Question from new VPAP user

Slinky · Post by **Slinky** » Tue Jul 15, 2008 10:16 am

Duh! It just occurred to me. You haven't mentioned what your pressure settings are! What is your IPAP and your EPAP setting? I'm wondering if it might not be a matter of too wide a spread in pressure range between EPAP and IPAP and the Pressure Support setting?

My sleep doctor ordered an IPAP/EPAP range of 13/8 but w/pressure support at 4. Despite the wildest leaks, etc. the highest pressure my VPAP has gone is 11 cms IPAP.

shortspark · Post by **shortspark** » Tue Jul 15, 2008 11:10 am

Thanks again. Well, I did figure out how to join, I just missed it before. Slinky, I am not sure I know how to read the settings. I know TMax is set to 4. I see on the display SPONT and across from it 8.0-11.3 and below that PRES 3.2. I'm not sure what all that means. I think it means the pressure is set at 3.2 and the TMax is set to the limit of 4 seconds to give my long breaths enough time. The 8.0 might be the out and th 11.3 the in pressure. I think that is how she explained it. I am going to call the supplier and see if I can get another machine out here to test. I don't care if they like it or not.

As far as the mask is concerned, I did try the ResMed mask. At least it is the one they gave me and I think it is called Liberty it has nasal pillows like I prefer but they are attached to a full mask covering the mouth - which I do not like. It gives me the "pulse" effect too but not to the extent the Comfort Gel does. The Puritan Nasal Pillows seem to work the best. The doctor gave me the Comfort Gel which I think is Respironics. It and the Liberty leak. The pillows fit my nose like a glove and that is all that touches me except for the head strap. I guess I am just use to it from my CPAP days.

jnk · Post by **jnk** » Tue Jul 15, 2008 11:33 am

Snoredog,

There is a rise time adjustment when the VPAP Auto is set to S Mode, which is Resmed's name for the mode that is regular bilevel in that machine. But in VAuto Mode (Resmed's name for auto-bilevel in that machine), there is no adjustment available for rise time--which is interesting, since there IS an adjustment in that mode for exhalation relief! Go figure.

In the saw-tooth charts that are supposed to represent the VAuto Mode in action, the rise is shown as gradual from epap up to ipap, in a little rounded lop-sided triangle, as if the ipap pressure is only reached the very instant before epap begins. If that's how it works, that's not very long to be at ipap pressure, is it? To me that means the maximum ipap pressure should usually be a few cm higher than prescribed from titration. That's just my personal opinion on that, though.

Slinky,

You are most certainly not lazy. Sometimes you just hint at something so that the rest of us get the privilege of backing you up!

The VPAP Auto is smart enough to make allowances for conflicting numbers if max ipap, min epap, and pressure relief don't match up. Priority is given to the max ipap number entered, then to the min epap number entered, and lastly to the pressure support number entered. So if there isn't enough room between max ipap and min epap, the machine will shorten the pressure support (which is simply the amount of difference in pressure between ipap and epap in any given breath, usually set to 4 cm these days.) In other words, if a tech enters 10 max ipap, 8 min epap, and 4 for pressure support, the machine will automatically change the 4 pressure support to a 2.

The last few nights, I have used the Swift II pillows with my VPAP III. I love the mask. It will become my primary mask now. I will reserve the UM FF for any time I'm congested, having trouble with mouth leak, or in case my nostrils get sore (which I don't expect to happen unless my wife rips the mask off my head in her sleep).

BTW, my VPAP Auto was just delivered to me an hour ago. I love it. The 3i is much better as far as the design. And the s8 makes the s7 look like a sumo wrestler. Now my Fisher-Price toy is the SIZE of a Fisher-Price toy!

The poor tech guy had set it up in VAuto Mode with a pressure relief of 4 cm (good boy!), but with max ipap at 16 and min epap at 12, so that it would have acted as a regular bilevel instead of an auto bilevel. Nothing for the auto to do automatically! He has no clue. I hope Resmed has him in for training one day, the poor guy.

jnk

Slinky · Post by **Slinky** » Tue Jul 15, 2008 11:37 am

SnoreDog, according to ResScan 03.04.07 here is what is available w/the various Resmeds:

AutoSet
Minimum Pressure: Min 4 - Max 20
Maximum Pressure: Min 4 - Max 20
Settling Time: Min 0 - Max 45
Maximum Settling Time: Min 0 - Max 45
Mask Selection: Standard Nasal - Mirage Full - Mirage Nasal - Ultra Mirage Nasal - Mirage Activa Nasal - Mirage Swift Nasal Prongs
Mask Fit. Usage, Pressure, Auto Appear: On - Off
Reminders (Mask, Data Card, Service, Air Filter, Call Provider, Customized)

CPAP
Set Pressure: Min 4 - Max 20
Start CPAP: Min 4 - Max 20
Max Ramp: 0 to 45
Ramp Time: 0 to 45
EPR Setting: 0 to 3
EPR Type: Off - Ramp Only - Full Time
Mask Selection: Standard Nasal - Mirage Full - Mirage Nasal - Ultra Mirage Nasal - Mirage Activa Nasal - Mirage Swift Nasal Prongs
Smart Start, Leak Alert, Mask Fit, Usage, Pressure, Auto Appear: Off - On
Reminders (Mask, Data Card, Service, Air Filter, Call Provider, Customized)

CPAP [Basic]
Set Pressure: Min 4 - Max 20
Start CPAP: Min 4 - Max 20
Max Ramp: 0 to 45
Ramp Time: 0 to 45
Reminders (Mask, Data Card, Service, Air Filter, Call Provider)

Spontaneous
IPAP: 5 to 20
EPAP: 3 to 20
Start EPAP: 3 to 20
Rise Time: Min 100 - Max 900
Max Ramp: 0 to 45
Ramp Time: 0 to 45
Cycle Sensitivity: Low - Medium - High
Trigger Sensitivity: Low - Medium - High
Ti Max: 0.1 Min to 4 Max
Ti Min: 0.1 Min to 4 Max
Mask Selection: Standard Nasal - Mirage Full - Mirage Nasal - Ultra Mirage Nasal - Mirage Activa Nasal - Mirage Swift Nasal Prongs
Smart Start, Leak Alert, Mask Fit, Usage, Pressure, Auto Appear: Off - On
Reminders (Mask, Data Card, Service, Air Filter, Call Provider, Customized)

VAUTO
Pressure Support: 0 Min - 10 Max
Max IPAP: 4 Min - 20 Max
Min EPAP: 4 Min - 20 Max
Cycle Sensitivity: Low - Medium - High
Trigger Sensitivity: Low - Medium - High
Exhalation: Slow - Medium - Fast
Settling Time: Min 0 - Max 45
Max Settling Time: Min 0 - Max 45
Ti Max: 0.1 Min to 4 Max
Ti Min: 0.1 Min to 4 Max
Mask Selection: Standard Nasal - Mirage Full - Mirage Nasal - Ultra Mirage Nasal - Mirage Activa Nasal - Mirage Swift Nasal Prongs
View Exhalation Menu, Smart Start, Leak Alert, Mask Fit, Usage, Pressure, Auto Appear: Off - On
Reminders (Mask, Data Card, Service, Air Filter, Call Provider, Customized)

The AutoSet can be used in Auto or CPAP mode.
The VPAP can be used in Auto, CPAP or Spontaneous mode.

jnk · Post by **jnk** » Tue Jul 15, 2008 12:47 pm

the highest pressure my VPAP has gone is 11 cms IPAP.

Slinky, I believe that number, 11, may be the highest your "AutoSet pressure" has gone, but not the highest your ipap pressure has gone. ("AutoSet pressure" is a number that represents the midway point between your experienced ipap and experienced epap.) If your pressure support is at 4, your minimum epap at 8, and your maximum ipap at 13, the lowest your ipap can ever go is 12 and the highest your epap can go is 9, as I understand it. (Although, naturally, I am in no position to judge whether I truly understand it or not. )

Slinky · Post by **Slinky** » Tue Jul 15, 2008 1:20 pm

Ha! You probably understand it one h*ll of a whole lot better than "I" do, jnk!! I'll take your word for it unless someone comes along to establish otherwise.