Problems with ResMed VPAP Auto / Using ResScan Software

[rpfister51]

(The following is a long post. Three main questions: 1) any experience or knowledge about ResMed VPAP Auto, and getting best results with it, 2) mechanics of ResScan software; do I need just the software and a USB cable, and 3) have others found the ResScan software helpful in understanding their OSA).

I'm a long time CPAP / BiPAP user. My brother was recently diagnosed with Obstructive Sleep Apnea (I shared a hotel room on a trip with him in January, heard him sleep and told him to get a sleep study and a machine as quickly as he could).

He, finally, has a ResMed VPAP Auto, and has not had good success with it. He lives in a small town in NC, I live on the other side of the country. I don't think the DME providers or the doctor are being very helpful.

I sleep with a six year old Respironics BiPap pro (which I love) with a setting of 17/12. Based on his sleep study, his doctor said he needs a pressure of 17 or 18. We figured out how to use the Clinical Menu on the machine, it is in VAUTO mode, min EPAP is 12, max IPAP is 18, pressure support is 4.

He finds the machine very uncomfortable, finds it "fights" him as he tries to breathe. When he does fall asleep with the mask on, he wakes up hours later having torn it off. Based on the usage stats it looks like he pulls it off after only five or ten minutes (His daily usage was "0", his weekly usage was 48 minutes when I looked at it this weekend).

(Incidentally I tried his machine for a few minutes, found it very uncomfortable, found it didn't sync up with my breathing very quickly or, really, at all. He's tried my machine but doesn't like it any better than his).

My questions for the forum:

1) Any experience or knowledge about ResMed VPAP Auto, and getting best results with it would be appreciated.

2) While searching for solutions I stumbled across ResScan software. It looks like he can buy the software plus a ResMed proprietary USB cable, and then download detailed data to the software. Do I need to buy anything else? Also, it doesn't need to be connected during the night, does it?

3) Have others found the ResScan software helpful in understanding their OSA?

Thanks
Bob

[dsm]

Slinky is the person to talk to. She is using one recently obtained.

DSM

[Slinky]

I'm not going to be one heck of a whole lotta help 'cause I've only been on a bi-level since late March, its on a capped rental and I have COPD so I haven't been able to play around w/any settings, etc. I don't even see the sleep doc again until July when he'll want a download so I've gotta be a good girl for a while yet.

I do have the software. You need ResScan v3.4 or better (only one newer, the Vista compatable one). That's all you need is the right ResScan version and the propriatary cable reader.

There are some settings that can be changed that I don't have the slightest knowledge about. Perhaps you, as a long time bi-level user, would understand them.

Pressure Support options are: Minimum 0, Maximum 10
Trigger Sensitivity: High, Medium, Low
Cycle Sensitivity: High, Medium, Low
Exhalation: Slow, Medium, Fast
Ti Minimum: 0.1 to 4
Ti Maximum: 0.1 to 4

and others I do, easy things like:
Mask Setting
Settling Time: 0 to 45 minutes
Maximum Settling Time: 0 to 45 minutes
and etc.

I did find the first night I used it, and when I changed masks during the night, that it was NOT as comfortable for the first 10 minutes or so until it "learned" my breathing pattern.

Also, you are going to find that this Resmed VPAP Auto is so new, especially to North America, that finding someone who does know much about, including the sleep docs and RTs, who do know diddley-squat about it.

[jnk]

Try setting the TiMax setting higher. If it is on 2 seconds, change it to 3. That should allow the VPAP Auto to sync with his breathing.

[Slinky]

Thanks, jnk.

I don't know if my settings will be any help or not but here is the way mine was set up.

IPAP 12 cms, EPAP 8 cms
Pressure Support 4
Trigger & Cycle Sensitivity and Exhalation: Med
Ti Minimum 0.5
Ti Maximum 4

I use the Respironics Simplicity simple nasal cushioin mask so have my Mask Selection set on Standard.
I only use Settling for 10 minutes, just to get my mask seated well and my pillow scrunched up "just right".

The ResScan software provides as much info as EncorePro except for the Daily Events Per Hour chart so you would have to judge its value according to your estimation of your EncorePro's value to you and your xPAP therapy.

You only insert the Resmed data card when you want to do a data download. But the download should be done every 4 days before noon in order to save the detailed data to the software. Every 5th day the previous first day is rolled over into the total averages. I usually download mine most every day. And when I travel and will be away from my 'puter more than 7-8 days I take an extra data card along, donwload the first 4 days on my usual data card and the next 4 days on my extra data card. When I get home I download my usual data card first and the second data card next. I'd have to check my manual but I think it is 365 days of Usage Data that is stored on the card. And the averages, of course.

[jnk]

Thanks for that info, Slinky. And for thanking me. I have never participated in any online discussions before (the earlier post was my first), so please pardon any newbie lack of manners I may display.

I am also new to the OSA world. I was recently diagnosed with severe OSA and have had a machine and mask for about a week, a ResMed VPAP III (at 16/12) and a Respironics ComfortGel nasal mask.

The first night that I tried to use the machine, I kept waking up, fighting the machine. I found myself trying to breathe in as it was trying to make me breathe out and couldn't sync with it at all. It was making the timing decisions for me, and I just couldn't cycle my breathing as fast as it wanted. I knew the situation wasn't good, because my whole body felt like it was vibrating when I woke up the second time, which I took to be an indication that my brain had surged some hormone through me to wake me up. I hate that caught-in-the headlights/ near-death feeling!

I wasn't sure what to do, so I fired up the computer and did a search to try to figure out what I should do. That first night I stumbled onto the way to get into the clinician's menu to see what was going on and what the numbers meant. Once I figured out that the TiMax number was providing the window of opportunity for me to breathe before breathing for me, I changed that number from 2 seconds to 3 seconds. That solved the problem immediately, and I was able to get 4 hours on the machine that first night of use. (Yeah, you're right, I'm a little proud of that.)

The DME company is supposed to replace my VPAP III with a VPAP Auto in the next few weeks, becuase my doctor had specified "Bilevel Auto" as a possibility on the prescription (at my request, since I am not fond of titration studies). Since he had given the numbers on my prescription, though, the DME chose at first to send a regular bilevel machine. Fortunately, my "insurance" people agreed with me that an Auto machine was worth it. That's why I am now going to be getting the VPAP Auto.

My question for you is, are you using the VPAP Auto in VAuto mode, the adjusting, self-titrating mode? If so, aren't you supposed to use a ResMed mask? Page 7 of the users manual says, "In VAuto mode, only ResMed masks are compatible for use with the VPAP Auto." Based on that, I insisted that the DME company bring me a ResMed mask when they bring the VPAP Auto. (I asked for a Mirage Ultra full face mask.) I assumed that the circuitry in the VPAP Auto must be very sensitive to the point where the machine needs to know the specific properties of the mask being used in order to recognize and automatically adjust pressures in the prevention of apneas and hypopneas. I assumed that's why the specific mask has to be chosen on the menu. Apparently that isn't so important if the machine is being used in "S" mode as a straight bilevel, but isn't using it in VAuto level different? What has been your experience?

Maybe that's none of my business, but I am just trying to be helpful as I learn. Hope the above doesn't ramble too much and that it is useful in the discussion thread I posted it in. If not, I am willing to learn how to do better.

jnk

[Slinky]

Not a problem at all, jnk. You're doing just fine. Don't be bashful.

I went thru several masks before I found the comfort and compatability of the Simplicity. I was reluctant to give it up. My sleep doctor did script a Resmed Mirage Micro along w/the VPAP Auto which came as a surprise to me. I did try and do use the Micro but it is NOT as simple and easy to "get right" as the Simplicity. Being a stubborn ole broad and not willing to give up my Simplicity I've used both in the same night. I've used one or the other for several nights or a week at a time. Frankly, I've not noticed much difference in my results. And since the recommended setting for the Micro is the Standard Mask Selection I don't have to change the Mask Selection for either one.

I'm not saying that would hold true for every non-Resmed mask nor even that I'm doing the right thing. Just that it is working for me. For instance, your Resmed Ultra Mirage full face mask is NOT going to have the same allowed vent rate as the Standard mask setting. So, using other than a Resmed mask you would have to use the Standard mask setting and then calculate your leak rate accordingly. The Standard mask setting allowed leak rate is .4 L/M or 24 L/s.

Ooops, almost forgot. I'm using my VPAP Auto in VPAP mode. ResScan 3.3 will not support the VPAP Auto so you need ResScan 3.4 if you opt to get the software and cable reader as well. If you like I can send you a .pdf of the VPAP Auto's Clinician's Menu. Just PM me if you want it w/your e-mail address.