New PR S1 BiPAP Auto 60 Series. Where to start

[palerider]

I've been following this thread trying to learn about bilevel. I was wondering if you guys might have a link to the clinical manual for the machine Sleeprider is using.

http://apneaboard.com/adjust-cpap-press ... tup-manual <- lots of manuals there, scroll down near the bottom to the 'manuals by mail' stuff.

[Macpage]

I've been following this thread trying to learn about bilevel. I was wondering if you guys might have a link to the clinical manual for the machine Sleeprider is using.

http://apneaboard.com/adjust-cpap-press ... tup-manual <- lots of manuals there, scroll down near the bottom to the 'manuals by mail' stuff.

Many thanks as always. Thanks for putting up with me!

Best,

Mike

[Sleeprider]

I just requested the manual from the Apneaboard at the link in my signature.

Last night was good, with an increase in OA and FL with AHI =2.0 with apnea events up to 28 seconds duration. I am leaving everything the same except the minimum EPAP which I have changed to 11.0 This corresponds to the beat minimum pressure in APAP for me. I set a minimum pressure support of +1 last night and the auto bilevel climbed to the max of 3 for part of the night. It's interesting to see the IPAP and EPAP pressures converge and move apart through the night. I had no awareness of that happening in my sleep, and that's just how I want it. I notice most apnea events with arousals feel like I have exhaled, and just not inhaled.

I'll get around to posting some charts in a few days, but I'm just trying to sort out what effect all of this has right now.

[Macpage]

I just requested the manual from the Apneaboard at the link in my signature.

Duh! I completely missed your link. Mr. obvious I'm certainly not!

Last night was good, with an increase in OA and FL with AHI =2.0 with apnea events up to 28 seconds duration. I am leaving everything the same except the minimum EPAP which I have changed to 11.0 This corresponds to the beat minimum pressure in APAP for me. I set a minimum pressure support of +1 last night and the auto bilevel climbed to the max of 3 for part of the night. It's interesting to see the IPAP and EPAP pressures converge and move apart through the night. I had no awareness of that happening in my sleep, and that's just how I want it. I notice most apnea events with arousals feel like I have exhaled, and just not inhaled.

I'll get around to posting some charts in a few days, but I'm just trying to sort out what effect all of this has right now.

So, this is the difference in the dancer analogy when looking at the Phillips auto bi-levels, you set a range for the pressure support. I take it that the pressure support mentioned in posts with the max ipap/minimum epap is the maximum pressure support, in this case 3? In general how does the machine know when to vary the pressure support, and what does it start with when you are awake, the minimum or maximum pressure support? Just a few newbie questions as I'm thinking of trying a bilevel as well. Feel free to send me off if I should ask elsewhere. Thanks.

Best,

Mike

[Sleeprider]

See if this helps you visualize it. Here we have Min EPAP at 10.5 (not enough), Max IPAP at 18, PS min 1.0 PS max 3.0. You can see the PS mean keeps the pressure lines separate by at least 1.0 and they may move together, but somehow the machine decides I need more inhalation support and they do split further at 3:20 AM. I dunno why it changes, but it does.

Some leaks in there which is unusual for me.

[Sleeprider]

For more fun and games, this was the first night on the auto BiPAP with a split night of auto and fixed BiPAP. Pretty wild stuff. AhI was low but I didn't sleep well at all on the fixed pressure difference, just too disruptive.

[Sleeprider]

And for the truly sadistic, here is a 42 second hypopnea, bookended by not one, but two clear airway apneas, and preceeded by some nice periodic breathing. Great stuff here from last night, and THIS is what the big spike in pressure was all about.

[Macpage]

See if this helps you visualize it. Here we have Min EPAP at 10.5 (not enough), Max IPAP at 18, PS min 1.0 PS max 3.0. You can see the PS mean keeps the pressure lines separate by at least 1.0 and they may move together, but somehow the machine decides I need more inhalation support and they do split further at 3:20 AM. I dunno why it changes, but it does.

Some leaks in there which is unusual for me.

It absolutlely helps! That's pretty cool, at least as much as therapy things can be. Somtimes they move lock step, some times the ipap spikes, and sometimes the ipap spikes but the epap only moves slightly! Now, that's an algorithm. I would say only rocket scientists need apply, but this is truly rocket science, at least to me.

So I take it this is why it works for higher pressures as it trys to keep the epap as low as possible even in many cases of increasing ipap?

For comfort (aerophagia) issues at low pressure requirements, I've been running my S9 auto like a mini bilevel with EPR at 3. Of course in Resmed world, my epap climbs right with the ipap. I just thought that an increasing ipap indicted a corresponding need to increase the epap. However, I see from your data that this doesn't have to be the case. Keeping that epap closer to the minimum when the ipap increases might give one more headroom to let the ipap run with out the negatives. I guess the thing is each individual isn't going to know how it works until giving it a try as you are doing. It's no wonder physicians don't always want these as there's no way to get it really locked down without lots of trials. Good thing we've got this forum!

I'm beginning to think that just as everyone should get an apap because it can do cpap and more, we all should be getting auto bilevels because they can do all this and the rest as well. I hope you get it fine tuned without a lot of sleepless moments. Thanks for letting me follow.

Best

Mike

[Wulfman...]

For more fun and games,.......

And for the truly sadistic,.......

OK......whatcha gonna try next?


Den

.

[Sleeprider]

Well of course, I say Encore, but that's a different software.

[palerider]

machine decides I need more inhalation support and they do split further at 3:20 AM. I dunno why it changes, but it does.

see if you can correlate the epap vs ps changes with oa, hypops, snores and flow limitations.

I'm *guessing* that epap will go up after oa's and h's and ps will bounce for snores and FL, mainly.

[Sleeprider]

machine decides I need more inhalation support and they do split further at 3:20 AM. I dunno why it changes, but it does.

see if you can correlate the epap vs ps changes with oa, hypops, snores and flow limitations.

I'm *guessing* that epap will go up after oa's and h's and ps will bounce for snores and FL, mainly.

In some cases yes, and in others, no. There instances of all those events where the pressure stays dead level before, during and after. There are others like the detail above where a flow limitation and two CAs cause a considerable spike. In come cases pressure rises with no apparent events in sight. So I'm still looking for the correlation, but I think it relates more to an average flow/time relationship than specific events.

The APAP definitely moves on snores, FL and H, but the auto biPAP, not so much, but sometimes.

[palerider]

There are others like the detail above where a flow limitation and two CAs cause a considerable spike.

CAs shouldn't cause any reaction at all, since the machine can't do anything about them... they were probably just coincidence.

[Sleeprider]

True, but pressure increased on the periodic breathing that immediately preceded the FL and CA. The PB was not flagged, but it was pretty typical of oscillating breathing pattern. I am still getting to know this machine and the results it produces, so I'm missing Pugsy's insights.

[Sleeprider]

Just a quick update. AHI has continued to fall with results of 1.58 and 0.52 the last two nights. No changes to prescriptions. Feeling better rested. Last night EPAP pressure never deviated from 11 cm and IPAP varied from 12-14. Pressure increases seem to correspond to occasional snores (13), flow limitations (2) REM sleep periods. 0-CA, 2-OA and a 108 second periodic breathing episode with no apneas.

This is the lowest AHI count ever, I have never had a 0 AHI night, so I'm feeling pretty good about these settings in Auto BiPAP mode.