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Permalink Reply by Judy on May 17, 2009 at 3:51pm

I agree, jnk. I get very good therapy w/my VPAP Auto in auto mode. But with IPAP at 11, EPAP at 6 and PS at 5 someone explain to me WHERE THE AUTO function is? Like it "ain't" an auto "no more", its just plain a VPAP w/the new EasyBreathe technology. WHY isn't that EasyBreathe techonology available in Spontaneous mode? According to my understanding EasyBreathe IS available in Spontaneous mode in the VPAP Auto 25.

And in Spontaneous mode it is NOT a particularly comfortable straight VPAP. I have NOT HEARD OF OR READ OF ANYONE w/the Auto 25 having this issue. Yet among the few w/the VPAP Auto on the various apnea support forums there are AT LEAST 4 of us who have or are experiencing this too abrupt transition from inhalation to exhalation in Spontaneous mode and so far NO ONE has been able to advise any of us on how to eliminate that abrupt transition EXCEPT we've found out ON OUR OWN that we can get good, comfortable therapy IN AUTO MODE..

I am STRONGLY suspecting at this point that this abrupt transition in Spontaneous mode is WHY the VPAP Auto 25 was introduced so soon after the introduction of the VPAP Auto - only 6 months. January 2008 to July 2008. And THAT is why I am posing this question. You KNOW I love my Resmeds BUT it also seems we or our insurances PAID FOR AN AUTO BI-LEVEL and DID NOT GET an AUTO bi-level.

And NO, even tho I have a backup Respironics bi-level auto I will NOT give up my VPAP Auto (in auto mode) for it!!!! That Respironics is for emergencies ONLY.

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Permalink Reply by Judy on May 17, 2009 at 10:23pm

Bless your pea-picking heart, jnk. Thank you again for such a clear explanation.

I was just reading tonight - someone started on the VPAP Auto (not the 25) in auto mode w/IPAP at 20 and EPAP at 4. Isn't the maximum pressure support 10?? And isn't the data questionable when the PS is set higher than 6?? It sure sounds like it is going to be one heck of a roller coaster ride! Sure ought to be putting the EasyBreathe technology to the test, don't you think??? This is a person who has been on CPAP for over a year and has had at least one in-lab titration.

AND - I've run into a 5th person who has had this transistion problem in Spontaneous mode.

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Permalink Reply by Judy on May 18, 2009 at 12:37pm

Unfortunately, that person had no idea what the PS was set at. I know my VPAP Auto the PS can't be set higher than 9.8. The next "step" is 0.0.

And a SIXTH person has also said that he couldn't tolerate his VPAP Auto in Spontaneous mode and they had resorted to running in auto mode and he LOVES it in auto mode. As do all of us so far.

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Permalink Reply by Judy on May 27, 2009 at 5:35pm

Bump.

There are 7 of us now, 6 of us w/the VPAP Auto and 1 w/the VPAP Auto 25 who are encountering this rough transition from IPAP to EPAP in Spontaneous mode only. All 7 of us have switched to Auto mode and love our VPAP Autos and the smooth, flowing, easy transition from IPAP to EPAP - in Auto mode. None of our sleep professionals have been able to come up w/an answer except stay in Auto mode if that is what is working for you.

THANK GOODNESS, there is one of our forum member professionals INTERESTED and CARING enough to pursue this w/the sleep doctor on staff and with Resmed.

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Permalink Reply by Judy on May 28, 2009 at 8:03pm

A Resmed Rep explained that the reason the Auto mode is much more comfortable is it utilizes ResMed’s “EasyBreathe” technology, which speaking mathematically just means the curve between IPAP and EPAP is more round and less abrupt. Spontaneous mode is simply a regular bilevel mode which is a square wave form and more abrupt. Therefore, all of you are experiencing an easier transition from IPAP to EPAP when in Auto mode. The trouble with Spontaneous mode is related to the rise time setting. He explained that a lower setting equates to a faster delivery, or shorter breath cycle, and vice versa. However, while an RT can play around with the rise time, it does not eliminate the abruptness of the transition. When asked why we then even bother with this mode: because it is an old standard that still works in the hospital setting when patients need ventilation for other breathing problems and the Auto mode is sufficient for the simple sleep apnea patient. So, they keep the old mode available too. There is no reason for you to use any mode other than Auto unless you are having trouble in this mode. In other words, it doesn’t hurt anything to be in Auto mode.

I don't think I "buy into" his explanation. Take the Resmed S8 Elite w/EPR. EPR provides expiration pressure relief. It senses you are exhaling and reduces pressure by 1 to 3 cms depending on the EPR setting. And there is/was NO rough transition and the S8s did NOT have this new EasyBreathe technology.

The Resmed S8 Autoset Vantage did not have EPR in Auto mode but it did when used in straight CPAP mode. And there was no rough transition in straight CPAP mode w/EPR at any of the EPR settings.

Now - maybe the Rep's explanation holds true for most but not for me because of my COPD. Maybe there isn't enough leeway in Rise Time adjustment for my COPD breathing. But I have my doubts about that too. It will be up to the others to discover whether it holds true for them.

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