I need Help Understanding how a ResMed VPAP Auto 25 Works

[fredn]

At another apnea board:
http://www.apneasupport.org/viewtopic.php?p=24677

In a reply titled "Nope" sleepydave (RRT, RPSGT and manager of an accredited sleep center) responds to honda's question:

honda wrote:
"Thanks for the comments, one other question though, do the 4 central apneas have any significance ?"

"None whatsoever.
sleepydave"

sleepydave's nicknames on cpaptalk are "deltadave" "StillAnotherGuest"(SAG) "Muffy" and "NotMuffy"

Thanks for the info .... the part of the study that did "get my attention" was that her blood oxygen level got down to 83% at one time. That doesn't sound real good to me.

And here's another rub ... she had her sleep study AFTER she was diagnosed with AFIB ... I'm thinking it's time for another sleep study anyway .... cause on Tuesday morning she went through 2 cardio-versions complimented with an anti-rythm drug and she's back to normal sinus ... everything could be different now ....

[robysue]

jnk,

Thanks for the VPAP tutorial. I appreciate you taking the time to educate me on the differences between the PR BiPAP's Auto routine and the Resmed VPAP's VAUTO routine.

So many subtle differences that can definitely affect how therapy feels. And no-one lets us know *beforehaznd.* I'm happy with the PR (except for the lack of on-board data), it seems like those of us lucky enough to be given a choice of machines wind up having to choose between them without any test drives to see how they feel. Like being ask to buy a care based on a picture without being allowed to drive it.

[jnk]

Well, you are far ahead of the game in that you are taking the time to look at those things--many never bother. Your active interest will pay off. You are informing yourself about things that many patients frankly don't want to know. I very much respect your approach.

The reason I am asking about specifics is that most simple-OSA patients don't end up on bilevel right away when what they have is a simple-OSA diagnosis. Either they fail at CPAP or there is something else the doc is trying to get at--such as some sort of hypoventilation or cardiac situation, for example, I believe. That is part of my reason for being cautious in my replies, just so you know.

If you want, some block out the personal identifying information (theirs, their doc's, and the lab's) in their studies and then post a copy of them on a picture site somewhere and post links to them here in this forum in order to let others see the sleep studies. If you ever feel like doing that, there may be something said by the doc that will catch someone's eye here. If nothing else, you may get ideas here for specific questions to ask the medical team you are dealing with. Sometimes it helps for them to hear you ask the questions, in that it lets them know you are interested, perhaps more than the average patient and spouse. Good medical teams like that, since it indicates a patient who is trying to cooperate with their doctors' efforts to be of help to them.

Anyway, you made it here and are willing to ask questions, so take the time to take a breath and pat yourself on the back for that. It is the ones who don't find their way here that I worry most about.

[jnk]

jnk,

Thanks for the VPAP tutorial. I appreciate you taking the time to educate me on the differences between the PR BiPAP's Auto routine and the Resmed VPAP's VAUTO routine.

So many subtle differences that can definitely affect how therapy feels. And no-one lets us know *beforehaznd.* I'm happy with the PR (except for the lack of on-board data), it seems like those of us lucky enough to be given a choice of machines wind up having to choose between them without any test drives to see how they feel. Like being ask to buy a care based on a picture without being allowed to drive it.

Ain't it the truth!

You are welcome. I am only passing on what I've learned from others here.

[fredn]

My wife and I went through the "papers" a little while ago ... we couldn't find and she doesn't remember any paper work after the titration or any formal Rx from the Doctor .... looks like I am going to have to see what I can get ahold of.

[jnk]

My wife and I went through the "papers" a little while ago ... we couldn't find and she doesn't remember any paper work after the titration or any formal Rx from the Doctor .... looks like I am going to have to see what I can get ahold of.

What worked for me was for my primary doc to ask for full copies of everything from the sleep doc. Once my primary doc had that, his nurse made me photocopies for me to have "for my personal files." In my experience, that kind of low-key request doesn't raise eyebrows and may seem routine to everyone involved. A full sleep study report is usually more than four pages. You should be able to get more than just the one or two page summary report. It is always good for you to have a copy of your Rx, since it is good for life.

[fredn]

My wife and I went through the "papers" a little while ago ... we couldn't find and she doesn't remember any paper work after the titration or any formal Rx from the Doctor .... looks like I am going to have to see what I can get ahold of.

What worked for me was for my primary doc to ask for full copies of everything from the sleep doc. Once my primary doc had that, his nurse made me photocopies for me to have "for my personal files." In my experience, that kind of low-key request doesn't raise eyebrows and may seem routine to everyone involved. A full sleep study report is usually more than four pages. You should be able to get more than just the one or two page summary report. It is always good for you to have a copy of your Rx, since it is good for life.

Shyness is NOT one of my qualities .....

[jnk]

My wife and I went through the "papers" a little while ago ... we couldn't find and she doesn't remember any paper work after the titration or any formal Rx from the Doctor .... looks like I am going to have to see what I can get ahold of.

What worked for me was for my primary doc to ask for full copies of everything from the sleep doc. Once my primary doc had that, his nurse made me photocopies for me to have "for my personal files." In my experience, that kind of low-key request doesn't raise eyebrows and may seem routine to everyone involved. A full sleep study report is usually more than four pages. You should be able to get more than just the one or two page summary report. It is always good for you to have a copy of your Rx, since it is good for life.

Shyness is NOT one of my qualities .....

I figured. Thus my hinted suggestion to maybe be low-key.

[fredn]

My wife and I went through the "papers" a little while ago ... we couldn't find and she doesn't remember any paper work after the titration or any formal Rx from the Doctor .... looks like I am going to have to see what I can get ahold of.

What worked for me was for my primary doc to ask for full copies of everything from the sleep doc. Once my primary doc had that, his nurse made me photocopies for me to have "for my personal files." In my experience, that kind of low-key request doesn't raise eyebrows and may seem routine to everyone involved. A full sleep study report is usually more than four pages. You should be able to get more than just the one or two page summary report. It is always good for you to have a copy of your Rx, since it is good for life.

Shyness is NOT one of my qualities .....

I figured. Thus my hinted suggestion to maybe be low-key.

Gotcha ....... obee wan

[rested gal]

We need to look somemore for the titration (if I have this right, that was the followup sleep study where she wears headgear and uses a cpap and they see what works?)

Correct.

Like everything else to do with doctors, medicines, and all else, you never know what should be happening, what you should be getting, what you should be doing, and even if you do get something what the heck it means.

I'd venture a guess that most of the doctors who prescribe machines like the ResMed VPAP Auto and the Philips Respironics BiPAP Auto don't know themselves what all the settings are on those machines or what settings would be best to prescribe. They prescribe pressure settings (probably most of the time simply signing off on what the sleep tech found during the titration) and pretty much leave all the other setting adjustments up to the DME. Many of the DMEs or RTs who work for them may not understand all the settings either....and probably are not aware at all of the very different ways the two major brands handle "Pressure Support."

I'm a reasonably intelligent guy .... and I find it a huge undertaking .... what about those that have if even harder.

Really a shame .....

Fred

You're doing an excellent job educating yourself about the machine your wife is using. The first great step you took was finding this forum...and Jeff responding in the topic you started.

[fredn]

Well I never got a call from the place that supplied the Machine .....

Soooooo ..... based on what I think I know about how it works I lowered the Min EPAP to 9.0 ..... if I have everything right that flat-line that was at 15.0 should now be at 13.0 .... and it will still have a Max IPAP of 16.0 .... which is what it can go to if it needs to.

Tomorrow I will dump the data from the machine to a card .... I'll have a detailed report .... I'll read it in and look it over.

It would be great if it did run at 13.0 now AND the 2.0 drop made it easier for my wife to tolerate.

If I review the "detailed reports" everyday it will become obvious if the number of incidents increases.

I'll post in the morning .....

Fred

[Slinky]

jnk, correct me if I'm wrong but my understanding is that ResScan does not present an IPAP pressure line and an EPAP pressure line in the pressure graph but rather the middle pressure between IPAP and EPAP. So w/a pressure support of 4 if EPAP goes up to 11.5, IPAP goes up to 15.5 and one pressure line appears on the graph at 13.5 (PS=4, 1/2 of 4 = 2).

[jnk]

jnk, correct me if I'm wrong but my understanding is that ResScan does not present an IPAP pressure line and an EPAP pressure line in the pressure graph but rather the middle pressure between IPAP and EPAP. So w/a pressure support of 4 if EPAP goes up to 11.5, IPAP goes up to 15.5 and one pressure line appears on the graph at 13.5 (PS=4, 1/2 of 4 = 2).

It is confusing how the VPAP Auto (which shows the middle pressure when in VAUTO mode) differs from the Auto 25 (which, as I understand it, shows the IPAP pressure in all modes) in how the pressure is shown in ResScan. At least, I think that's what we figured out the last time that particular point came up:

viewtopic.php?p=428022#p428107

[fredn]

So it's the morning after lowering the Min EPAP from 11.0 to 9.0 on my wife's ResMed VPAP Auto 25 Machine ....

As I had predicted, the air pressure graph was now flat at 13.0, rather than 15.0. By lowering the Min EPAP to 9.0 with the pressure support at 4 the air pressure graph moves to 13.0. (9.0 + 4.0 = 13.0)

My wife says that it was a little more comfortable last night .... burned less .... although she still only made it a little over 4 hours (might be a conditioned reflex wanting to remove after 4 hours .... we'll have to see on this one)

Also NO Apneas and NO Hypopnea's ..... which is good BUT I could not see how the pressure would respond to either a CSA/OSA or hypopnea.

I'm not going to go any further lowering the pressure without consulting with her provider and her doctor .... but it would be interesting how she would feel with it running at around 10 (Min EPAP 6 + pressure support 4) leaving the MAX IPAP at 16.0.

The one good thing about this whole thing is that I can talk to her Doctor with an understanding of how the machine works and what I would like to try.

Fred

[jnk]

What did the leak line look like?

She's not losing therapy out of her mouth, is she?