VPAP lll problems

[dsm]

Barry,

Here is a set of photos of the 3 VPAP models.
http://www.internetage.com/cpapinfo/vpap3-1

Seems like you have a standard VPAP III S model (note the others have ST & Enhanced on the panel).

I'll take a look at the comfort settings on the S model. But it is a bit unusual for a standard BiLevel to not follow your in out breathing cycle esp the VPAP III. They are very responsive.

On a hunch take a look at the filter & wash it - let us know if it was in anyway clogged.

Also, what size & type mask do you use ?

If you look through your settings menu, what mask is listed ?

Do you have the 2i Heated Humidifier fitted ?

Cheers DSM (DS = Dougal & Stuart )

Loch Ness, interesting place to be staying - neer bin there misself ba a wud ne mind a wee stop over at some time.

[dsm]

Barry,

After thinking about what you plan to undertake, I feel I should make these points ...

1) You don't have software that monitors your nightly data & will have no way of knowing other than how you feel over time, to determine if changes you make are genuinely beneficial vs cosmetically nice.

2) The Vpap III is one of the more sophisticted BiLevel machines & the settings are hard enough to grasp for a respiratory specialist. If you were for example, to change your rise time to a figure like 900ms, it may feel nice lying on your back in the afternoon but while you sleep could be causing you serious airflow problems, especially if you breath deeply & solidly as you say you do. Upping rise time to beyond 350 ms is a place where only angels fear to tread. Take a look at this link http://www.apneasupport.org/viewtopic.php?p=24770 - it should put you off playing with the rise time in excess of about 250-350 ms max esp if you are a deep breather.

3) If you do decide to change your settings, try to at least keep the epap as is & the ipap *no more* than 4 above it. Going beyond that without monitoring is folly.

4) My kindest advice is to keep your maxInsp at 3.0 or below (try 2.25-2.75 range) & minInsp at 0.5 or less. Changing these and the rise time all combine to alter the I:E ratio & as you are not really familiar with the effects of doing that, I really suggest you seek expert assistance.

Whatever your do, record all the current settings & make sure you know how to get back to where you were before playing with the settings.

As mentioned in the prior post - clean your filter.

Good luck

DSM

[KeziasPurr]

I use a VPAPIII as well. Last night I noticed that the machine wasn't giving me enough inhalation time. I continued to breathe at my normal pace (ignoring the machines attempt at making me exhale) and eventually the machine caught up with me again.

[BarryBlust]

Here is all the data on my machine/mask... hope this helps you help me!

Mode: spont
Ipap: 13.0
Epap: 7.0
Rise time: 150
Ipap max: 2.0
Ipap min: 0.10
Mask alarm: off
Smart start: on
Mask: Mirage
Humid: pass over
Tube length: 2m
Max ramp: 45
start Epap: 4.0

My mask is Resmed Ultra Mirage - full face mask - medium

Thanks again nice people!!

Ba

[rested gal]

Ipap max: 2.0

I think that's the culprit. If it were me and inhalation was being cut off prematurely, I'd change that to 4.0.

While I was at it, I'd also change (if it were me) these, since they are also "comfort" settings:

Max ramp: 45 -- I'd turn ramp off.
start Epap: 4.0 -- I'd set the "start EPAP" at the prescribed EPAP setting of 7.0

[dsm]

[quote="BarryBlust"]Here is all the data on my machine/mask... hope this helps you help me!

Mode: spont
Ipap: 13.0
Epap: 7.0
Rise time: 150
Ipap max: 2.0
Ipap min: 0.10
Mask alarm: off
Smart start: on
Mask: Mirage
Humid: pass over
Tube length: 2m
Max ramp: 45
start Epap: 4.0

My mask is Resmed Ultra Mirage - full face mask - medium

Thanks again nice people!!

Ba

[BarryBlust]

Thank you all so very much... I will make the changes as advertised. And please do send me that link!

Ba

[rested gal]

Take a look at this link http://www.apneasupport.org/viewtopic.php?p=24770

Nice link, dsm, and interesting information from sleepydave there. I've taken the liberty to emphasize in red a couple of his points:

The effect of rise time is to gradually increase the pressure over period of time. Feels comfortable, yes, but reduces the time spent at peak (effective therapeutic) pressure. If you're using this to overcome the effect of hypopneas, this may not be an issue.

If you're using it to address central apneas, however, a change in rise time could significantly change the effect of trying to generate a reasonable facsimile of a normal breath. Using BiPAP in this case is trying to create a volume breath, and the volume delivered is based on the flow rate times the duration of flow. By prolonging rise time, flow rate is reduced for a significant portion of the breath, resulting in a lower tidal volume (the infamous "area under the curve" concept).

Using BiPAP to overcome central apnea is frequently not completely effective. Adding a lengthy rise time may further compromise the ability of the machine to treat CSA.
sleepydave

The subject of Dave's topic was:

Respironics Synchrony S/T vs Resmed Adapt SV (CS-2)

And his follow-up post dealt with:

If Not S/T, Then What?
So. the question becomes, how do you effectively treat CSA with BiPAP?

That topic is discussing an S/T (spontaneous/timed) bi-level machine and the CS-2 machine, neither of which BarryBlust is using. According to his description of what words are not in the name of his machine, he's using a regular VPAP III which has no timed backup rate capability....not an S/T machine.

Granted, we have no information about BarryBlust's sleep study or underlying health issues -- no inkling of why he was prescribed a regular bi-level machine in the first place. Nor why he was prescribed such a large gap between EPAP/IPAP pressures.

If we're going to talk about what is wise or not wise to "suggest" when we're not doctors and have no knowledge of the why's and wherefore's of Barry's prescribed regular bi-level machine's pressure settings, I'd gently point out that saying what you did in your point 3 is treading much more deeply into suggesting a change in his medical treatment than any suggestion I've made so far about adjusting comfort settings:

3) If you do decide to change your settings, try to at least keep the epap as is & the ipap *no more* than 4 above it.

Which reminds me... Hey, Barry, did your sleep doctor say you had Central Sleep Apnea or a lot of centrals in your sleep study? If so, disregard everything and do one of the things dsm suggests:

I really suggest you seek expert assistance.

Which is probably what both of us should have restricted ourselves to all along!

(I'd still change that IPAP max to 4.0 s -- if it were me. )

[BarryBlust]

Two things stood out as a result of my sleep study: my incidence was 99+ episodes/hour, my O2 sat was below 40.

As I said previously, I was literally being killed in my sleep. My heart was racing, fluids were being shunted off, and I was well on the way to diabetes. Not a pretty picture at all.

I also had/have COPD resulting from smoking for 40 years (no longer smoking at all).

I also had 5L O2 delivered with the CPAP originally... no longer necessary.

I assume all these factors were taken into consideration.

Good news is that I am well on the way to being back!

The more you know...

[dsm]

Take a look at this link http://www.apneasupport.org/viewtopic.php?p=24770

Nice link, dsm, and interesting information from sleepydave there. I've taken the liberty to emphasize in red a couple of his points:

The effect of rise time is to gradually increase the pressure over period of time. Feels comfortable, yes, but reduces the time spent at peak (effective therapeutic) pressure. If you're using this to overcome the effect of hypopneas, this may not be an issue.

If you're using it to address central apneas, however, a change in rise time could significantly change the effect of trying to generate a reasonable facsimile of a normal breath. Using BiPAP in this case is trying to create a volume breath, and the volume delivered is based on the flow rate times the duration of flow. By prolonging rise time, flow rate is reduced for a significant portion of the breath, resulting in a lower tidal volume (the infamous "area under the curve" concept).

Using BiPAP to overcome central apnea is frequently not completely effective. Adding a lengthy rise time may further compromise the ability of the machine to treat CSA.
sleepydave

The subject of Dave's topic was:

Respironics Synchrony S/T vs Resmed Adapt SV (CS-2)

And his follow-up post dealt with:

If Not S/T, Then What?
So. the question becomes, how do you effectively treat CSA with BiPAP?

That topic is discussing an S/T (spontaneous/timed) bi-level machine and the CS-2 machine, neither of which BarryBlust is using. According to his description of what words are not in the name of his machine, he's using a regular VPAP III which has no timed backup rate capability....not an S/T machine.

Granted, we have no information about BarryBlust's sleep study or underlying health issues -- no inkling of why he was prescribed a regular bi-level machine in the first place. Nor why he was prescribed such a large gap between EPAP/IPAP pressures.

If we're going to talk about what is wise or not wise to "suggest" when we're not doctors and have no knowledge of the why's and wherefore's of Barry's prescribed regular bi-level machine's pressure settings, I'd gently point out that saying what you did in your point 3 is treading much more deeply into suggesting a change in his medical treatment than any suggestion I've made so far about adjusting comfort settings:

3) If you do decide to change your settings, try to at least keep the epap as is & the ipap *no more* than 4 above it.

Which reminds me... Hey, Barry, did your sleep doctor say you had Central Sleep Apnea or a lot of centrals in your sleep study? If so, disregard everything and do one of the things dsm suggests:

I really suggest you seek expert assistance.

Which is probably what both of us should have restricted ourselves to all along!

(I'd still change that IPAP max to 4.0 s -- if it were me. )

RG,

Yes good points but read barry's latest post please. COPD - all bets are off.
(but the point the link was covering was the effect of risetime adjustments - that has the same effect on the minute ventilation volume on all these particular machines).

Re COPD, this should have come out (with more questioning) before any of us began suggesting changes but once the cat was out of the bag ...

I come right back to my early posts - we must do more questioning of someone who has a BiLevel and is having problems, before we hint of how to change settings.

But it is done!.

Maybe we need to be more cautious this has been an interesting example of why.

Cheers

DSM

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, bipap, CSA, Bi-Level Machine

[dsm]

[quote="BarryBlust"]Two things stood out as a result of my sleep study: my incidence was 99+ episodes/hour, my O2 sat was below 40.

As I said previously, I was literally being killed in my sleep. My heart was racing, fluids were being shunted off, and I was well on the way to diabetes. Not a pretty picture at all.

I also had/have COPD resulting from smoking for 40 years (no longer smoking at all).

I also had 5L O2 delivered with the CPAP originally... no longer necessary.

I assume all these factors were taken into consideration.

Good news is that I am well on the way to being back!

The more you know...

[BarryBlust]

My experience with sleep centers/studies/MD's has been mixed. Certainly I appreciate the healing!! The living!! But the place was so busy took over 6 months to get the study done and so forth... then another 3 months adjusting to and selecting the right mask, etc. Though I was required to revisit the center, those sessions were little more than any visit to a GP.

One thing I have learned is to be more proactive!! I can do this.

Thanks again for all your help... I continue to read the forum and will let you know how things turn out.

Ba

I am in Scotland actually because of love... and that is a profound healer as well. Though I might not find a cleaner and fresher place in the English speaking world (maybe New Zealand?). Scotland is fabulous.

[dsm]

Barry,

Take a look into the software. Well worth the 30 or so pounds cost.

Love the reason you are in Scotland not the single malt after all

& yes New Zealand is a paradise full of Scots & Scottish descendants.

DSM

[AnotherElizabeth]

Rested Gal said:To change any of those, you'd have to go into the clinical setup menu by holding down together the right arrow button (the red arrow) and the down arrow button (the black double-arrow button.) If a person does go into the clinical menu on any machine I think it's a good idea to walk through the menu making NO changes at all the first time. Simply write down every setting, every symbol, every word on the screen to have a record of all the original settings.

I tried to respond to this earlier but have no clue where that post went....so I begin again.

I tried accessing the clinical setup menu in the way described above but am not able to obtain it. I have the VPAP lll ST-A (bilevel). Could the method of accessing that be different on my machine? I'm not interested in changing anything at this point but I am interested in seeing how it is setup. I have symptoms similar to Barry's and am setting off alarms constantly. I'm needing to use my faltering Respironic in the meantime, just to get some sleep. Have an appointment with pulmonologist in a few weeks. Clinician is unfamiliar with my machine and limited in helping me.

This site and all of you are the greatest.
Thank you,
Elizabeth, who hopes this gets where it's going this time.

[dsm]

Rested Gal said:To change any of those, you'd have to go into the clinical setup menu by holding down together the right arrow button (the red arrow) and the down arrow button (the black double-arrow button.) If a person does go into the clinical menu on any machine I think it's a good idea to walk through the menu making NO changes at all the first time. Simply write down every setting, every symbol, every word on the screen to have a record of all the original settings.

I tried to respond to this earlier but have no clue where that post went....so I begin again.

I tried accessing the clinical setup menu in the way described above but am not able to obtain it. I have the VPAP lll ST-A (bilevel). Could the method of accessing that be different on my machine? I'm not interested in changing anything at this point but I am interested in seeing how it is setup. I have symptoms similar to Barry's and am setting off alarms constantly. I'm needing to use my faltering Respironic in the meantime, just to get some sleep. Have an appointment with pulmonologist in a few weeks. Clinician is unfamiliar with my machine and limited in helping me.

This site and all of you are the greatest.
Thank you,
Elizabeth, who hopes this gets where it's going this time.

Elizabeth,

What RestedGal said should have worked.

The buttons on the VPAP III form a + shape. Ther are the left & right buttons & in the middle the up & down buttons (crude diag below - someone on cpaptalk has an exact diag and showing two fingers holding the buttons (similar to the Resmed S8))

....^....
<----->
.....u....

Press on the right arrow button and at the same time hold the down button - do so for at least 3 secs.

That puts you into the clinical menu, If you step through the clinical menu (middle up down buttons - start with down button) you come to a SETTINGS menu you enter this by pressing the left arrow button & exit it by pressing the right arrow button when the word exit appears above it. In between entering SETTINGS and seeing the word exit, you get to see all the settings for the machine.

As for anyone on a prescribed Bilevel, record all settings and act with extreme care. When traversing the settings, don't touch the middle up/down buttons as these will change the settings.

DSM

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed