Resmed VPAP Auto Users - Question

[Slinky]

Have those of you w/the Resmed VPAP Auto experienced too abrupt a transition between inhalation and exhalation in Spontaneous mode?

If so was your local DME supplier's RT able to come up w/the WHY and eliminate it?

Or did you have to switch to Auto mode to eliminate it and get the new EasyBreathe technology providing smooth, comfortable therapy for you?

[danmc]

Hiya Slinky,
I couldn't even tell you what settings I have mine on now its so peaceful. In fact it's been so long since I fiddled with settings and such I'm not even certain I'm using the vpap auto ....that might be memory loss though oh dear...

I'll have a look at what settings I am using and a fiddle if you like.

I should put it in spontaneous mode and see how I like transitions yes? I do recall finding some transitions abrupt when I first started using it but can't say what mode I was in back then.

[Slinky]

Well, I "would" be curious as to what settings you are using now .... and how you would do now in Spontaneous mode. I'm in auto mode and "flat-lining" on mine. IPAP 11, EPAP 6, PS 5.

You just "might" be the SIXTH person w/the VPAP Auto experiencing that abrupt IPAP/EPAP pressure transition but I've not found any on the VPAP Auto 25 who've had the problem.

I'm thinking tho that I shouldn't have excluded them in my Subject line, just to be sure. I may go back and see if I can edit that and then add a clarifier that I'd appreciate any responders being sure to be explicit as to which VPAP they are using. Thanks for the response, danmc. I appreciate it very much.

[jerseygirl]

I have the new Auto 25 and am having the same issue, the switch from inhal 14 to exhale 6 is very abrupt and I feel like my face is pushed up against a wal of pressure and suddenly fall off - exhale. I got a copy of the AutoII Clinical manuel but haven't fiddles with the settings yet.
It takes me about an hour to conform to the difference in pressure and fall asleep! BUT My MASK IS NOT BLOWING OFF MY FACE ANYMORE! yeah!

[Slinky]

I waa just thinking last night that I really should not have put "NOT Resmed VPAP Auto 25" in my subject line for this thread and was going to try to Edit it out.

And BINGO! You were kind enough to reply this morning that you were encountering this w/your VPAP Auto 25 too. You have a pretty wide spread between IPAP and EPAP. Is that what you were titrated at in-lab?

Am I understanding you correctly that you are using your Auto 25 in Spontaneous (straight bi-level) mode and NOT in auto mode??

[dsm]

I have the new Auto 25 and am having the same issue, the switch from inhal 14 to exhale 6 is very abrupt and I feel like my face is pushed up against a wal of pressure and suddenly fall off - exhale. I got a copy of the AutoII Clinical manuel but haven't fiddles with the settings yet.
It takes me about an hour to conform to the difference in pressure and fall asleep! BUT My MASK IS NOT BLOWING OFF MY FACE ANYMORE! yeah!

A pressure jump of epap=6 and ipap=14 is quite extraordinary. I'd really like to see the nightly data from that - am betting it will be wild.
If your Ipap is 14, an epap of 10-11 makes a ton more sense. Was there any special reason your epap was set to 6 ! (a really quite odd choice).

Cheers DSM

[tom@]

I have the Resmed VPAP S which is spontaneous only. Ipap:16 Epap:12 I think I may be having a similar issue to what you are describing. I don't have anything to really compare it too though. If I don't have my Full Face mask on tight enough when I inhale my mask burps just about every breath (happens with both Liberty and worse with Quatro mask). My leak rate is always way off the chart with a FFM.

I have recently started using a nasal pillow mask (optilife) that I don't have the issue with, but have to figure out how to keep my mouth shut better.

I am doing a bit better with the optilife. I am down to about 13AHI with it, whereas I had 20+AHI most nights with either FFM. Also my leak rate is lower with the optilife. I also have a lot less dry mouth with the Nasal mask than with FFM.

I have been at this since late January, and my best night so far is 10AHI and that was within the last 2 weeks. I'm still a new and struggling this stuff.

[Slinky]

Bump

[happyfarmer]

Hi Slinky...I don't have a VpapAuto25 but now I do have a couple of VPAPSTs which I bought on CPAPAuction for really cheap. (Can't figure why so cheap...this machine does 5 modes; CPAP, VPAPauto, S, ST, and T.) And yes, the inhale/exhale transition is rather abrupt on this blower also (PS 3 to 4), but slightly less so after fiddling with the many adjustments. I use the Activa and Activa LT masks which I think probably increase the abruptness due to the "bellows" action but I've gotten quite used to it when I decide to use the S modes. I suspect the VPAPAuto25 is probably the same...its a Resmed thing. Hope this helps. I look forward to your helpful posts. Regards.
Happyfarmer.

[hawkwind]

Slinky, I have the same machine as you. Settings are IPAP 14, EPAP 10, in SPONT mode.
I have experienced the same feeling in transition from inhale to exhale. I have tried going ahead and forcing my exhale longer through the exhale and it kicks back in to inhale mode. My next breath was longer. I don't know if that makes sense, but it seemed to adjust itself to the longer inhale and the next breaths were better.

Still getting used to the VPAP Auto, sleep therapy in general as a matter of fact. I'm still a rookie, began this January. My numbers are pretty inconsistent, AHI might be 8 one night, 3 the next. Respiratory rate runs high at times as well.

Good luck Slinky, I'll be watching this thread for more on this new machine.
Gary

[Slinky]

I don't think it is necessarily a "Resmed thing" in all their xPAPs as I had a Resmed S8 Elite w/EPR for 17 months and did not experience it and the lady I sold it to bought it as a backup/travel device for her Respironics M Series and she likes it so much it is now her main CPAP for travel AND at home and the M Series has been relegated to emergency backup. Of course there was only the one pressure setting, but then we both used Ramp and EPR at least for a while w/no such problem. I had a Resmed S8 AutoSet Vantage that was also smooth transitioning thru out the night in straight CPAP mode w/EPR.

When I was switched to this bi-level I used it in Auto mode for the first 3 months or so and its SMOOOTH, EASY transition between IPAP and EPAP - UNTIL the darn doctor(s) decided they wanted me in Spontaneous mode. I used it in Spontaneous mode for about 3 weeks before I just plain needed some decent sleep again and switched back to Auto mode and SMOOTH, EASY transitioning between IPAP and EPAP and GOOD SLEEP again!

The seven of us I've mentioned have all done well in Auto mode w/SMOOTH, EASY transitioning from IPAP to EPAP and all had our problems w/the transitioning ONLY in Spontaneous mode. It is something we are all working on making Resmed aware of.

Personally, I don't believe it is a Resmed problem. I think the devices are just too darn smart for the idiots we have to deal w/in setting them up. The doctors don't know or care beyond IPAP and EPAP settings. The local DME RTs don't know beyond the IPAP and EPAP the doctors order and the Default settings. And NONE of them want to bother reading the Clinicians Manual - or they don't even understand what they should about what is in the Manual.

[Slinky]

A Resmed Rep explained that the reason the Auto mode is much more comfortable is it utilizes ResMed’s “EasyBreathe” technology, which speaking mathematically just means the curve between IPAP and EPAP is more round and less abrupt. Spontaneous mode is simply a regular bilevel mode which is a square wave form and more abrupt. Therefore, all of you are experiencing an easier transition from IPAP to EPAP when in Auto mode. The trouble with Spontaneous mode is related to the rise time setting. He explained that a lower setting equates to a faster delivery, or shorter breath cycle, and vice versa. However, while an RT can play around with the rise time, it does not eliminate the abruptness of the transition. When asked why we then even bother with this mode: because it is an old standard that still works in the hospital setting when patients need ventilation for other breathing problems and the Auto mode is sufficient for the simple sleep apnea patient. So, they keep the old mode available too. There is no reason for you to use any mode other than Auto unless you are having trouble in this mode. In other words, it doesn’t hurt anything to be in Auto mode.

I don't think I "buy into" his explanation. Take the Resmed S8 Elite w/EPR. EPR provides expiration pressure relief. It senses you are exhaling and reduces pressure by 1 to 3 cms depending on the EPR setting. And there is/was NO rough transition and the S8s did NOT have this new EasyBreathe technology.

The Resmed S8 Autoset Vantage did not have EPR in Auto mode but it did when used in straight CPAP mode. And there was no rough transition in straight CPAP mode w/EPR at any of the EPR settings.

Now - maybe the Rep's explanation holds true for most but not for me because of my COPD. Maybe there isn't enough leeway in Rise Time adjustment for my COPD breathing. But I have my doubts about that too. It will be up to the others to discover whether it holds true for them.

[tom@]

Thanks Slinky for the detailed post. I guess I am out of luck since my machine only has Spontaneous mode. I may try to adjust the rise time a bit, and see what happens.

[Slinky]

Good luck, Tom. Do let us know.

By the way, another Resmed Rep told me to try changing Exhalation from Medium to Slow. (Again, remember, I have COPD). I've seen that the VPAP Auto 25 also have a slower than Slow and a faster than Fast Exhalation settings that the VPAP Auto doesn't have. Does your VPAP S have Exhalation options?

[Whodathunkit]

I have had the same problem with the VPAP Auto 25. With a Spont mode setting of 15-19 I have actually had great AHI numbers (1.6 to 1.9) and AI (0 to 0.4) but the same trigger issue described above has led to an increase in respiration rates from a prior average of 15-20 to a new baseline of 16-56!

I am going to try the same pressure limits in auto mode. My concern is that by going to Auto mode I lose the ramp period which had allowed me to fall asleep using Spont.

If I use "Settle" to give myself a sleep onset window, won't I also retard the device's response to an apnea or hypopnea?

(My doctor is slow to respond, the supply tech is afraid to give "medical advice"; I purchased a gray market machine and thus have access to the clinical menu!)