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Need Help Setting Vpap/Bilevel
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Kate Offline

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Posts: 85
Joined: Dec 2013

Machine: ResMed S9 VPAP S
Mask Type: Full face mask
Mask Make & Model: Philips Resperonics FitLife
Humidifier: ResMed S5i
CPAP Pressure: 8/4
CPAP Software: ResScan

Other Comments: VPAP always makes me feel like my avatar.

Sex: Female
Location: Poulsbo, Washington

Post: #1
Question Need Help Setting Vpap/Bilevel
Paul from Perth,

My new machine has arrived. In another thread you had said that someone could help me set this bpap machine. Here is the maker and type of machine that I have.

Resmed Vpap/Bilevel adapt SV is my new machine.

I'm not sure about what is involved in setting my machine, but the doctor had wanted the pressure set at 8/4. I believe that's inhalation 8, inhallation 4. That is less than what my cpap machine's pressure is but I think the doctor wants to start there and change if necessary.

Thanks, Kate

:Using cpap then vpap since Feb.2013,
Kate
01-27-2014 06:38 PM
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zonk Offline

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Posts: 7,908
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Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #2
RE: Need Help Setting Vpap/Bilevel
(01-27-2014 06:38 PM)Kate Wrote:  I'm not sure about what is involved in setting my machine, but the doctor had wanted the pressure set at 8/4. I believe that's inhalation 8, inhallation 4.
This is above my paygrade, 4 EPAP (exhale pressure) ... 8 IPAP (inhale pressure)
8-4= 4 ... pressure support (the difference between IPAP and EPAP)

CPAP EPR is not exactly the same as bi-level pressure support
01-27-2014 07:15 PM
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Kate Offline

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Posts: 85
Joined: Dec 2013

Machine: ResMed S9 VPAP S
Mask Type: Full face mask
Mask Make & Model: Philips Resperonics FitLife
Humidifier: ResMed S5i
CPAP Pressure: 8/4
CPAP Software: ResScan

Other Comments: VPAP always makes me feel like my avatar.

Sex: Female
Location: Poulsbo, Washington

Post: #3
RE: Need Help Setting Vpap/Bilevel
I made a mistake. It's inhallation 8, exhallation 4. I was genetically diagnosed with narcolepsy and I have found that some days, it's better to stay in bed and not communicate.

:Using cpap then vpap since Feb.2013,
Kate
01-27-2014 11:05 PM
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Peter_C Offline

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Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #4
RE: Need Help Setting Vpap/Bilevel
I imagine one of the smart guys will be by shortly to tell you how to do it. While I know which settings to adjust, I do not know how to get into the menu of your machine.

Unless the Doc told you not to do so, I would put the machine in 'auto' mode, with those numbers as the minimums - then by wathing the data (in software) you can learn over time what the machine thinks is best for you.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
01-28-2014 12:18 AM
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vsheline Offline

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Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #5
RE: Need Help Setting Vpap/Bilevel
(01-27-2014 06:38 PM)Kate Wrote:  I'm not sure about what is involved in setting my machine, but the doctor had wanted the pressure set at 8/4.

Hi Kate,

Your profile says your (old) pressure was 9. This would seem to indicate your pressure when exhaling needed to be 9 or a little lower (if you were using EPR) to prevent obstructve apneas.

With the change to bilevel, it is possible your doctor is prescribing EPAP = 8 (to continue to prevent obstructive events) and Pressure Support (PS) = 4. This would make your inhale pressure 12. I think these would be reasonable settings for someone who needed a pressure of 9 when on standard CPAP machine. You can ask your doctor if that was his intention.

When treating central events an ASV machine somtimes needs to automatically increase Pressure Support as high as 10 or even higher, to keep you breathing. I reccomend setting the supper limit for Pressure Support at 10 or higher. The PS won't go higher than necessary.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 01-28-2014 12:17 PM by vsheline.)
01-28-2014 05:01 AM
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DeepBreathing Offline
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Posts: 2,294
Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Perth, Western Australia

Post: #6
RE: Need Help Setting Vpap/Bilevel
Hi Kate - that's the same machine I have. If you want the full clinical manual, go to this page and follow the directions. (You'll find it's listed in Section 3, manuals that are only available by email).

http://www.apneaboard.com/adjust-cpap-pr...tup-manual

You can get into the "secret" clinical menu by holding down the push dial (the big button) together with the setup button (with the two tick marks) for 3 seconds.

Once in the clinical menu, you should already be in the settings menu. If not, turn the push dial to get to the settings menu then push down to click the dial.

In the settings menu, turn the dial to get to EPAP, click on it, then turn the dial to set your EPAP (exhalation) value. Click again to lock it in.

Do the same for maximum and minimum pressure support(PS).

Once you've go everything set, turn the dial to get to "Home", click it, and you're done.

Following Vaugn's advice, set the EPAP to 8, the minimum PS to 4, and the maximum PS to 10. Also as per Vaugn's advice, confirm these settings with your doctor. These machines have a number of different modes, and it's easy to get confused.

Hope this helps.

DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
01-28-2014 06:57 AM
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robysue Offline
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Posts: 1,226
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Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #7
RE: Need Help Setting Vpap/Bilevel
(01-28-2014 05:01 AM)vsheline Wrote:  
(01-27-2014 06:38 PM)Kate Wrote:  I'm not sure about what is involved in setting my machine, but the doctor had wanted the pressure set at 8/4. I believe that's inhalation 8, inhallation 4.

Hi Kate,

Your profile says your (old) pressure was 9. This would seem to indicate your pressure when exhaling needed to be 9 or a little lower (if you were using EPR) to prevent obstructve apneas.
Not necessarily.

When titrating straight CPAP, it is typical that the OAs are the first events eliminated (they turn into hypopneas) and that it requires more (inhalation) pressure to properly prevent the residual hypopneas--i.e. the "OAs turned into Hs". On a straight CPAP titration, they keep increasing the pressure until these residual Hs are eliminated. On a bi-level titration the EPAP is increased for OAs, but not Hs; the IPAP is usually increased for both OAs and Hs. So once the OAs are eliminated, the EPAP is not increased further, but they continue to increase the IPAP until the residual Hs disappear.

As a result, for people being switched from straight CPAP to bi-level, it is not uncommon for the EPAP pressure to be several cm lower than the old straight CPAP pressure and the IPAP pressure to be roughly the same as the old CPAP pressure.

Quote:With the change to bilevel, it is possible your doctor is prescribing EPAP = 8 (to continue to prevent obstructive events) and Pressure Support (PS) = 4. This would make your inhale pressure 12. I think these would be reasonable settings for someone who needed a pressure of 9 when on standard CPAP machine. You can ask your doctor if that was his intention.
Without knowing more about how the script is actually written I would NOT make this assumption. It could be that the OP has some problems with pressure induced centrals (otherwise why the switch to an ASV machine?) and hence the doc wants to see if reducing the overall pressure needs is enough to fix the pressure induced centrals. It is quite possible that an IPAP = 8 or 9 is enough to take care of the Hs, and the reasoning would then be that less pressure is needed to take care of the OAs.

Quote:When treating central events an ASV machine somtimes needs to automatically increase Pressure Support as high as 10 or even higher, to keep you breathing. I reccomend setting the supper limit for Pressure Support at 10 or higher. The PS won't go higher than necessary.
The exact meaning of the PS setting on a VPAP ASV machine depends on the mode that you are using the machine in. If you're not using it in ASV mode, then there will only be one PS setting and it will fix the distance between EPAP and IPAP. In other words, if the machine is not in ASV mode, setting (min) EPAP = 8 and PS = 10 will result in a starting IPAP = (min) EPAP + PS = 8 + 10.

In ASV mode, however, there are two PS settings. The min PS setting is what controls the relationship between IPAP and EPAP when the machine is not trying to trigger breaths. At the start of the night, IPAP = EPAP + min PS. When the machine needs to trigger an inhalation, the IPAP is increased (sometimes dramatically) while the EPAP is left alone. The maximum the IPAP can increase to, however, is controlled by the max PS setting: max IPAP = EPAP + max PS.

To the OP: You need to clarify with your doctor exactly how s/he wants your machine set up. These are the questions you need to get answers to in writing:

What mode to use? Regular VPAP S, VPAP ST, or VPAP ASV?

Min EPAP = What?
Min PS = What?
Max PS = What?
Max IPAP = What?

On the S9 VPAPs there are also settings that control how and when the machine changes from IPAP to EPAP and back. So you will need to know what the doc wants you to use for:

TI max = What?
TI min = What?
Trigger sensitivity = What?

Note that in some modes, you might not have all these settings. In other modes, you will have more settings that you need to have the doc's written instructions in order to get the machine set up correctly. In both ST an ASV mode, there will be settings to control when the machine starts to trigger inhalations (the "breaths per minutes rate" and the "target minute ventilation" settings).
(This post was last modified: 01-28-2014 11:42 AM by robysue.)
01-28-2014 11:40 AM
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robysue Offline
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Posts: 1,226
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #8
RE: Need Help Setting Vpap/Bilevel
(01-27-2014 06:38 PM)Kate Wrote:  My new machine has arrived. In another thread you had said that someone could help me set this bpap machine. Here is the maker and type of machine that I have.

Resmed Vpap/Bilevel adapt SV is my new machine.
Do you know why the doc ordered a VPAP Adapt SV machine rather than the much simpler and much less expense VPAP Auto???

VPAP adapt SVs are usually NOT prescribed unless there is an identifiable problem with central apneas.

VPAP Autos are (rather routinely) prescribed when a person has had difficulty adjusting to CPAP or APAP.

It would help us help you make more sense about the settings if we knew why you were prescribed an adapt SV?
01-28-2014 11:47 AM
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Kate Offline

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Posts: 85
Joined: Dec 2013

Machine: ResMed S9 VPAP S
Mask Type: Full face mask
Mask Make & Model: Philips Resperonics FitLife
Humidifier: ResMed S5i
CPAP Pressure: 8/4
CPAP Software: ResScan

Other Comments: VPAP always makes me feel like my avatar.

Sex: Female
Location: Poulsbo, Washington

Post: #9
RE: Need Help Setting Vpap/Bilevel
Robysue,

The doctor wanted me to have this machine because most of my apnea events were centrals, around 15 an hour.

Kate

:Using cpap then vpap since Feb.2013,
Kate
01-28-2014 10:42 PM
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robysue Offline
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Posts: 1,226
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #10
RE: Need Help Setting Vpap/Bilevel
(01-28-2014 10:42 PM)Kate Wrote:  Robysue,

The doctor wanted me to have this machine because most of my apnea events were centrals, around 15 an hour.

Kate
Then the doc probably wants you to use the machine in ASV mode. It's just as important (probably MORE important) to get the ASV-only settings right on the machine as it is to get the EPAP/IPAP settings right. It's those ASV settings that control how the machine will treat your central apneas.

I'd suggest calling the doc's office back and telling them you've got the machine, but it still needs to be set up and that you are not sure about exactly what the doc wants all the settings to be.

If you're having problems with centrals, that may also explain why the EPAP pressure seems to be several cm lower than your old straight CPAP setting.
01-29-2014 10:14 AM
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