ResMed's EasyBreathe -- What a Difference

Jdm2587 correctly describes the machine's feedback loop maintaining a much tighter pressure control or servo loop than past CPAP implementations. But that better-controlled or more tightly-coupled servo loop, in and of itself, would actually provide a much straighter or flatter 10cm pressure delivery at the impeller's output if EasyBreathe control logic features and EPR were turned off.

The EasyBreathe control logic employs yet additional wave template control to make the pressure output more friendly to human stretch receptors.

But the essence or core of EPR is that 1cm, 2cm, or 3cm expiratory-phase pressure drop described on page two of this Resmed marketing sheet:
http://www.resmed.com/us/assets/documen ... sa_eng.pdf

Again, using the 10cm example, the three possible EPR settings on a Resmed CPAP machine provide intermittent BiLevel pressures as follows:
1) EPR=1 would provide intermittent BiLevel pressures of 10/9 (w/ BiLevel modality suspended in favor of strict CPAP operation when SDB events are afoot)
2) EPR=2 would provide intermittent BiLevel pressures of 10/8 (w/ BiLevel modality suspended in favor of strict CPAP operation when SDB events are afoot)
3) EPR=3 would provide intermittent BiLevel pressures of 10/7 (w/ BiLevel modality suspended in favor of strict CPAP operation when SDB events are afoot)

-SWS wrote:But that better-controlled servo loop, in and of itself, would actually provide a much straighter or flatter 10cm pressure delivery at the impeller's output if EPR were turned off and no other EasyBreathe control logic features were turned on.

The EasyBreathe control logic employs yet additional wave template control to make the pressure output more friendly to human stretch receptors.

In other words, that means that EasyBreathe (without EPR) is varying the pressure for comfort purposes, and the machine clearly is not just attempting to deliver a constant pressure.

jdm2857 wrote:

-SWS wrote:But that better-controlled servo loop, in and of itself, would actually provide a much straighter or flatter 10cm pressure delivery at the impeller's output if EPR were turned off and no other EasyBreathe control logic features were turned on.

The EasyBreathe control logic employs yet additional wave template control to make the pressure output more friendly to human stretch receptors.

In other words, that means that EasyBreathe (without EPR) is varying the pressure for comfort purposes, and the machine clearly is not just attempting to deliver a constant pressure.

Well, EPR's expiratory-phase pressure drop is precisely when all those comfort pressure transitions are going to happen by design.

Turn EPR off altogether, and I suspect all you will get is a much better-maintained flat or straight (CPAP) pressure, thanks to that tightly-coupled servo loop. However, if you enable EPR, you enable BiLevel---but with those much more "natural" pressure transitions from inhale-to-exhale and exhale-to-inhale.

To go back to the beginning of this thread, I have EPR disabled, but find a huge difference between the way my machine (with EasyBreathe) feels and the way the Respironics tank felt at my doctor's clinic. My auto is set 12/20 whereas the tank was set to a straight 12. No C-Flex.

jdm2857 wrote:To go back to the beginning of this thread, I have EPR disabled, but find a huge difference between the way my machine (with EasyBreathe) feels and the way the Respironics tank felt at my doctor's clinic. My auto is set 12/20 whereas the tank was set to a straight 12. No C-Flex.

I don't necessarily find your above EPR-off observation incompatible with this suspicion:

-SWS wrote:Turn EPR off altogether, and I suspect all you will get is a much better-maintained flat or straight (CPAP) pressure, thanks to that tightly-coupled servo loop. However, if you enable EPR, you enable BiLevel---but with those much more "natural" pressure transitions from inhale-to-exhale and exhale-to-inhale.

Forgetting about EPR's fancy expiratory drop for a moment. Didn't you also correctly say that instantaneous human-diaphragmatic pressure and CPAP pressure can additively spike or exceed prescribed pressure during the very beginning of exhalation without a tightly-coupled (time domain) servo loop? So if you employ a tightly-coupled servo loop to bring that instantaneous pressure spike back down to prescribed levels at the very beginning of exhalation... why would we expect that would NOT be more comfortable than a CPAP machine that allows pressure spikes at expiratory onset?

That, in and of itself, should be much more comfortable than old-fashioned CPAP pressure spikes I would think. With that said, I acknowledge that Resmed may well be employing at least some of their non-EPR EasyBreathe wave softening in CPAP mode with EPR turned off. Definite possibility IMHO...

-SWS wrote:But that better-controlled servo loop, in and of itself, would actually provide a much straighter or flatter 10cm pressure delivery at the impeller's output if EPR were turned off and no other EasyBreathe control logic features were turned on.

The EasyBreathe control logic employs yet additional wave template control to make the pressure output more friendly to human stretch receptors.

If the pressure delivered is straighter or flatter with EasyBreathe off, the the pressure is less straight (or flat) with EasyBreathe on.

In other words, EasyBreathe causes pressure variations, no?

-SWS wrote:...instantaneous human-diaphragmatic pressure and CPAP pressure can easily exceed prescribed pressure during the very beginning of exhalation without a tightly-coupled servo loop in the time domain?...

I think this is why I find breathing out against straight pressure such a challenge. Even tho my pressure was just 11 from Aug07 to July09, I always found it uncomfortable...just lived with it as I've been 100%compliant since the beginning. 5 days on the ResMed Vantage (set 4-20) with no sense of this exhalation effort was wonderful & I slept much, much better. I had 2 mins of Stage 3 and no S4 or REM during 1st half of PSG with RAs of 37 (severe AHI too, all hypops) so I assume I had pretty fragmented sleep. While I've felt like I was sleeping well, I think the RAs have continued as my recovery has been slow...steady but slow. Having a dumb CPAP hasn't helped optimizing therapy as I was leaking for months before joining here and didn't know that was why I backsiding into OSA. Doc wants me on APAP based on the 5 night's data plus the 4 nights recording ox (reminder to self: get the printout of data). At a pressure of 9, the exhale effort is much less but sleep is nowhere near as good as on the APAP. I hate ins companies & having to fight them over everything

jdm2857 wrote:

-SWS wrote:But that better-controlled servo loop, in and of itself, would actually provide a much straighter or flatter 10cm pressure delivery at the impeller's output if EPR were turned off and no other EasyBreathe control logic features were turned on.

The EasyBreathe control logic employs yet additional wave template control to make the pressure output more friendly to human stretch receptors.

If the pressure delivered is straighter or flatter with EasyBreathe off, the the pressure is less straight (or flat) with EasyBreathe on.

In other words, EasyBreathe causes pressure variations, no?

Well, not only do we NOT know all the little implementation details of EasyBreathe, but we also do not know exactly which components are employable during CPAP modality ("EPR=off") when BiLevel EPAP pressure drops ("EPR=on') are disallowed so that CPAP modality can be just that. In all possible modalities, that tightly-coupled servo loop is going to run 100% of the time and it can be much more comfortable than any loosely-coupled control loop that allows instantaneous pressure spikes during expiratory onset. So right there you have one plausible reason to find that machine more comfortable during exhale.

But yes, I absolutely agree that Resmed might have turned on yet additional EasyBreathe wave-dampening features that actually soften (rather than hold steady) the pressures at the very beginning of exhalation. Now we have gone from additive expiratory-phase pressure spikes, to no such expiratory-onset pressure spikes, to softened or briefly reduced pressures at the very beginning of exhale. Kind of like Sears good, better, and best.

In addition to whatever Resmed may or may not be doing at the very beginning of exhalation to make that transition more comfortable, we also have the fact that EPR is not only intermittent BiLevel modality, but EPR's waveform transitions are supposedly designed for more comfortable transitions than the prior Resmed EPR implementation.

Muse-Inc wrote: I think this is why I find breathing out against straight pressure such a challenge.

Years ago your choice would have been ordinary CPAP (with absolutely no expiratory-phase pressure relief of any kind) or a BiLevel machine designed to put out that squared off pressure wave I have pictured above. That type of BiLevel was the only expiratory-phase pressure relief back then.

Muse-Inc wrote:I hate ins companies & having to fight them over everything

Me too! Good luck getting that APAP machine you sleep better with. Might want to keep an eye peeled at cpapauction.com (prescription required) or even Craig's List in case a bargain pops up there.

According to RT magazine on Easy-Breathe in 2008:

". . . it recreates patients’ natural breathing patterns. . . ."

http://www.rtmagazine.com/news/2008-01-08_01.asp

Say wha . . .? Oh, NOW I get it!

So if your natural breathing pattern isn't having enough fun in life, send it to Easy-Breathe camp for a little fun, because recreation is important.

But what if I don't believe in re-creation?

So here's a wild question.

My VPAP Auto is what is being mentioned in that article. But the VPAP Auto does not have the shark-fin waveform in S mode, according to the picture in my clinical manual. Does that mean it doesn't have Easy-Breathe in that mode? And if not, does that mean it doesn't have it in CPAP mode either? Or does it? Do little PAP elves sneak in and change motors when I change modes? Or is it just a software thing going on in my machine?

I have decided that Easy-Breathe does not exist. It is advertising lingo meant to sucker us in.

ResMed, either explain to somebody just what exactly the carrying-on Easy-Breathe is, or just shut up about it, OK? Prove to us that Easy-Breathe is something more than just another one of your clever advertising stunts to steal business from F&P and all the rest of the hard-working PAP manufacturers who spend more money on product than advertising!!!!!

There. I feel better now.

Ahhhhhh.

jeff

jnk wrote:According to RT magazine on Easy-Breathe in 2008:

". . . it recreates patients’ natural breathing patterns. . . ."

Well, there are "natural" patterns and there are "comfortable" pressure deliveries. Those two don't always necessarily intersect. But anyone who buys into Resmed's new, improved EPR as being one of several EasyBreathe components...

http://ventureresp.blogspot.com/

above link wrote:What is Easy Breathe? It's a revolutionary new therapy system that combines new software, a quiet motor and improved EPR for maximum comfort and a quiet night’s sleep.

Just might suspect "EPR=on" recreates more natural inhale and exhale patterns than "EPR=off" (where the exhale pattern can't be as closely mimicked since exhale pressure drops are disallowed)...

But what if I don't believe in re-creation?

Best to write a letter of query to re-Darwin.

Jeff,

Got any more of that soup left? My rant made me hungry.

jnk wrote:I think the ResMeds apparently needed, badly, an improvement in their pressure relief. I found the transition abrupt in my VPAP III, and Slinky finds the transition abrupt in Spontaneous mode in her VPAP Auto (which I assume has no Easy-Breathe in that mode), and I believe many experienced users, such as rested gal, have expressed that they prefer the feel of the transitions in Respironics' version of expiration relief. If Easy-Breathe improves some of those issues, great!

Does anyone think that the future may bring a machine that perfectly matches up pressure to a patient's individual flow pattern of breathing? Now that would be real comfort, I assume! And maybe it will come from a company that can give the big two a run for their, uh, money.

Absolutely

But I am getting the feeling that the smaller companies are falling by the wayside & that Resmed & Respironics are effectively dominating the market.

Respironics has gone global which really happened when Philips took them on board. Resmed started out in Asia/Pacific, US UK & also set up in Europe.

With Coviden/Sandman now taken over by who ? it becomes a bit of a worry as to will survive. Weinmann still look good in Europe but unless they can get into the global market with competitive home cpap devices they may go the way of the others.

I fear we are seeing the emergence of a 2 horse race in home cpaps (at least for say next 5 years or so).

DSM

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.

LOL !!!


DSM

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.

10 points -

DSM