Resmed 25 auto setting question

[fred123]

I have been put on the resmed 25 auto as a rental to get medicare compliant. My final machine is to be a Resmed S9 Auto. The DME set the Resmed 25 maching as follows. Max IPAP =10; Min IPAP=8; Press Sup = 0;Ti MAX =2.0s;Min Ti=.3s. Mode is VPAP. My question is what is the purpose of the Press Sup. setting and is it correct to be zero if the pressure is to vary between 8 and 10? Thanks Fred123

[Slinky]

Those are interesting therapy settings. They've loaned you a bi-level auto and after you've established compliance on the bi-level auto they will switch you to a CPAP auto. IPAP 10, EPAP 8 would be interesting therapy settings in an auto CPAP w/a range of 8 to 10 cms. It doesn't even sound like the person setting up this VPAP 25 was setting it as if it were a BPAP Auto from Respironics.

Have you used it yet?

I'd be inclined to ask for a copy of your current prescription from the sleep lab/sleep doctor.

[avi123]

fred, like slinky, I also think that you got a multi purpose machine which is used in sleep clinics and hospitals. It has lots of features.

Notice that pressures are measured AT THE MASK.


This is what I see in its User Guide:


Link:

http://www.resmed.com/us/assets/documen ... er_eng.pdf


Technical Specifications

Note: The manufacturer reserves the right to change these specifications without notice.
Symbols Which Appear On The Device
Attention, consult accompanying documents; Drip proof; Type CF equipment;
Dangerous voltage; Class II equipment; Start/Stop; Manufacturer.
Operating pressure range 3 to 25 cm H2O
Maximum single fault steady
state pressure
40 cm H2O
Pressure measurement
tolerance
±0.5 cm H2O ± 4% of the measured reading
Flow measurement tolerance ±0.1 or 20% of reading, whichever is greater
VAuto mode 4 to 25 cm H2O (measured at the mask); Min EPAP: 4 cm H2O;
Max IPAP: 25 cm H2O; Pressure Support: 0 to 10 cm H2O
S, ST and T modes IPAP: 4 to 25 cm H2O (measured at the mask); EPAP: 3 to 25 cm H2O
(measured at the mask); Pressure Support: 0 to 22 cm H2OCPAP mode 4 to 20 cm H2O (measured at the mask)
DECLARED DUAL-NUMBER NOISE EMISSION VALUES in accordance with ISO 4871:
Sound pressure level 26 dBA with uncertainty of 2 dBA as measured according to
ISO 17510-1: 2002
28 dBA with uncertainty of 2 dBA as measured according to
ISO 17510-1:2007
Sound power level 36 dBA with uncertainty of 2 dBA as measured according to
ISO 17510-1:2007
Dimensions (L x W x H) 4.4” x 6.5” x 5.7” (112 mm x 164 mm x 145 mm)
Weight 2.9 lb (1.3 kg)
Power supply Input range 100–240V, 50–60Hz, 40VA (typical power consumption),
< 100VA (maximum power consumption)
Housing construction Flame retardant engineering thermoplastic
Operating temperature 41ºF to 95ºF (+5ºC to +35ºC)
Operating humidity 10–95% non-condensing
Storage and transport
temperature
-4ºF to 140ºF (-20ºC to +60ºC)
Storage and transport humidity 10–95% non-condensing
Operating altitude Sea level to 8,500’ (2,600 m)
Supplemental oxygen Recommended maximum supplemental oxygen flow:
4 L/min (VAuto mode); 15 L/min (CPAP, S, ST and T modes)
Electromagnetic compatibility Product complies with all applicable electromagnetic compatibility
requirements (EMC) according to IEC60601-1-2, for residential,
commercial, and light industry environments
Air filter Two-layered, powder-bonded, polyester non-woven fiber
Air tubing Flexible plastic, 1 x 6’6” (2 m)
Air outlet The 22 mm conical air outlet complies with ISO 5356-1
IEC 60601-1 classification Class II (double insulation), Type CF


TECHNICAL SPECIFICATIONS
Performance
Operating pressure range: 3 to 25 cm H2O
Maximum single fault pressure: 30 cm H2O
Dynamic pressure characteristics
VAuto mode: 4 to 25 cm H2O
(Pressure support: 0 to 10 cm H2O)S
mode: IPAP: 4 to 25 cm H2O; EPAP:
3 to 25 cm H2O
CPAP mode: 4 to 20 cm H2O

*********************************
You asked:

Mode is VPAP. My question is what is the purpose of the Press Sup. setting and is it correct to be zero if the pressure is to vary between 8 and 10? Thanks Fred123

About Pressure Support, check this:

(it looks to me that Pressure Support = Pressure Relief = B or C- Flex = EPR)


A Closer Look at BiPAP Machines
By Andrew Senske, President CPAP-Supply.com
Last Updated 4/10/2007 3:06:00 PM

This article will explain the fundamental differences between BiPAP machines and CPAP machines and the reasons one might choose to use a BiPAP machine over a standard CPAP machine. I'll also take a look at the specific features offered by a few of the most prevalent BiPAP machines being offered today, including the Respironics BiPAP Auto M Series.

Bilevel CPAP machines - commonly referred to as BiPAP machines - provide the most flexibility with regard to exhalation pressure relief. A bilevel CPAP system delivers two different positive pressure levels - an inspiratory positive airway pressure, or IPAP, and an expiratory positive airway pressure, or EPAP. The difference between these two pressure levels is commonly referred to as the pressure support.

This type of pressure relief is similar to pressure relief technologies like C-Flex, EPR, and SoftX, with the primary difference being that the pressure support on a bilevel CPAP machine can be much higher. That is, the difference between the IPAP and EPAP on a bilevel machine can be much greater than the difference you might experience using one of the aforementioned pressure relief technologies.

So the question becomes, "who is a candidate for a BiPAP machine?". In general anyone with a relatively high CPAP pressure setting is a candidate for bilevel therapy. For example, if a CPAP user is prescribed a CPAP pressure setting of 16 cm H2O, then the maximum pressure support (or pressure relief) you could expect to experience with a technology like C-Flex is a drop of approximately 3 cm H2O, leaving you with the task of exhaling against a pressure of 13 cm H2O. For some CPAP users, an exhalation pressure of 13 cm H2O is uncomfortable. For others, it's simply just not possible.

With a BiPAP machine, this same CPAP user can have an inhalation pressure of 16 cm H2O and have an exhalation pressure that is extremely low, even all the way down to 4 cm H2O. In this case, the CPAP user gets the pressure required to prevent apneas, hypopneas and snoring, but doesn't have to suffer the effects of a high level of pressure during exhalation. You just can't get that kind of pressure relief with a standard CPAP machine.

In addition to the pressure support (i.e. pressure relief) offered intrinsically through the difference between IPAP and EPAP pressure levels, you may also hear about an additional pressure relief feature called Bi-Flex. Bi-Flex is similar to C-Flex and is found on new BiPAP machines manufactured by Respironics. Bi-Flex allows for a decrease in the EPAP level. You may now be wondering why one would use Bi-Flex in addition to an EPAP level that is already significantly lower than the IPAP level. Why not just lower the EPAP level even more? The answer to this is that Bi-Flex can be unlocked during the setup process to make it adjustable by the CPAP user. This gives the CPAP user a little room for tweaking the EPAP level if necessary. If you want some control over your expiratory positive airway pressure level, then a feature like Bi-Flex is for you.

The BiPAP Auto M Series from Respironics is an example of a bilevel CPAP machine that adjusts automatically throughout the night. Rather than programming specific IPAP and EPAP levels, the clinician or supplier will program the bilevel machine for a maximum IPAP and a minimum EPAP. Much like the more common automatic CPAP machine, the automatic bilevel machine senses the breathing of a CPAP user on a breath-by-breath basis and automatically delivers the optimal pressure level. A maximum pressure support level can be programmed into the BiPAP Auto M Series, so that when the machine needs to ramp up to the maximum IPAP level, the delivered EPAP level will not necessarily be the pressure defined by the EPAP level setting, but it will be the IPAP level minus the pressure support level that is programmed into the unit.

The BiPAP Auto M Series can also be used as a regular BiPAP machine with fixed IPAP and EPAP levels, and it can be programmed to transition from the fixed pressure mode to the automatic mode after a certain period of time.

A slightly more sophisticated bilevel CPAP machine is one that has a "spontaneous / timed" mode or S/T mode. This type of machine is designed to deliver a machine-triggered breath if the CPAP user does not spontaneously breathe within a set period of time. The Respironics BiPAP S/T and the ResMed VPAP III are examples of CPAP machines that ensure the CPAP user receives a minimum number of breaths per minute.

[jnk]

I have been put on the resmed 25 auto as a rental to get medicare compliant. My final machine is to be a Resmed S9 Auto. The DME set the Resmed 25 maching as follows. Max IPAP =10; Min IPAP=8; Press Sup = 0;Ti MAX =2.0s;Min Ti=.3s. Mode is VPAP. My question is what is the purpose of the Press Sup. setting and is it correct to be zero if the pressure is to vary between 8 and 10? Thanks Fred123

I believe that setting pressure support at zero makes the machine run as a regular APAP. So you are basically on APAP, getting a single pressure that can roam between 8 cm and 10 cm. Ti settings are at the defaults, but they don't matter, since you aren't running the machine as a bilevel anyway. The settings you listed should be fine, if your prescription was for CPAP or APAP. If your prescription was for bilevel, only then would it be a problem that pressure support was set to zero.

I am not a doc or a medical professional of any sort.

[avi123]

I still don't see why fred can't drop the Pressure Support by setting it on #2 or #3 cm H2O if the machine is to run as a CPAP? By setting it for example on #2, then the expiration pressure would be lowered by that much and fred would feel easier to exhale.

[scrapper]

I still don't see why fred can't drop the Pressure Support by setting it on #2 or #3 cm H2O if the machine is to run as a CPAP? By setting it for example on #2, then the expiration pressure would be lowered by that much and fred would feel easier to exhale.

Maybe when you have 3600 posts and use a similar machine, you'll understand.........until then, don't worry about it.

[fred123]

Prescription was for CPAP Auto 8--10 cm H2O

[jnk]

Prescription was for CPAP Auto 8--10 cm H2O

Sounds to me like that's how they set up your machine, so you should be good.

I still don't see why fred can't drop the Pressure Support by setting it on #2 or #3 cm H2O if the machine is to run as a CPAP? By setting it for example on #2, then the expiration pressure would be lowered by that much and fred would feel easier to exhale.

Good point.

If Fred finds he is uncomfortable with the way his machine feels to him, I agree he might want to ask his doc if he could run it with a PS of 2 or 3 cm and with his maximum IPAP raised higher by the same amount (2 or 3 cm) to give the machine some room to be an auto with that pressure support. I agree that would be similar to running a ResMed with EPR set at 2 or 3.

The doc and the RT may find that a confusing request, though, since the doc and RT may not understand that EPR is basically a form of bilevel. The goal for now is compliance, it sounds like, so the main thing is that Fred not give up. So it is good he understands that his machine, as presently set up, is giving him no EPR, and so may not feel as comfortable to him as a machine using EPR or a bilevel actually running as a bilevel.

Is his machine set up in a valid manner to deliver his prescription? I would say yes. Is it set up in the most comfortable manner? I would say maybe not, if he is the sort of person who likes the feel of exhale pressure being lower than inhale pressure, as would happen with EPR or with bilevel running in a true bilevel mode.

Thanks, avi123.

ps- For the record, most of my 3600 posts have been utter nonsense, if you care to go back and read any of them.

[avi123]

[quote="jnk]

ps- For the record, most of my 3600 posts have been utter nonsense, if you care to go back and read any of them. [/quote]

I am still curious to know how did you get the death report of that sportsman who died from cardiac failure and also had sleep apnea?

[jnk]

ps- For the record, most of my 3600 posts have been utter nonsense, if you care to go back and read any of them.

I am still curious to know how did you get the death report of that sportsman who died from cardiac failure and also had sleep apnea?

No special connections. I simply found the link to it at the Wikipedia entry for "Reggie White." Reference number 6.

[fred123]

Yes, I am bothered that it seems to be an effort to exhale. I will give the machine a few more days to see if I will get used to it. If not, thanks to all of you, I know what to ask for...FRED123