First Post - Now on a Bipap Auto from CPAP "Brick" -My Story

[viking67]

Pugsy, do you have any thoughts about the PS? Do you think it should be lower? I love these posts about Bipaps because I'm experimenting with the S9VpapAuto for the last 2 weeks. I really love this machine and will probably give my personal report on it in a new thread.

Yes, I can now actually see this great example of how SystemOne and Resmed do different "dances". Light Bulb!!

I am very curious about the Resmed S9 VPAP Auto as compared to my PR S1 BiPap Auto. I am a researcher/experimenter kind of person, and so I am already considering grabbing an S9 VPAP Auto on craigslist or ebay or secondwindcpap. Openbox on secondwind they are about 950. That's a lot, but at some point I may do it if I can save the money. If you have the resources, it's nice to be able to try different machines. It's all about getting the best and most effective therapy possible. We deserve it.

[squid13]

This is a good explanation that shows the differace in PS between the 2 machines. It was written by jnk.
Re: ResMed VPAP Auto 25 Clinician's manual

Postby jnk on Mon Jun 15, 2009 8:19 am

Wuqing Wang wrote:the two machines are not in the same technical level.



I think you may misunderstand the differences between the two machines and how each machine must be set. They are both good autobilevels, but you can't set either of them up correctly by attempting to use the numbers that were used on the other brand of machine. You have to think about the numbers and translate them for how you want the other brand of machine to run.

As an illustration, think of inhale and exhale as being two dancers. On the Respironics dance floor in the Respironics world, the two dancers dance two different dances without caring what the other dancer is doing. You simply set the size of the dance floor and you tell the dancers the maximum distance they are allowed to get from each other during their separate dances (there is an automatic minimum to keep them from bumping into each other), and they each do their own thing. Sometimes they dance close to each other, and sometimes they dance far apart. That distance varies. On the other hand, on a ResMed dance floor in the ResMed world, the two dancers do the same dance and are always the exact same distance from each other, but they can still roam the full dance floor, as long as they do it together. So if you mistakenly set the fixed distance of the dancers to be the same size as the dance floor, you keep the dancers from moving at all.

In other words, for the Respironics machine, you set the maximum IPAP and minimum EPAP (the size of the dance floor), then you set the MAXIMUM pressure support, or maximum distance allowed between the two separate pressures (dancers). For the ResMed, you similarly set a maximum and minimum (the dance floor), but then you set the ACTUAL pressure support, the fixed distance (or, difference) between inhale pressure and exhale pressure for the night. On that machine, those two pressures increase and decrease TOGETHER, NOT SEPARATELY, moment to moment, during the night (since the two do the same dance together).

[jweeks]

How does this look to you guys? Better than night #1 for sure.

Hi,

Yes, the 2nd set of graphs look better. You might want to run that way for a few days, and see how you adapt. It does take a little while for your body to adjust to new settings. What I did see is that your exhale pressure is 8, but your 95% value for exhale was up around 13. As a general rule of thumb for APAP machines, you want that lower number to be within 1 or 2 centimeters of your 95% pressure. However, with BiPAP, all bets are off. If you are running on a low EPAP to avoid centrals or some other disruption due to problems exhaling against pressure, upping that number could make things worse. The issue with keeping it low is that it can make the machine take longer to ramp up to treat events when they start happening. If this were my data, and knowing that I personally don't have pressure induced centrals, I'd move the EPAP number up, possibly to 11 or 12, as an experiment. However, give yourself a few more days to get adjusted to your current settings, and then take another look at the 95% numbers.

-john-

[viking67]

This is a good explanation that shows the differace in PS between the 2 machines. It was written by jnk.
Re: ResMed VPAP Auto 25 Clinician's manual....

Thanks for this squid13. Excellent description. My PR S1 MaxPS setting of 8 means IPAP and EPAP have a lot of range on the dance floor and can dance very far apart if the brain in the machine thinks it best. And in the second half of the night is where they seem to drift/dance further apart.

[viking67]

How does this look to you guys? Better than night #1 for sure.

Hi,

Yes, the 2nd set of graphs look better. You might want to run that way for a few days, and see how you adapt. It does take a little while for your body to adjust to new settings. What I did see is that your exhale pressure is 8, but your 95% value for exhale was up around 13. As a general rule of thumb for APAP machines, you want that lower number to be within 1 or 2 centimeters of your 95% pressure. However, with BiPAP, all bets are off. If you are running on a low EPAP to avoid centrals or some other disruption due to problems exhaling against pressure, upping that number could make things worse. The issue with keeping it low is that it can make the machine take longer to ramp up to treat events when they start happening. If this were my data, and knowing that I personally don't have pressure induced centrals, I'd move the EPAP number up, possibly to 11 or 12, as an experiment. However, give yourself a few more days to get adjusted to your current settings, and then take another look at the 95% numbers.

-john-

Hey John, I have thought of this and would appreciate any follow ups you may have the more data I get. Here is the thing about EPAP--if I were to move it up to say 11 or 12, then it could never get down below that later in the night when things calm down. I wish it had settings for: MinEPAP, MaxEPAP, and StartingEPAP. Wouldn't that be great? Start me at 11, let me go as high as 13 (my 95% value), but let me go as low as 8 if I can make it there (for comfort and less centrals) and stay there without events. I like the idea that I can sleep deeply/soundly with lower pressures, but that the machine "has my back" if things get ugly.

[DoriC]

I'm glad Squid posted "The Dance" by jnk. I didn't realize you probably hadn't read it yet. It's really an educational masterpiece. If you're going to experiment with the Epap setting I'd suggest you try it in small increments, sometimes just a small adjustment does the trick. Although I don't always practice what I preach, it's really a good idea to stay with a new setting for a week or so unless it's really intolerable and only change one setting at a time. I think you're going to do fine. Keep us posted.