How Come? Auto Bipap seems to be fighting me.

[Snoozin' Bluezzz]

Hi....remember me?...Getting back to MY question, if we may,...

Nice post dllfo - it's interesting how far afield from an original posting we can get.

I think it ended up being useful though. By nature I am a peacekeeper even when at times I can be an agitator so I kept wanting to say something but I really didn't see a way to make peace so it just needed to burn itself out.

My $.02 - regardless of how rational and analytical we strive to be everything is personal and everything has emotional content so we can't be surprised when these tangents occur. In this case there were a lot of divergent opinions and many folks wanted to be RIGHT.

I'm glad you piped up and brought it back to the original source.

David

[NightHawkeye]

Hi....remember me?...Getting back to MY question, if we may,...

Which was:

Anyone have a Respironics Auto Bipap "fight" them?

I responded affirmatively, and provided some suggestions that I thought might help Dave out. I also provided just a little bit of background info that I thought Dave might find interesting. For the record, in glancing back over this thread I don't see that anyone else provided Dave any specific suggestions other than to echo what I said, which was to minimize leaks.

There were exactly two responders using BiPAP-auto machines who responded to Dave's question. I was one. Sthnreb was the other. I responded affirmatively to the question and sthnreb responded negatively. Now, I also know of one other regular poster here who has answered a similar question before and indicated that she has never experienced the problem.

By my count that makes two folks who actually live with the BiPAP-auto who have encountered this problem, and two folks who haven't. That's 50% of the BiPAP-auto users I know about who have encountered the problem. Statistically speaking, even though the sample size is small, the percentage of 50% is very significant. Threshold numbers that I know of for problem indications are usually well under the 1% range.

I'll also add that the percentage of xPAP users who live with a BiPAP-auto is not very large. In a recent poll, only two responders indicated they use a BiPAP-auto.
viewtopic.php?t=9017

. . . regardless of how rational and analytical we strive to be everything is personal and everything has emotional content so we can't be surprised when these tangents occur. In this case there were a lot of divergent opinions and many folks wanted to be RIGHT.

Somewhat baffling to me is the number of posters weighing in who do not use the BiPAP-auto, but who were all too willing to defend the machine's operation. That's fine. I wonder though why so many folks feel compelled to quickly pooh-pooh our experiences with the machine when they don't even use one, and can't possibly know. And why in the world they would defend Respironics so vehemently is simply baffling.

I'm glad you piped up and brought it back to the original source.

We'll see if this helps.

Regards,
Bill

[guessed]

(like "really, this guy probably doesn't ACTUALLY hold 55 gallons of air").

Clearly you have never met Ted Kennedy.
Otherwise I appreciate your anthropopsychedelic perspective kookee dude!

[dsm]

<snip>
Dude. No one said you don't have a problem. What's got everybody so riled up is the fact that whenever anybody describes a problem, you immediately pop in and tell them it's because their machine is defective.
<snip>

Dude
I think I can see why you chose to be anonynous.

Produce 1 post of mine that backs up your assertion other than me posting about one of my own machines where even then I said I believe I have found a problem but still gathering info.

You won't ever produce such evidence because it doesn't exist.

Sheesh !!!

DSM

[Moogy]

Wow, I go out of town for a few days and I get back to see this really.....amazing.....thread.....

As one of the FEW actual BiPAP users on this forum, I am compelled to join the fray....so here are a couple of comments.

I have experienced a LITTLE trouble with the BiPAP "fighting" me. However, this does not happen often. It happened more when I was first using the BiPAP. I am not sure whether the machine learned to match MY breathing, or I learned to match ITS breathing, but either way, it is better now.

If the machine is throwing too much air at me I use the ramp.

If it seems I cannot take a long enough breath, I breathe more shallowly for a while, and then we seem to get into better sync.

For the original poster, a few questions:

What are your settings for IPAP and EPAP. (Sorry if you already said this and I missed it).

What setting are you using for Respiratory Support? (You have to access the Clinical Menu to see this.)

What is your beginning ramp setting?

For DSM, a semi-technical comment/question: I do not think the Respironics Auto BIPAP S/T is entirely comparable to the "regular" Respironics Auto BiPAP. It has to be more "insistent" about the "right time" to start an inhalation, at least, or it would not be an S/T. Have you done any experiments on the "regular" Auto BiPAP?

Finally, my comment regarding who SHOULD post and who should not. People who are nice and informative should post. People who are in a bad mood should not post.

Can everybody please play nice? .

Thanks,
Moogy

[rested gal]

Hi....remember me?

Sure do, and am very glad to see you made it back in.

Getting back to MY question, if we may, I wondered why the machine and I were "suddenly" out of synch. Due to the human factor we may never know.
My body has been malfunctioning serioulsy since Nov 2002. If ANY manufacturer could build a machine that worked perfect for me, it probably would not work for the other 99.9% of you.

Very good point, dllfo.

Anyway, last night...I took a mild sleeping pill (prescription from the PM&R doctor) and slept almost ten hours. My wife says I was breathing very smooth.....uh.....like in a smooth rhythm. Both last night and this morning when she got up.

That's great that you had a smooth night. Excellent!

Anyway, I slept great last night. The machine did pretty well. I could still feel it restricting my intake of air on deep breaths. That is probably normal, since regular breathing has a shorter duration of intake, it anticipated my exhale...but since I was still trying to inhale....I bumped up against myself.

Yes, I think what you describe is normal...happens when a person draws in an occasional unusually long inhalation. I had that happen sometimes with all four bi-level machines I tried, when I'd occasionally draw in a very long breath. Happened even with the extra setting of "IPAP Max" set as long as it would go on a VPAP III and a VPAP III STA.

For whatever the reason (possibly because in a sleep lab bi-level titration, it's the lower EPAP that is the "important" pressure, so to speak....EPAP being the pressure titrated to eliminate apneas) all bi-level machines seem to be designed with a built-in cut off time for duration of the higher IPAP pressure. An occasional long, slow inhalation can go past that timer. When the pressure switches down to EPAP while you're still inhaling, it can certainly feel like a bump.

Perhaps if bi-level machines in general had another second or two designed into the built-in maximum time for IPAP before automatically switching to EPAP, maybe things would go even more smoothly more of the time.

there is NO way any machine could ever guess or anticipate a human's breathing patterns 100%.
WE CHANGE...I don't even know when I am about to take a slightly deeper breath......unless I "tell myself" to do it.

Exactly.

Soooooooo before we all go overboard here.....let's remember we are here to help each other, not aggravate each other. As a rookie, I am asking questions 99% of the time. And I thank each and every one of you for trying to help me learn about my new way of life.

Well said. Fortunately, that's what usually does happen on the apnea message boards...people learning and helping each other all we can. Looks like you're helping people already, dllfo. By coming back to report how things are going and describing things so clearly, you're definitely adding to all our learning experiences. Thanks!

Hope you have many more smooth nights and good treatment.

[dsm]

<snip>
For DSM, a semi-technical comment/question: I do not think the Respironics Auto BIPAP S/T is entirely comparable to the "regular" Respironics Auto BiPAP. It has to be more "insistent" about the "right time" to start an inhalation, at least, or it would not be an S/T. Have you done any experiments on the "regular" Auto BiPAP?
<snip>

Moogy, a breath of fresh air - welcome

Re my Bipap S/T - all I intend doing re it is to try to get it useable. I am very welcoming of positive feedback and suggestions such as from you and Bella (who posted on this issue elsewhere), I doubt either of you are technocrats but your positive approach to looking at real issues is both encouraging and a hope that we can explore these issues in a *constructive* fashion.

I am presently waiting on delivery of a 2nd Bipap Pro 2 and a VPAP III. I plan to use these and to compare across 5 models the effects of a F/F mask when used at varying CMS with each of these machines.
PB330 Knightstar, Bipap Pro 2 (2 units), Bipap S/T, VPAP III (plus for some experiments, a Healthdyne Bilevel). I want to discuss & share the results as the tests are done.

In my mind this is what I call a constructive an informative approach to exploring with others, a perceived problem. Where others can help is in suggesting ways of conducting such tests. I can think of many good ways but many heads can think of even more.


Cheers

DSM

[dllfo]

Well...I just finished another set of "lung" tests at the hospital. To give you
an idea of how difficult a job Respironics has....I was given a chemical to
reduce my lung capacity. Most people taking this series of tests would see
a 20% drop in lung capacity. Mine increased. I will say that again...the tech
did the test twice. My lung capapacity actually increased a small amount.
The tech did not want to increase the dosage any further as the doctor had to go elsewhere during the set up. As I said earlier in this thread, and I think we ALL agree here....the machines we have are incredible, but not perfect. Another weird thing is my blood pressure dropped to 80/40 with a
pulse rate in the fifties. And no, you will not confuse me with an olympic
athelete. So, once more, with such a wide variety of humans, for any of
these people to come as close to perfection as Respironics has is a real gift
for me.

And after reading some of the comments, it sounds like we have the nucleus of a sharp bunch. My learning curve is still straight up and will be.
BTW, Moogy: What is a ramp? My EPAP is 3 and the IPAP is 5-25. Or did I say that backwards. What are my settings for respiratory support? I don't know. I have a clinical Menu? My beginning ramp? Again, what is a ramp?

NOW...I have about 9.5 hours of SmartCard info. The only thing I am pretty
sure I understand is the AHI of 8.7. I think that is good.

Daily events per hour:
IPAP is highlighted on the number 13 and EPAP is highlighted on the number
ten.
I incorrectly put in Monday nights data. I want to take it out. I had laid
the hose down for a short period while it was running. I am not sure the
data is reliable after doing that.
BUT, my summary says
AUTO BI LEVEL STATISTICS
Avg device IPAP pressure <90% of time 15.6cm h2o
Max Titrated EPAP pressure 13.3cm
avg device EPAP pressure <90% of time 9.7cm
Avg time in Apnea per day 8 mins
Avg time in large leak per day zero

So does that make sense to anyone? I feel like I slept real good. What
did the machine say?

Adult supervision appreciated.......Dave

[dsm]

Dave,

>>
And after reading some of the comments, it sounds like we have the nucleus of a sharp bunch. My learning curve is still straight up and will be.
BTW, Moogy: What is a ramp? My EPAP is 3 and the IPAP is 5-25. Or did I say that backwards. What are my settings for respiratory support? I don't know. I have a clinical Menu? My beginning ramp? Again, what is a ramp?

NOW...I have about 9.5 hours of SmartCard info. The only thing I am pretty
sure I understand is the AHI of 8.7. I think that is good.

<<

ramp is a feature that when it can be activated, allows the user/clinic to set a time typically 30mins or 20 mins, over which your pressure is 'ramped' up from a much lower setting to your recommended setting.

It is usually used in fixed cpap or fixed bilevel modes.

AHI of 7.1 is certainly looking good

DSM

[Moogy]

Moogy: What is a ramp? My EPAP is 3 and the IPAP is 5-25. Or did I say that backwards. What are my settings for respiratory support? I don't know. I have a clinical Menu? My beginning ramp? Again, what is a ramp?

Sounds like everything is going well. To answer a couple of your questions...a ramp is helpful if your beginning pressure is high. If you are set for 5-25 IPAP, you probably don't need a ramp. If the time comes that you need one, let me know.

I can tell you how to access the clinical menu to read your settings, including ramp. This is easier to do if you have the machine plugged into a power strip instead of directly into the wall.

Turn off power. Now, hold down the two little triangular buttons WHILE plugging back in the power. (See why a power strip with on/off works better than reaching down to plug it into the wall? ). It will beep, then you will see the readings. You use the triangular buttons to go forward and back through the settings, and you use the heat/ramp buttons to RESET any of the settings. DON'T do this accidently!

The first setting is which mode you are using. The series of options changes depending on which mode you are using. If you look at the TINY print, you can see a label that says what option is on the screen.

Sounds like you need a clinician's manual for yourself. PM me with your mailing address.

I am leaving Friday morning early to take my 89+ year old dad on a cruise to ALASKA. If I don't hear from you soon, I will get back to you when I return.

Moogy

[NightHawkeye]

Hey Moogy,

I've never used the ramp, but I think I've gathered from your previous posts that the BiPAP-auto's ramp can be used in Auto-mode. Is that correct? If so, I think that is different from the way the ramp in the Remstar-auto operates.

Regards,
Bill

[Moogy]

I think I've gathered from your previous posts that the BiPAP-auto's ramp can be used in Auto-mode. Is that correct?

Yes! Another of the bells and whistles on this machine. I have my minimum pressure set at 12 now, but I like to start my ramp at 9.5 or 10.0 for 10 minutes. Just more comfortable as I start the night. It also gives me time to mess with the mask to minimize leaks before the pressure starts cranking up.

Moogy

[dllfo]

Moogy---I just PM'd you about the manual mam.

Bill.....are my numbers...about 4 posts prior to this...in the ball park?

What numbers are most important from our smart cards?

Any other info?

[NightHawkeye]

Bill.....are my numbers...about 4 posts prior to this...in the ball park?

IPAP is highlighted on the number 13 and EPAP is highlighted on the number
ten.
I incorrectly put in Monday nights data. I want to take it out. I had laid
the hose down for a short period while it was running. I am not sure the
data is reliable after doing that.
BUT, my summary says
AUTO BI LEVEL STATISTICS
Avg device IPAP pressure <90% of time 15.6cm h2o
Max Titrated EPAP pressure 13.3cm
avg device EPAP pressure <90% of time 9.7cm
Avg time in Apnea per day 8 mins
Avg time in large leak per day zero

So does that make sense to anyone? I feel like I slept real good. What
did the machine say?

It's good to hear that you are feeling better, Dave. I think your data looks pretty good for just starting, however, the average time in apnea of 8 minutes looks like something to improve on, although I'm sure that's a small fraction of the time you used to spend in apnea. I've been doing this for nearly five months now and most nights my total time in apnea is under one minute. (Early on, before I got things better adjusted, I used to see many thousands of seconds in apnea.) From one of the polls here, it is clear that most folks do even better than I do in controlling their AHI though.

Most folks report that narrowing the range of pressures brings improvement, so that might be the first thing you'd want to try. What I've found works best for me is constant pressures, so I've just gotten away from auto mode entirely now. What I'm trying to say though, is that you have to decide what works best for you. Moogy, I believe, uses the auto function and seems to love it.

What numbers are most important from our smart cards?

Time in apnea is a biggie for monitoring your therapy. AHI is kinda the one summary number that folks throw around here though. I key in on time in apnea personally, because I still have quite a few hypopneas which raises my AHI number.

Hope that answers your questions a little, Dave. Hopefully, some other folks will offer suggestions as well.

Regards,
Bill

[sthnreb]

I have some difficulty with the ramp because it starts low. I used the Bipap Pro 2 for to long I guess and got used to the stronger more constant pressure. I orginally tried ramp and felt like I wasn't getting enough air at the lower pressure. Anyway, the auto works similiar to a ramp if you have the Epap setting low. Speaking for myself and my machine (since they seem to differ) mine always starts Epap at the lowest setting and puts the Ipap 2 cm's above that, in my case 8 Epap and 10 Ipap. I can tolerate this fine as being high enough. I have the max difference in the two set at my prescription setting of 4 cm (12/8). My Encore Pro software verifies that my average Ipap and Epap is extremely close to my prescription of 12/8.
These auto's are versitle and do require tweeking for each individual, imho. Did I suggest that before? BTW..these are just my deductions and not being objective.