Respironics Auto CPAP vs Respironics BiPap Manual

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
archangle
Posts: 9294
Joined: Sun Mar 27, 2011 11:55 am

Re: Is a titration study needed ?

Post by archangle » Wed Jan 18, 2012 2:30 pm

heartchakra wrote:So , my father has been trying a CPAP Auto and a Bipap manual machine.

The doctor here said using a CPAP auto negates the need for a titration study to see how much pressure is needed as the machine automatically decides that.
Even with an auto machine, it's probably a good idea to look at the recorded data. Figure out the minimum pressure needed and set the minimum pressure to that level. That way, the patient doesn't spend part of each CPAP session with too low a pressure. It's also not a bad idea to consider whether you should limit the maximum pressure. Large pressure swings can cause leaks and disturb the patient.

With a manual or auto machine, it's not a bad idea to monitor the data, make small adjustments and monitor the results. That's true even if you do have an in lab PSG sleep test.

A real PSG does do a lot more than any home CPAP machine data does. You may argue that not everyone needs one, but some people do.

_________________
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Also SleepyHead, PRS1 Auto, Respironics Auto M series, Legacy Auto, and Legacy Plus
Please enter your equipment in your profile so we can help you.
Click here for information on the most common alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check for yourself.

Useful Links.

heartchakra
Posts: 78
Joined: Tue Dec 20, 2011 1:54 pm

Pugsy

Post by heartchakra » Thu Jan 19, 2012 12:12 pm

In the Respironics Bipap machine which I am trying on dad now with the suggested pressure of 6 and 10 as you suggested, in the Biflex settings it has 3 settings ( 1, 2 and 3). Is there any preference for one setting over the other that you have ?

Also, though the AHI number with the machines are down to 1.8 , dads restless leg syndrome which he has since years seems to still persist also when he wears the mask. What can be done for that ?

Thanks

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by Pugsy » Thu Jan 19, 2012 12:33 pm

BiFlex setting is strictly a comfort exhale setting. There is a test demo in the BiFlex menu if you want to test each setting and ask your dad how it feels. When in doubt...I split it and go with 2...though I can really use it at 2 or 3 with ease. One really doesn't need much of an extra exhale relief when using Bilevel therapy. ResMed machines don't even offer any extra exhale relief.

Restless Leg as in moving around all night long or just random jerking even while awake? Minor symptoms might be helped with some over the counter mineral supplements. My husband has a wee bit of the restless leg thing...mainly when overly tired with just random jerking. I think he took some magnesium and zinc and it helped him. I am sorry I can't remember exactly what he took. For anything more than random jerking only thing I know of is the common RX meds for Restless Leg Syndrome or meds for PLMD. My husband had the jerking while awake never really much of a problem when asleep.
With PLMD the movement is going on while asleep and is involuntary.
PLMD (Periodic Limb Movement Disorder)...http://en.wikipedia.org/wiki/Periodic_l ... t_disorder

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

heartchakra
Posts: 78
Joined: Tue Dec 20, 2011 1:54 pm

Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by heartchakra » Thu Jan 19, 2012 12:41 pm

Thanks Pugsy.

He does not have the RLS thing while awake but when asleep he has minor jerks periodically, sometimes often and sometimes less so. Will try the magnesium and ask the doctor here for medicines.

One question I have is, in case the inhalation pressure is set to a bit more than dad may need , is that in any way harmful ? I am thinking that the Auto cpap had an average pressure of 9.7 and today on the Bipap I have put it to 10 as suggested.....so if I had put it on 11 , for example, would that in any way be harmful ? - just a thought - trying to learn

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by Pugsy » Thu Jan 19, 2012 12:52 pm

A change from 10 IPAP to11 IPAP shouldn't be harmful. With his APAP peak average being 10.4 he was likely getting awfully close to 11 or even above 11 for short periods of time anyway for his average to be above 10. Hard to say without seeing the graphs as to where the APAP pressure went for sure...but we know it was real close to 11 anyway.

You might split the difference if you are concerned and use 10.5 IPAP..I think 10 IPAP would do a great job though based on the 6/8 pressures that were used. BiPap settings don't have to mirror APAP settings.
I found this out myself. When using APAP I used 10 minimum and 20 maximum...often saw 15 to 18 cm on the reports. I was a bit concerned about using a fixed bilevel rate with IPAP well below my APAP maximum but it works just as good. I use 9 EPAP and 13 IPAP fixed (like your dad's machine) and my AHI is still the same as it would be if I used APAP 10/20.

If you try magnesium and zinc...be sure to get the magnesium that doesn't work like a laxative
I forget the exact name but I bet someone here will know or you can look it up on the internet or ask your doctor. I have it written down somewhere but I don't know where.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

heartchakra
Posts: 78
Joined: Tue Dec 20, 2011 1:54 pm

Pugsy

Post by heartchakra » Thu Jan 19, 2012 1:07 pm

So the most important number to see in the report is the AHI ? What range of AHI is usually considered good and acceptable ?


User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by Pugsy » Thu Jan 19, 2012 1:58 pm

heartchakra wrote:So the most important number to see in the report is the AHI ? What range of AHI is usually considered good and acceptable ?
I use the software. I don't like the limited data on the LCD screen of the Respironics machines. 7 and 30 day averages and the pitiful % of time spent in large leak and for the leak to be flagged as "Large" it has to be a monumental leak.

I look at leak line...not the number...if leak line is fairly stable and no huge leaks up into large leak area (around 90 L/min for total leak reporting on the Respironics machine) for any prolonged length of time then I move on to AHI.. AHI is useless number if half the night is spent in large leak.

If leak is decent all night..look at AHI.. and anything under 5 AHI is considered acceptable. Your dad's was less than 2...so extremely acceptable. Don't strive for 0.0 AHI. It will drive you crazy.
Night before last I had 4.87 AHI...fluke night for me. Most nights I have around 1.0 AHI..sometimes a little less and sometimes a little more. Now if I saw that 4.87 AHI for a week or two..I might do more than shrug my shoulders.

If you don't use the software and choose to use the LCD screen data...Keep the AHI well under 5 and things are likely going along fine.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

heartchakra
Posts: 78
Joined: Tue Dec 20, 2011 1:54 pm

Pugsy

Post by heartchakra » Thu Jan 19, 2012 2:19 pm

Do you mean the sleepyhead software ? The reports they gave me just seems to have the average data of all days combined.

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by Pugsy » Thu Jan 19, 2012 2:24 pm

heartchakra wrote:Do you mean the sleepyhead software ? The reports they gave me just seems to have the average data of all days combined.
Yes, SleepyHead software.

Yes, they probably just gave you an average of the days combined. Possibly the 7/30 day average off the machine or they may have used another software called Encore Pro to come up with an average. Encore Pro shows details like SleepyHead does. It also will give averages. BTW...Pro doesn't do anything that SleepyHead won't do and in fact SleepyHead does more with less hassle. You aren't missing anything but headaches by not using Encore Pro.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

heartchakra
Posts: 78
Joined: Tue Dec 20, 2011 1:54 pm

Pugsy

Post by heartchakra » Thu Jan 19, 2012 2:33 pm

Yes they used encore pro.

OK I just saw there is one number called vibratory snore index - in the auto CPAP which has avg readings for 7 days that Vibratory snore number is 5 but on the Bipap which has avg reading for 3 days the VS number is 21 ! But like you would recall, the AHI in both machines is around 1.8. Does this VS number have any significance.

Thanks

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by Pugsy » Thu Jan 19, 2012 2:43 pm

heartchakra wrote: in the auto CPAP which has avg readings for 7 days that Vibratory snore number is 5 but on the Bipap which has avg reading for 3 days the VS number is 21 ! But like you would recall, the AHI in both machines is around 1.8. Does this VS number have any significance.
Different machines may have different algorithms so not quite an apples to apples comparison.

My PR S1 BiPap records my snores from my little Pug dog when he is up by my head. So these machines sometimes "hear" things and flag them as snores from me when they aren't.

Snore numbers will vary and unless hugely large we don't worry about them. VS of 21 isn't hugely large but if it happened that these snores were indications of small reductions in flow....that change in IPAP to 10 or so will go along way in reducing any possible snores that were accompanied by flow limitations. The treatment for problematic snores with flow limitations...is a bit more pressure anyway.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

heartchakra
Posts: 78
Joined: Tue Dec 20, 2011 1:54 pm

Pugsy

Post by heartchakra » Sun Jan 22, 2012 2:33 am

Dear Pugsy,

I just downloaded the sleepyhead software and am attaching dads graphs for yesterday but am unable to figure out how to do that. Any idea ?


User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by Pugsy » Sun Jan 22, 2012 9:51 am

We can't do attachments here at this forum. Most of us just do screen shots.
Below is how I post images here. If you can't manage it send me a private message and we can work out something so I can post them for you.


Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.

Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

heartchakra
Posts: 78
Joined: Tue Dec 20, 2011 1:54 pm

Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by heartchakra » Wed Jan 25, 2012 11:06 am

Thank you Pugsy.

I have tried to do what you said regarding attachments. But when i try to take a screen shot I dont get the entire sleepyhead screen but part of it, so I have adjusted it to mainly show AHI and pressure and leaks. If you would like to see the other parts also do let me know and I will take separate sceen shots for them.

I have uploaded the last 4 days charts on the link below. I have put the cpap auto at ramp time of 10 minutes and a starting at 4 pressure. Is this ok or shoud I change it. The pressure settings are from 8-15. From what I see, dad seems to get some apneas especially after 4 am. Please let me know what you think .

Also when he takes out the mask in the night when he needs to go to the bathroom, should he switch off the machine first and then take the mask out ? As of now he just takes it out without switching off the machine and each time he wears the mask again he presses the ramp button.

http://www.flickr.com/photos/74904217@N03/ ( click once on the chart , and then once more for it to become full screen )

Thanks always
Deepak

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by Pugsy » Wed Jan 25, 2012 11:14 am

Looks like your dad's reports are quite excellent. I don't see the need to change anything if he is feeling like he is resting well. The frequent bathroom breaks? Does he have prostrate issues that are likely a factor? It doesn't really matter if he turns the machine off or not when he gets up to go to the bathroom.
You can easily see on the reports when this happens and the short ramp time with each bathroom break isn't hurting anything.

His AHI is quite acceptable..leaks are quite acceptable. If he has no complaints..I see no need to change anything.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.