RemStar 560p APAP vs BiPAP

[BlizzardUK]

I saw a Philips S/T C Auto-BiPAP being sold for a very decent price. Right now I use the 560p APAP one. Is a BiPAP a bonus to have as a back-up machine or would it be completely different ? I take it you can't just change it to standard APAP ? What are the advantages and disadvantages ?

[Miss Emerita]

The ST machine has been recalled, and in any case, an ST machine is a very different beast from your PAP machine. (I'm not sure, but I think your current machine has been recalled too, if it's a REMstar machine.)

https://www.fda.gov/medical-devices/res ... s#recalled

[rick blaine]

Hi BlizzardUK,

You seem to have missed the re-call notice that Philips Respironics UK put out to known users in the UK a few years ago about indicators of the small but real health risks associated with the sound-proofing foam in previous ranges of their machines.

From the fact that you still are using the 560, I take it that PR UK haven't managed to contact you (even though I am sure they've made every reasonable effort) so they could put you on the list for non-fee replacement of that 560.

(And if its an NHS-provided machine, The sleep-medicine department at the NHS hospital seems not to have contacted you either.)

What I can tell you is that Philips Respironics UK are still making good that replacement offer – so if you contact them, with the individual machine number, they will send you a DreamStation equivalent, delivered by one of the major parcel carriers.

I can also tell you: when the driver brings the replacement new machine, he or she will also bring a pink plastic box to put the 560 in, said box to be sealed, and the box taken away, with its contents to be properly disposed of by PR or their agents, so that no other patient can possibly get their hands on it. Ie, PR want to bring a definite and clear end to their possible liability.

(If, rather than you owning the machine, the machine is on semi-permanent loan from the NHS, then the SMD will do the change over at their hospital rather than at your home, and will aim to convert every OSA patient on their books over one weekend. This program has been rolling out nationally, hospital by hospital, and if hasn't reached your hospital yet, it will eventually.)

Now, as third and fourth things: if you own that 560, it's up you whether you stay with it or not. (Although if it's an NHS loan, your sleep medicine department will insist that you hand in the old one.) But it would be wrong to sell it, knowing what is now known about it.

And by the same token, purchasing a bi-level machine from the System One range from some other source or some other user may prove difficult, if not impossible. People will have been handing them in for disposal, in the way I describe.

But (as far as I have read) all the models that there were in the System One range have now been re-designed and re-engineered and can be found in the DreamStation range.

It's a hassle, I know. But at least, here in the UK, it is cost-free.

And your clinician is the person to ask about trialing a bi-level.

[BlizzardUK]

Damn, I had no idea the 560p was recalled, I got it second hand many years ago. I thought it was just the Dreamstations at fault. My first 560p had an annoying whistling noise so I got a replacement, so I actually have 2 of them still. I wonder if they will exchange both of my machines. I actually just emailed Philips yesterday to see if I could get my old one fixed for the whistling noise, had no idea about the 560p replacements when I emailed.

Does anyone know if the Dreamstation works as well in the operating as the 560p ? By this I mean does it use the same algorithm ? I just can't get on with the ResMed Autosense 10 algorithm for some reason so was hoping to stick with the 560p style.

EDIT : I am on the recall page now. What difference does the "is the device actively in use" mean ? Does it mean it will be replaced faster if I say yes ? Also do they phone you, as it asks for a phone number ? Or is it for texts ? As I will give my mobile number if that. Also given this is a second hand machine, what happens if the original owner registered the serial in America years ago with Philips ?

[rick blaine]

Hello again, BlizzardUK,

I bought my 561 in January, 2015, direct from PR, so it was my personal property, and not on loan from the NHS. And I bought that 561 when the 551 that I had previously been using reached a big number of hours and began making the kind of noises that indicate extreme wear.

I then asked the repair crew at the headquarters of PR in the UK to fit a new blower to the 551, so I could keep that and use that as a back up.

When it came to the recent exchange, PR changed both the 561 that was in active use and the 551 that wasn't (in active use) at the same time. Meaning, to be clear, that they gave me two new machines.

Both exchanges were for a brand new DreamStation auto. So perhaps that answers your question – do they respond quicker if it's in active use? – the answer seems 'yes', because one of mine was definitely in active use. And then, they thought, if they were delivering to me, they might as well replace the back-up as well.

In my experience, the people running the exchange program for and on behalf of Philips Respironics are keen to get the job done. And I can tell you that, in my case, the time from me contacting PR and PR delivering the two brand new DreamStation autos was three weeks.

As to your having bought your 560 in the States. PR already knows that – because the model number is 560, and not 561. The '1' in 561 indicates that the machine was manufactured and sold outside the United States. The '0' in 560 tells PR the opposite.

As far as I can see, successive ownership is not the issue. Rather, it is that PR will not entertain (at this time) a claim from each of the several owners of any one machine. Their remedial action 'covers' only the machine and not any other equipment, and involves responding only to whoever is the current legal owner, and not to anyone else.

In that respect, I surmise that what counts with the exchange team is the individual unit number – but do bear in mind that (1) I am not a solicitor (UK lawyer), and (2) I do not speak on behalf of PR.

You ask about the algorithms – and my answer (using OSCAR) is they seem to be the same.

The phone number – I think that's because they really do want to make sure you are home when the delivery guy comes. They aren't going to 'leave it with a neighbour'. They want that previous machine back – and that hand-back has to come direct from you. And for that, they need you to tell them if, at the last minute, you are not going to be in.

[BlizzardUK]

Thanks Rick. How did you manage to get both done, did you just fill in the recall form twice or did you contact them via phone ? Also do they want the humidifier and power cables back ?

[rick blaine]

Yes, I filled in the form twice and I told them on each form, "This is one of two machines that I bought."

Especially on each form I included the individual unit number for each machine (it's on the bottom of the unit), along with the date and seller (to me) of that unit.

The exchange team don't want any part of the humidifier back, nor the hose, nor the power transformer and the cables that go with that. The delivery-and-collection guy isn't interested in any of those.

They only want the unit with the blower and the foam in it.

[BlizzardUK]

Hi Rick. I heard back. They said "Thank you for registering your device. Please can I ask you to confirm your device serial number and also fill in the form attached, once this is done I can then arrange to swap over your machine for a brand new Dreamstation CPAP 1 device. We can get your device swapped over within the next couple of weeks."

I am a bit concerned with the "Dreamstation CPAP" mention, as I hope it is the auto unit and not the fixed CPAP. You mentioned you got auto units so touch wood I will also. I presume they don't come with any humidifier ? Which is a shame as that will cost me £200 and I can't attach my old System One humidifier.

Just one final question, on the form they want to fill in it says the below........

 Confirm default setting are applicable OR
 Device Prescription (signed and dated less than five years old) if applicable OR
 Request to be referred to Sleep Doctor if you are unable to contact your original Sleep Physician.

So I presume I can just say default settings are fine and they won't need any prescription ? Then I can enter the clinicians menu and change it myself ? Is this what you did ? Thanks !!

[rick blaine]

Hello again BlizzardUK,

What I had before the exchange was: one 551 auto, plus humidifier, plus 22mm hose, and one 561 auto, plus humidifier, plus a second 22mm hose.

As replacement, Philips Respironics sent me:

two boxes, each with a white label on it, and each containing one DreamStation Auto machine, plus cables, plus one brand new 15mm hose.

AND on the same delivery, they sent me:

another two boxes, each with a blue label on it, and each containing one 'clip-to-a-DreamStation' humidifier.

So: four boxes in all, making two complete auto-level machines.

And oh, yes, two provider guides and two manuals.

As for the bit on the form to do with prescriptions and settings, I ticked the first option – 'Confirm default settings are applicable' – because, to me, these settings can be considered 'applicable'.

A digression.

When I bought my 551, back in 2010, there was no advice given, no personal settings. The retailers seemed to be saying that just by being automatic, the machine would find the right pressure, and no further adjustment would be required.

Shortly after I first began using the machine, I told my GP that I was so doing, because as a matter of clinical ethics, I did not think it right that I should be 'in receipt' of a major form of medical treatment that she did not know about. She deserved to know.

My GP's response was to regularise my position as one of her patients by referring me to the nearest sleep medicine department – for which appointment I only had to wait three weeks (SMDs in the UK were quite new then, and only beginning to see patients in any numbers).

Now the first thing the staff at the SMD said was: they would have to 'sleep study' me a second time – because, legally, they could not accept me as a patient unless they themselves did the study. So I agreed. And the second study agreed with the first, the one I had had done outside the NHS.

Now here's the bit I'm leading up to. In those days the standard machine – and indeed the only machine – that the SMD staff issued was a Philips Respironics fixed-pressure machine, the 451. That was 'what is applicable'.

So I was an oddity for the department at that time. Not only was I 'the patient who arrived at the department already with a diagnosis and machine', but the machine was one of those clever clever ones, one that 'thought for itself'.

Some of the staff had never seen one, and during my early appointments, said staff would make excuses to drop in on me and my nurse, to check it out.

What was also true then is that none of the SMD staff knew how – and with what parameters – to adjust it. The same as I didn't, not then.

And why would we think of adjusting it? The sales and promotional material had implied that an auto would do all the work. Thanks to it's programming, it would find the pressure. The default settings were what was 'applicable'.

It took two years before before I began to think about refinement. Over those two years, my AHI was typically 8 to 10 – which was a lot better than before I started treatment – and which was accepted at my annual follow-ups as A Result. And I even found one medical website which said, with great authority, that 10 was the right target for the average patient to aim for.

But I wondered if I could do better.

Long story shorter, I found I could. Using Sleepyhead, which I discovered thanks to this website, I found my then average pressure was 8. I wondered: if I set my minimum to just below that, say to 7.5, what effect would that have? Answer: a lot.

It seems to me that auto machines are best used as a kind of hybrid. Fixed pressure to get the machine into that part of pressure range where it can be 'in contention', as they say in sports commentating. And then, free to deploy its algorithms to really close in on the pressure required.

And short of doing full-on titration (which, by the way, is not readily available in the UK), starting out at the default pressures can be very much 'applicable' – if by 'applicable', you mean 'a good place to start'.

I hope you'll forgive me for my digression. I just thought this was a good opportunity to tell my story. Thanks.

[BlizzardUK]

Hey Rick. Thanks for all that info, really interesting. Knowing about an auto CPAP before the sleep staff even did is impressive, guess they might have thought it would put them out of a job. It is strange that this was 2010, as that seems so recent, but going from what you said also seems so far away with technology, I didn't know Auto CPAP was so new.

So, some good news, I sent one back and got my brand new Dreamstation and humidifier today, just like you said, even down to the pink box. It seems brand new. Didn't seem to take long at all, but I guess they have got rid of the backlog by now.

I now have another 560p still here, as I returned the older one that made weird hissing noises. I wonder if I should return my other one too ? I could just remove the foam. I like how easy the old 560p is to see the water levels and stuff compared to the Dreamstation, so not sure what to do there, return or keep.