BiPap...VPAP....heated hose..Experiments

Warning to newbies.. I tend to write novels but I try to cover all bases with explanations so newbies understand my thoughts fully. Everyone else here knows I write novels and just laugh at me. That is ok..I laugh at me too. I have a new heated hose and I am using a BiPap now so offering my experiences and hopefully some of my thoughts may help you in some fashion.

First, the Hybernite 2300 heated hose. Last night was my first night with it. I think I am going to really like it.
Weather needs to turn a bit colder to get a true test as last night didn't turn off cold till almost time to get up.
I happen to need lots of added moisture (setting of 5 feels really good to me) and every winter I have battled rain out. This will be my 3rd winter on the hose. I have tried all the usual fixes to limit rain out and had partial success. Homemade hose cozy,Padacheek barrel cozy, Padacheek hose cozy (so much nicer than my homemade cozy), machine lower, etc... all offered some rain out relief but not complete. I like a cold bedroom at night.
High humidity and cold bedroom equals rain out.

The new PR S 1 Humidification system itself helps because it delivers a comfortable humidity level going to my nasal cavity with minimal water because it uses minimal heat. The old "Classic" humidification system, which is still an option on my machine, uses more heat and a lot more water and copious amounts of rain out no matter what I do when winter comes. The Padacheek hose cozy and the barrel cozy do a very decent job of preventing copious amounts of condensation when using the new PR S1 humidification system but I still get some spray in my face from nasal pillow condensation from the moisture in my exhaled breath coming into contact with cooler nasal pillow even with barrel cozy. I could use a second barrel cozy and probably fix that little problem.

There still remained one other problem.. Ice cube nose. With the new Humidification system and less heat the air is just plain cold going up my nose. Woke me up often. Hugely annoying. The hose cozy helped somewhat but not enough help and really cold nights aren't here yet. The air in hose is so cold that for the first time my husband complained about the cold air from the vent. Up till now he said the vent was actually quite pleasant..sort of like a small fan. Changing over to Classic mode with more heat helped warm the air a little but then I had lots of rain out to deal with. Not enough warmth to offset rain out annoyance.

Every winter I have drooled over the Aussie heated hose. Yikes...Pricey and I am a tightwad. Every winter I threatened to build a reptile cable heater hose but didn't do it. Then someone posted a link about the Hybernite 2300 heated hose and since the cost is almost half the Aussie hose...this tightwad decided she didn't want to go to the trouble to build a reptile cable heated hose so I bought it from EBay seller for $82 and that included S & H who happens to also have this website http://www.sleeprestfully.com/hybernite.asp.
For the newbies wondering what the heck a reptile cable heated hose might be...this is one discussion on it. There are many more on the forum.viewtopic.php?t=27579

Ordered late last Thursday night I got it yesterday via USPS Priority mail.
It is quite light and quite flexible..Along the lines of the white Performance hose. They don't recommend using a hose cozy because they say it can maybe cause the air to be too warm. I will test that though later. No warning about the hose cozy (like maybe fire hazard) except air temp may feel too warm . They do recommend turning PR S 1 new humidification system off which then reverts the machine back to the Classic mode. So that is what I did last night. Set the humidifier to 4 which normally would have me snorting water even with the barrel cozy and hose cozy. House temp got down to 60 last night. Zero rain out. Air noticeably warmer but still cool overall. Vent air is still cool but not cold. If I hold the hose in my hand with heater on I feel just a gentle warmth. No where near heating pad warmth.

Only negative for me is the fact that there is no on/off switch and I have so very little room between the bed, the night table and the surge protector I can't easily get to the plug or switch on the surge protector. It does come with a power brick so I am going to try to fix some way to have the brick on top of the table and just unplug it from there.

It is nice to not have the added weight of the hose cozy to deal with since I don't care for hanging the hose over my head. I prefer just let it flop around. While turning over in bed is not horribly difficult with the hose cozy on, one does notice the weight a little.

Should be colder tonight so the heated hose will have a little more room temperature drop to deal with. So more reports on it later. So far I really like it.

Report on BiPap trial coming up shortly.

Does the hose have any controls beyond the basic on/off afforded by the power plug? Any thermostat? How standard is the hose-to-brick plug? Just considering my options before the temperatures drop too far.

I had been discussing non-machine-specific heated hoses with both my DME and my PCP earlier today. My DME's vote is adding a second hose cover, which they gave me. My PCP's vote is the Repti-hose with custom controller, and these days, I can even afford lead-free solder.

Hi Pugsy,
I have a lady friend who knits and she made me a really nice hose cozy. Maybe someone could knit you a nose cozy

I don't need too much humidity since I live in the high desert and my body is used to dry air...setting 2 is more then enough. But for those with higher humidity needs, an electric hose sounds like the ticket.

Cheers and looking forward to your BiPap report,
Jamis

tetragon wrote:Does the hose have any controls beyond the basic on/off afforded by the power plug? Any thermostat? How standard is the hose-to-brick plug?

No ON/OFF. No thermostat. No other controls. I wish it had a rheostat but it doesn't but I knew that when I bought it. I did leave it on when I first got it for a couple of hours to see if the brick got hot..It did not.
Hose has a small (very small..think cell phone battery adapter plug) connector down at the end of the hose where the hose attaches to the humidifier that then goes to electric to brick..power cord is small to the brick (again like cell phone charger cord to wall outlet. Brick is much, much smaller than PR S1 brick. About the size of a disposable camera. Cord from brick to outlet is larger standard size cord similar to cord from PR S1 brick to outlet.

The connector from brick to hose while small..snaps in (tiny catch) and is pretty darn snug. It won't accidentally come off. It takes a bit of effort to unplug at the hose connection. This is good IMHO. It is not difficult to remove but it does take specific effort.

Based off of that, I think the Aussie or Repti would be a better candidate for my plans.

So here is my BiPap story.
Brief history..APAP for 2 1/2 years at 10 min and 20 max. Pressure variations never bugged me and on occasion I would have some events that seemed to need 16 to 19 cm pressure. Not all night and not every night but fairly often for an hour or so. Documented much, much worse OSA in REM sleep and not any particular difference in regards to sleep position per sleep study. No real problems using APAP. AHI most often less than 2 and sometimes less than 1. I do have a history of back problems which gives me quite a bit of pain and disturbs by sleep so we deal with that. It is what it is. I have been using a PR S1 APAP since April at same settings AFlex of 2. I don't use ramp. No problem exhaling at 10 cm.

I have been helping a friend of mine with her CPAP therapy. She needs 16.5 cpap (uses PR S1 Pro) pressure to have a chance to get her OSA under control. She has a touch of COPD..uses an inhaler as needed. I kept telling her that I thought BiPap would be much easier on her. Her doctor is an idiot. Flat out just told her not much more she could do. So I stumbled across a PR S1 BiPap Pro that someone offered to sell with not many hours on it and at a very fair price. So I bought it. Had it shipped to me so that I could make sure everything was okay and also figure out how to set it up for my friend.

Well of course I had to try it. I was just too curious not to try it. So I set it up 8 EPAP & 12 IPAP. OMG from the first breath I said I have to have one of these. It truly was just like my own natural daytime breathing after the first 2 breaths. No effort whatsoever. So I slept with it. Slept well. AHI was around 6 as I had a few little clusters probably in REM and the 8 EPAP wasn't quite enough BUT despite the AHI.. I woke up earlier than usual and felt absolutely fabulous. I finally had the "miracle". It lasted all day. No need to nap. Felt awesome. I thought to myself.."this is what people talk about"... It was completely unexpected. I was just using the BiPap on a lark. Used it 2 more nights before I sent it to my friend and told her that if for some reason she didn't like it I would be more than happy to take it back.. No such luck.. She is using 14.5 EPAP & 18.5 IPAP and has had some good reports and some not so good reports but that isn't the BiPap's fault. More importantly...she says exhaling is simply no work for her anymore. She won't send me the machine back. Don't blame her.

So I had to try to find me another BiPap. Stumbled across a good deal on PR S1 BiPap Auto so I snatched it up.
I have been using it for about 3 weeks now. I am using straight BiPap mode for now. I figured I had used APAP for so long I would give straight BiPap a try...besides the difference in exhale is more dramatic in straight mode because I can set the range to allow more difference than in auto mode which is only 2 cm difference. The more the difference the more perceived ease in respiration. So using 9 EPAP and 13 IPAP BiFlex of 2. It has taken about 2 weeks for AHI to stabilize and this past week AHI has been quite low. Last night...0.90 ...0.3 OA index and 0.6 CA index. Report below. Don't ask why the weird dude VS that first hour. I have no idea. This has shown up once before like this. Once with the hose cozy on and then last night with no hose cozy. I can't explain it. So I don't try. Encore Pro report with software set to show only unintentional leaks.

So 3 weeks on a Bipap. You all have rarely heard me say that I "love" anything about this therapy. I accept it as something I have to do to live. I now say I love my machine. For 3 weeks I have felt hugely improved during the day. I am averaging one hour more of sleep each night and even short nights (for reasons not related to sleep) have left me feeling better during the day. I no longer have the strong need to nap around 4 PM.
AHI is no different on the BiPAP than it was on APAP and no change in my meds. I seem to be resting better. Husband says I am not moving around nearly so much. I have waited to see if this was placebo effect but I don't think it is. I did not really expect anything when I tried that first BiPap. Reports for the first 2 weeks jumped around a bit but this past week they have really settled down.

So while I suppose I didn't technically "need" BiPap for any special reason.. it sure seems to agree with me.
I do plan to try auto mode a little later but with nights like below..and I feel great..I am not in any huge hurry to change. The exhale relief is remarkable. I wish I had a chance to compare it to ResMed's EPR but RestedGal has and she says it is just different. There is more to it than the cm difference. There is something in the timing that makes this hugely more comfortable. How it translates to the overall improvement in how I feel during the day..I don't know. More sleep sure helps but I feel better even on short nights. Last night was a short night as I had to get up early and take my husband to his truck. He had a rare chance to sleep at home mid week last night.

More thoughts as I think of them.

tetragon wrote:Based off of that, I think the Aussie or Repti would be a better candidate for my plans.

Aussie hose does not have any temperature controls. I can't tell if it has an on/off switch but I know someone who has one. I will ask.

Pugsy wrote:Warning to newbies.. I tend to write novels but I try to cover all bases with explanations so newbies understand my thoughts fully. Everyone else here knows I write novels and just laugh at me. That is ok..I laugh at me too.

If you write novels, then what is it that I write???? Encyclopedias?

Good to hear that the BiPAP is working wonders for you. And I hope that new heated hose does the trick too ....

robysue

robysue wrote:If you write novels, then what is it that I write???? Encyclopedias?

We both can get a little wordy sometimes can't we?
Oh well, our hearts are in the right place.

Thought I would try to explain how the difference between EPAP and IPAP feels when compared to AFlex.
There is no comparison really...AFlex at all 3 settings does not present to me any sensation of the pressure being reduce. Instead I feel more of a rhythm change with the AFlex settings. AFlex is flow based exhale relief and the actual drop in pressure is not a huge drop.

Now EPAP and IPAP the change is immediate and the wider the range the greater the difference the change in exhale is remarkable. I can sit and watch the machine bounce immediate between straight bipap EPAP 9 cm and IPAP 13 cm. Huge difference in how easy it is to breath.

Now in APAP mode, the way the machine works, I don't get the 4 cm difference in exhale .
Even at the same settings. In auto mode IPAP max doesn't come into the playing field until events drive it up. Instead there is only a 2 cm difference when the machine starts up. No matter what my EPAP and IPAP range inhale while awake and prior to events driving IPAP it up will be 2 cm above EPAP.
So if I wanted to set the machine in auto mode with min EPAP 9 cm and max IPAP at 13...when I mask up I get 9 exhale and 11 inhale.. 2 cm difference. It is actually feels like more work to exhale at these settings than it is at the straight bilevel settings. Of course once I am asleep it doesn't matter. But while awake this is what I feel.

Pugsy wrote:Aussie hose does not have any temperature controls. I can't tell if it has an on/off switch but I know someone who has one. I will ask.

I think its on/off is the same as on the Hybernite: the power cord. It's just that while I can make a control circuit and add in temperature tracking and the like, I'm not a fan of cable surgery. The more standard power plug on the Aussie hose mean that I can put together my own brick with proper strain relief with cheap, stock parts. Of course, one of my friends think I should go completely overkill and use an Arduino for the controls and sensors when a simple Amtel microcontroller would do.

Pugsy wrote:while I suppose I didn't technically "need" BiPap for any special reason.. it sure seems to agree with me.

I don't "need" bilevel either, but sure do like the natural feel it gives to breathing.

Pugsy wrote:The exhale relief is remarkable.

Yep.

Pugsy wrote:I wish I had a chance to compare it to ResMed's EPR but RestedGal has and she says it is just different. There is more to it than the cm difference. There is something in the timing that makes this hugely more comfortable.

Right. Of course each person's perception can be different, regarding how it feels to breathe out against "EPR" in a ResMed cpap or autopap. "EPR" is often compared to being "like" bilevel, in that EPR can be set for an exact number of cms for breathing out... 1, 2, or 3 cms of drop in pressure when exhaling.

So, you'd think that a ResMed CPAP machine with pressure set at, say, 15 and EPR set at "3" (for a 3 cm reduction in pressure... 12 for breathing out) would feel exactly the same while breathing in and out as a ResMed VPAP bilevel machine set for IPAP 15 / EPAP 12. Sure doesn't to me. The bilevel drops the pressure down to EPAP immediately. The instant I start to breathe out. No feeling of resistance at all when I start to exhale. But with EPR there is a slight feeling of resistance the instant I start to breathe out. It feels like EPR winds its way down to the "3 cm drop" as my exhalation continues. As you say, Pugsy, it's in the timing of how the full effect of the exhalation relief happens that makes bilevel so comfy.

That's probably the reason Respironics' "A-Flex", and even their "C-Flex" felt more comfortable to me (for exhaling) than ResMed's EPR. A-Flex and C-Flex do most of their drop at the beginning of breathing out. The "flex" features simply don't keep holding the pressure down for the entire exhalation and during the pause after finishing the exhalation. EPR does keep it down, but....it's at the START of breathing out that I personally want to feel the most exhalation pressure relief. True bilevel (BiPAP or VPAP) can't be beat for that kind of wonderful instant drop in pressure when you exhale. And bilevel is gonna keep it down until you start to breathe in again. Very natural feeling.

All that said, there can be a difference in how well the various brands of bilevel machines "follow" different people's breathing. Several people I know who have tried Respironics (and Philips Respironics) "BiPAP" have found that brand's "digital tracking" not able to interpret their breathing well....sometimes switching up to the higher IPAP pressure when they are still trying to exhale. I've not heard that said about ResMed's VPAP. Either brand follows my breathing perfectly, but if a person had one shot, and one shot only, at choosing a bilevel machine with the best chance of staying in sync with their breathing -- following the person's inhale/exhale cues -- I'd suggest the ResMed VPAP (and VPAP Auto.)

There is also a big difference in how the two brands' bilevel auto machines handle the "PS" (pressure support) setting. But that's a whole different ballgame. jnk wrote an excellent explanation of the bilevel autotitrating difference between the two major brands:
viewtopic.php?p=376749#p376749

The two brands' different ways of using "PS" could have an impact on some people's therapy, especially those who are very prone to aerophagia, but for most people either way probably works equally well.

Generally speaking, either brand's bilevel -- PR's BiPAP or ResMed's VPAP -- is going to feel extra comfortable and very natural to many people. I had the same "wow, this is NICE" reaction you had, Pugsy, the first time I tried a "bilevel" machine. And the same, "I WANT one of these!" Don't need it (bilevel therapy), but it's what I use by choice.

Quick update and a comment about leak line and open mouth and mouth dryness.
Open mouth and dryness doesn't always mean mouth breathing of the magnitude to impact therapy. See my report below. I woke once last night in the wee hours of the morning with mouth open (on my back) and some dry mouth. It cannot have been for very long because nowhere on the leak line does it even come close to Large Leak territory where it might impact therapy.
My software is set to show only unintentional leak. I could reset it if someone wishes to see it the other way. I just prefer it this way.

Also, Hybernite hose did extremely well last night. Got awfully cold here (at night house temp to 55) and bedroom is colder and no rain out and setting of Classic 4 on my humidifier.

I continue to do extremely well on the BiPap and my reports are trending more to look like this one below..Took me about 3 weeks to get to this point with zero changes in anything. Nearly broke my good wrist patting myself on the back when I saw this report.

Pugsy, thanks for the report, I appreciate our "books", this one makes me want to try a bipap kathy

mayondair wrote:Pugsy, thanks for the report, I appreciate our "books", this one makes me want to try a bipap kathy

Pugsy,

Thanks from me as well! I love reading the info from you, RobySue, Rested Gal and other experienced folks. It really helps us newbies learn!

I wouldn't call your posts novels or at least not novels in a bad way. Sometimes it just takes a few words to describe something precisely!

2 months into CPAP on my shiny new PRS1 and you've given me BiPap envy!

Pugsy wrote:Brief history..APAP for 2 1/2 years at 10 min and 20 max. Pressure variations never bugged me and on occasion I would have some events that seemed to need 16 to 19 cm pressure. No real problems using APAP. No problem exhaling at 10 cm.

I'd appreciate your (or anyone else's) thoughts on the benefit of BiPap at relatively low pressures-
(My minimum is at 10 and my average is only 10.3, I do hit 15 occasionally, but I'm normally in the 10.0 - 11.0 range.)

You mention a minimum of 10, but not what your pressures "average". For comparison to my own situation, I'm wondering if you also tend to stay in the 10s throughout the night or if your average is higher? (You mention occasional spikes to 19 cm, but I'm wondering about "averages")

Do you think BiPap seems so much better than the PRS1 with A-flex to you mainly because of
1) the BiPap breathing rhythm / exhale relief? (regardless of pressure)
Or
2) due to your high pressures which makes exhaling a little more difficult? In other words, do you think you would still find it as significant if your APAP therapy averaged at a lower pressures?