BIPAP ASV ... Backup Rate?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
AfibApnea
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BIPAP ASV ... Backup Rate?

Post by AfibApnea » Thu Oct 30, 2014 11:04 am

I’ve been on CPAP for about a year. I was just prescribed a BIPAP ASV machine. There are two BipapASV machines available: One ([insurance prices] considerably cheaper: $3XX.XX; the other, over $1000 after a year of “renting”). The only difference I can get out of the “Distribution of Medical Equipment (DME)” department is that both are BIPAP ASV but one (the expensive one, of course) has something called “backup rate”.

So I looked up the difference https://www.cpap.com/productpage/pr-60- ... anced.html
Advanced back-up rate
Complex Sleep Apnea occurs when Central Sleep Apnea is experienced while being treated with a CPAP or BiPAP Machine for Obstructive Sleep Apnea. The Advanced Back Up Rate of the autoSV helps to prevent this by encouraging spontaneous breathing at a natural rate for the user. This is accomplished by the system automatically calculating the backup rate to closely match the natural breathing rate.


This all seems so scarey. It’s disturbing enough that air is being forced into me all night through just the CPAP machine (which I will continue to use since I cannot constantly be carting the new machine everywhere I go) but to have all these (Auto EPAP/Advanced back-up rate/Servo ventilation (SV) algorithm/Bi-flex/System One Resistance Control) algorithms controlling the way I breath… I wonder that my body isn’t being trained to be dependent on the machine.

1) What has your experience been with BIPAP ASV?
2) What is Backup Rate?
3) I notice that this the description I looked up applies to a particular (REMStar) manufacturer’s machine. Do all manufacturers have these “sophisticated algorithms” and are they all the same (probably not…I would think they’re exclusive to each company)?
4) Since the machine is so algorithmically charged, can these machines have their firmware updated as their algorithms are updated?
PR S1 REMstar 60 Series BiPAP ASV Advanced & PR S1 with humidifier
Various Nasal masks or Nasal pillows
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cnaumann
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Re: BIPAP ASV ... Backup Rate?

Post by cnaumann » Thu Oct 30, 2014 12:42 pm

1)I have no experience with ASV. I have just been diagnosed with CSA and all this is new to me as well

2) The backup rate is used to treat CSA. If you don't take a breath after a set amount of time, the BiPAP machine will automatically switch to the higher pressure to try to get you to take a breath. It does not really force you to breathe, but it encourages it. The 'rate' is the number of breaths per minute that the machine will try to induce and determines how long the machine will wait for you to breathe on your own before inducing a breath. Some ASV machines determine the rate automatically (RESMED), some allow it to be either automatically or manually set (PR).

3) All manufactures use 'the best and most sophisticated algorithms' available. Every manufacturer's algorithms are different, and every manufacture's algorithms are better than all the other manufacturer's algorithms. As impossible as that seems, it is on the internet so it must be true.

4) It is very likely that firmware can be updated on your machine. I have no idea how often this happens. Being a medical device, there is probably a complicated software verification process so it might not happen often. But I really do not know.

*edited for spelling.
Last edited by cnaumann on Thu Oct 30, 2014 7:08 pm, edited 1 time in total.

JDS74
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Re: BIPAP ASV ... Backup Rate?

Post by JDS74 » Thu Oct 30, 2014 4:59 pm

The machine that is referred to as a "BiPap ASV" is the one built by Philips-Respironics and is the current model 960.
ResMed makes a similar machine whose name escapes my just now but is something like VPAP Adapt.

Both manufacturers make really complex machines that allow the patient to continue breathing even when their brain is not telling them to. That is a circumstance called central apnea.

From time to time, firmware updates are available through authorized repair facilities such as such as Acc Bio.
You will need to have a different machine to use while your machine is off getting its face lifted. If you speak to them nicely, you can get a turnaround time of a few days.
There are two BipapASV machines available: One ([insurance prices] considerably cheaper: $3XX.XX; the other, over $1000 after a year of “renting”). The only difference I can get out of the “Distribution of Medical Equipment (DME)” department is that both are BIPAP ASV but one (the expensive one, of course) has something called “backup rate”.

Those numbers and descriptions make no sense at all. The actual cost of a Respironics 960 is something like $3,500 and they make only one ASV machine. Respironics does make another BiPap machine called the Auto BiPap but it definitely is not an ASV machine. It has model number 760.

To the best of my knowledge, all ASV machine have a parameter called "back up rate."
It is the breaths per minute the machine will default to if the patient either stops breathing altogether or their breath rate gets too slow. That calculation is part of the Auto Servo Ventilation part of the machine. On Respironics machines, the rate may be a fixed number like 10 bpm or left at auto and the machine constantly is calculating what to do (that is the way mine is set.)
It’s disturbing enough that air is being forced into me all night through just the CPAP machine

The pressures from cpap machine won't force air into your system. They are designed to keep your airway from collapsing but you do the breathing. An ASV machine, on the other hand, during ventilator mode changes pressure (in my case) from an exhale pressure of 10 cm to an inhale pressure of 25 cm. That allows your rib cage to expand and contract just like normal breathing and can induce you to resume normal breathing. That doesn't always happen and it may continue in this mode for quite a long time (in my case, I have on example of the machine being in this mode for two and a half hours before I began breathing on my own once again.) Its scary thinking of doing without.

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Mask: Oracle HC452 Oral CPAP Mask
Humidifier: DreamStation Heated Humidifier
Additional Comments: EverFlo Q 3.0 Liters O2 PR DSX900 ASV
Last edited by JDS74 on Fri Nov 07, 2014 5:02 pm, edited 2 times in total.
Oracle 452 Lessons Learned Updated
DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
Sleepyhead and Encore Pro 2.21.

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palerider
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Re: BIPAP ASV ... Backup Rate?

Post by palerider » Thu Oct 30, 2014 5:10 pm

JDS74 wrote: ResMed makes a similar machine whose name escapes my just now but is something like VPAP Adapt.
exactly right, model 36037
JDS74 wrote: To the best of my knowledge, all ASV machine have a parameter called "back up rate."
the resmed vpap adapt doesn't have a settable backup rate, it's automatic only

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Sir NoddinOff
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Re: BIPAP ASV ... Backup Rate?

Post by Sir NoddinOff » Thu Oct 30, 2014 6:02 pm

Here's a topic on firmware updates for ResMed.
viewtopic/t77550/Resmed-S9-latest-firmware-905.html

To find other firmware update topics for all machines type the phrase below into you internet browser (google, duckduckgo etc... whatever you like). Don't use CPAPtalks search function... it's way to basic to be useful:
site:cpaptalk.com firmware updates (you can try and change the search argument to firmware install or upgrade firmware etc).

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Last edited by Sir NoddinOff on Fri Oct 31, 2014 3:43 pm, edited 1 time in total.
I like my ResMed AirFit F10 FFM - reasonably low leaks for my ASV therapy. I'm currently using a PR S1 AutoSV 960P Advanced. I also keep a ResMed S9 Adapt as backup. I use a heated Hibernite hose. Still rockin' with Win 7 by using GWX to stop Win 10.

JDS74
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Re: BIPAP ASV ... Backup Rate?

Post by JDS74 » Thu Oct 30, 2014 7:25 pm

Not having a settable backup rate is a real patient comfort issue.
If your breathing rate is unstable enough, being able to set a rate that eliminates the constant switching back and forth to ventilator mode can make this machine more tolerable.

Mine is quite unstable but fortunately I am not bothered with the switching even during the wake-to-sleep period. I can feel them but am not disturbed. I am truly grateful for that.

_________________
Mask: Oracle HC452 Oral CPAP Mask
Humidifier: DreamStation Heated Humidifier
Additional Comments: EverFlo Q 3.0 Liters O2 PR DSX900 ASV
Oracle 452 Lessons Learned Updated
DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
Sleepyhead and Encore Pro 2.21.

AfibApnea
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Re: BIPAP ASV ... Backup Rate?

Post by AfibApnea » Fri Oct 31, 2014 6:33 pm

When I posted this topic yesterday I was very interested in getting all replies as soon as possible. In order to have that happen, I checked "Notify me when a reply is posted."

I've done this before and have had no problem getting a "Topic reply notification..." every time a reply was posted. But this time I've received no emails.

Is there anything I did wrong or is this a known problem?

Thanks
PR S1 REMstar 60 Series BiPAP ASV Advanced & PR S1 with humidifier
Various Nasal masks or Nasal pillows
Software:

JDS74
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Re: BIPAP ASV ... Backup Rate?

Post by JDS74 » Fri Oct 31, 2014 7:01 pm

It used to work for me but I haven't used it recently.
I have it checked so we will see if it still works.

_________________
Mask: Oracle HC452 Oral CPAP Mask
Humidifier: DreamStation Heated Humidifier
Additional Comments: EverFlo Q 3.0 Liters O2 PR DSX900 ASV
Oracle 452 Lessons Learned Updated
DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
Sleepyhead and Encore Pro 2.21.

dreamless
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Re: BIPAP ASV ... Backup Rate?

Post by dreamless » Fri Nov 07, 2014 3:49 pm

I have been on my machine, which is a Respironics Bipap with Auto SV advanced machine for 2 1/2 years. I have had tremendous difficulties dealing with it. I had no help, from the DME provider or the sleep neurologist who prescribed it, in learning how to 'work' with it. I was diagnosed with Central Sleep Apnea in March of 2012 and started with this machine in June the same year. I still feel like the settings are not correct for me. I've had nights when I wake up and am gasping for air, my heart is racing and I feel very panicked. I wake up every night every 20 to 30 minutes and don't understand why this is happening. I have had four sleep neurologists in the last 2 1/2 years (they keep getting transferred from my location), I feel that the DME provider is incompetent and would rather not hear from me, and I can't get in to see my new sleep neurologist until February. All in all, its been a nightmare (pun intended).

Backup Rate - my original settings - 12. Currently it is set to Auto. This machine is so sophisticated that it is supposed to 'learn' your breathing cycles - at least that's the way I understand it.

Good luck to you.

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palerider
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Re: BIPAP ASV ... Backup Rate?

Post by palerider » Fri Nov 07, 2014 4:34 pm

you'd do better to start your own thread and post some sleepyhead graphs instead of piggybacking on a mostly unrelated thread.

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cnaumann
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Re: BIPAP ASV ... Backup Rate?

Post by cnaumann » Fri Nov 07, 2014 7:20 pm

Dreamless, you have about the most advanced machine avaiable to treat Central Sleep Apnea. You may have other issues (panic attacks?) but you have a good machine. If the settings aren't right for you, you can change them yourself. Look at your data, make a small adjustment, and see if it made things better or worse. Unfortunately, you may have a hard time finding an someone who is an expert on such matters. That does not mean you cannot become an expert yourself.

JDS74
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Re: BIPAP ASV ... Backup Rate?

Post by JDS74 » Fri Nov 07, 2014 8:27 pm

dreamless wrote:I have been on my machine, which is a Respironics Bipap with Auto SV advanced machine for 2 1/2 years. I have had tremendous difficulties dealing with it. I had no help, from the DME provider or the sleep neurologist who prescribed it, in learning how to 'work' with it. I was diagnosed with Central Sleep Apnea in March of 2012 and started with this machine in June the same year. I still feel like the settings are not correct for me. I've had nights when I wake up and am gasping for air, my heart is racing and I feel very panicked. I wake up every night every 20 to 30 minutes and don't understand why this is happening. I have had four sleep neurologists in the last 2 1/2 years (they keep getting transferred from my location), I feel that the DME provider is incompetent and would rather not hear from me, and I can't get in to see my new sleep neurologist until February. All in all, its been a nightmare (pun intended).

Backup Rate - my original settings - 12. Currently it is set to Auto. This machine is so sophisticated that it is supposed to 'learn' your breathing cycles - at least that's the way I understand it.

Good luck to you.
A couple of things you can do to get a better handle on your therapy.

If you haven't done so, get a copy of your sleep studies especially any titration studies.
Also get a copy of your prescriptions so you can see any differences between your current settings and what was originally prescribed.

Then update your profile to show current machine and mask.

With that housekeeping done, get a copy of software so that you and us can see what is going on in your therapy.

Two are available: Encore and SleepyHead. Both are excellent but have differences that affect how the data is collected and displayed.

Because you are waking so frequently, you might consider getting a pulse-oximeter so you can look at heart rates and SpO2 levels. If you get a separate one, I have a CMS50F that I used to use and it is compatible with SleepyHead but not Encore.
Or, the much more expensive route is one that integrates with your machine (my current setup roughly $1,000) it is compatible with both SleepyHead and Encore.
The less expensive CMS50F is just over $100 or so at the PulseOxStore. Send me a PM if you want to get a Respironics setup.

As was suggested, starting a new thread might be a better way to get advice.

_________________
Mask: Oracle HC452 Oral CPAP Mask
Humidifier: DreamStation Heated Humidifier
Additional Comments: EverFlo Q 3.0 Liters O2 PR DSX900 ASV
Oracle 452 Lessons Learned Updated
DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
Sleepyhead and Encore Pro 2.21.