ResMed's EasyBreathe -- What a Difference

But, jnk, I had the Resmed S8 Elite w/EPR and never experienced an abrupt transition when using the EPR. AND I had the Resmed S8 AutoSet Vantage and never experienced an abrupt transition when using EPR in straight CPAP mode nor in Auto mode (which didn't allow use of EPR).

Really, first I was positive it was because the VPAP Auto was so new my local DME's RT wasn't familiar w/its proper setup. Then I realized it was most likely that none of the medical professionals I talked to about it were familiar w/its proper setup and too lazy to investigate proper setup. Then I began to suspect that "I" had gotten a faulty VPAP Auto. Then I suspected that there was a "faulty" lot of VPAP Autos - until we encountered a couple of VPAP Auto 25 users w/the same problem.

Now I suspect EITHER there is a problem having an in-lab bi-level titration on Respironics equipment and provided w/the Resmed bi-level VPAP Auto - or - at least for some of us the conversion from in-lab Respironics titration to Resmed VPAP Auto provision just doesn't work well. I did have a manufacturer's RRT/RPSGT Rep tell me that both companies provided the labs w/conversion charts but that neither was particularly accurate.

And I am finally reluctantly strongly considering the fact that Resmed just plain has made a "boo-boo" w/these VPAP Autos and VPAP Auto 25s and their Spontaneous mode. *sigh*

One of the things I considered is that some of us have "daytime breathing" problems such as COPD, asthma, etc. - but then I encountered those who have NO LUNG PROBLEMS and have one or the other of these VPAP Autos having the same problem. *sigh* I'm TRYING to keep an open mind - but in the words of a country song "it ain't easy being easy".

Its funny how my DME did not even remotely understand the concept of the wind tunnel effect that the original poster was describing. If it wasn't for this forum, I would think that I had an unusual breathing problem. I don't have easy breath or EPR, but I hope I soon will.

Slinky,

Do people get the same puff when using a ResMed mask?

I like Easy-Breathe, myself, but in its smoothing out the waveform, I wonder if it does as good a job at ventilating, which is what bilevel is supposed to help with, in many cases, not just comfort, as I understand it. In other words, I wonder if the abrupt "puff" may be helpful in ventilating someone needing ventilation more than comfort. It may be more of a feature than a bug in that mode. I am just guessing here, nothing more, based on assumptions about "effectiveness" versus "comfort" aspects in the context of what bilevels are supposed to be about in some cases.

Anyway, to me, it doesn't matter, since those ResMed bilevels can be run in Auto mode (puffless) but in a way that locks them into the two pressures (making it run in a non-auto fashion) by making PS the same as the distance between Min EPAP and Max IPAP. That would turn the Max and Min into the ACTUAL EPAP and IPAP all night with no roaming, just like Spontaneous mode.

jeff

You know, jnk, masks weren't something any of us discussed w/each other altho I do remember one of those I corresponded with described his complaint w/the abrupt transmission as his mask actually rising up and down w/the pressure transition. That is why I mentioned it. Its not something that I encountered. But further discussion did reveal that adjusting the Auto mode PS to run as a straight bi-level worked WONDERFULLY; smooth and easy breathing.

For me, I am sure that it is a "puff" of pressure at the END of inhalation, beginning of exhalation. Another describes it as a "puff" of pressure at the BEGINNING of inhalation, end of exhalation.

I'm still trying to understand the "shark fin" waveform. Whether it applies to pressure or volume vs. time, it seems like this waveform has a very abrupt transitions, both at the peak and trough. Does not seem like it would provide comfort to me.

I understand that it does make good soup, though.

jdm2857 wrote:I'm still trying to understand the "shark fin" waveform. Whether it applies to pressure or volume vs. time, it seems like this waveform has a very abrupt transitions, both at the peak and trough. Does not seem like it would provide comfort to me.

I understand that it does make good soup, though.

Well, that shark-fin wave form provided particularly good results when the technology was first tested on sharks. I tried to tell them that that sharks and humans are ENTIRELY different seafaring creatures, but they wouldn't listen...



Seriously... That shark fin waveform applies to pressure delivery at the machine's impeller. However, if you measured pressure at the mask, you would end up with a resultant pressure waveform comprised from both pressure contributors: the impeller and the human diaphragm.

Prior to that somewhat gradual shark-fin pressure waveform, the standard BiLevel pressure-output at the impeller was an even more abrupt square wave like the one we see below:

So, was there ever a time when people found the transition from 10 cm to 10 cm too abrupt? And did it ever get out of sync with their breathing? And do those people now find 10 cm with Easy-Breathe (no EPR) easier to breathe out against than 10 cm on a machine without Easy-Breathe (no EPR)? Or does Easy-Breathe somehow affect something in relation to how the machine maintains even pressure during inspiration and expiration when EPR is not on? Or is it really irritating how I keep asking the same question over and over just using different words, as if I actually have any idea what I'm saying when I'm surely only managing to continue confusing myself with my run-on string of questions? And is that why most would not bother to even read this far in this paragraph, because they gave up reading this silly post about two questions ago? Or am I wrong?

I think that you are making a false assumption that the machines all maintain an absolutely constant pressure throughout the breathing cycle. If the machine is maintaining 10 cm H2O while the patient is inhaling, when exhalation begins, the pressure will rise, until the machine recognizes this and reduces the blower speed to compensate for the pressure of the exhalation. Similarly, after the machine adjusts to get back to 10 during exhalation, the pressure will drop when the patient starts to inhale. The machine then senses this pressure change and adjusts the blower speed upwards to regain that pressure of 10.

The more closely the blower adjustments match the patient's breathing, the less the pressure will fluctuate, and the more comfortable the experience will be.

I think.

Resmed's CPAP machine using EPR does not deliver straight-line pressure. That modality is really an intermittent BiLevel machine when EPR is enabled:

Resmed's EPR applied to CPAP is actually BiLevel therapy that quickly goes back to being CPAP therapy when/if SDB events show up. So let's take that 10cm example in all three cases:

1) Ordinary CPAP with no EPR is a straight-line 10cm of pressure being delivered at the impeller.

2) Ordinary old-fashioned BiLevel set at 10/7 approaches that pressure square wave I have above---with 10cm on the top and 7cm on the bottom.

3) Setting Resmed's CPAP machine to an EPR of 3 will deliver those same BiLevel pressures in implementation 2 above, but with these modifications:
a) the more gradual shark fin transition instead of the more abrupt pressure square wave, and
b) when SDB events show up, the machine goes back to delivering straight CPAP pressures as the preferred method of "event handling"

Expiratory end-phase apneas are less prone to happen when the higher CPAP pressure replaces that lower EPAP pressure. That moving back up to CPAP pressure's higher ground during exhalation is the essence of EPR's "event handling" on a Resmed CPAP machine.

Slinky wrote:Please do and let us know your results!

My IPAP setting is 12, EPAP is 7, and Pressure Support is 5. With the PS set the difference between IPAP and EPAP in Auto mode, the VPAP Auto is essentially running as a straight bi-level. i.e. 12 - 7 = 5 and it is COMFORTABLE, smooth easy pressure transitions.

BUT - put it in Spontaneous mode at the same settings??? For 14 of us ..... uh uh. Abrupt pressure transitions. They can feel like an extra "puff" of pressure at the end of IPAP, start of EPAP or actually almost "bounce" your mask on your face, etc.

Yup, I experienced the same thing last night. Spontaneous mode was not comfortable at all, and I changed it after about 15 minutes. I tried:

Spontaneous: IPAP=10, EPAP=6, PS=4
VAUTO: maxIPAP=10, minEPAP=6, PS=4

I then switched it to CPAP mode at 10, EPR=3, and I could almost duplicate the abruptness of Spontaneous mode by setting EPR INHALE to Fast. At Medium, it's much smoother and doesn't make the mask do that little "jump."

I read not too long ago, a couple VPAP S users had been switched to VPAP Auto 25 because of inability to duplicate the VAUTO's smoother pressure transition.

The interesting thing is that I ended up sleeping all night at CPAP=10, and I got the best sleep (and AHI) I've had in a long time. I think I'll leave it at CPAP for another night or two and then try VAUTO settings which prevent auto pressure changes. I've been using it in Auto mode so the RTs and doc can decide if I do better on BiPAP and at what pressure.

Anyway, very interesting about so many users experiencing abrupt pressure changes in S mode and using the VPAP S. Seems like ResMed could do better? Especially if pressure changes in VAUTO mode are much smoother and less disruptive.

jnk wrote: Or am I wrong?

JNK, I have been following the discussion literally holding
my breath in antisipation of the next, inspiretional post.....
and overwhelmed by the shear brillance of every expiratory effort.
Very encouraging to see that whether cpap, bi-pap, EPR, EasyBreath, A-flex, C-flex,
everyone is getting something and are definitely full of it.

.....and as always, I know exactly, pretty much, for sure,
mostly, unequivocally, with no doubt, at least ball park,
that you hit the nail on the head w/every comment or question.

I'm right there w/you. You're good.

Slinky wrote:You know, jnk, masks weren't something any of us discussed w/each other altho I do remember one of those I corresponded with described his complaint w/the abrupt transmission as his mask actually rising up and down w/the pressure transition. That is why I mentioned it. Its not something that I encountered. But further discussion did reveal that adjusting the Auto mode PS to run as a straight bi-level worked WONDERFULLY; smooth and easy breathing.

For me, I am sure that it is a "puff" of pressure at the END of inhalation, beginning of exhalation. Another describes it as a "puff" of pressure at the BEGINNING of inhalation, end of exhalation.

Depending on the mask I'm wearing, I too notice an "accordion" effect in the cushion/seal. My F&P masks use a foam cushion, so the seal inflates less and doesn't behave quite as disruptively as some other masks I've used.

carbonman wrote:

jnk wrote: Or am I wrong?

JNK, ...
I'm right there w/you. You're good.

Amen!

jdm2857 wrote:I think that you are making a false assumption that the machines all maintain an absolutely constant pressure throughout the breathing cycle. If the machine is maintaining 10 cm H2O while the patient is inhaling, when exhalation begins, the pressure will rise, until the machine recognizes this and reduces the blower speed to compensate for the pressure of the exhalation. Similarly, after the machine adjusts to get back to 10 during exhalation, the pressure will drop when the patient starts to inhale. The machine then senses this pressure change and adjusts the blower speed upwards to regain that pressure of 10.

The more closely the blower adjustments match the patient's breathing, the less the pressure will fluctuate, and the more comfortable the experience will be.

I think.

That makes sense. I think.

So would that would mean some CPAPs are better at maintaining a constant pressure than others? And if so, is that ever advertised as a comfort feature? "Our brand is less likely to cause treatment pressure to rise above your prescribed pressure when you exhale!"?

In trying to sum up this discussion,
I recall a basic explanation for how things
work when I was w/Motorola.

When a customer would ask, "How does that work?"
We were trained to say, "It's FM."

....known in the trade as a special kind of magic.