ResMed VPAP Auto 25 Clinician's manual

Does anyone know where I can get a copy of this manual? Pls PM me if available.
Thanks in advance,
LKTNKY

Today I turn on my new Vpap auto 25, I feel very disappointed. The VAuto mode was selected. If I set the MaxIPAP to 15,MinEPAP to 7, Support pressure to 8, the actual IPAP was 15,and EPAP was 7,and it would not change!!!! Why?
I need help,Thank you.

Wuqing Wang wrote:Today I turn on my new Vpap auto 25, I feel very disappointed. The VAuto mode was selected. If I set the MaxIPAP to 15,MinEPAP to 7, Support pressure to 8, the actual IPAP was 15,and EPAP was 7,and it would not change!!!! Why?
I need help,Thank you.

Did someone else set the mode to VAuto before you received the machine, or did you go into the menu and select VAuto mode after you received the machine?

If you selected VAuto after receiving the machine, is it possible that you might have gotten only as far as pressing the button under the word "Change", but you didn't press the button again under the word "Apply" after you made it show the word "VAuto" in the menu?

"Change" doesn't make a change in a setting happen -- doesn't save the "change" you are looking at in the menu.

"Apply" makes the change happen -- saves the change you are looking at in the menu.

Wuqing Wang wrote:Today I turn on my new Vpap auto 25, I feel very disappointed. The VAuto mode was selected. If I set the MaxIPAP to 15,MinEPAP to 7, Support pressure to 8, the actual IPAP was 15,and EPAP was 7,and it would not change!!!! Why?
I need help,Thank you.

Are you asking why the pressures never moved during treatment with the machine set up that way?

If so, the "problem" is that the machine has been set with the amount of pressure support being the same as the amount of distance between Min EPAP and Max IPAP. When a ResMed bilevel is set up that way, the pressures never change during treatment. In order for the pressures to move around, someone would have to raise the Max IPAP, or lower the Min EPAP, or lower the amount of pressure support.

Speaking of pressure support, most bilevel titrations start at 4 cm of pressure support and then work from there to see what the patient needs. As I understand it, 8 cm is a lot of pressure support to be prescribed, but that may be the case for you. Mind if I ask how your prescription was worded?

jeff

jnk can explain this better than I can. But - I'll try. Whereas the Pressure Support in the Respironics is flexible. In the Resmeds it is not. So if Pressure Support is set at the number between IPAP and EPAP, the VPAP Auto is running in auto made as if in straight VPAP (Spontaneous) mode.

VAuto Mode
The treatment pressure required by your patient may vary through the night, and from night to night, due to changes in their sleep state, body position and airway resistance. In VAuto mode the VPAP Auto provides only the pressure required to maintain upper airway patency. The bilevel waveform gently increases pressure on inspiration and decreases on expiration to maximize comfort. You may set the difference between the inspiratory and expiratory pressures using the Pressure Support (PS) setting (see “Pressure Support” on page 10).
AutoSet pressure is a conceptual value. The patient is delivered an auto-titrated inspiratory and expiratory pressure based on the AutoSet algorithm, which has the AutoSet pressure as its midpoint. The AutoSet pressure is reported in data management and efficacy results information.
You may also restrict the range of pressures in which the AutoSet algorithm operates, using the Min EPAP and Max IPAP settings respectively (see “Min EPAP and Max IPAP” on page 9). The VPAP Auto analyzes the state of the patient’s upper airway on a breath-by-breath basis and the AutoSet algorithm adjusts the AutoSet treatment pressure within the allowable range, according to the degree of airway obstruction. The AutoSet algorithm adjusts treatment pressures according to apnea, snore and inspiratory flow limitation.
In VAuto and S modes, the VPAP Auto senses when the patient breathes in and when the patient breathes out. The device follows the patient’s spontaneous breathing rate to supply the appropriate pressure.

Setting Min EPAP and Max IPAP pressures in VAuto mode
Priority is given to the Max IPAP setting, followed by Min EPAP and then Pressure Support. The device automatically adjusts the lower-priority settings to ensure the device pressure limits are not exceeded.
Example:
Start with the settings Max IPAP = 15 cm H2O, Min EPAP = 10 cm H2O and
Pressure Support = 3 cm H2O. If the Max IPAP setting is readjusted to 11 cm
H2O, the device automatically reduces Pressure Support to 1 cm H2O. Max IPAP
(the highest-priority setting) is preserved.

(VAuto mode) Pressure Support allows you to set the difference between inspiratory and expiratory pressure. This value can be adjusted for patient comfort. A maximum PS value of 10 cm H2O can be selected.
In VAuto mode, if Pressure Support is above 6 cm H2O, treatment efficacy may be reduced.
Note that the actual delivered pressures will be AutoSet pressure ± 0.5 x pressure support (as set by the clinician).

What the excerpts from the Vpap Auto manual remind me of, is that the written English language as flexible as it is, is quite inadequate to explain the technical workings of both the Resmed Vpap Auto & the Respironics Bipap Auto.

No matter how one tries, it doesn't always come through. Each attempt to further explain adds new confusion. Moving diagrams & words can help but are always a lot of effort & we generally neither have the time nor the tools to explain things in animated diagrams / video.

This complexity brings home to me why some in the profession are concerned about us plebs playing with our settings. But thank heavens I can figure out how to mess about with my own machines

DSM

rested gal wrote:

Wuqing Wang wrote:Today I turn on my new Vpap auto 25, I feel very disappointed. The VAuto mode was selected. If I set the MaxIPAP to 15,MinEPAP to 7, Support pressure to 8, the actual IPAP was 15,and EPAP was 7,and it would not change!!!! Why?
I need help,Thank you.

Did someone else set the mode to VAuto before you received the machine, or did you go into the menu and select VAuto mode after you received the machine?

If you selected VAuto after receiving the machine, is it possible that you might have gotten only as far as pressing the button under the word "Change", but you didn't press the button again under the word "Apply" after you made it show the word "VAuto" in the menu?

"Change" doesn't make a change in a setting happen -- doesn't save the "change" you are looking at in the menu.

"Apply" makes the change happen -- saves the change you are looking at in the menu.

Thank you rested gal. I have press the "apply" button. I have a Remstar Bipap Auto M700, the pressure of inhalation and exhalation will change frequenty and respectively between MaxIpap and MinEpap. The gap of the IPAP and EPAP will always change. Thank you again for your provider mannual of the machine.
Many people said the Resmed machine is more comfortable and quiet, so I try the resmed Vpap auto 25. The Vpap auto 25 is truely quieter than the Bipap auto M700. But if the support pressure of Resmed Vpap auto 25 will not change in VAuto mode treatment, the two machines are not in the same technical level. The Remstar Bipap Auto M700 is much better.

Slinky wrote:jnk can explain this better than I can. But - I'll try. Whereas the Pressure Support in the Respironics is flexible. In the Resmeds it is not. So if Pressure Support is set at the number between IPAP and EPAP, the VPAP Auto is running in auto made as if in straight VPAP (Spontaneous) mode.

VAuto Mode
The treatment pressure required by your patient may vary through the night, and from night to night, due to changes in their sleep state, body position and airway resistance. In VAuto mode the VPAP Auto provides only the pressure required to maintain upper airway patency. The bilevel waveform gently increases pressure on inspiration and decreases on expiration to maximize comfort. You may set the difference between the inspiratory and expiratory pressures using the Pressure Support (PS) setting (see “Pressure Support” on page 10).
AutoSet pressure is a conceptual value. The patient is delivered an auto-titrated inspiratory and expiratory pressure based on the AutoSet algorithm, which has the AutoSet pressure as its midpoint. The AutoSet pressure is reported in data management and efficacy results information.
You may also restrict the range of pressures in which the AutoSet algorithm operates, using the Min EPAP and Max IPAP settings respectively (see “Min EPAP and Max IPAP” on page 9). The VPAP Auto analyzes the state of the patient’s upper airway on a breath-by-breath basis and the AutoSet algorithm adjusts the AutoSet treatment pressure within the allowable range, according to the degree of airway obstruction. The AutoSet algorithm adjusts treatment pressures according to apnea, snore and inspiratory flow limitation.
In VAuto and S modes, the VPAP Auto senses when the patient breathes in and when the patient breathes out. The device follows the patient’s spontaneous breathing rate to supply the appropriate pressure.

Setting Min EPAP and Max IPAP pressures in VAuto mode
Priority is given to the Max IPAP setting, followed by Min EPAP and then Pressure Support. The device automatically adjusts the lower-priority settings to ensure the device pressure limits are not exceeded.
Example:
Start with the settings Max IPAP = 15 cm H2O, Min EPAP = 10 cm H2O and
Pressure Support = 3 cm H2O. If the Max IPAP setting is readjusted to 11 cm
H2O, the device automatically reduces Pressure Support to 1 cm H2O. Max IPAP
(the highest-priority setting) is preserved.

(VAuto mode) Pressure Support allows you to set the difference between inspiratory and expiratory pressure. This value can be adjusted for patient comfort. A maximum PS value of 10 cm H2O can be selected.
In VAuto mode, if Pressure Support is above 6 cm H2O, treatment efficacy may be reduced.
Note that the actual delivered pressures will be AutoSet pressure ± 0.5 x pressure support (as set by the clinician).

If the support pressure of the Resmed Vpap Auto 25 will not change, this machine is not a true Bilevel auto machine. The Ipap and Epap change in equal amplitude in Vauto mode, the machine in Vauto mode is just like a single level machine( APAP), or just a new APAP machine which is better than one with EPR.

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).

It seems that the person who set up your machine didn't understand that difference between the two machines and set up the ResMed as if it were a Respironics. That is incorrect. If you want the ResMed to run as an auto, make sure the pressure support number is a number LESS THAN the distance between Max IPAP and Min EPAP so the dancers have some room to move. If the machine isn't set up correctly, it is the person who set it up who has kept the machine from running as an auto. That is not a limitation of the machine; it is a limitation of the person who set it up. That person was confused. So don't blame ResMed.

As for which approach to autobilevel dancing is best, I don't know. I just know the two approaches are different and that before you set up one brand after using another brand, you had better learn something about dance floors and choreography in the other world and translate from one to the other, if you want to see a dance.

jeff, who set up his own autobilevel, but is a lousy dancer in real life if he doesn't have a guitar in his hands.

jnk!! That is a BRILLIANT and excellent, understandable, explanation of the differences between the two brands' method of bi-level therapy delivery!!!!! THANK YOU! Even "I" can grasp and understand it!

Slinky wrote:jnk!! That is a BRILLIANT and excellent, understandable, explanation of the differences between the two brands' method of bi-level therapy delivery!!!!! THANK YOU! Even "I" can grasp and understand it!

I agree!

Jeff, you wrote a masterpiece!

Thank you Jeff! I see! You are a good teacher. I love you!
But I have a question. The resmed machine needs to be set a proper support pressure, but who know the proper distance? The amount should be adjusted according to the treating results for several times till the correct support pressure being found. On the contrary, the remstar machine could give the proper support pressure by itself.
Thank Slinky,rested gal. You all warm my heart.

Wuqing Wang wrote:Thank you Jeff! I see! You are a good teacher. I love you!
But I have a question. The resmed machine needs to be set a proper support pressure, but who know the proper distance? The amount should be adjusted according to the treating results for several times till the correct support pressure being found. On the contrary, the remstar machine could give the proper support pressure by itself.
Thank Slinky,rested gal. You all warm my heart.

Love back at you, Wuqing Wang. Glad if the explanation helped. I needed to hear myself write it.

When a doctor writes a bilevel prescription, the doctor writes down the two numbers from the sleep study that worked best. If you have those two numbers, you subtract the lower from the higher and the result is your prescribed pressure support. If the doctor wrote 17/13, for example, you subtract the 13 from the 17 to get your prescribed pressure support, 4.

Four is the usual amount of pressure support a bilevel titration tries. If a lot of hypopneas are occurring, but not many apneas, I might try increasing my pressure support a few cm, but other than that, 4 cm should be plenty.

jeff

@ Slinky and rested gal: YOU are the teachers here. Glad to know I finally learned some of this stuff! You are too kind. I was looking for a way of describing it that didn't involve dogs or horses.

jnk wrote: ... Slinky and rested gal: YOU are the teachers here. Glad to know I finally learned some of this stuff! You are too kind. I was looking for a way of describing it that didn't involve dogs or horses.

THAT is WHY it took us so long to catch on, jnk!!! Shame on you! FORTUNATELY, dancing is the other love of my life. Hubby and I hit the dance floor every weekend, even after the kids hit the ground, for years. Until his back and my lungs did us in. Even as a kid my dad danced w/me - a LOT. He was a MARVELOUS dancer, as was my step-dad. No one knows HOW to dance like that generation did!! Real couples dancing is a lost art any more, unfortunately. That "ballroom dancing" show on TV is such an absolute farce. More like athletics. The female dancers more interested in how much flesh they can expose than how well they or their partners can actually dance.

JNK

I agree - great analogy that works well enough to get the message across - well done !

DSM