Original 2 patents + 1 new app, for Bipap AutoSV

Have been hunting for this patent for months & thanks to clues provided by Snoredog & SWS in Banned's AVAPS thread I finally found what I believe is the original Bipap Auto SV patent plus two updates. What I did know was that it went back to 2001 & the 1st below patent was applied for in sept 2001 & granted in 2004 to Peter D Hill. The other two are 2004 (granted 2007) and a recent application
is 2007 (not yet granted)

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Filed 2001 - granted 2004 to Peter D Hill as 6752151
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ABSTRACT:
A method and apparatus for treating a breathing disorder and, more particularly, a method and apparatus for providing a pressurized air flow to an airway of a patient to treat congestive heart failure in combination with Cheyne-Stokes respiration and/or sleep apnea or other breathing disorders. A positive airway pressure ventilator is utilized in combination with an algorithm that adjusts IPAP and EPAP in order to counter a Cheyne-Stokes breathing pattern. Cheyne-Stokes respiration is detected by monitoring a peak flow of the patient.

http://www.google.com/patents?id=U40QAA ... xy_is=2008


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The newer applications by the same inventor Peter D Hill & are to 'RIC Investments'


Filed 2004 granted 2007 to Peter D Hill as 7267122
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ABSTRACT:
A method and apparatus for treating a breathing disorder and, more particularly, a method and apparatus for providing a pressurized air flow to an airway of a patient to treat congestive heart failure in combination with Cheyne-Stokes respiration and/or sleep apnea or other breathing disorders. A positive airway pressure ventilator is utilized in combination with an algorithm that adjusts IPAP and EPAP in order to counter a Cheyne-Stokes breathing pattern. Cheyne-Stokes respiration is detected by monitoring a peak flow of the patient.


http://www.google.com/patents?id=zNqBAA ... xy_is=2008



Filed 2007 (not yet granted) by Peter D Hill
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Abstract:
A method and apparatus for treating a breathing disorder and, more particularly, a method and apparatus for providing a pressurized air flow to an airway of a patient to treat congestive heart failure in combination with Cheyne-Stokes respiration and/or sleep apnea or other breathing disorders. A positive airway pressure ventilator is utilized in combination with an algorithm that adjusts IPAP and EPAP in order to counter a Cheyne-Stokes breathing pattern. Cheyne-Stokes respiration is detected by monitoring a peak flow of the patient.

http://www.google.com/patents?id=6cWhAA ... xy_is=2008

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Have started a new thread for it as we have been hijacking Banned's AVAPS thread for long enough.

DSM

This patent that Snoredog posted in Banned's AVAPS thread seems to be very similar to the Bipap Auto SV, but not quite the same.

http://www.google.com/patents?id=zd6hAA ... on#PPA1,M1

Is it the AVAPS patent ? - I'll work thru it as time permits.

Meanwhile I have been reading through the one I believe is the Bipap Auto SV & it matches very well & explains all the detail very well - it is full of gems such as in para 0051 that the machine limits pressure rises to 3 CMs so as not to cause arousals. Now I know I had some debates with both Rested Gal and SWS over the optimum value I had found in a gap of 3 CMs. IIRC Rested Gal questioned me when I wrote posted that an Ipap Epap gap of 6 was likely to cause problems. SWS responded with a post that based on recent publications an 8 CMs gap was acceptable. But in para 0051 of this patent we have Respironics begging to differ. Not a big deal but it is good to find real expert opinion on these matters.

Also am still hunting through the patent for the genie that delivers the 'puffs' of air that I have experienced. Still haven't found anyyhing I can relate to it but astill have lots more to read through.

DSM

#2 One interesting matter the patent raises is that it says it will dynamically adjust Epap as well if it detects CSR patterning (PB). It is pretty clear about doing this. But, none of the Respironics marketing material mention this feature !.

Just reading paras 68 to 71 re dynamic adjustment of Epap & got to para 72 - Hmmmmm, this is looking more like an AVAPS than a Bipap AutoSV.

Anyone else willing to comment re para 0072 & what it is actually saying ?

DSM

IIRC Rested Gal questioned me when I wrote posted that an Ipap Epap gap of 6 was likely to cause problems. SWS responded with a post that based on recent publications an 8 CMs gap was acceptable. But in para 0051 of this patent we have Respironics begging to differ. Not a big deal but it is good to find real expert opinion on these matters.

Doug, you might want to check if those EPAP/IPAP gaps discussed in the patent text happens to be a continuation of identical text---from an older patent. The above recommendations seem to mirror consensus recommendations from only a couple years ago.

If you would consider AASMNET consensus medical recommendations to be valid expert opinions, they now recommend a gap of no less than 4cm and a gap of no more than 10cm:

http://www.aasmnet.org/Resources/Clinic ... 040210.pdf

http://www.pubmedcentral.nih.gov/articl ... id=2335396

2008 AASM PAP titration clinical guideline wrote: 4.3.1.6 The recommended minimum IPAP-EPAP differential is 4 cm H2O and the maximum IPAP-EPAP differential is 10 cm H2O (Consensus).

-SWS wrote:

IIRC Rested Gal questioned me when I wrote posted that an Ipap Epap gap of 6 was likely to cause problems. SWS responded with a post that based on recent publications an 8 CMs gap was acceptable. But in para 0051 of this patent we have Respironics begging to differ. Not a big deal but it is good to find real expert opinion on these matters.

Doug, you might want to check if those EPAP/IPAP gaps discussed in the patent text happens to be a continuation of identical text---from an older patent. The above recommendations seem to mirror consensus recommendations from only a couple years ago.

If you would consider AASMNET consensus medical recommendations to be valid expert opinions, they now recommend a gap of no less than 4cm and a gap of no more than 10cm:

http://www.aasmnet.org/Resources/Clinic ... 040210.pdf

http://www.pubmedcentral.nih.gov/articl ... id=2335396

However, just a year or two ago they were making similar recommendations to what is described in the patent description.

2008 AASM PAP titration clinical guideline wrote: 4.3.1.6 The recommended minimum IPAP-EPAP differential is 4 cm H2O and the maximum IPAP-EPAP differential is 10 cm H2O (Consensus).

SWS,

so the arousals all went away

Joking aside - thanks - your doc certainly backs up your position very well.

DSM

#2 - But, I note that Respironics still limit rises in the Bipap Auto SV PS mechanism to max 3 CMs per breathing cycle.

-SWS wrote:

2008 AASM PAP titration clinical guideline wrote: 4.3.1.6 The recommended minimum IPAP-EPAP differential is 4 cm H2O and the maximum IPAP-EPAP differential is 10 cm H2O (Consensus).

Doug,

Why not trial EPAP 11, IPAP Min 15, IPAP Max 21, and tell us what you think?

Banned

Banned wrote:

-SWS wrote:

2008 AASM PAP titration clinical guideline wrote: 4.3.1.6 The recommended minimum IPAP-EPAP differential is 4 cm H2O and the maximum IPAP-EPAP differential is 10 cm H2O (Consensus).

Doug,

Why not trial EPAP 11, IPAP Min 15, IPAP Max 21, and tell us what you think?

Banned

Banned, I will admit I was very surprised when I first read about those changed recommendations. Those larger EPAP/IPAP gaps also seem to concur with Dr. Krakow's experimental findings in his UARS/BiLevel threads.

dsm wrote:But, I note that Respironics still limit rises in the Bipap Auto SV PS mechanism to max 3 CMs per breathing cycle.

I was under the impression that was a time-based parameter variation feature that might be overridden. IIRC the Resmed patent allows for override under certain circumstances. But I vaguely thought the Respironics time-based parameter variation patent allowed for override as well. But which features from which patent descriptions really went into the BiPAP autoSV machine anyway? That's hard telling since the manufacturers all love to play Three-Shell-Monty with patent descriptions just to throw their competitors off track---us too.

Anyway, you're saying a four-breath cycle might gradually achieve a target PS in this manner: PS=3, PS=6, PS=9, PS=12. All the more reason to get the obstruction out of the way IMO.

SWS,

The patent does state that IpapMin *must* be set to clear OSA. It is stated as a requirement for using the machine in question.

It was interesting that they didn't say this about Epap ? - then they have those paras prior to 0072 that talk of dynamically adjusting Epap under certain conditions, if a CSR pattern is recognized.

DSM

Banned wrote:

-SWS wrote:

2008 AASM PAP titration clinical guideline wrote: 4.3.1.6 The recommended minimum IPAP-EPAP differential is 4 cm H2O and the maximum IPAP-EPAP differential is 10 cm H2O (Consensus).

Doug,

Why not trial EPAP 11, IPAP Min 15, IPAP Max 21, and tell us what you think?

Banned

Banned,

I have already trialled those settings but always kept coming back to gap = 3 CMs as the most effective and least number of unwanted scores in the events line.

I did run a Bilevel for a couple of months with a gap = 7 CMs & was scoring AI count as high as 40.

I see what the document SWS linked to says, but my practical testing just doesn't match that suggested range & I can at best assume that the max gap of 8 is recommended for serious copd cases where max ventilatin is an absolute reqt.

The reason I set my PB330 with the 7 CMs gap was because (IIRC) the PB330 clin manual said a gap of 8 was ok.

DSM

Hello Everyone,
I am currently using the M Series BiPAP and the MinPS is hard wired at 2. When I read the reports the next day my machine seems to want to keep the EPAP at 10 and bump the IPAP to 13CMS, a 3 CMS differential. This has produced the lowest AHI I have seen, but since I cannot set the MIN PS to 3 I am thinking about getting the SV. Although, as noted, there is so much smoke and mirrors I dont see how I can know what result I will get from the SV. Does the SV use the same software with addtional layers added on or is it a completely different model? The other part that is of interest is the fact the the BiPAP has flex settings. I have mine set to 3 with an EPAP of 10. I read a study today that stated the flex CMS delta was dependant on BPM and CMS. There was also a +/- or around .8CMS at those levels. So even though I am thinking that I am only getting a 2CMS differential, with the flex set to 3 I am really getting another 2-3CMS swing in there for a possible net delta of 5CMS? The machine wants to gravitate to a spread of 3 CMS and I am getting great AHI improvement. I just wish there was a way to change the PSmin on this machine. Does anyone know if I can set the SV to get the same response but with a PSmin of 3? I have nasal resistance due to allergies and anotomy so the results I get from these AUTOs tend to be very unpredictable. I was review some patents today to try to get some ideas and there are some great ideas out there but unfortunately none of the ones I liked are commercially out there yet. I will probably test drive an SV and take it from there. I am just live with a manual BiPAP since I now have an idea of what pressures work for me the best thanks to the AUTO BiPAP probing.

dnaonejax wrote:Does anyone know if I can set the SV to get the same response but with a PSmin of 3?

Jeff, the SV algorithm and design approach are radically different than your BiPAP auto M-series. The pressure-delivery strategies of those two different auto BiLevel machines are almost like comparing a bicycle's design with that of a truck.

You had mentioned the possibility of OHS. The SV machines are not well suited for hypoventilation syndromes. Your BiPAP auto M-series configured in ordinary BiLevel mode with a larger PS may turn out to be an improvement over your current BiPAP auto modality. The work of breathing (or WOB) related to obesity can be often be reduced by using a wider PS. Assuming that you really do have a genuine case of OHS (versus just guessing) this machine would be much better suited for hypoventilation syndromes than any SV type of machine:
http://bipapavaps.respironics.com/

However, that's not to say the above AVAPS machine is guaranteed to treat you better than the machine you currently have. Also, I added to your other thread here: viewtopic/t37084/Respironics-M-Series-A ... ml#p323642

Good luck!