ResMed VPAP S - Got some learning to do.

[kteague]

My old Respironics M Series Pro is still getting the job done, but I have wondered if things could be better. My pressure has inched up to 13 which is a bit problematic with air in the belly. In recent weeks I've sensed another small pressure increase was on the horizon, as I am occasionally waking myself with snores and what seem to be events. Haven't downloaded my data in years since I ran into card reader issues after the computer that recognized it crashed and I was unable to get other computers to recognize it. I finally gave up trying as my treatment has been boringly routine for several years and didn't feel a need for more than what the screen gives. (I get easily overwhelmed then get a mental block.) I had been thinking that when I could afford to I wanted to upgrade my machine to one that didn't need the old card reader. Well, yesterday, right on time to be a birthday present, I got a call from a friend who asked me if I was interested in what appeared to be an unused CPAP stored in the garage of a recently deceased friend. It was believed to have belonged to the friend's mother, also deceased. Well, I went to check it out and it appears to be a new S9 VPAP. Suddenly I'm having flashbacks of all the times I've told bipap users I'm grateful to not have to learn all that stuff about bipap data. Looks like I'll be eating those words. Haven't a clue where to start. Will pull it out tomorrow and check the hours etc. and start to familiarize myself with it. Is there a usual IPAP/EPAP starting place for one who uses a pressure of about 13.5?

[palerider]

Is there a usual IPAP/EPAP starting place for one who uses a pressure of about 13.5?

sure! epap 13.4 and ipap=13.4 easybreath on or off as you like, timax/timin rise time, and trigger/cycle don't come into play until you start splitting the epap/ipap pressures.

or, you can just put it in cpap mode and ignore all those extra settings.

[Madalot]

Looks like I'll be eating those words. Haven't a clue where to start. Will pull it out tomorrow and check the hours etc. and start to familiarize myself with it. Is there a usual IPAP/EPAP starting place for one who uses a pressure of about 13.5?

Nah -- no word eating. Just time for a change. Hopefully someone smarter than myself will chime in but if it were me, I'd start with a narrow range (especially if you're subject to air in the stomach) -- say 12/13 to 15/16 and see how it goes. You can always make adjustments as necessary.

[Pugsy]

Are you wanting to make use of the differences available between EPAP and IPAP to see what it is like or do you just wish for it to work like your current machine?
Are you curious and want to experiment?

[palerider]

Nah -- no word eating. Just time for a change. Hopefully someone smarter than myself will chime in but if it were me, I'd start with a narrow range (especially if you're subject to air in the stomach) -- say 12/13 to 15/16 and see how it goes. You can always make adjustments as necessary.

the vpap s does not auto adjust, it's like an elite, a regular cpap, only with a greater than 3 epr setting.

[Madalot]

Nah -- no word eating. Just time for a change. Hopefully someone smarter than myself will chime in but if it were me, I'd start with a narrow range (especially if you're subject to air in the stomach) -- say 12/13 to 15/16 and see how it goes. You can always make adjustments as necessary.

the vpap s does not auto adjust, it's like an elite, a regular cpap, only with a greater than 3 epr setting.

Oops. My bad. Shouldn't respond when I haven't had my coffee! Thanks!

[robysue]

My old Respironics M Series Pro is still getting the job done, but I have wondered if things could be better. My pressure has inched up to 13 which is a bit problematic with air in the belly.
...
Well, I went to check it out and it appears to be a new S9 VPAP. Suddenly I'm having flashbacks of all the times I've told bipap users I'm grateful to not have to learn all that stuff about bipap data. Looks like I'll be eating those words. Haven't a clue where to start. Will pull it out tomorrow and check the hours etc. and start to familiarize myself with it. Is there a usual IPAP/EPAP starting place for one who uses a pressure of about 13.5?

Your title indicates the VPAP is a VPAP S, which is a fixed bilevel machine. And you are currently using an old Resprionics M Pro CPAP. So you are used to fixed pressure, and adjusting to a fixed bilevel should not be a problem. But it does mean that there's no "VPAP Auto" mode that would allow the machine to titrate you automatically.

One obvious setting is to simply set EPAP = IPAP = 13.4 or set both to 13.6. (The Resmed machines adjust the pressure in 0.2 increments instead of the 0.5 increments used on the PR machines.) You won't have any pressure relief available with this setting if I recall correctly: The VPAPs don't have EPR since the EPR algorithm is essentially the same as the VPAP algorithm for switching between EPAP and IPAP. There are a few very minor differences between the two algorithms that are not important for the vast majority of people when it comes to comfort---except for the fact that EPR is limited to no more than a 3cm drop in pressure and the VPAP algorithm is not.

Do you use Flex on your M-Series? If so, what's it set to?

And are you looking to try to address the air in the belly problem with the VPAP?

And are you willing to get back into the habit of looking at the data at least for a while?


Answers to those questions open up a lot more possibilities when it comes to setting EPAP and IPAP on the new machine. But there's not a general rule for writing a bi-level script based on a straight CPAP script. Some bilevel users find that they can use IPAP = old CPAP pressure and EPAP = 2-4 cm below IPAP. Others find that they need EPAP = old CPAP pressure and IPAP = 2-4 cm above IPAP. And others find that they need EPAP = 1-2 cm below the old CPAP pressure and IPAP = 1-2 cm above the old CPAP pressure. In other words, all of the following are reasonable starting points:

• EPAP = 10.6 and IPAP = 13.6 (or EPAP = 11.6 and IPAP = 13.6)
• EPAP = 13.6 and IPAP = 16.6 (or EPAP = 13.6 and IPAP = 15.6)
• EPAP = 12.6 and IPAP = 14.6 (or EPAP = 11.6 and IPAP = 14.6) (or EPAP = 11.6 and IPAP = 15.6)

Since air in belly is a real concern, I would suggest trying EPAP = 10.6 and IPAP = 13.6 for a week or so. Check the data and see how many events are getting through. If it's acceptable and the air in the belly problem is decreased and you're feeling decently enough, then you've got your settings. If the AHI data becomes unacceptable at 13.6/10.6, you can bump the EPAP and IPAP both up by the same amount (if you like the feel of the spread between IPAP and EPAP. Or you can bump only the EPAP up if you're worried that an IPAP > 14 will start triggering more air in belly problems.

If you find that you want more pressure relief, you might try a 4cm spread between EPAP and IPAP. (Start with either EPAP = 10.6 and IPAP = 14.6 OR EPAP = 9.6 and IPAP = 13.6.

[Pugsy]

I found that when I went to try a bilevel machine that I was able to get good results with EPAP being about 3 cm lower than what I would have to use if using cpap and the very first bilevel I tried was the Pro BiPap which is essentially like the VPAP s.

If you are wanting to experiment I would probably suggest that you try the 10.xx to 13.xx that Robysue suggests and/or maybe experiment to see if 3 to 4 difference (pressure support) makes any difference in comfort. I personally happen to like 4 cm a little better than 3 but that's just me.

The beauty of the VPAP is that available difference and I thought it was a pretty sweet deal myself. First time I ever tried bilevel was when I was testing out a BiPap Pro that was to go to a friend and it took me all of 2 minutes to decide "I gotta have one of these". I would be surprised if you didn't like it.

[kteague]

Thanks everyone for the input. I did go read how to get into the settings to make changes. I decided to not mess with too much yet except I got rid of that 45 minute ramp and changed the IPAP and EPAP to 13/10. I do want to experiment and see how allowing it to function as a bilevel works for me. Like was mentioned, I can always change it to a single pressure if need be. I did have my exhale relief on the M Series set to 2. Will download Sleepyhead soon. Still got to read up to understand things like Ti Max/Min and Rise Time ect., but one bite of this elephant at a time.

Questions:
In the Service menu the Run Hours are 4. Does that mean it is indeed new or is there another place I need to check to tell that?
Does it matter if in the Settings menu it says Tube Slim Line but I don't have that?

Oh, this little baby is SILENT!!!

[palerider]

Thanks everyone for the input. I did go read how to get into the settings to make changes. I decided to not mess with too much yet except I got rid of that 45 minute ramp and changed the IPAP and EPAP to 13/10. I do want to experiment and see how allowing it to function as a bilevel works for me. Like was mentioned, I can always change it to a single pressure if need be. I did have my exhale relief on the M Series set to 2. Will download Sleepyhead soon. Still got to read up to understand things like Ti Max/Min and Rise Time ect., but one bite of this elephant at a time.

Questions:
In the Service menu the Run Hours are 4. Does that mean it is indeed new or is there another place I need to check to tell that?
Does it matter if in the Settings menu it says Tube Slim Line but I don't have that?

Oh, this little baby is SILENT!!!

yup, you've got 4 hours on your baby.

change the tubing setting, it matters, it affects the pressure delivered at the mask, (slimline tubing has more resistance, so the machine has to push a little harder to get the same pressure at the mask than it does with regular tubing... that's why there's a setting, so it can factor that into it's calculations to give you accurate pressure at your face)

the bipap settings are really simple when you wrap your head around them. ti min/max are the minimum, and maximum time it will stay at ipap. for instance, timax defaults to 2, I found that sometimes I was taking long, slow inhales and after 2 seconds, the machine said "ok, you're done!" and dropped to epap. I saw that on the chart my inhale time was 'clipping' at 2. so I bumped it up to 3, now if i want to breath bigger inhales, the machine doesn't cut me off early. timin is the same way, it's the minimum time it will stay at ipap. if you breath in really fast, and then want to exhale, you might have to reduce timin, for instance.

trigger and cycle are what triggers the machine to switch to ipap, and cycle back to epap. ie, how sensitive is it to your starting to inhale, and starting to exhale. you can make it more, or less sensitive to each. for instance, if you feel it's popping to ipap before you're ready, you could lower trigger. or if it's not quick enough to start ramping up you could raise trigger.

and how *fast* it goes from epap to ipap is rise time.

any questions, when you're ready

[kteague]

Thanks for the continued support. Looking on the screen for my AHI and wondering if there's something I need to turn on for the AHI to show. My first impression of the machine is it's love at first si... err, night. But need to confirm it's not just infatuation.

EDIT: Never mind. Just had to turn Sleep Quality to On instead of Usage. My AHI for last night's 8.9 hours of sleep was 0.6 and I am a happy camper. No noticeable air in the belly. Yes, this just might be love.

[palerider]

Thanks for the continued support. Looking on the screen for my AHI and wondering if there's something I need to turn on for the AHI to show. My first impression of the machine is it's love at first si... err, night. But need to confirm it's not just infatuation.

EDIT: Never mind. Just had to turn Sleep Quality to On instead of Usage. My AHI for last night's 8.9 hours of sleep was 0.6 and I am a happy camper. No noticeable air in the belly. Yes, this just might be love.

hold down info and setup for several seconds to get into the extended screens.

there is tons more info in sleepyhead though

[qckndrty]

My settings are 10/13 as well on the VPAP S. AHI always under 1. I replaced a 13.5 year old VPAP last week and this new one is super duper quiet.