hi debbie i missed welcoming you in october but now heres my welcome, welcome

Ooops, and yes, I know when in Standard mode I have to add 24 L/M to the reported leak rate which I didn't do when I told you the reported Leak rate w/the Zzz-Mask. But they were still the BEST reported Leak rates I've gotten since starting CPAP in 2006.

And ha! ha! on me: I left it in Standard Mask Selection which switching masks.

It would appear that I may owe ProBasics and PUBLIC APOLOGY!!! The Zzz-Mask full face mask has a one way valve design The one way valve design of the exhalation port is designed to help to minimize CO2 retention.

According to Resmed if using a non-Resmed mask we should use the Standard Mask Selection. But - I did something today I so often preach - READ THE MANUAL!!!!

In VAuto mode, only ResMed masks are compatible for use with the VPAP Auto.

Now I have to go find which Resmed full mask or masks has/have a one way valve design and compare the allowed vent rates to determine WHICH Mask Selection I SHOULD be using!!!

Mirage Vista™ Nasal Mask
• Ultra Mirage™ Nasal Mask
• Ultra Mirage™ II Nasal Mask
• Mirage Activa™ Nasal Mask.

Just goes to show you how dangerous a little knowledge can be!!!!!!!!

Thanks again, Debbie. That is interesting that you spend that time w/your patient adjusting the Rise Time, etc. I just might request that we try that at my sleep lab since I blew my opportunity at Mayo.

When my local sleep doc told me to switch from Auto to Spontaneous we had no idea I was going to have a problem in Spontaneous mode. The jerk at Mayo I think did it just for spite as we didn't hit it off from the get-go. He KNEW the REASON I was having the titration at Mayo was to try to eliminate the abrupt pressure transition in Spontaneous mode. It was such a shock and my family and I have been going to Mayo for some 50 years and he just is NOT Mayo calibre.

W/the Zzz-Mask last night my Leak rate was 1.2 and 2.4 and 10.8
Reported Pressure was 10.4 and 10.4 and 12

But my AHI was HORE-EYE-BULL!!! It boggles my mind that I am experiencing so much pressure difference between the Zzz-Mask and my Simplicity!

I have COPD. I use the S8 ResLink and Nonin XPod oximeter and sensor. Whilst at Mayo the RRT, RPSGT manager of their CPAP Shop (the sleep doctor was an ... a jerk) I told him about the abrupt pressure transition between IPAP and EPAP and he spent some time w/me changing the "comfort settngs". I'm not sure if he tried Rise Time, Ti Max and Ti Min or just which ones he did adjust but I could never feel one whit difference w/the changes. My neighbor was sitting behind me waiting, and then a gentleman walked in w/a Respironics in a carry case and this RRT/RPSGT manager was the only staff in the shop at the time and I got uncomfortable w/everybody sitting around waiting on me and gave up. I WISH I hadn't. But its too late to do over now. *sigh* I do have ResScan 3.7 and the cable reader and do my own downloads.

My current Rise Time is 350 mS, Ti Max is 3.0s and Ti Min is 0.5s, IPAP 12, EPAP 7, PS 5. And I'm using the Zzz-Mask.

How long should I stay at one Rise Time before trying another?
How long should I stay at one Ti Max before trying another?
How long should I stay at one Ti Min before trying another?

The local Resmed Rep and my local DME supplier's RRT spent some time whilst I was at Mayo trying to eliminate that abrupt pressure transition in Spontaneous mode. And said they had no success.

Meanwhile, I've talked to 14-15 others w/the VPAP Auto and 1-2 others w/the VPAP Auto 25 that also had problems w/the abrupt pressure transition in Spontaneous mode. We've all done great switching to Auto mode w/the PS set at the difference between IPAP and EPAP so its running as if in straight bi-level mode. Have YOU run into this abrupt transition in Spontaneous mode w/any of your patients?

Thanks, Debbie. I have the Resmed VPAP Auto (the January 2008 release, NOT the July 2008 released VPAP Auto 25. I was originally titrated Feb 2008 at IPAP 13, EPAP 8, PS was set at 4 tho that wasn't on my script using the Simplicity simple nasal cushion. I did fine for several months (3 maybe?) until doctor said to switch from Auto to Spontaneous. So while I was at Mayo in MN Oct 2008 I was re-titrated at IPAP 10, EPAP 5, PS 5 the first half of the night w/the OptiLife nasal cradle cushion & last part of the night w/my Simplicity simple nasal cushion. They also insisted on Spontaneous mode. I get too abrupt a transition from IPAP to EPAP in Spontaneous mode but smooth as silk in Auto mode. At home I did find that the pressure felt higher w/the OptiLife than the Simplicity. I like my Simplicity better so that is what I used until recently I switched to the full face Zzz-Mask. I THINK I am going to have to be re-titrated to use the Zzz-Mask. I have a WONDERFUL Leak rate w/it BUT AI is running way too high. It was the abrupt transistion between IPAP and EPAP I wanted to ask about tho. And I'm running out of room in this PM. Will send a second to ask about the Rise Time, Ti Max and Ti Min.