Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

From Sleep Review e-magazine:

Philips Respironics, Murrysville, Pa, has released the BiPAP autoSV Advanced—the company’s next generation servo ventilation (SV) device. The device is updated to make patient management nearly automatic and optimize therapy for complicated patients; furthermore, it has the ability to manage the airway and assure proper ventilation by continually monitoring and adjusting to patients’ changing therapy needs.

The BiPAP autoSV Advanced features an auto adjusting EPAP, utilizing REMstar Auto titration algorithm. With this addition, BiPAP autoSV Advanced automatically distinguishes obstructed-airway from clear-airway apneas and adapts pressure to patients’ needs as their conditions change due to weight, alcohol use, or lifestyle. In addition, BiPAP autoSV Advanced adds Bi-Flex technology, which enhances patient comfort by providing pressure relief during exhalation and at critical transition points.

The SV algorithm monitors peak flow and can rapidly normalize breathing patterns of patients who have complex sleep apnea conditions, with breath-to-breath adjustments of pressure support. In the presence of central apneas, when care must be taken not to over- or under-ventilate a patient, the delivery of automatically calculated backup breaths encourages spontaneous breathing at the patient’s own natural rate. BiPAP autoSV Advanced also offers integrated heated humidification and built-in digital data storage. The Encore patient management system automatically collects vital patient information and enables the entire care team to continuously monitor and track treatment progress and transfer new or updated prescriptions.

I wonder what the price point will be considering the model 1038917 SV is still available.I noticed that Cpap.coms competitor is already advertising the new "advanced" model at less than msrp.Won't that conflict with the older model?

It would be interesting to try that new machine. My experience with Resperonics BiPAP wasn’t that positive.

Slinky wrote:From Sleep Review e-magazine: <...snip...>
BiPAP autoSV Advanced also offers integrated heated humidification and built-in digital data storage. The Encore patient management system automatically collects vital patient information and enables the entire care team to continuously monitor and track treatment progress and transfer new or updated prescriptions.

I like my current Bipap ASV very well. The idea of built in data storage, in case you forget to put your card or SD back in is a good one.

My only question is... Is the patient included in that "care team"?

I suspect that this will replace the BiPAP SV, as the improvements are of an incremental nature.

I have to agree with Kiralynx though: Is the patient part of the 'care team'?

It would be really bad if the battle to 'have control over the patient' get to the point where we will all have to use hacked machines or software to manage our own therapy.

The new machine is a logical extension of the existing one. Adding EPAP auto adjustment was a natural.
Here are the specs (see memory detail) ...

http://bipapautosvadvanced.respironics. ... ations.asp

http://bipapautosvadvanced.respironics.eu/features.asp

(I will later post a copy of the new titration protocol guide - just need to store it)

Once again the indications are that the newer generation of SDB machines are being extended to cover broad-spectrum SDB requirements.

I will stick with my current model - but, one aspect of the new Bipap Auto SV that caught my attention is that the settings on it bear a striking similarity to the previous Bipap AUTO (with BiFlex).

The differences I can see between the older Bipap Auto with BiFlex & the new Bipap Auto SV Advanced include ...

1) They added 'fixed' PS (pressure Support) the Bipap Auto machine dynamically set the PS in-flight. The user could only set the max & not the min gap (which defaulted to 2 CMs). So the SV Advanced allows the patient to set the PS gap to a set value.

2) They added the SV algorithms from the current SV

3) The new SV Advanced now has the BiFlex that was in the older Bipap Auto. This adds an extra adjustable - drop to epap + boost to ipap - at end inhale phase. Helps smooth the transition a bit more.

4) Internal memory has been added

DSM

The titration protocol for the new Bipap Auto SV Advanced ...
(NOTE: This protocol document covers Periodic & Complex Breathing diagnosis)

http://www.internetage.ws/cpapdata/bipa ... otocol.pdf

Enjoy

DSM

I tried a ResMed VPAP during the 3rd sleep study when they did my titration for my newly diagnosed CSA. I HATED IT, felt like I was fighting it over control of when I could breath, clear my throat or swallow. The constant fight, I knew I couldn't stick with it.
So, the Engineer in me kicked in and the research began. I research ALL machines for treating CSA and discovered the Respironics BiPAP autoSV Advanced. I told my provider the make and model of the machine I wanted. I had to be FIRM with them; they wanted to set me up with the resmed VPAP because that is was they tested me with. I was persistent to the point of finding and contacting the local Respironics sales rep. He helped them convert the setting from the sleep stud results to be used with the BiPAP autoSV Advanced. And I got the one I wanted !
The research paid off ! The algorithms used in the Respironics BiPAP autoSV Advanced blows away the Resmed VPAP for comfort.

DO YOUR RESEARCH, AND VERIFY YOUR SETTINGS ARE CORRECT!!
Now its been over a month of use... still having some problems. Something didn't seem right. So.... (Engineer remember) the research began again. Researched all the setting until I understood it, and how to change it +more.
My results from today:
My current settings that they programmed into the unit:
BPM = A (Auto)
PRES Max = 23
EPAP Max = 12
EPAP Min = 12
PS Max = 7
PS Min = 7
FLEX = 2 ( I can adjust this one 1,2 or 3)

I thought it was odd that my EPAP min = 12 and my EAPAP max = 12 Doesn't that defeat the purpose of the "Advanced" feature of the autoSV advanced ?

Luckily.. when my DME was setting up the device I took a few cell phone pictures of the PROVIDER MANUAL when they were out of the room. In the Manual she had written in the settings, in the step-by-step setup section (chapter 6.1.2). I wish I had checked this earlier, because I discovered they made a mistake when setting up the unit.
They had written in EPAP Min=12 and EPAP Max=7; They obviously got the 2 setting mixed up. My guess it the machine detected a minimum setting was set greater than a maximum setting, and set both to 12. I plan to fix it tonight.
Now PS Max = 7 and PS Min = 7 ?? that doesn't make sense either. Researching.... researching...


Hardly over a month of use, but I'm on my 3rd mask type. I did not do a lot of mask research... this one was more trial-and-error.
MY MASK STORY
I figured it was important to get the mask right, because I knew I wouldn't stick with it if it was painful or too uncomfortable.
1st mask (full face mask) was severely irritating the bridge of my nose, to the point of making it bleed after just a few nights.
2nd mask, which covered nose only, did the same thing, but not as bad.
3rd mask: Nasal PIllow ! (magic) but I had my difficulties with it also. They set me up with a large nasal pillow, but leaks, leaks, leaks, ... I asked a friend with OSA for some advice on using the nasal pillow; she gave 3 tips that made a world of difference, and eliminated all leaks for me: (Thank you JB)
Nasal Pillow Tip #1 : use the small size, (this made it fits better & seals better on the nostril)
Nasal Pillow Tip #2 : Keep it loose, not too tight so it floats on your nose (I had it too tight before, pushing up on the tip of my nose; I had figured, more is better so I tightened when it leaked)
Nasal Pillow Tip #3 : Put it on while the pressure is on for a better fit and seal. (I used to turn the pressure on after I had it on... this tip did help some.)
Nasal Pillow Tip #4 (my own tip): Use a Chin Strap ( this reduced the leaks that wake me up.. my lips fluttering as air escaped, drying out my mouth and throat)
I still have the Mouth leak problem (5th night with the Nasal Pillow) but working on it.

Anyone have any tips for using a Nasal Pillow with a BiPap to stop mouth leaks ?

FYI: The Communications Port in the back is a RS232 port; figuring out how to log all my sleep data to my PC is my next challenge.

Slinky wrote: The BiPAP autoSV Advanced features an auto adjusting EPAP, utilizing REMstar Auto titration algorithm. With this addition, BiPAP autoSV Advanced automatically distinguishes obstructed-airway from clear-airway apneas and adapts pressure to patients’ needs as their conditions change due to weight, alcohol use, or lifestyle. In addition, BiPAP autoSV Advanced adds Bi-Flex technology, which enhances patient comfort by providing pressure relief during exhalation and at critical transition points.

Aside from the auto adjusting EPAP it would appear that Respironics has taken a song out of the ResMed VPAP Adapt Sv book and is finally trying to catch up. Unless they have also added a proximal line, it maybe too little, too late.

Banned

mdboze wrote:... I tried a ResMed VPAP during the 3rd sleep study when they did my titration for my newly diagnosed CSA. I HATED IT, felt like I was fighting it over control of when I could breath, clear my throat or swallow. The constant fight, I knew I couldn't stick with it. ...

This just goes to show you that not everyone is alike. My experience was very similar, just the opposite. I found that with the BiPAP AutoSV unit (granted not the Advanced unit), I had the hardest time with it trying to take over my breathing. But my ResMed VPAP Adapt SV unit breathes with me and allows me to relax. I know that if I fail to breathe (as can happen all too often), it will increase the pressure as I need it, not wait until if figures out I needed it. For me the ResMed approach works much better. For you the Respironics approach is a better choice.

In other words, I'm glad we have options.

Really, mdboze, you can not compare the Resmed VPAP Auto w/the Respironics BiPAP Auto SV. They are NOT equivalent devices.

You have no idea how the Resmed Adapt SV or Adapt SV enhanced would have worked for you as compared to the Respironics unit you are satisfied with.

You really do have to compare apples to apples and oranges to oranges.

mdboze

When you did your initial sessions with the Vpap Adapt SV, were you given nasal pillows to use with it ?

Re your sense of frustration in starting with the Vpap Adapt SV, I went through a lot of the same - but it improved greatly once I got a mask that worked with the Vpap Adapt SV.

If I were to characterize the 2 machines I would say that the Vpap Adapt SV induced me to change the way I breathe at night & in time that has worked exceedingly well.
The Bipap Auto SV is always easy to use and tends to follow the way I want to breathe. That makes for for deep & restful sleep.
For me, both machines ramp up the SV pressure around 12-16 times or so per night.
The Vpap Adapt SV is a 'set and forget' machines that requires little to no more tweaking
The Bipap Auto SV has so many settings most people would get lost trying to balance them

I value both machines as being excellent but they go about the job differently.

The Vpap Adapt SV being a volume ventilator may have the edge in effectiveness. It uses the proximal airline tube to sense the actual pressure and events occurring at the mask & this allows it to exercise much tighter control over how it adjusts pressure but if there are any substantial leaks it goes pear shaped.

The Bipap Auto SV doesn't sample at the mask but at the air exit port so it estimates what is happening at the mask & does a pretty good job. This approach though, means the Bipap Auto SV only samples peak average flow (vs Vpap Adapt SV sampling actual volume breath-by-breath) but it can still adjust pressure very quickly to bring the peak average flow back in line. The added epap auto-titration is a new and interesting addition. I believe that this epap auto-titration would be very helpful if kept to a very very narrow band of pressures (say 2 CMs or at the widest 3 CMs). This may of course vary quite a bit if the user has a significant weight problem in which case, a wider epap min-max gap may be better.

OPINION
At a best guess, I would say the Vpap Adapt SV would be at its best in serving people with heart side effects or with straight CA but also good for people with Mixed SA & CompSA.

The Bipap Auto SV would more likely be a best choice for morbidly obese patients but would also do well for patients with Mixed & CompSA.

A conclusion I have drawn from 2 years use switching between the 2 types of machine, is that the Vpap Adapt SV is a dominant machine that has changed the way I breathe (for the better). The Bipap Auto SV, is a passive machine that always allowed me to breathe the way I wanted to. I still switch between them and enjoy the different styles of sleep I get from each.

After my initial months of frustration with the Vpap Adapt SV & finding a mask that worked with it. It would be the machine I would probably hang on to if forced to give one or the other up. But If someday soon a cheap Bipap Auto SV advanced finds its way to cpapauctions.com I would be ready to bid on it just to try it out.

DSM

Slinky,
My mistake if I mentioned comparing to the "Resmed VPAP Auto". I compared the "Resmed VPAP Adapt SV" to the "Respironics BiPap autoSV"
And later compared both of them to the Respironics BiPap autoSV Advanced
Regarding the Resmed Adapt SV enhanced. Tell me what you know about it, what is new in the “Enhanced” version.


DSM,

Good feedback. I always like to hear about first hand experience with two brands.
Although I ended up getting a Respironics BiPap autoSV Advanced, my research led to two potentially good options:
1. Respironics BiPap autoSV (not Advanced, I learned about that one a few days before my purchase)
2. Resmed VPAP Adapt SV - the one I was battled with over who was in charge of my breathing - but still a top candidate

Here is what I found in my final comparison of the two options:
The key reasons I prefer the Respironics BiPAP autoSV

[*]Uses standard tubing, allowing use of any mask, any brand; no restrictions.
[*]Target peak flow adapts to SDB event changes
[*]Dynamic pressure support, recognizes and reacts to changing pressure needs
[*]Includes the capability for data logging periodic breathing events. (not an extra purchase)

[*]overall, newer technology, more control, more options; (as an Engineer, I like features and options)
[*]The Respironics machine is reported to be far more leak tolerant than the Resmed machine.
[*]seems to have a better algorithm. (With the Resmed unit, I felt I was constantly fighting it)

About the Algorithms:
ResMed VPAP Adapt SV:
* Minute Ventilation Based
* 3-min moving average
* 90% of the minute ventilation to determine the tidle volume
* Always 90% of MV. No change in response to SDB events

Respironics BiPap autoSV
* Peak Flow Based
* 4-min moving average
* Statistical processing on peak flow data to determine target level
* Target peak flow adapts to SDB event changes

Pressure Settings Comparison:
VPAP Auto SV ; BIPAP Adapt SV
Max Pressure: 20cm ; 30cm
EPAP Limit: 10cm ; 25cm (my EPAP is set min7 to max12 with the Adapt SV Advanced feature)
IPAP Limit: 20cm ; 30cm
CPAP+SV Mode: NO ; Yes (EPAP = IPAP Min)
Back-Up Rate Options: Auto only; Off, Auto or Fixed (3-30 BPM)
Tubing: Non-Standard ; Standard
Humidification: optional; optional
Masks: ResMed only ; No restrictions, various maks types and brand options
Patient Alarms: Disconnect, high leak ; Disconnect, low minute venilation, apnea
Rise time: not selectable ; 100 to 600 msec

Also I read about oher peoples experience:
"The Respironics algorithm tends to be softer and less 'commanding"
"The Resmed algorithm sort of takes control & you follow it rather than it follow you. (probably why I felt like I was fighting it)"

And after all of that.... right as I was about the get the BIPAP Adapt SV; the BIPAP Adapt SV Advanced was released; and I really like its ability to set a EPap min and Epap Max.
Yesterday, I fixed the mistake my DME made in setting up the machine (they set both Epap max and min to 12);
With EPAP Min =12 and PS = 8, then my min IPAP was 20 !
Fixing the mistake it made a big difference, and was noticible immediatly. And I finally slept through the night and got a good nights sleep. (Last night)

FINALLY! I tell ya'... these companies are great. It has been at least 8 months since I felt like I got a good nights sleep.
Resmed.... Respironics... the competition is great for us customers.
Tonight is the first time in a LONG time, that I am actually looking forward to going to bed.

mdboze

You post above is very tidy & readable (an organized mind ) - the comparison details very clear.

I think though that the Resmed Vpap Adapt SV 'Enhanced' (which was released in 2008 IIRC ) extended the Ipap upper limit to 25 CMs from 20 CMs. I have the older not enhanced version & it peaks at 20 CMs (& that works well enough for me ).

Other than that can't disagree with a point you made.

Cheers

DSM

dsm wrote:... I think though that the Resmed Vpap Adapt SV 'Enhanced' (which was released in 2008 IIRC ) extended the Ipap upper limit to 25 CMs from 20 CMs. ...

You are correct. It can reach 25cm H2O. Due to my needs, my system reaches 23cm H2O it almost every night.