Disadvantages of Bi-Level?

[palerider]

I have limited experience
I had a Resmed S9 Autoset with heated humidifier and heated hose, for 3 years and could never hear a sound from it.
I now have a PRS1 960TS ASV. From the first night the noise as it follows my breathing paterns has disturbed my sleep and my wife's sleep.

So I am predjudiced toward Resmed now.

I got rid of a pr560 because I didn't like the whine noise that followed my bedmates breathing, it wasn't loud, and if I had my earplugs in and was asleep, I didn't hear it, but being awake in the same room... it just was annoying.

the resmeds don't have that varying whine.

[Pugsy]

With that change, then, I now have no reservations concerning anyone's use of that brand's autobilevels, since those machines, theoretically anyway, could be set up just as effectively as a ResMed for anyone now, I would think.

That PS of 2 default I had with the model 750 machine was annoying because I liked PS of 4 and the only way I could get PS of 4 with the 750 was to use fixed bilevel mode but then I had to use more pressure all the time than I really wanted just to deal with the REM events on steroids that would plague me at times.

So when the 760 was released I jumped on that puppy real quick. Plus I really, really like the heated hose as it suits my needs so much better in the winter.

But I can see situations where having a lower PS minimum might come in handy for some people...so there probably were situations where the PS of 2 default worked quite well. It just didn't particular feel nearly as good to me while awake and the whole idea of the bilevel for me was the "while awake comfort thing". I was able to use it but had gotten spoiled by the PS of 4 I used on a BiPap Pro that as my very first BiPap. It was a difference that while not a deal breaker for me....it was annoying.

Respironics fixed that little issue quite nicely with the variable PS in the 760 in auto mode. I kinda wish ResMed would do the same...because it never hurts to have something and not need it..just in case.

PS of 4 feels wonderful to me...PS of 2 didn't feel so wonderful (but still better than nothing) but I can understand that are probably people out there that PS of 2 might be a better choice for them. It's nice to have the flexibility now to cover almost everyone in terms of PS needs and preferences if for no other reason than comfort...and comfort is high on my list of stuff that makes me happy.
Plus Respironics also offers BiFlex relief to aid further in comfort even in bilevel modes. I don't know just how much difference it makes but again..nice to have it there in case it is needed.

[jnk...]

. . . I kinda wish ResMed would do the same . . .

Maybe one day both companies will get together and have a big swap meet to trade for each other's patents and then just call it even.

And maybe there are clinicians out there somewhere who like the idea of variable PS. I don't know. But my impression (and that's all it is) is that PS is generally considered pretty much the whole point of bilevel, so making it variable is counter-intuitive to the docs and a difficult thing for them to wrap their minds around. I mean, when and if they bother to think about it. Which is part of the big disconnect that I believe remains among researchers, engineers, and clinical practitioners.

That said, I am fascinated by the Respironics approach and think it could very well be ideal for many OSA patients who don't need any help with work-of-breathing issues. In other words, for those who need it for comfort more than for other medical reasons.

Just my take.

I'm glad that the forum has settled into a mostly brand-loyalty-neutral place, even though I miss the old brand wars just a little.

[Pugsy]

And maybe there are clinicians out there somewhere who like the idea of variable PS. I don't know. But my impression (and that's all it is) is that PS is generally considered pretty much the whole point of bilevel,

RobySue is someone who the variable PS with the 750 works to her advantage with her aerophagia issues.
She does well with the 2 cm minimum and a very small PS range. She has to keep a tight lid on the pressures because with much time at all around 8 cm IPAP...she blows up like a puffer fish and has a lot of pain. She has very little flexibility with EPAP without having significant problems. She wouldn't do well with 4 cm fixed PS like the most of us would.
This way her EPAP can climb to 6 (from 4 minimum) and she can keep her IPAP at 8 and get the apnea prevention she needs without the aerophagia issues. If she had to use fixed PS that would force her IPAP up and that's a problem in her situation.
She's not a typical case but I bet she isn't the only one with similar issues out there.

Obviously she would also probably do well with the 760 but it wasn't available when she had to go to bilevel and the 750 was.

[jnk...]

. . . RobySue is someone who the variable PS with the 750 works to her advantage with her aerophagia issues. . . .

She is smart enough to understand all that. But I doubt that most docs or DME-RTs are. Or have any desire to be. For them, unlike for the patient, air-swallowing is a minor comfort issue. Just my impression. Similarly, I think that in many of their minds, autobilevel is autobilevel. Even though it ain't.

The info you, and she, post is absolutely priceless.

Sometimes your posts alone are enough to make me conclude that this whole Internet-thingy was one of the best ideas Mr. Gore ever had. I mean, really: How would patients be able to navigate this stuff without the OSA forums!

Personally, I decided on my own to move from autobilevel to the S9 APAP w/3 cm EPR. That virtual-autobilevel approach seems to do me just fine. In fact, I think the suspending of EPR during events actually makes that APAP a little more advanced than the autobilevel algorithm for helping me. Just my opinion. And my opinions do get pretty weird. I tend to think completely outside the blower. Fortunately, my primary doc will write out on his pad pretty much whatever I ask him to, so he wrote me a straight CPAP Rx so I could get that APAP.

[Pugsy]

Personally, I decided on my own to move from autobilevel to the S9 APAP w/3 cm EPR. That virtual-autobilevel approach seems to do me just fine. In fact, I think the suspending of EPR during events actually makes that APAP a little more advanced than the autobilevel algorithm. Just my opinion. And my opinions get pretty weird.

Well we all know I have some pretty far out there ideas myself.
Hey, whatever works for a person is fair game in my book. If someone told me that felt better sleeping upside down then I would be all for it ...for them anyway. My vertigo would never let me try that sort of thing.

The frustrating part is that there are so many potential variable with so many potential issues and people and we can't feasibly cover everything and as you and I know that the medical community sure aren't enormously helpful in anything unless it is the easy cases with plain jane vanilla OSA that people take to cpap like a duck to water.
The bulk of the medical community can't seem to think outside the box far enough to help the people that cpap doesn't work the miracle on right out of the box.
Forum member 49er and I were just talking about this today. She can't find anyone who is honest enough to say "I don't know what the problem is but let's try to figure it out".

Or the 2 most recent members whom I have been trying to help who are having a truckload of centrals and had home studies so we don't know if the centrals pre date cpap therapy or were caused by cpap therapy but really need some help and their docs blew them off.

Makes me want to chew up nails and spit out tacks. I understand it can be more complicated but the asshole docs won't even try.
Sigh...climbing down off my soap box and get ready to go to town. I have some masks to send out...nasal pillow mask to someone the idiot DME told that they couldn't use because their pressure was too high...dumb asses...if the minimum pressure was better they wouldn't even need the higher pressures most likely but even if they did...there's no reason to not at least let someone try the nasal masks when they have a nice breathing nose with no congestion issues. Lazy and stupid DMEs....the 2 types that irritate me the most.

[49er]

The bulk of the medical community can't seem to think outside the box far enough to help the people that cpap doesn't work the miracle on right out of the box.
Forum member 49er and I were just talking about this today. She can't find anyone who is honest enough to say "I don't know what the problem is but let's try to figure it out".

So true Pugsy. I am at the point where all I want from my next sleep doctor is a full scale study so I can see exactly what is going on and go from there in making some decisions. Unfortunately, the last two I saw didn't want to give me one. Maybe, the third time is a charm?

Don't mean to get off topic but I did want to chime on this. It just seems if you have a complex medical case regarding any issue, it is going to be very tough to find any help. But I am preaching to the choir on this one.

[Joyful Sleeper]

Thank you, thank you, THANK YOU to everyone who has given their feedback and ideas here! I appreciate it!

A couple of follow-up questions:
JNK: I'm aware that sleeping on one's left side, tucking the chin and/or the modified Sims' (Falcon position on this board) position can help aerophagia. When you said particular positions can sometimes help aerophagia, did you mean anything else I'm not aware of?

I was able to purchase a used PR System One REMStar 60 Series BiPAP Auto with Bi-Flex (DS760) with low machine hours from my local Craigslist yesterday so I'm excited to try it out and see how it works for me. Can anyone tell me:

1) Is there anything I should do to clean or sterilize a used machine before using it besides wiping it down on the outside (with disinfectant cleaner of some type?) and cleaning the humidifier chamber & hose with soap/water and/or vinegar/water? Maybe cleaning the filter in some way? Other? Are there any safety concerns here?

2) How can I best track my data since I now have two machines (a Resmed S9 Auto Set & the PR 760)? Do I use a separate SD card for the PR? The previous user gave me two SD cards--how do I get rid of the previous user's data and start over so I can use the SD cards myself? Also, I use SleepyHead to see my reports (I have a MAC)--do I need to set up a separate user in SleepyHead for the PR 760 data so it's separate from the ResMed S9 data? Or do I use the same user? Will SleepyHead choke with information from two machines?

Thanks again!

Joyful Sleeper

[jnk...]

. . . JNK: I'm aware that sleeping on one's left side, tucking the chin and/or the modified Sims' (Falcon position on this board) position can help aerophagia. When you said particular positions can sometimes help aerophagia, did you mean anything else I'm not aware of? . . .

I'm no expert on it, so the things that I think I know are based mostly on anecdotal evidence I've overheard (or read) as expressed by other patients or docs who think outside the box.

A few have actually found that if they refrain from consuming anything but water within the three (or four, depending on the person) hours before lying down, sleeping on their right side is more helpful to them personally than the left. It is highly individual based on personal anatomy of their LES and stomach, I believe.

Some have also found that raising the head of the bed helps them with aerophagia, but I suspect those are the people who still have food in the stomach while they are in bed.

I would also throw out there that although it is true that many aerophagia-from-CPAP people benefit from bilevel or autobilevel, a few have found that the changes in pressure, even though momentary, can make their problem worse. It really is a matter of trying things that work for you specifically.

Hope that helps.

I'm really hoping you find the key, and I am impressed by all the work you are putting into this. You are setting a good example for any other people who may happen by here after doing Web searches.

[Pugsy]

To erase previous users data from the SD card(s)....just do whatever you need to do with your Mac to get into the SD card and manually erase everything so that you start with a clean SD card.
Don't put it back into the machine until you also erase the previous users therapy data from the machine.
How to do that is explained in the manual I sent you...if you have trouble finding it or doing it let me know. Reset the data is under the Info box and you have to hold the buttons down until it beeps...5 or 10 seconds I think but a long 5 or 10 seconds.
Then you verify by checking the AHI and usage data...should be reset to 0.0 for everything.

SleepyHead won't care...you can use just one user profile. I have multiple machines under my SH profile.

Your S9 will care though so you will have to keep the SD cards separate.

The black/gray foam filter...just wash it in hot soapy water and pat it dry. The white fine disposable filters are optional and you may not have got one of those included. They are easy to get and use if you feel the need. I use them myself....I see how nasty they get after a month...so I use both the foam filter that is washable and the white fine disposable filter. I have pets in my house and live out in the country in an old dusty farmhouse...So I like the extra filtration but it is optional to use that white disposable filter. EBay is a good quick cheap source for those disposable filters.

No need to do anything special in terms of cleaning of the unit itself. I just wipe used machines down with some sort of antibacterial substance...whatever I have handy. The hose and water chamber gets a really good cleaning though.
I personally usually end up wanting to use a brand new hose... just my own preference as they are cheap. Again, check EBay for the Respronics white performance hose....I have seen them offered with white fine filters for around $14 and that includes shipping. Unless you want to get the heated hose instead but then you also need the special lid and power supply.

The water chamber...hot soapy water and a good vinegar soak...then rinse really, really well (I hate the vinegar smell). The vinegar will remove any prior water calcium build up and disinfect well enough. You can use stronger if you wish but not really needed.

[Joyful Sleeper]

Brilliant:)!
Thank you, thank you, THANK YOU SOOOO MUCH JNK, Pugsy & others for your help!!! I appreciate it!
Have ordered new hose & filters & look forward to trying out the machine once I've received them:)!
I so appreciate all of the information & suggestions here!!!!
Joyful Sleeper