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DOES ANYONE KNOW IF THE MINIMUM PRESSURES FOR THE IPAP AND EPAP NEED TO BE ON
A PRESCRIPTION WRITTEN FOR THE AUTO MODE ON A VPAP AUTO 25 ..OR...ARE THE MAXIMUM PRESSURES FOR IPAP AND EPAP SUFFICIENT.....?
A PRESCRIPTION WRITTEN FOR THE AUTO MODE ON A VPAP AUTO 25 ..OR...ARE THE MAXIMUM PRESSURES FOR IPAP AND EPAP SUFFICIENT.....?
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Replies to This Discussion
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Permalink Reply by Judy on
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There is no Minimum IPAP or maximum EPAP for the VPAP Auto. There is just IPAP (maximum) and EPAP (minimum). Resmed's VPAP Auto's Pressure Support works entirely differently than Respironics'.
It is hard to explain. I'll borrow Velbor's explanation:
"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.
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there is nothing wrong with keeping the dancers pinned, if that's what a person wants to do. Some like the feel of a ResMed autobilevel in auto mode (because of how Easy-Breathe feels) but don't want the pressures to move around at night. So to get straight bilevel while the machine is in VAuto mode, they purposely make the pressures stay the same by setting pressure support the exact distance between Min EPAP and Max IPAP. But if a person wants to use a ResMed autobilevel as an autobilevel, the stick has to be shorter than the walls or the pressures won't vary."
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AMAZING...GREAT ANALOGY...BUT I WILL HAVE TO READ THIS A FEW TIMES TO INGEST IT THOROUGHLY..
I NEVER REALIZED HOW MUCH THERE WAS TO TREATING SLEEP APNEA....I HAVE WASTED A NUMBER OF YEARS BEING A FOLLOWER....NO MORE...IT WILL TAKE TIME FOR ME TO FULLY UNDERSTAND ALL THE NUANCES OF TREATING....BUT THE MOST IMPORTANT THING I DO UNDERSTAND IS THAT I NEED TO FULLY COMPREHEND ALL ASPECTS AS IT RELATES TO MY TREATMENT. THAT WILL TAKE SOME TIME ESPECIALLY AS I HAVE TO SHARE MY HOURS WITH OTHER IMPORTANT ISSUES....BUT COMING TO THIS SITE HAS CERTAINLY STIRRED ME AND IS WITHOUT DOUBT A WAKEUP CALL FOR ME....THANKS SO MUCH JUDY FOR TAKING THE TIME....ALSO I WAS WONDERING DID YOU EVER FIND A WAY TO GET A COPY OF THE CLINICIAN MANUAL? EVEN THO I WOULDNT UNDERSTAND IT ALL I AM CURIOUS TO READ IT AND IT TROUBLES ME GREATLY THAT ALL AVENUES OF INFORMATION ARE NOT OPEN TO THOSE OF US WHO DEAL WITH THIS SERIOUS DISEASE FOR OUR PERSONAL EVALUATION AND IMPLEMENTATION IF WE SO CHOOSE..
Judy said:There is no Minimum IPAP or maximum EPAP for the VPAP Auto. There is just IPAP (maximum) and EPAP (minimum). Resmed's VPAP Auto's Pressure Support works entirely differently than Respironics'.
It is hard to explain. I'll borrow Velbor's explanation:
"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.
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there is nothing wrong with keeping the dancers pinned, if that's what a person wants to do. Some like the feel of a ResMed autobilevel in auto mode (because of how Easy-Breathe feels) but don't want the pressures to move around at night. So to get straight bilevel while the machine is in VAuto mode, they purposely make the pressures stay the same by setting pressure support the exact distance between Min EPAP and Max IPAP. But if a person wants to use a ResMed autobilevel as an autobilevel, the stick has to be shorter than the walls or the pressures won't vary."
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CPAPs are NOT rocket science. Bi-levels on the other hand ... sigh .... are a bit more complicated.
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IF THE VPAP AUTO 25 IS NOT SET UP IN THE AUTO MODE....THEN HOW WOULD THE INSTRUCTIONS TO THE
RT READ? THANKS AGAIN....!
j n k said:The Rx for an autobilevel may be written many ways, but the instructions to the RT for setting up the Auto 25 in auto mode should contain a maximum IPAP number, a minimum EPAP number, and a constant pressure support number.
For example:
Max IPAP - 25
Min EPAP - 10
PS - 4
BTW Judy, I really like how "Velbor" worded that. I couldn't have said it better myself. ;-)
jeff
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Yeah, unfortunately, it turns out my memory REALLY sucks! Velbor e-mailed me, HE was NOT the one who wrote the analogy!!!! I haven't had the opportunity to find the original post a cpaptalk.com - but since it wasn't Velbor it had to be another very special "patient", DSM, who has occasionally posted here.
I'm sorry. I've been on a "downer" since Thanksgiving - and then my darling granddaughter introduced some wormware to my 'puter and I lost about a day and a half 'til my 'puter guru could get over and clean it up for me and then a good half of today w/hubby at endoscopy center. At least good news on both those scores!!! He's free now for another 5 years!! And my 'puter is up and running again and I can safely send e-mail w/o infecting my friends.
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nice to know judy that i am not the only one whose memory occasionally fails them....i hope that you are feeling better...and of course the good news re the endoscopy is great....the computer problems that arise...are as frustrating for me as trying to start learning more about these sleep apnea machines etc.....take care....
Judy said:Yeah, unfortunately, it turns out my memory REALLY sucks! Velbor e-mailed me, HE was NOT the one who wrote the analogy!!!! I haven't had the opportunity to find the original post a cpaptalk.com - but since it wasn't Velbor it had to be another very special "patient", DSM, who has occasionally posted here.
I'm sorry. I've been on a "downer" since Thanksgiving - and then my darling granddaughter introduced some wormware to my 'puter and I lost about a day and a half 'til my 'puter guru could get over and clean it up for me and then a good half of today w/hubby at endoscopy center. At least good news on both those scores!!! He's free now for another 5 years!! And my 'puter is up and running again and I can safely send e-mail w/o infecting my friends.
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Jeff, thank you so much!! i am totally in agreement with you re patient responsibility for his/her own understanding re actually any health related issue...and i am sorry that i couldnt be on this site when i first started apnea treatment...i have been in the dark for years and was not able to devote time to understanding and now i have a real thirst for thorough comprehension especially since i have some comorbidities that i am also dealing with....and frustrated cause i dont have some kind of primer to follow...thank goodness all of you are here....
on the resmed auto 25 loaner that i am using....my max ipap is 20 and my minimum epap is 7....i have asked to have the pressure support changed from 3 to 4.....(because i read that 4 might create more comfort... just to try it for a week)
when the machine is set with a pressure support of 3...the numbers that appear in the window in the mornings when i shut the machine off are always distanced by 3......
shouldnt those numbers in the morning... re my ipap and epap pressures for the previous nite... have varying differences between them rather than always being separated by 3..... if set in automode?
thanks again!!
j n k said:Then it would be a standard bilevel Rx, and there would be no need for the doc to specify any ranges or anything specific about a value (or in the case of a Respironics, a range) for pressure support, since the IPAP and EPAP would never move from their prescribed levels. All that would be needed from the doc are two numbers--a number for IPAP and a number for EPAP (in that order).
For example:
"BiPAP 14/10"
or
"IPAP 14, EPAP 10"
Prescriptions for bilevel are relatively common. Prescriptions for the use of autobilevel, on the other hand, are less common. And docs rarely understand that the two major brands of autobilevel approach the idea of setting up an autobilevel very differently. It is my impression from what I've read on forums that a few RTs, in fact, have a little trouble now and then understanding that fact. I personally don't blame the RTs for that. The docs have one way of viewing things and manufacturers have their way of viewing things, and the RTs get caught in the middle trying to translate the doc's wishes into how a manufacturer's machine gets set up. In a perfect world, docs would keep up with what is going on with the machines. This world, however, is far from perfect in many respects. That is why patients need to keep educated on this stuff when it comes to the patient's specific circumstances and needs. In my not-so-humble opinion, that is. :-)
It is my opinion that when a doc prescribes an autobilevel (also called auto BiPAP) but then only gives two numbers (one for IPAP and one for EPAP) then the responsibility rests squarely on the RT to get clarification from that doc on how to reflect that prescription in setting up the autobilevel in auto mode according to which machine is to be used. However, no clarification of that sort would be needed for using either brand of machine as a regular (nonauto) bilevel. If the Auto 25 is only being used as a bilevel, not as an autobilevel, that simplifies everything in that only the numbers for bilevel, one for IPAP and one for EPAP, would be needed.
I am only a patient, though.
jeff
claudette paluch said:IF THE VPAP AUTO 25 IS NOT SET UP IN THE AUTO MODE....THEN HOW WOULD THE INSTRUCTIONS TO THE
RT READ? THANKS AGAIN....!
j n k said:The Rx for an autobilevel may be written many ways, but the instructions to the RT for setting up the Auto 25 in auto mode should contain a maximum IPAP number, a minimum EPAP number, and a constant pressure support number.
For example:
Max IPAP - 25
Min EPAP - 10
PS - 4
BTW Judy, I really like how "Velbor" worded that. I couldn't have said it better myself. ;-)
jeff
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Thanks for the chuckle and your version of the conspiracy theory....it warmed my heart... as i have conspiracy theories for many aspects of health care and when i expound on them to persons i know ....i am met with complete disbelief and an occasional comment alleging paranoia.
thank you so much for your welcome input....i am going to try the ps of 4 tonite for the first time and see if it makes a difference....as i have mentioned, this machine is a loaner... ....i dont think there is much support for obtaining this one for me....due to reimbursement issues and a comment concerning the fact that there is not much clinical data out there to support consistent use of the auto function...which i cant really speak to.....so i have no way of knowing how it will all ultimately work out....
but whatever i can learn will help me to build my arguements for obtaining one....as well as give me a sense of peace because i understand what i am using that is so important to my health.....
your comment re the cpap is interesting and i will also pursue that possibility.....i have heard that resmed is planning to come out with a machine similar to a new one that respironics has issued....perhaps after january...so perhaps that is something also to look into.....
j n k said:There should always be the same distance between IPAP and EPAP, even in auto mode, with that brand of autobilevel. The other brand allows the distance between IPAP and EPAP to vary, but that one does not. That is the big difference between the two brands.
At first it may seem silly to keep PS (pressure support) the same if the idea of an auto is to meet varying needs. But when you think about it, it makes perfect sense for IPAP and EPAP to be locked together as they move up and down in unison to meet patient needs throughout the night. It is disturbing enough to sleep for pressures to change, and for pressures to change in relation to one another along with the other changes can be disturbance on top of disturbance. Besides, 4 cm has become something of a standard for PS these days, and only your present brand has the ability to lock that in. The other brand's PS cannot be locked in, only limited.
I have used both brands of autobilevel and feel that I got good treatment with both. My preference is the brand you are using, though. It is quiet and comfortable. You are using a great machine.
Personally, I have found that I like my PS at 3 these days. I find I get slightly less leak that way with my nasal pillows, and my efficacy numbers are just as good. My doc doesn't mind. In fact he says it is OK for me use a PS of 2, if I want. But, yeah, 4 is the standard.
WARNING, NOTSTANDARD CONSPIRACY THEORY TO FOLLOW: My theory is that the standard of four is more about insurance and money for manufacturers than medicine. You see, ResMed's regular CPAP machines give something very close to bilevel treatment by giving up to 3 cm of EPR, their version of exhalation relief. (And, thus, the autos with EPR are very close to autobilevels.) If they want to continue to sell the more expensive bilevel machines, there needs to be a way of differentiating what the bilevels do. Making the standard bilevel spread 4 cm instead of 3 means the bilevel machines can do something the regular CPAP machines can't. Get my drift? Money plays a role in how medicine and manufacturers interact through the wonders of the present insurance maze. END OF CONSPIRACY THEORY.
Anyway, I personally would not worry about kicking the PS up to 4 unless the numbers show there is something wrong with your therapy. And if you are paying out of pocket, you may even want to give the ResMed CPAP machines with EPR a serious look, since they give something very close to bilevel therapy at a lower price than true bilevel, especially if 3 cm PS is working for you. But hey, that's just my personal opinion combined with one of my many off-the-wall conspiracy theories. And ResMed would probably want to kick my fanny for saying any of the above. :-)
Glad to help. Just remember I often don't know what I'm talking about. This is, after all, the Internet, right?! :-)
jeff
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Permalink Reply by 99 on
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clinicians manual are on ebay
claudette paluch said:AMAZING...GREAT ANALOGY...BUT I WILL HAVE TO READ THIS A FEW TIMES TO INGEST IT THOROUGHLY..
I NEVER REALIZED HOW MUCH THERE WAS TO TREATING SLEEP APNEA....I HAVE WASTED A NUMBER OF YEARS BEING A FOLLOWER....NO MORE...IT WILL TAKE TIME FOR ME TO FULLY UNDERSTAND ALL THE NUANCES OF TREATING....BUT THE MOST IMPORTANT THING I DO UNDERSTAND IS THAT I NEED TO FULLY COMPREHEND ALL ASPECTS AS IT RELATES TO MY TREATMENT. THAT WILL TAKE SOME TIME ESPECIALLY AS I HAVE TO SHARE MY HOURS WITH OTHER IMPORTANT ISSUES....BUT COMING TO THIS SITE HAS CERTAINLY STIRRED ME AND IS WITHOUT DOUBT A WAKEUP CALL FOR ME....THANKS SO MUCH JUDY FOR TAKING THE TIME....ALSO I WAS WONDERING DID YOU EVER FIND A WAY TO GET A COPY OF THE CLINICIAN MANUAL? EVEN THO I WOULDNT UNDERSTAND IT ALL I AM CURIOUS TO READ IT AND IT TROUBLES ME GREATLY THAT ALL AVENUES OF INFORMATION ARE NOT OPEN TO THOSE OF US WHO DEAL WITH THIS SERIOUS DISEASE FOR OUR PERSONAL EVALUATION AND IMPLEMENTATION IF WE SO CHOOSE..
Judy said:There is no Minimum IPAP or maximum EPAP for the VPAP Auto. There is just IPAP (maximum) and EPAP (minimum). Resmed's VPAP Auto's Pressure Support works entirely differently than Respironics'.
It is hard to explain. I'll borrow Velbor's explanation:
"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.
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there is nothing wrong with keeping the dancers pinned, if that's what a person wants to do. Some like the feel of a ResMed autobilevel in auto mode (because of how Easy-Breathe feels) but don't want the pressures to move around at night. So to get straight bilevel while the machine is in VAuto mode, they purposely make the pressures stay the same by setting pressure support the exact distance between Min EPAP and Max IPAP. But if a person wants to use a ResMed autobilevel as an autobilevel, the stick has to be shorter than the walls or the pressures won't vary."
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Ooops!!! God bless you, it was YOU, wasn't it, jnk??? I'm gonna go check but .... I SHOULD have known .... color me RED-FACED! I'm going to check now, but I just KNOW it WAS you.
j n k said:Does this link help, Judy? ;-)
http://www.cpaptalk.com/viewtopic.php?f=1&t=39248&p=378447#...
Judy said:Yeah, unfortunately, it turns out my memory REALLY sucks! Velbor e-mailed me, HE was NOT the one who wrote the analogy!!!! I haven't had the opportunity to find the original post a cpaptalk.com - but since it wasn't Velbor it had to be another very special "patient", DSM, who has occasionally posted here.
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Oh, jnk!!! I could cry!! How in the devil did I make that mistake?? I am so embarrassed and hurt that I would not remember it was YOU who made it so clear for me!!! I had cut and pasted your analogy but not the URL nor the credit. I added dsm's comments to my cut and pasted save and his "sig" was included in the cut and paste and .... I'm gonna go eat worms! I am crushed that I could forget so quickly.
There are some very special friends I have made in the forums and you and RestedGal and Velbor and dsm have always been so patient explaining things that have gone over my head to me .... even when you have repeatedly had to take the "dumbing down" to the lowest level before I grasped it.
Now I'm gonna go crawl in my hole for a while .... (((hugs))) and THANKS for being you!!!
PS: I have gone back and added your name as the source in my saved file so that I NEVER make such a mistake again!!!
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