

[@Freecpapadvice]

@@400_billion_suns I think I would agree with all of this, but the arousals are still easily seen. No arousals or decreases in airflow prior to arousals and the pressure must be right. An external cannula that could be attached to the other side (mask side) of the vcom would be helpful. You're not going to get argument from me there.

[@400_billion_suns]

@@Freecpapadvice Yes, agreed. The data can still be useful in a relative sense like that. I just wanted to make the point that the absolute values of the data are no longer apples-to-apples with the data prior to V-Com, so I'd hesitate to draw further conclusions from it (like total breathing volume, precise mask pressures, etc.) Even the measured/reported leak rate will be affected by the presence of V-Com. Since the V-Com builds hose pressure faster due to the restriction, the mask could be leaking more than before and the machine won't "see" it as much. What I'm really trying to say is, just be careful and apply appropriate skepticism when using OSCAR data with V-Com, because it's no longer a 1:1 reference with the data you were seeing before.

[@JoelZBub]

I'm here too early for the "I don't care if you're having good results, the science in my brain tells me this is no good" crowd. What do I do now with this popcorn?

[@NameyNames]

I just realized that my AirMini in principle already does this - the disposable cartridge in its passive humidifier is in effect an IPAP flow restrictor (?). Also noticed that its factory default min pressure (for APAP) is 1cm H2O higher than the default in my AirSense 11. Hence, my interest in bumping up the pressure 1cm H2O on my AirSense 11 and trying a VCOM has now risen. But ... I'm running APAP, and you said the VCOM only works well with CPAP?

[@cebruthius]

Sorry, your realization is wrong. The HumidX modules are designed to have the same cross section of open area as the tubing so not to impose any resistance, that's why the module is considerably wider than the tubing. The vcom is not, and has only small openings so it definitely is a restrictor.

[@NameyNames]

@@cebruthius I figured the cartridge would still impede airflow significantly, though now that I think about it would equally impede EPAP. What you say does certainly make a lot of sense. Still a little weird though, that the factory default APAP min pressure is 1cm H2O higher on the AirMini than the AirSense 11, 5 vs 4.

[@ajzepp8976]

All it did for me was make it feel like my inhalation was restricted. Not sure what everyone is on about with this thing.

[@danyelle6525]

Hey you!!! When are going to fix your CPAP advice link??? I’m sick of seeing Error establishing a database connection Error establishing a database connection Error establishing a database connection Error establishing a database connection Error establishing a database connection

[@lorenzoishere]

If you want to be serius you need to do clinical trials, pick a bunch of people with mouth leaks, half test them for a few days with vcom the other without, and study the results. If you only show isolated cases ..... thats no evidence of nothing

[@andrew9170]

Great Video as always - Thank You - but you may want to give your dogs over your shoulder 'a room' prior to your next video! LMAO 🤣😂

[@deepderp9957]

Reduced my aerophagia by about 80%. Works for me. I’m still fucking tired all the motherfucking time but that’s not this little piece of plastics fault. Maybe less farting and burping during the night will help.

[@veryberry39]

I'm still wondering if I've got something going on besides just apnea, because I've had every test done that I can think of, and even treating my subclinical hypothyroidism and using CPAP isn't keeping me from being super tired all day.

[@deepderp9957]

@@veryberry39 I found out I’m prediabetic, have metabolic disorder , and a leaky gut. It’s taking a long time to fix it all, even now I’m not sure something else isn’t going on. It’s all very difficult to determine. Hope you find out what it is and fix it 🙏

[@KPHVAC]

I'm a skeptic but if it works, it works! Thank you for sharing the results!

[@cebruthius]

9:40 How about you interview someone who did the painstaking programming for the feedback loop algorithms (or at least understands them) from ResMed or Philips first?

[@Fiawordweaver]

Got my two. I sleep better

[@diamaunt2782]

Hey, jason, if you want to help people with this, why not address the fact that there's NO RETURNS if the thing doesn't work? (At least, that's what I've been told by someone suckered into buying one, finding it doesn't work (at least for them), and being told "SUCKER!".

[@dandifusco1868]

Still get puffy cheeks. Why dat?

[@SBDavin]

4:00 Wow - the VCOM looks as big as your head in this shot. JK - thanks, LL.

[@johnc7144]

This is a product that costs about 25 cents to produce and sells for 30 dollars. You are definitely not an impartial reviewer.

[@bakersnursery]

tell me 'HOW' to stop the 'whistling' and I'll STOP leaving NEGATIVE comments! ( my wife screams at me EVERY night)

[@rasmusharrasmus]

Disappointed. Tried because of aerophagia, doesn't feel as if it helped that. ResMed 11 with N20 mask and mouth tape. Leak rates really not much improved.

[@AlwaysAudacity]

Unlike the stupid lock downs, this device can actually "flatten the curve".

[@Freecpapadvice]

😂

[@colt10mmsecurity68]

That thing sucks! What a waste of money. Hey if it works for you, fantastic. But it didn’t for me. It’s just another sales gimmick to buy for one’s cpap machine in my own opinion. 👎👎👎

[@djovis]

Useless! Waste of money.

[@gilrose12345]

Is Lankylefty27 slightly curious as to what is causing his hypopneas and apneas? Is it his tongue falling back? uvula, tonsils or nasal obstruction the cause? He looks fit and at the right BMI so why not try to find out what is structurally causing the AHIs? It is all about keeping people hooked on CPAP forever? It is all about the $$$. Could it be maxillofacial? No interest. Sad.

[@Freecpapadvice]

Huh? It feels like my soft palate and tongue. What is the "keeping people hooked on CPAP" comment all about though? I'm pretty consistent in being a proponent for anything that works and considering pros and cons. What am I missing?

[@veryberry39]

@@Freecpapadvice They don't know either, they just like criticizing anything related to the medical industry. We're probably all supposed to cure our apnea by using essential oils or something.

[@gilrose12345]

@@Freecpapadvice Just that in general there is no interest by industry insiders to try to find out what is causing the restrictions and obstructions leading to SA. band aid$

[@gilrose12345]

@@Freecpapadvice All I am saying is that CPAP is a band aid solution. It seems few in Sleep Medicine want to focus on an individual basis what is causing the sufferer of OSA to have these h's and a's. My OSA was due to a benign tumor pressing against my airway. Luckily I was able to get a brain MRI that picked it up recently. Had one removed in 1998 and had a geniglosus advancement and a UPPP. But due to the lock down I gained a lot of weight (which I am currently losing) and my SA came back. There are ENT's that do supine 3D CAT scans that can determine what is causing the SA as far as what structurally is causing the restrictions in airflow. So once you eliminate the restrictions/obstructions then no SA and no need for CPAP! It is all about the $$$.

[@400_billion_suns]

@@gilrose12345 Eh. For a lot of people, it’s simply due to their anatomy. Big tongue, small airway. Weight, of course, makes things worse, but there are a lot of relatively fit people who still have this problem. Your specific issue-a benign tumor-is definitely a rare outlier. The simple sad reality is that there is no obvious cure for a lot of people, and yes, CPAP is the easiest bandaid to fix the issue. There are facial and jaw surgeries that are highly invasive, have difficult recovery, and aren’t always effective at fixing OSA. I mean, really, if weight loss doesn’t fix it and you don’t have a tumor, what else are you going to do? How is that “about money?”

[@WarFox-1]

I bought the V com the night of you r vid. I have been using it. But I still get dry throat with tape. I can t get rid of the dry mouth and throat even with tape. Help if you can.

[@screamtoasigh9984]

Certain meds and allergies can cause dry mouth.

[@Freecpapadvice]

What do your OSCAR leak trend windows look like?

[@WarFox-1]

I am low vision so I can t really use oscar. I been on cpap for 12 years never had any problems. But the last year or so man. Not sure what changed other then I started working out. Any thoughts.?@@Freecpapadvice

[@fracman55]

I USE A RESMED 10 AUTO SET I DO NOT. USE ANY RAMP OR EPR CHEAT SETTINGS I HATE THAT CRAP.ANY PRESSURE UNDER 7 TOO START CPAP , I FEEL LIKE IM NOT GETTING ENOUGH AIR , MY MAX PRESSURE IS ONLY 12 AND I USE HUMIDICATION I CANNOT STAND BREATHING COLD AIR I LIKE SLIGHTLY WARM, I ALREADY ORDERED THE V-COM I DO GET MASK AND MOUTH LEAKS ANYTHING OVER 10 I GET PUFFER LIPS ,WILL THIS PRODUCT STOP THE MOUTH LEAKS AND RUMBLING SOUNDS ,OVERALL MY AHI RIGHT NOW IS 6.5 PER HOUR . MY MASK IS THE VITERA FULL FACE AND ALSO THE EVORA FULL FACE WITH THE ELEPHANT HOSE ,BOTH VERY GOOD MASK I LOVE THEM. CAN ANYONE HERE GIVE ME SOME ADVICE HOW TOO STOP THE RUMBLING PUFFER SOUNDS WAKING ME IN THE MIDDLE OF THE NITE .THE ONLY REASON I BOUGHT THE V-COM IS HOPING IT WILL RESOLVE THESE ISSUES FOR A SOLID NITES SLEEP.

[@aland680]

I have the same ResMed machine and mask as you have and had the same issues except I was on 5 to 15 pressure. When I was measured for the mask I fell between a medium and large so they gave me a large to start with. After about a month of playing with the straps I ordered the medium mask and it made ALL the difference. Something else that helped me was when I got up to use the restroom I always wipe the area under the mask with a wet washcloth to remove any oils/sweat from my face. Hope you get relief soon.