Resmed VPAP Auto 25

Anyone else using one and what should I be aware of in using this machine. Any input for users would be welcome.


JeffH

This is the machine that I have used for a while. Can't think of anything special you need to know about it. Did you have specific questions?

Mary Z wrote:This is the machine that I have used for a while. Can't think of anything special you need to know about it. Did you have specific questions?

Only that it has more settings than a regular machine and I don't know what all of them mean / do. I don't have a copy of my prescription (I'm getting it soon). I'm just trying to educate myself on this equipment.

Thanks

JeffH

What settings are you talking about in particular? I suggest getting a copy of the manuel and clinical manual and reading through them. If you are new the only things you can change from the user menu is the length of time for ramp or settling and mask. I wouldn't suggest changing any settings from the clinical menu until you've used the machine a while. Most of the settings depend on what mode you are running the machine in- CPAP, AUTO, or Spontaneous. What mode of operation are you using?
As I said my best suggestion is to thoroughly go over both the manuals.

Jeff, to get you started well up the side of the learning curve, here's a link to jnk's excellent description of how the PS (pressure support) setting works when using a VPAP Auto 25 in auto bilevel mode:

Jeff's (jnk) great explanation about the difference in how the ResMed VPAP Auto (and "25") and the Respironics BiPAP Auto handle the "PS" (Pressure Support) setting:
topic: ResMed VPAP Auto 25 Clinician's manual
viewtopic.php?p=376749#p376749


___________________

Jeff (jnk) answering IFLEW's questions:
topic: ResMed Pressure Support
viewtopic.php?p=428022#p428022

rested gal, thanks, your answer was much more helpful that mine have been. I was going to check out Jeff's post myself, but all I get is the message "No posts exist inside this topic for the selected time frame." Do you know the way around this? I have display posts for one year checked.
Thanks,
Mary Z

How interesting, Mary. I didn't know anything about setting a time frame for displaying posts. Never did that myself.

So, went to my User Control Panel just now - Board Preferences - Edit Display Options - Display posts from previous days: ___

Mine was set in the drop down menu for the default (presumably) of "All days."

I guess "All days" is what you'd have to change yours to, to see jnk's post written back on Jun 15, 2009.

Likewise, his post replying to IFLEW's questions... written Dec. 10, 2009

Thanks everyone.

My questions are about the additional settings on the machine and what they mean.

Here's my 'script

IPAP 18 (that's the max pressure, I've figured that out)

EPAP 10 (same as above)

PS 4 (I think this means pressure separation?)

TiMax 2.5 (I think, can't read it too good)

TiMin 0.3

Trigger / Exhale Medium

Cycle High

There are my questions.

Thanks

JeffH

Oh my goodness!!
I just posted a question on this topic and then saw the very same topic listed 5 min ago!!
i will read through all this first
thanks

Ping to jnk... our VPAP Auto 25 answer man.

This is quoted from the clinical manual. I hope it is of some help.

VPAP assists spontaneous breathing by cycling between two pressures in response
to the patient flow or a preset fixed time.
The inspiratory positive airway pressure (IPAP, or the sum of EPAP and the pressure
support level) assists inspiration.
The lower expiratory positive airway pressure (EPAP) eliminates exhaled air through
the mask exhaust vent. This facilitates exhalation comfort while providing a splint to
maintain an open upper airway.
The difference of the two pressures—pressure support level—contributes to
improved patient ventilation.

(So PS is pressure support

Triggering and Cycling
(S, ST and VAuto modes) Under normal conditions, VPAP triggers (initiates IPAP)
and cycles (terminates IPAP and changes to EPAP) as it senses the change in patient
flow. Patient breath detection is enhanced by VPAP’s automatic leak management
feature—Vsync.
In addition, VPAP has adjustable trigger/cycle sensitivity to optimize the sensing level
according to patient conditions.
Rise Time Adjustment
(S, ST and T modes) Rise time sets the time taken for the VPAP to reach IPAP. The
greater the rise time value, the longer it takes for pressure to increase from EPAP to
IPAP.
Patients with a high ventilatory demand may prefer a shorter rise time, while patients
who are slow breathers may prefer a longer rise time.
Note: A prolonged rise time inhibits fast pressurization, therefore, rise time should
not be set longer than Ti Max or the patient’s normal inspiratory time.

TiControl™ – Inspiratory Time Control
(S, ST and VAuto modes) Unique to ResMed bilevel devices, TiControl allows the
clinician to set minimum and maximum limits on the time the device spends in IPAP.
The minimum and maximum time limits are set at either side of the patient’s ideal
spontaneous inspiratory time, providing a ’window of opportunity’ for the patient to
spontaneously cycle to EPAP.
The minimum time limit is set via the Ti Min parameter and the maximum time limit
is set via the Ti Max parameter.
TiControl’s Ti Max and Ti Min parameters play a significant role in maximizing
synchronization by effectively intervening to limit or prolong the inspiratory time
when required. This ensures synchronization even in the presence of significant
mouth and/or mask leak.
The following table is a guide to selecting the Ti Max and Ti Min values that best
correspond to the patient’s respiratory rate and inspiration and expiration ratio,
depending on the respiratory conditions.Notes:
• Factory default values are Ti Max = 2.0 seconds and Ti Min = 0.3 seconds.
• I:E = 1:1 – Ti Min prevents the premature cycling to EPAP for patients whose
inspiratory effort is extremely weak.
• I:E = 1:3 – Ti Max limits the inspiration time for patients who require a longer
expiration time.
(Table omitted)
Exhalation
(VAuto mode) You can adjust the Exhalation rate so the rate of pressure drop is at a
level that is most comfortable for the patient. The medium rate is usually most
comfortable. If required, you can select a rate that is faster or slower.

Min EPAP, Max IPAP & Pressure Support
(VAuto mode) Pressure support allows you to set the difference between inspiratory
and expiratory pressure. Min EPAP and Max IPAP settings allow you to restrict the
range of pressures in which the AutoSet algorithm can operate.
The AutoSet pressure will vary across the session according to the patient’s needs.
It responds to snoring, apneas and flattening of the patient’s flow curve.
Min EPAP and Max IPAP can be adjusted to limit the upper and lower delivered
pressure limits.
Notes:
• The device will stay at Min EPAP (with the selected amount of pressure support)
during the Settling time (if selected) at the beginning of a session.
• If Pressure Support is set above 6 cm H2O, treatment efficacy may be reduced.

Mary Z wrote:This is quoted from the clinical manual. I hope it is of some help.

VPAP assists spontaneous breathing by cycling between two pressures in response
to the patient flow or a preset fixed time.
The inspiratory positive airway pressure (IPAP, or the sum of EPAP and the pressure
support level) assists inspiration.
The lower expiratory positive airway pressure (EPAP) eliminates exhaled air through
the mask exhaust vent. This facilitates exhalation comfort while providing a splint to
maintain an open upper airway.
The difference of the two pressures—pressure support level—contributes to
improved patient ventilation.

(So PS is pressure support

Triggering and Cycling
(S, ST and VAuto modes) Under normal conditions, VPAP triggers (initiates IPAP)
and cycles (terminates IPAP and changes to EPAP) as it senses the change in patient
flow. Patient breath detection is enhanced by VPAP’s automatic leak management
feature—Vsync.
In addition, VPAP has adjustable trigger/cycle sensitivity to optimize the sensing level
according to patient conditions.
Rise Time Adjustment
(S, ST and T modes) Rise time sets the time taken for the VPAP to reach IPAP. The
greater the rise time value, the longer it takes for pressure to increase from EPAP to
IPAP.
Patients with a high ventilatory demand may prefer a shorter rise time, while patients
who are slow breathers may prefer a longer rise time.
Note: A prolonged rise time inhibits fast pressurization, therefore, rise time should
not be set longer than Ti Max or the patient’s normal inspiratory time.

TiControl™ – Inspiratory Time Control
(S, ST and VAuto modes) Unique to ResMed bilevel devices, TiControl allows the
clinician to set minimum and maximum limits on the time the device spends in IPAP.
The minimum and maximum time limits are set at either side of the patient’s ideal
spontaneous inspiratory time, providing a ’window of opportunity’ for the patient to
spontaneously cycle to EPAP.
The minimum time limit is set via the Ti Min parameter and the maximum time limit
is set via the Ti Max parameter.
TiControl’s Ti Max and Ti Min parameters play a significant role in maximizing
synchronization by effectively intervening to limit or prolong the inspiratory time
when required. This ensures synchronization even in the presence of significant
mouth and/or mask leak.
The following table is a guide to selecting the Ti Max and Ti Min values that best
correspond to the patient’s respiratory rate and inspiration and expiration ratio,
depending on the respiratory conditions.Notes:
• Factory default values are Ti Max = 2.0 seconds and Ti Min = 0.3 seconds.
• I:E = 1:1 – Ti Min prevents the premature cycling to EPAP for patients whose
inspiratory effort is extremely weak.
• I:E = 1:3 – Ti Max limits the inspiration time for patients who require a longer
expiration time.
(Table omitted)
Exhalation
(VAuto mode) You can adjust the Exhalation rate so the rate of pressure drop is at a
level that is most comfortable for the patient. The medium rate is usually most
comfortable. If required, you can select a rate that is faster or slower.

Min EPAP, Max IPAP & Pressure Support
(VAuto mode) Pressure support allows you to set the difference between inspiratory
and expiratory pressure. Min EPAP and Max IPAP settings allow you to restrict the
range of pressures in which the AutoSet algorithm can operate.
The AutoSet pressure will vary across the session according to the patient’s needs.
It responds to snoring, apneas and flattening of the patient’s flow curve.
Min EPAP and Max IPAP can be adjusted to limit the upper and lower delivered
pressure limits.
Notes:
• The device will stay at Min EPAP (with the selected amount of pressure support)
during the Settling time (if selected) at the beginning of a session.
• If Pressure Support is set above 6 cm H2O, treatment efficacy may be reduced.

Thanks, Mary. That helps explain things.


JeffH

JeffH wrote:Thanks everyone.

My questions are about the additional settings on the machine and what they mean.

Here's my 'script

IPAP 18 (that's the max pressure, I've figured that out)

EPAP 10 (same as above)

If that's exactly the way those two pressures were written on the Rx, it would mean to set the machine in plain bilevel mode (not autotitrating bilevel mode.) For autotitrating bilevel mode, it should be written Max IPAP 18, Min EPAP 10.

But that's a minor quibble because....since the Rx goes on to say:

JeffH wrote:PS 4 (I think this means pressure separation?)

Right, that's what it means... how far the varying (when autotitrating) separate IPAP/EPAP pressures are to stay apart from each other, per jnk's explanation in the posts of his I linked to.

And since the Rx mentions a setting for "PS", it's obvious (well, kind'a ) the doctor intends the machine to be set for autotitrating bilevel mode since there would be no separate "PS" setting appearing in the menu for plain bilevel mode. Or...I guess I should say, "obvious, only if the doctor really understands the settings for autotitrating bilevel vs plain bilevel in the VPAP Auto 25's operating modes."

Doctors generally leave the nuts/bolts of machine setting stuff to the DME or RT, and sometimes don't know the particulars about the machines themselves.
Or.... even some of the basics about a bilevel machine. Can be true even of "sleep doctors" who use bilevel themselves.
viewtopic.php?p=233928#p233928

JeffH wrote:TiMax 2.5 (I think, can't read it too good)

As I understand it (I could be wrong) that's the setting for the maximum amount of time in seconds (?) that the machine is allowed to use the higher IPAP pressure while you are inhaling. Time for inspiration. Personally, I'd want the TiMax set for the most it can be set for, even if I knew I didn't normally breathe in that long before I switched to breathing out. I'd want TiMax set for as long as possible, in case I did occasionally want to draw in an extra, extra long breath for longer than 2.5 seconds. Unlikely I would, but I'm into comfort...and I would not like to be breathing in slowly and deeply, even if that happened rarely, and have the machine suddenly switch down to the lower EPAP pressure before I was completely finished breathing in.

TiMax governs how long it will be (while you're breathing in) before the machine drops back down, on its own, to the lower EPAP pressure...whether you've finished breathing in or not. Setting an extra long TiMax won't keep the machine from dropping down when YOU exhale. It will still drop to EPAP the instant you exhale. A long TiMax will simply insure that it won't cut off your inhalation prematurely IF you happen to draw in an extra long, slow breath.

The length of time for that kind of setting (TiMax) matters if a person has certain kinds of pulmonary problems, but for "healthy" OSA people who happen to be using a bilevel machine, I don't think it matters beyond having enough extra margin of time to NOT cut off your inhalation with a drop to EPAP before you, yourself, start to breathe out. So, I'd set TiMax for as long as it can be set for.

JeffH wrote:TiMin 0.3

That's the minimum amount of time (in this case three-tenths of a second?) that the higher IPAP pressure has to blow. I'd leave that setting as is. It's very unlikely you're going to be breathing in for less than 0.3 seconds...you'd be doing some seriously fast panting if your inhalations were THAT short.

I was still writing while Mary found the info right in the manual. Very good. Will go on and stick this post in anyway.

rested gal wrote:

JeffH wrote:Thanks everyone.

My questions are about the additional settings on the machine and what they mean.

Here's my 'script

IPAP 18 (that's the max pressure, I've figured that out)

EPAP 10 (same as above)

If that's exactly the way those two pressures were written on the Rx, it would mean to set the machine in plain bilevel mode (not autotitrating bilevel mode.) For autotitrating bilevel mode, it should be written Max IPAP 18, Min EPAP 10.

But that's a minor quibble because....since the Rx goes on to say:

JeffH wrote:PS 4 (I think this means pressure separation?)

Right, that's what it means... how far the varying (when autotitrating) separate IPAP/EPAP pressures are to stay apart from each other, per jnk's explanation in the posts of his I linked to.

And since the Rx mentions a setting for "PS", it's obvious (well, kind'a ) the doctor intends the machine to be set for autotitrating bilevel mode since there would be no separate "PS" setting appearing in the menu for plain bilevel mode. Or...I guess I should say, "obvious, only if the doctor really understands the settings for autotitrating bilevel vs plain bilevel in the VPAP Auto 25's operating modes."

Doctors generally leave the nuts/bolts of machine setting stuff to the DME or RT, and sometimes don't know the particulars about the machines themselves.
Or.... even some of the basics about a bilevel machine. Can be true even of "sleep doctors" who use bilevel themselves.
viewtopic.php?p=233928#p233928

JeffH wrote:TiMax 2.5 (I think, can't read it too good)

As I understand it (I could be wrong) that's the setting for the maximum amount of time in seconds (?) that the machine is allowed to use the higher IPAP pressure while you are inhaling. Time for inspiration. Personally, I'd want the TiMax set for the most it can be set for, even if I knew I didn't normally breathe in that long before I switched to breathing out. I'd want TiMax set for as long as possible, in case I did occasionally want to draw in an extra, extra long breath for longer than 2.5 seconds. Unlikely I would, but I'm into comfort...and I would not like to be breathing in slowly and deeply, even if that happened rarely, and have the machine suddenly switch down to the lower EPAP pressure before I was completely finished breathing in.

TiMax governs how long it will be (while you're breathing in) before the machine drops back down, on its own, to the lower EPAP pressure...whether you've finished breathing in or not. Setting an extra long TiMax won't keep the machine from dropping down when YOU exhale. It will still drop to EPAP the instant you exhale. A long TiMax will simply insure that it won't cut off your inhalation prematurely IF you happen to draw in an extra long, slow breath.

The length of time for that kind of setting (TiMax) matters if a person has certain kinds of pulmonary problems, but for "healthy" OSA people who happen to be using a bilevel machine, I don't think it matters beyond having enough extra margin of time to NOT cut off your inhalation with a drop to EPAP before you, yourself, start to breathe out. So, I'd set TiMax for as long as it can be set for.

JeffH wrote:TiMin 0.3

That's the minimum amount of time (in this case three-tenths of a second?) that the higher IPAP pressure has to blow. I'd leave that setting as is. It's very unlikely you're going to be breathing in for less than 0.3 seconds...you'd be doing some seriously fast panting if your inhalations were THAT short.

I was still writing while Mary found the info right in the manual. Very good. Will go on and stick this post in anyway.

It does say Max and Min so it must be set in Auto mode.

Thanks for the info. Makes sense.

JeffH