Using a Bipap Auto SV and using a Vpap Adapt SV

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
-SWS
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Post by -SWS » Thu Apr 24, 2008 9:29 am

Banned wrote:
dsm wrote: Tuning this cut-over CMS point is why having a machine that can do partial adjustments (like 0.2 cms or at least 0.5 cms) is of value. (NOTE to Respironics designers, please please allow for partial adjustments of at least 0.5 CMS on the Bipap AutoSV (you do it on other Bipaps ! )).
Maybe the BiPAP Algorithm doesn't allow for more sensitive measurement? Could the proximal sensor tube on the Adapt SV have anything to do with incremental cms?

Banned
Banned, I think you're right about why the Resmed ASV can allow for 0.2 cm adjustments: precise proximal measurements at the mask. I'm still a bit surprised that the BiPAP autoSV hasn't allowed for at least 0.5 cm incrementation.

Doug, your data and thoughts about the BiPAP autoSV are extremely helpful IMO. Thanks so much for your excellent work!

I recall that you didn't receive such stellar results when you trialled the Respironics BiPAP Auto model. While your former BiPAP Auto model is targeted for patients with purely obstructive SDB, your new BiPAP autoSV is targeted primarily for patients with: 1) central dysregulation, or 2) central dysregulation intermixed with obstructive SDB components. Theoretically a patient with purely obstructive SDB should not require any of the SV machines.

So my question is: if you're sleeping better on an SV machine do you think there may be at least some component of central dysregulation in your SDB? Along that same line of thought, can you discern just what it was about your former BiPAP Auto model (targeted for OSA) that felt inadequate for your treatment needs---and how this BiPAP autoSV model seems to succeed in treating your particular case of SDB (with respect to those same areas that formerly lacked adequate SDB treatment)?

Again, thanks for all your great efforts!!! .


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Post by dsm » Thu Apr 24, 2008 5:36 pm

Todays chart - increasing the epap to 12 has not improved the AHI score.

I am satisfied that taking the average Ipap to 16 CMS is counterproductive (mildly) and thus will now drop epap back to 11 CMS and IpapMin back to 13 and monitor this for a few days.


http://www.internetage.com/cpapdata/dsm ... 5apr08.pdf Bipap Data

http://www.internetage.com/cpapdata/dsm ... pr08-2.jpg 24-25 April 08.

**************************************************************************************

SWS,

The big problem I had in trying - Bipap Pro II (2 of), Bipap S/T (grey), Bipap Auto(non SV model) was that epap would switch to ipap part way through my breathing in. Interestingly there were many other posters over the past 3 years who came to cpaptalk and said very similar things but the topic never got dealt with. Someone would inevitably say "I have one of them & it doesn't do that for me" (not a very reassuring scientific contribution ).

So, I could not get any of these machines to adjust in any way that felt comfortable & ended up being very dissapointed. But, if I breathed through my mouth, this premature ipap/epap switch was much less likely to happen. The big clue to me was the difference in air flow through nose vs mouth. That pointed to the Bipaps mentioned, having some airflow algorithm that was troubled by lower airflows. Here I was taking long slow breaths through my nose & the machine couldn't cope. All Bipaps have a 3 sec limit on breathing in.. There I was exceeding that regularly.

I had many machines to compare these Bipaps with & no other brand exhibited this type of ipap/epap switching. Interestingly 2 early Bipaps I own didn't do this premature ipap/epap switching & they are the Quartet Clinical System (a large 4 function machine - cpap, auto, bipap, split night) and the big square box Bipap S/T (prior to the intro of AutoTrak which IIRC first appeared in the Bipap-30 S & S/T models).

The other Bilevels that didn't do the early ipap/epap switch were the Healthdyne Bilevel, the Vpap III S & S/T models, the PB320 Bilevel, and my trusty PB330 Bilevel. They all did the ipap to epap transition on the smallest of airflow change. I have long believed that the other Bipaps mentioned above had a design limitation (to me a flaw) that meant they would only
work for people who did not score high hypopneas. But the Bipap S/T has always been sold as a machine that could deal with CAs so hypopneas should have been easy. My belief re this design 'limitation' is that Bipaps (until the AutoSV came along) are poor at differentiating fixed leak vs accidental leak & thus get tangled up when someone breaths slowly through their nose & thus switch too early. BUT the Bipap AutoSV is totally different & has very smooth transitions. Wonderful !.

One change for me since I started cpap is I no longer try to just nasal breathe. Now I breathe through what ever works & can & will in the same night -

- Breathe in & out through nose
- Breathe in & out through mouth
- Breathe in through nose & out thru mouth
- Occasionally will breathe in through mouth & out thru nose.
- And sometimes will breathe in through both nose & mouth & out through mouth.

It has taken a long while to adapt to doing this & it is my way of dealing with on/off periods of nasal congestion.

At the moment I am not having any serious nasal trouble but still do a puff of Nasonex but not religiously whereas on some occasions I will use Nasonex and Otrivin at the same time (Otrivin works very quickly but can only be used for about 4-5 nights in a row).

Bipap Auto (non SV 'tank' model)
================================
I may well switch to the Bipap Auto (non SV model) tonight & post a nights data from it. It would be a very interesting comparison. If I can test breathe satisfactorily with its cycling I'll give it a go allowing my new skill at concurrent nose/mouth breathing.


DSM

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Post by dsm » Thu Apr 24, 2008 6:46 pm

SWS,

Just did a quick test & tried the Bipap Auto (non SV model). It seemed fine & I am now sure that by changing my breathing to either nose mouth & also because I have no severe nasal congestion at the moment, I can do a night with this machine.

The data from it will be an interesting comparison.

DSM

I'll also test try the other 2 (Bipap Pro II & Bipap S/T)

D

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Post by dsm » Thu Apr 24, 2008 7:06 pm

SWS,

Verrry interesting.

I just tried all the Bipaps & with my nose clear and easy to breathe, all the Bipaps are working acceptably - the Pro II did seem a tad more sensitive on the ipap to epep switch but as just tested I would confidently sleep using it.

This brings me to another issue. It seems to me that I have long got used to taking long slow breaths through my nose due to a lifetime of restriction - I am now thinking that with cpap I have been slowly changing my breathing rate & in the past 8 months or so, with the ability to switch nose to mouth with ease, that I can now maintain a higher BPM - the data from the Bipap AutoSV shows BPM (spontaneous) of 14 & 15 bpm as typical.

Allowing for the noticeable improvement with the Bipaps from the tests I just ran, I still can't explain why the other brands did not exhibit the premature ipap to epap that I was finding with the Bipsps specified.

There is a story her, just need to think about it.

DSM

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Post by Banned » Thu Apr 24, 2008 7:22 pm

dsm wrote:But, if I breathed through my mouth, this premature ipap/epap switch was much less likely to happen. The big clue to me was the difference in air flow through nose vs mouth. That pointed to the Bipaps mentioned, having some airflow algorithm that was troubled by lower airflows. Here I was taking long slow breaths through my nose & the machine couldn't cope. All Bipaps have a 3 sec limit on breathing in.. There I was exceeding that regularly.

My belief re this design 'limitation' is that Bipaps (until the AutoSV came along) are poor at differentiating fixed leak vs accidental leak & thus get tangled up when someone breaths slowly through their nose & thus switch too early. BUT the Bipap AutoSV is totally different & has very smooth transitions. Wonderful !.
Hummm.. that's very interesting. The Adapt SV definitely does (IPAP)/EEP switch upon slow breathing through the nose. I'm happy you brought this up. You say you cannot get the BiPAP Auto SV to IPAP/EPAP switch with slow breathing through the nose?

Banned

AVAPS: PC AVAPS, EPAP 15, IPAP Min 19, IPAP Max 25, Vt 520ml, BPM 10, Ti 1.8sec, RT 2 (Garage)
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro

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Post by dsm » Thu Apr 24, 2008 7:41 pm

Banned wrote:
dsm wrote:But, if I breathed through my mouth, this premature ipap/epap switch was much less likely to happen. The big clue to me was the difference in air flow through nose vs mouth. That pointed to the Bipaps mentioned, having some airflow algorithm that was troubled by lower airflows. Here I was taking long slow breaths through my nose & the machine couldn't cope. All Bipaps have a 3 sec limit on breathing in.. There I was exceeding that regularly.

My belief re this design 'limitation' is that Bipaps (until the AutoSV came along) are poor at differentiating fixed leak vs accidental leak & thus get tangled up when someone breaths slowly through their nose & thus switch too early. BUT the Bipap AutoSV is totally different & has very smooth transitions. Wonderful !.
Hummm.. that's very interesting. The Adapt SV definitely does (IPAP)/EEP switch upon slow breathing through the nose. I'm happy you brought this up. You say you cannot get the BiPAP Auto SV to IPAP/EPAP switch with slow breathing through the nose?

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Post by Banned » Thu Apr 24, 2008 8:07 pm

I think the IPAP/EEP switch is not necessarily a problem with the Adapt SV. It happens on the few occasions where I'm semi-awake and inadvertently switch my breathing pattern in mid cycle of the machine's breathing rate (i.e. hold my breath a little longer), if that makes sense to you. As I think you are suggesting, holding my breath a little longer (breathing slower) maybe a function of the chronic, 'congested' turbinates which I just live with. What is the normal BPM range for most people?

Banned
AVAPS: PC AVAPS, EPAP 15, IPAP Min 19, IPAP Max 25, Vt 520ml, BPM 10, Ti 1.8sec, RT 2 (Garage)
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro

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Post by dsm » Thu Apr 24, 2008 8:52 pm

Banned wrote:I think the IPAP/EEP switch is not necessarily a problem with the Adapt SV. It happens on the few occasions where I'm semi-awake and inadvertently switch my breathing pattern in mid cycle of the machine's breathing rate (i.e. hold my breath a little longer), if that makes sense to you. As I think you are suggesting, holding my breath a little longer (breathing slower) maybe a function of the chronic, 'congested' turbinates which I just live with. What is the normal BPM range for most people?

Banned
The target BPM is 12 but anything from 10 to 20 is ok.

But, take a look at this chart where I was experimenting with a Vpap III S/T
some time back ...

http://www.internetage.com/cpapdata/menu_130107.html

The max hit was 44BPM the effect reminded me of what happens to a kitty when you rub its fur repeatedly & quickly 'electric wide-eyed cat'

DSM
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Post by dsm » Thu Apr 24, 2008 11:00 pm

Banned wrote:
dsm wrote: Tuning this cut-over CMS point is why having a machine that can do partial adjustments (like 0.2 cms or at least 0.5 cms) is of value. (NOTE to Respironics designers, please please allow for partial adjustments of at least 0.5 CMS on the Bipap AutoSV (you do it on other Bipaps ! )).
Maybe the BiPAP Algorithm doesn't allow for more sensitive measurement? Could the proximal sensor tube on the Adapt SV have anything to do with incremental cms?

Banned
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dllfo
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Post by dllfo » Fri Apr 25, 2008 12:28 am

DSM,
thanks for the emails...in the "What the heck is this" department ..... last summer I was gone to the National Jewish Hospital who found a "hole/tear" in my heart. The Occluder was installed and my pulse ox went back up into the mid to high 90s.

Tonight, per dr. orders, I started using the Nonin 9600 and found my pulse ox in the mid 80s AGAIN!! I was shocked. I haven't used the oximetry overnight since the surgery. I am going to write down what time I turn the light off and within moments, turn the SV on.

Any bets as to whether the SV will Ventilate me to the point I won't set the alarm on the 9600 off? I set it off at 87, while setting up watching tv. I lowered the alarm to 85. Hmmmm. I feel like I am almost guaranteed to hit 85 and am wondering about setting the alarm at 75 or so. Remember, NJC did the test where my pulse ox was down to 18 and I wasn't aware I was low on oxygen. The local cardiaologist just did another echocardiagram with agitated saline. All looked fine. I wonder...........

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Post by dsm » Fri Apr 25, 2008 3:56 am

dllfo wrote:DSM,
thanks for the emails...in the "What the heck is this" department ..... last summer I was gone to the National Jewish Hospital who found a "hole/tear" in my heart. The Occluder was installed and my pulse ox went back up into the mid to high 90s.

Tonight, per dr. orders, I started using the Nonin 9600 and found my pulse ox in the mid 80s AGAIN!! I was shocked. I haven't used the oximetry overnight since the surgery. I am going to write down what time I turn the light off and within moments, turn the SV on.

Any bets as to whether the SV will Ventilate me to the point I won't set the alarm on the 9600 off? I set it off at 87, while setting up watching tv. I lowered the alarm to 85. Hmmmm. I feel like I am almost guaranteed to hit 85 and am wondering about setting the alarm at 75 or so. Remember, NJC did the test where my pulse ox was down to 18 and I wasn't aware I was low on oxygen. The local cardiaologist just did another echocardiagram with agitated saline. All looked fine. I wonder...........
Dave,

I was wondering what you would set the PulseOx alarm to - cos I knew you would set it at a number that would guarantee it would go off

Set it for 80 if you don't want your sleep interrupted. For you 80 will be quite acceptable.

As suggested, keep practicing with the BPM set to 12 as per your docs advise - you must practice as often as you can to get used to the rhythm.
If you don't it will go haywire as you found last night. But when going to bed, for the next few days set it to Auto (at bedtime) - but !!! practice daytime with BPM = 12.

We will do our best to keep you with us a long while yet - you are one tough battler Dave

DSM

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Post by dsm » Fri Apr 25, 2008 4:21 pm

Last nigth's data using the Bipap Auto (non SV model).

Unfortunately I can't get my PCs to read the datacard !!! - I did a trial run with the card before using it & that worked.

Looks like I need to repeat this test tonight (not that I want to - I really miss the Bipap AutoSV already )

The BipapAuto did get out of synch a few times but because the epap to ipap gap is so low, it is no big issue. But I can see that the BipapAutoSV must remain in synch as if it starts blasting a sleeper with 30 CMS in the middle of a breath, there would be one very unhappy sleeper.

I am now pretty sure that the algorithm in the Bipap AutoSV for sensing breathing must be a very refined one compared to the other Bipap models.

I do have last nights SpO2 data & will post that when I have processed it shortly.

DSM

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Post by dsm » Fri Apr 25, 2008 4:56 pm

Well it seems that the Bipap Auto data got corrupted as when I put the card back in the machine - turned in on & off thentried to read the card, it did read it this time but said there was no data. I'll grab another card for tonights repeat test with the Bipap Auto - I was really keen to see what the report came up with.

The SpO2 dtat is good but not as crisp as the data when using the Bipap AutoSV but it still looks good.

DSM


http://www.internetage.com/cpapdata/dsm ... pr08-2.jpg 25-26 April 08.

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Post by dllfo » Fri Apr 25, 2008 6:11 pm

DSM, actually, I was considering setting it at 85, as I knew it would go off at 87, then I think I said to heck with it, I was tired.

This morning my says I had a pulse ox of 91/44. As I woke up I continued taking my normal breaths and my heart rate was 43-44. That seems low.

My Avant/Nonin 9600 defaults for heart rate are 200/50. I need to read it again and see if I can't lower the default to 40.

Pulse side...it was at 85 I think. I woke up at set the pulse at 75 sometime during the night, and I set the heart rate at 40. After that I slept well.

Apneas? 3.0 AHI 4.0 No major leaks. I hit pressures of 20cmH2O quite a few times.

Go figure....now I need to figure out how to download info from a 9 pin to a 15 pin or a USB port on my computer. Hmmm


_________________
Mask: Mirage Swift™ II Nasal Pillow CPAP Mask with Headgear
Software: Encore Smart Card Reader - USB
Additional Comments: EPAP 8, MIN IPAP 11, MAX IPAP 30, Encore Pro 1.8.65, Oxygen, Heliox
Installing Software is like pushing a rope uphill.
I have Encore Pro 1.8.65 but could not find it listed
under software.

I LOVE the SV.

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dsm
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Location: Near the coast.

Post by dsm » Fri Apr 25, 2008 6:20 pm

[quote="dllfo"]DSM, actually, I was considering setting it at 85, as I knew it would go off at 87, then I think I said to heck with it, I was tired.

This morning my says I had a pulse ox of 91/44. As I woke up I continued taking my normal breaths and my heart rate was 43-44. That seems low.

My Avant/Nonin 9600 defaults for heart rate are 200/50. I need to read it again and see if I can't lower the default to 40.

Pulse side...it was at 85 I think. I woke up at set the pulse at 75 sometime during the night, and I set the heart rate at 40. After that I slept well.

Apneas? 3.0 AHI 4.0 No major leaks. I hit pressures of 20cmH2O quite a few times.

Go figure....now I need to figure out how to download info from a 9 pin to a 15 pin or a USB port on my computer. Hmmm

xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)