Newbie with questions about Respironics BiPAP Auto M

dsm · Post by **dsm** » Wed Mar 05, 2008 2:47 am

DRONE wrote:
dsm wrote:Drone,

Whoa - be careful, some of the advice posted is partially correct but enough to get you embarrassed if you try to debate with the DME. I have the provider manual & can give accurate detail of the settings - so don't be afraid to ask before a sit down with the DME. We here at cpaptalk do our best to advise but repeatedly we can get details wrong & confused. We always mean well but we aren't RTs. Make sure you have a lot of input before assuming any one of us is the authority. You will get enough good input quickly to be confident.

Rested Gal uses a Bipap Auto & she will be very helpful in explaining the way it works. She has used hers a lot more than I used mine.

Good luck DSM
Don't worry, DSM. I'm a smart guy. Many gray cells still functioning despite the apnea. And I know this is just a forum. If I had the provider manual, I could read it and answer most of these questions myself. Where can I get one?

Regarding RT's, to tell you the truth, I really don't have a high opinion of the RT's I've met. How can I say this in a charitable way? Let's see -- how about this -- The RT's I've met seem to be under-trained. How's that? Not too harsh? Maybe in your area they are experienced and well-trained, but I haven't met any around here. I've been dealing with my sleep apnea for 5 years (I told you there was a long back-story) and I just can't leave these decisions to other people anymore. They've been mis-handling my therapy for five years now. I've decided that I have to take control if I want to live to see 60. I was pre-Med at Yale until I flunked Calculus, so I figure I have enough smarts to get on top of this situation and make certain I get the therapy I need.

I am hoping that Rested Gal will chime in here, but I only started this thread this afternoon. Hopefully she'll see it sometime in the next few days and give us her thoughts.

It's after midnight here, so I'm going to log off for now. Thanks so much for caring. Really. I'm not saying that to be cute. It's great that you take the time and interest to get involved in these discussions. Thanks. But I'm done for tonight!

rested gal · Post by **rested gal** » Wed Mar 05, 2008 3:51 am

Hey, Drone...

Welcome to the board. I didn't see your thread until just now.

DRONE wrote:If I had the provider manual, I could read it and answer most of these questions myself. Where can I get one?

Send me your email address via a Private Message (the "PM me" button at the bottom of my message here) and you shall have it.

If it were me, and I'd been using a regular bilevel machine at 10/7... I'd try the M series BiPAP Auto this way:

auto bilevel (Auto-titrating bipap mode)
Max IPAP 20.0
Min EPAP 7.0
Max Press Sup 8.0
Bi-Flex Setting 3
Autoramp time 0:00
Mask Alert Feature OFF
Auto Off Feature OFF
Split Night Time - Off
Show AHI/Leak Feature ON
Patient Reminder OFF

The machine will start out each time giving you an inhale pressure 2 cms more than the exhale pressure (EPAP setting.)

So, with those settings:

Each time you turn it on, it will begin blowing 9 for inhaling and 7 for exhaling. It will vary both those pressures as needed throughout the night.

It will never let the inhale/exhale move closer together than 2 cms, and will never let them move farther apart from each other than 8 cms (the "max pres sup" setting.)
______________________________

Here are links to my explanation (as I understand it) of the Maximum Pressure Support setting -- like two dogs on a leash.

That setting is called "Max Press Sup" in the M series BiPAP Auto.
It's called "PS" in the older non-M series BiPAP Auto.
Same thing.

viewtopic.php?t=22099
Jul 14, 2007 subject: What is 'Max Press Sup'

viewtopic.php?t=15666
Dec 08, 2006 subject: Question for BiPap users - UPDATED 12/14/2006

________________________________

Explanation of "Bi-Flex":
Mar 08, 2007 subject: BiPAP Bi-Flex Feature
viewtopic.php?p=153809

(That discussion was about a pre-M series BiPAP machine.)

Bi-Flex can be turned on when these BiPAP Auto machines are in the listed operating modes (through the therapy setup menu on the machine) --

BiPAP Auto with Bi-Flex M series
bilevel
auto bilevel

BiPAP Auto with Bi-Flex, older non-M series
BFLE
AbFLE

KAZ · Post by **KAZ** » Wed Mar 05, 2008 7:39 am

Now you are cooking drone! I bought the Bi Pap auto M out of pocket,set it up with the good help of RG(all blessed by my Doctor) and had my provider pick up their Plus M non data straight crap . You will want the auto blower on a permanent basis. Regards

Nodzy · Post by **Nodzy** » Wed Mar 05, 2008 9:22 am

Yes'r.... Drone found the right place to get facts, tips and encouragement from. And all for the bargain, low price of tapping the keyboard.

With it all explained so well above, I can get back to infusing caffeine while knowing he's in good hands.

Drone... good luck and welcome to the board.

Nodzy

Guest · Post by **Guest** » Wed Mar 05, 2008 10:38 am

Drone,

You've received input here from the best. Sorry if my attempt at explaining how the machine works led you astray.

I really like my BiPap auto. It will probably be a battle, but I too suggest that you try to get one on a permanent basis - you can always de-activate the auto feature if you decide you don't like it.

Off-topic, but my guess is that your battle will be with your DME provider, as they get reimbursed a fixed amount for a Bipap, be it auto or not (and so they are economically incented to provide you with the lowest cost unit you are willing to accept). In my area I have a choice of DME providers. Once I mentioned that I knew that I had freedom of choice, and that if they would not provide me with an auto unit I would find a DME provider that would, they became much more accomodating.

You might also want to visit billmyinsurance.com (affiliated with cpaptalk.com's sponsor cpap.com) to see if your insurance plan would allow you to purchase through them.

Best,
Al

DRONE · Post by **DRONE** » Wed Mar 05, 2008 5:39 pm

Hi, fellas! You too, Rested Gal! Things are kinda slow here in the office this afternoon so I'm back online and just finished reading your comments. Thank you one and all.

Well surprise, surprise, the folks at Respironics actually got back to me with an "800" number that put me through to one of their staff Respiratory Therapists. Had a nice chat. He confirmed that the initial IPAP/EPAP settings of the BiPAP Auto M cannot be greater than 2cm apart, unless you disable the "Auto" mode and instead run it as a simple BiPAP machine. I asked him why the engineers at Respironics designed it this way and he admitted that the RT's at Respironics don't know. They don't think 2cm is a magic number and expect that the next generation of machines will have a little more flexibility.

For forum members who don't quite see why this is such a concern, imagine it this way--pretend you're under water and have to breathe through a straw. If you have a jumbo straw - say an inch in diameter - you can breathe easily in AND out with little effort. You could even sleep with that jumbo straw. But then they take away your jumbo straw and give you instead one of those itty-bitty straws. If you suck real hard, then also breathe out real hard, you'll be OK for a while but eventually your gonna need some air. What you need is a machine that will attach to the other end of the straw and push air through it to your lungs, then turn around and suck it back out again. I'm not talking about sleep apnea here, I'm talking about regular breathing while awake. You're gonna need a "push-pull" air pump.

So when I put on my mask, 10 cm of pressure is powerful enough to drive the air through my itty-bitty nose to fill my lungs. But then I need to exhale! For me to try to breathe out through my nose is hard enough with no mask on, so it's really hard if my CPAP machine is fighting me with 8 cm of back pressure. I've learned to tolerate 6 cm of EPAP but what I could really use is an EPAP setting of 0 cm! I hope this helps you to visualize the problem.

Where does this leave me? If I start at a setting of 8/6, I'll turn blue from not getting enough IPAP air, and if I start with a setting of 10/8, I'll turn blue because I won't be able to empty my lungs between breaths. So it looks like I'm going to have to disable the Auto titration feature and use the machine as a straight BiPAP machine with initial settings of 10/6, then just keep tweaking the knobs until I optimize my results.

I thank all of you for your help. Tomorrow I'm off to the DME to get my machine. It will be the BiPAP Auto M, simply because the DME has a boatload of them to get rid of and my RT has already gotten the insurance company's approval, so why not?

But, hey, here's another question. Does Resmed or one of the other outfits make a machine that'll do what I want it to do?

05Renegade · Post by **05Renegade** » Wed Mar 05, 2008 5:48 pm

rested gal wrote:Hey, Drone...

Welcome to the board. I didn't see your thread until just now.

DRONE wrote:If I had the provider manual, I could read it and answer most of these questions myself. Where can I get one?
Send me your email address via a Private Message (the "PM me" button at the bottom of my message here) and you shall have it.

If it were me, and I'd been using a regular bilevel machine at 10/7... I'd try the M series BiPAP Auto this way:

auto bilevel (Auto-titrating bipap mode)
Max IPAP 20.0
Min EPAP 7.0
Max Press Sup 8.0
Bi-Flex Setting 3
Autoramp time 0:00
Mask Alert Feature OFF
Auto Off Feature OFF
Split Night Time - Off
Show AHI/Leak Feature ON
Patient Reminder OFF

The machine will start out each time giving you an inhale pressure 2 cms more than the exhale pressure (EPAP setting.)

So, with those settings:

Each time you turn it on, it will begin blowing 9 for inhaling and 7 for exhaling. It will vary both those pressures as needed throughout the night.

It will never let the inhale/exhale move closer together than 2 cms, and will never let them move farther apart from each other than 8 cms (the "max pres sup" setting.)

I've just started BiPAP at 18/12...what auto settings could you suggest and can I request a copy of that provider's guide also?

DRONE · Post by **DRONE** » Wed Mar 05, 2008 6:00 pm

Hey, 05Renegade, I see you're a newbie like me. But maybe your new to forums in general. Here's the deal when in a forum. If you have a new problem or a question to ask, you should go ahead and start a new topic of your own. The people can reply directly to you instead of having two conversations going inside of the same thread. When you change the topic of a thread, it's called "hijacking the thread" and people lose track of who is saying what to whom. Not good.

So your question is a good one, you just need to start a new topic to ask it.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): newbie

05Renegade · Post by **05Renegade** » Wed Mar 05, 2008 6:09 pm

The "hijacking" wasnt intentional...I've been around since before there was an Internet (TheSource and QuantumLink anyone?), just a newb to CPAP and OSA.

Since the thread is titled "Newbie with questions about Respironics BiPAP Auto M", which I am and which I have, that it would be more appropriate to ask here than starting a new and/or duplicate thread.

Sorry to offend...I'll get my answers elsewhere.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap, CPAP, auto

cflame1 · Post by **cflame1** » Wed Mar 05, 2008 6:39 pm

Nobody meant any offense Renegade... the folks around here are always glad to help... though we do say the odd thing that some folks take the wrong way.

Sometimes (especially around here) you have to take the attitudes with a grain of salt.

mindy · Post by **mindy** » Wed Mar 05, 2008 6:55 pm

Not to worry about hijacking a thread here - happens all the time and it's my impression that nobody worries about it!
We get some really good conversations going that started out on one topic and evolved from there.

Mindy

Nodzy · Post by **Nodzy** » Wed Mar 05, 2008 7:10 pm

I tend to agree.... some of the best answers with most detailed info that caught my attention were on threads that were wobbing back and forth across the thin line of the original topic.

But then... what would I know.... I'm lucky I can find my memory on most days.

Nodzy

rested gal · Post by **rested gal** » Wed Mar 05, 2008 11:43 pm

05Renegade, it was perfectly fine for you to ask your question here in this thread. I'll be happy to send you the provider manual for the M BiPAP Auto. Just PM me your email address.

I'm not a doctor. But if it were me, and I were prescribed bipap at 18 IPAP / 12 EPAP, I'd set the bipap auto exactly as described in my post to Drone except I'd set it for these I/E pressures:

Max IPAP 20
Min EPAP 12

I'd check online cpap stores to find the lowest price for the Encore Viewer software. If I found it priced lower than at cpap.com, I'd give cpap.com a chance to price match it, which I think they will.

I'd buy the necessary card reader from this Hong Kong store (for about $31 including shipping to the U.S.):
http://www.two-factor.com/shop/index.php?productID=115

__________

Drone, I sent a reply to your PM, but I don't think you've seen it yet. You might want to check your PMs (button at top right of this webpage.)

05Renegade · Post by **05Renegade** » Thu Mar 06, 2008 11:54 am

rested gal wrote:05Renegade, it was perfectly fine for you to ask your question here in this thread. I'll be happy to send you the provider manual for the M BiPAP Auto. Just PM me your email address.

Done, and thanks for the help!

Right now everything is going well but I'd like to try going auto and see if things get better.

Also, thanks to everyone else for the encouragement and kind comments.
_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, auto

jules · Post by **jules** » Thu Mar 06, 2008 12:06 pm

People hijack threads? How terrible of them to do that.

I think they need to be tarred and feathered, run off the forum, and sent to the ASAA forum.