How do I adjust the rise‑time setting on my ResMed AirCurve V10 Auto, and should I increase the pressure support from 4 cm H₂O while humidification is set to auto?

Adjusting Rise Time and Pressure Support on ResMed AirCurve V10 Auto

You should adjust rise time based on your comfort and breathing pattern—use a slower rise time (300 ms) if you feel the pressure comes on too abruptly, or a faster rise time (150 ms) if you need quicker pressure delivery; increase pressure support above 4 cm H₂O only if you experience persistent shortness of breath, inadequate chest rise, or continued daytime sleepiness despite good adherence. 1

Understanding Rise Time Adjustment

Rise time controls how quickly the device transitions from expiratory pressure (EPAP) to inspiratory pressure (IPAP) when you begin to inhale. 1

How to Adjust Rise Time on Your Device:

• Access the Clinical Menu: Press and hold the home button and push button simultaneously for 3 seconds to enter the clinical settings menu on the AirCurve V10 Auto
• Navigate to Rise Time: Scroll through the menu options to find "Rise Time" setting
• Adjustment Guidelines:
  • Slower rise time (200-300 ms): Choose this if the pressure feels too abrupt or uncomfortable at the start of each breath, particularly if you have COPD or other obstructive lung disease 1
  • Faster rise time (100-150 ms): Select this if you feel you're not getting enough air quickly enough or have restrictive lung disease 1

Common Pitfall to Avoid:

• Do not set rise time too fast if you have obstructive airway disease—this can cause excessive initial flow and significant discomfort, leading to poor adherence 1

Should You Increase Pressure Support from 4 cm H₂O?

Pressure support (PS) of 4 cm H₂O is at the lower end of the therapeutic range (4-20 cm H₂O recommended by the American Academy of Sleep Medicine). 2

When to Increase Pressure Support:

• Increase PS if you experience:

  • Persistent use of accessory breathing muscles (neck/shoulder muscles visibly working during breathing) 3
  • Paradoxical breathing (chest and abdomen moving in opposite directions) 3
  • Continued excessive daytime sleepiness despite good device usage 3
  • Inadequate chest rise during inspiration 3

• Monitor your device data for:

  • Residual apnea-hypopnea index (AHI) >10 events/hour suggests inadequate pressure support 4
  • Low tidal volumes (if your device reports this metric) 3

How Much to Increase:

• Increase pressure support by 2 cm H₂O increments (from 4 to 6, then 6 to 8, etc.) every 5-7 days if symptoms persist 2
• Target pressure support range: Most patients require 8-12 cm H₂O for adequate ventilatory support 2
• Maximum safe pressure support: Up to 20 cm H₂O for adults, though most patients are comfortable between 8-15 cm H₂O 2

Critical Warning:

• Do not exceed maximum IPAP of 30 cm H₂O (IPAP = EPAP + Pressure Support), as this is the safety ceiling recommended by the American Academy of Sleep Medicine for patients ≥12 years of age 3

Humidification on Auto Setting

Your humidification setting on "auto" is appropriate and does not require adjustment. 5

• Auto humidification adjusts moisture delivery based on ambient temperature and your breathing pattern 5
• Heated humidification does not significantly interfere with bilevel device function when set to auto mode 5
• Only adjust humidification manually if you experience nasal dryness (increase level) or rainout/water in tubing (decrease level) 5

Follow-Up Requirements

• Download your device data using ResMed myAir app or have your sleep medicine provider review detailed compliance reports within 2-4 weeks of any setting changes 3

• Verify adequate treatment by checking:

  • AHI remains <5 events/hour (ideally <10 events/hour minimum) 3
  • Device usage >4 hours per night on >70% of nights 4
  • Resolution of daytime sleepiness 3

• Contact your prescribing physician before making pressure support changes >2 cm H₂O or if you experience worsening symptoms, as close follow-up by trained healthcare providers is mandatory after adjusting bilevel settings 3