First Anniversary

[Slinky]

Oh my goshes!! How could I have forgotten? Yesterday was my FIRST ANNIVERSARY on my Resmed VPAP Auto, my first anniversary on a bi-level. Sheesh!

And I still am not grasping how in the devil this thing works as an auto!! It sure seems to be working as a straight bi-level in when in auto mode.

[Violet]

Congratulations! Here are hopes and wishes for your second year being comfortable and successful.

[Wulfman]

ALREADY??? Good grief, time sure is a-flyin'.

Anyway, congratulations and best wishes for continued good therapy.

Den

[rested gal]

Doesn't seem that long ago that you switched to VPAP Auto, does it?!! Time do fly!

[SaltLakeJan]

Hi Slinky
Does this anniversary equate to "Time flies when you are having fun." Congratulations on completing your first year, and thanks for all the support you give to the beginners.

Jan

[Slinky]

Thank you. Heck, I always have fun. Even hubby says life's never been boring since he met me. (Of course, we won't mention frustrating, infuriating, etc.).

When I look back on how lousy I was doing for so long, and how frustrating it when first starting CPAP and how long it took to start seeing some improvement ... yeah, I'm doing great! But that's in comparison. I still don't think we have mastered this beast yet. I think "if" I can ever find anyone who knows and understands this Resmed VPAP Auto I can do even better, despite the COPD.

It was brought home just this week just how fast time is flying any more. One of my very best friends died in 1993. I still miss her. I last saw her son at my first in-lab titration about 1996-1998. Now mind you, I watched this "kid" grow up! His father just died this past Friday and I went to the funeral Monday looking forward to seeing the son. He's moved out of town now and this would likely be the last chance to see him.

Ha! I didn't recognize him. I thought he was his brother whom I didn't know as well and hadn't seen in ages before I'd last seen this son! The last I saw him he was as always rail thin whereas his brother had a solid, stocky build. He is now a rather good looking "portly" shall we say! It was sooo good to see him and to know he is doing well. I remember his brother's son as an infant. He's all grown up, tall and thin and good looking.

[-SWS]

And I still am not grasping how in the devil this thing works as an auto!! It sure seems to be working as a straight bi-level in when in auto mode.

Congrats, Slinky!!!!

If your machine is still set up this way, then it's forced to behave extremely close to an ordinary or non-auto bi-level:

Last night was IPAP 13, EPAP 6, PS 6

That's very little automatic-adjustment or wiggle room for your VPAP in auto mode. It's almost behaving like a straight bi-level because of those narrow high-limit (IPAP) and low-limit (EPAP) settings relative to that fixed PS setting of 6.

While in auto mode, your VPAP can only wiggle between a high of 13/7 and a low of 12/6. That's only 1 cm of up-and-down travel room as your VPAP attempts automatic pressure adjustment. So that 1 cm is not a whole lot of up-and-down travel room....

------------------------------------------------------------------------------------------------------------------------

The VPAP auto's up-and-down travel range used toward automatic adjustment will be determined by this simple equation:
("IPAP_max_setting" minus "EPAP_min_setting") minus "PS_setting" equals allowable up-and-down travel range while in VPAP auto mode.

the above reworded: (IPAPmax - EPAPmin - PS)= allowed up-and-down pressure travel

[Bluebonnet_Gal]

Congrats Slinky! And thanks for all the support you give newbies like me!

[Slinky]

Congrats, Slinky!!!!

If your machine is still set up this way, then it's forced to behave extremely close to an ordinary or non-auto bi-level:

Last night was IPAP 13, EPAP 6, PS 6

That's very little automatic-adjustment or wiggle room for your VPAP in auto mode. It's almost behaving like a straight bi-level because of those narrow high-limit (IPAP) and low-limit (EPAP) settings relative to that fixed PS setting of 6.

While in auto mode, your VPAP can only wiggle between a high of 13/7 and a low of 12/6. That's only 1 cm of up-and-down travel room as your VPAP attempts automatic pressure adjustment. So that 1 cm is not a whole lot of up-and-down travel room....

------------------------------------------------------------------------------------------------------------------------

The VPAP auto's up-and-down travel range used toward automatic adjustment will be determined by this simple equation:
("IPAP_max_setting" minus "EPAP_min_setting") minus "PS_setting" equals allowable up-and-down travel range while in VPAP auto mode.

the above reworded: (IPAPmax - EPAPmin - PS)= allowed up-and-down pressure travel

Now THAT makes sense to me, -SWS. A Resmed Rep said that 1/2 of the pressure support added to the EPAP set pressure would be the reported pressure and EPAP governed the pressure moves.

My initial titrated settings were IPAP 13, EPAP 8 and that is ALL that was on the script. When I checked the original settings the PS was set at 4 tho a PS setting wasn't included in the script. Considering we hadn't addressed the Leak rate I did pretty good. Better than on straight CPAP. But THEN the doctor decided he wanted me on straight bi-level at IPAP 13, EPAP 8. And THAT was a disaster becuase NO ONE (at least none of the "professionals") could figure out or had ANY idea of why or how to stop the "puff" I was encountering between the end of inhallation and start of exhalation in Spontaneous mode. I finally said to heck w/it and put her back in auto mode, same settings.

Another in-lab titration was done and THIS time the Leak issue was addressed and my leaks since have been well w/in accepted limits, 95th percentile most often 0.0. This titration they came up w/IPAP 10, EPAP 5 and again made absolutely no mention of a PS setting. And they insisted on using the Spontaneous mode. Same "puff" problem. So I put it in auto mode at IPAP 10, EPAP 5 and PS 5. No more "puff" as long as I stay in auto mode.

A Resmed Rep suggested changing Exhalation from Medium to Slow when I complained a good device wasn't worth diddley-squat if the pros didn't know how to set it properly. That has helped. BUT NOT in Spontaneous mode.

The software calculated pressures have been no help, obviously because of the PS setting. So I said to heck w/it all and decided to go back to square one and make one change at a time based on 5 days of data (I know, I preach one full week - but I was getting ticked and impatient by this time!) At least a REsmed Rep agreed w/me, forget Spontaneous mode and use auto mode since that is the comfortable mode for me. No disconcerting, disturbing "puffs".

Do you have ANY idea how it takes to go thru just the various IPAP, EPAP and PS at .0.2 increments at a time??? Sheesh! (I had tried the various Rise Times in Spontaneous mode - no help). I'm pretty sure that IPAP 10, EPAP 5 at any PS isn't cuttin' the mustard. I was tempted to jump to IPAP 11, EPAP 6, but have opted to work from the IPAP 10, EPAP 5 upward. I suspect my best settings are going to be in the IPAP 10/11, EPAP 5/6 range, but will have to see what the various PS settings produce - 5 days at a time per change - in 0.2 cm increments. *sigh* (It won't let me set a PS of 0).

[dsm]

Go Slinky

Re how they work. That would intrigue me too.

DSM

[-SWS]

A Resmed Rep said that 1/2 of the pressure support added to the EPAP set pressure would be the reported pressure and EPAP governed the pressure moves.

Well, as it turns out, that's a correct statement also. Both halves of your rep's compounded statement are correct as follows:

1/2 of the pressure support added to the EPAP set pressure would be the reported pressure

So when you look at your reported pressure, you'll know that it's reporting the very center of your delivered pair of BiLevel pressures. It's kind of like reporting only the yellow center-line of a meandering or wiggling 2-lane highway. Rather than describing the entire width of the road (from shoulder to shoulder), your reporting software describes your automatically wandering pressure by only reporting on the meandering that occurs at the very center.

...and EPAP governed the pressure moves.

It sure does, from deep inside the algorithm. The EPAP setting automatically wiggles up and down by pretty much the same A10 criteria that any ordinary AutoSet APAP machine wiggles its pressure. The big difference is that your machine also carries along that higher IPAP pressure---sitting up top--- as EPAP automatically wiggles up and down according to the algorithm's criteria. So that IPAP pressure just passively sits on top of the entire waveform, at whatever value above EPAP's wiggle that your PS setting tells it to passively sit.

And that range-of-travel for all that up and down wiggling by your meandering two-lane highway (IPAP/EPAP) will be restricted by the simple equation I have above.

[GumbyCT]

Congrats Slinky hoping there are many more to come.

I always remember Snoredog's posting about how EPAP is the BIG hammer taking care of the OA's.
The IPAP will handle the HI's and snores, etc.

Of course it could be just a matter of switching..... oh never mind.

HTH gf

[-SWS]

I always remember Snoredog's posting about how EPAP is the BIG hammer taking care of the OA's.
The IPAP will handle the HI's and snores, etc.

That makes your auto BiLevel model a bit more interesting to watch, as the IPAP and EPAP travel independently of each other (based on that sleep-event criteria you and our late friend Snoredog described from the Respironics training literature).

By contrast to your Respironics model, Slinky's VPAP auto always keeps IPAP and EPAP spaced identically, according to her PS setting. Her algorithm just wiggles EPAP up and down to the same criteria that A10 always employed. Once Resmed decided to make their IPAP and EPAP spread constant, then they decided to govern response to all events by substituting A10's old CPAP pressure variable with this model's EPAP pressure variable. IPAP then passively sits on top of EPAP for an equidistant up-and-down pressure ride. And if any snore, FL, or apnea comes along, then the equidistant tandem pair moves according to that same A10 criteria.

As design goes, that amounted to one fairly easy A10 platform migration for Resmed----from traditional AutoSet to VPAP auto by just adding a passively traveling IPAP pressure value on top of the old automatically traveling single pressure. Easy but very clever and effective IMO.

[junie]

Congratulations to you, thank you so much for inspiring us, you have been so helpful.

[Slinky]

Thanks everyone. I had this reply already for posting - and poof! Instead cpaptalk just disappeared and an error page took its place. FRUSTRATING! I just went down and watched TV awhile. And don't remember a darn thing I had tried to post!