Philips System One Problem

[Cathy2903]

I had been using a Respironics Remstar M series with a bipap setting 25/5 for close to 2 years without any problems when it burned out on me the other day. My home care company replaced it with a Respironics System One with the same settings but it doesn't always detect when I take a breath and it keeps me from falling asleep or wakes me up when I do fall asleep because it causes me to gasp for air. I have periods of shallow breathing which the Remstar responded to by forcing me to take a complete breath but the System One just doesn't give me any air at all. This is my second System One as I returned the first one because I thought it was defective because of the no air lapses.

I have not been able to get any uninterupted sleep with the System One and I wake up with a headache and very dizzy. The Home Care company just tells me that it is working fine and customer service from Phillips Respironics was not helpful at all. I am going to try to do without the bipap tonight to see if I do better.

Has anyone else had this trouble and if so how was it resolved?

[Slinky]

Your home health care RRT is responsible for knowing and understanding not only respiratory therapy but also the various CPAP, APAP and bi-level PAPs and what adjustments can and/or need to be made to make our PAP therapy "work" for us. Right off the bat, I am suspicious of the IPAP 25, EPAP 5 pressure settings. It sounds like some sleep doctor turned you loose w/an auto bi-level to auto titrate your pressure needs and then washed his hands of you. AND your home care company provided you w/the equipment, got the compliance data and payment for the equipment and washed their hands of you as well.

I also suspect that you don't really have a bi-level but rather you have an auto titrating CPAP.

Unfortunately, the RRT cannot take it upon him or her self to change your pressure settings as indicated by the data. HOWEVER, it WAS their responsibility to check your data and provide a printout to your sleep doctor who SHOULD have then scripted more reasonable pressure settings.

Personally, I would dump both that sleep doctor AND local DME provider and find an accredited sleep lab w/a good accredited sleep doctor and check w/my insurance company to ask what local DME CPAP providers they are contracted with. Hopefully you will have the option of more than just this current provider who has done you no favors nor even adequately served your needs.

What BRAND and MODEL bi-level PAP are you using? I'm suspecting that it may not really be a bi-level but rather as I mentioned earlier an auto-titrating CPAP, what we refer to as an APAP. IF so it really should be adjusted to provide a pressure range about 1-2 cms below and 2-3 cms above the reported 90% - 95% pressure in your data.

[builta]

Hi,

Can you post your equipment? There is printing on the front face of the unit that tells you what unit you have. For example it might say "BiPAP Pro" or "BiPAP Auto". On the back the label will have a similar statement and then below the wording on the upper left hand side of the lebel it will provide a model number. The number will show up just to the right if a small box with "REF" printed inside the box.

Do you know if your "M-Series" was a "BiPAP Auto" or a "BiPAP Pro". The "auto" will change pressure as needed but the "pro" runs at a fixed set of pressures.

Cheers

[robysue]

I had been using a Respironics Remstar M series with a bipap setting 25/5 for close to 2 years without any problems when it burned out on me the other day. My home care company replaced it with a Respironics System One with the same settings but it doesn't always detect when I take a breath and it keeps me from falling asleep or wakes me up when I do fall asleep because it causes me to gasp for air.

Given that the APAPs top out at 20cm of pressure, I'll assume that you really are using BiPAPs.

So the questions are: Was the M-series BiPAP running in Auto mode? Is the System One BiPAP running in Auto mode? If you are using Auto mode, do you know what your PS setting on the M-series was? And do you know what the PS on the System One is?

The answer to these questions is important because Resprionics changed how the PS setting in BiPAP Auto works between the M-series and the System One series BiPAPs if I understand what I've read about the M-series BiPAPs.

My understanding of the M-series BiPAP Auto is that:

• Starting EPAP = min EPAP
• Starting IPAP = min EPAP + PS
• IPAP and EPAP increase and decrease together and IPAP-EPAP = PS at all times

On the System One BiPAP Auto it works like this:

• Starting EPAP = min EPAP
• Starting IPAP = min EPAP + 2
• IPAP and EPAP increase and decrease independently whenever 2 < IPAP - EPAP < PS
• When IPAP-EPAP = 2:
  • IPAP and EPAP both increase when EPAP needs to be increased
  • IPAP and EPAP both decrease when IPAP needs to be decreased
• When IPAP - EPAP = PS:
  • IPAP and EPAP both increase when IPAP needs to be increased
  • IPAP and EPAP both decrease when EPAP needs to be decreased

If your PS on the M-Series was significantly greater than 2, then your System One starting IPAP = min EPAP + 2 is now significantly less than your M-series BiPAP starting IPAP = min EPAP + PS. That could easily explain why you feel as though you are not getting sufficient air through the new System One BiPAP Auto running in Auto mode.

One potential switch is to see if the DME would allow you to switch the System One BiPAP Auto for a Resmed S9 VPAP Auto which uses the PS setting in the same way the Resprionics M-series does.

A cheaper thing to try is tweaking your System One BiPAP Auto's settings. Two potential things to try are:

• Auto mode settings: Figure out the PS setting on the old M-series machine if possible. The use the fact that you want your starting IPAP on the System One to equal the starting IPAP on the old M-Series. That means you need to RESET the min EPAP on the System One to the desired starting IPAP - 2cm. In other words, you want to increase min EPAP by (PS -2). An example may clarify what I mean. Let's suppose that on the M-series your PS = 6. So on the M-Series your starting pressures were:
  
  starting EPAP = 5; starting IPAP = 5+6 = 11 since PS = 6 and starting IPAP = min EPAP + 6
  
  To start with an IPAP=11 on the System One, you need to up that min EPAP to 9 so that the starting pressures are:
  
  starting EPAP = 9; starting IPAP = 9 + 2 = 11
• Switch from Auto mode to straight BiLevel mode. I'd suggest using the 90% pressure levels from the old M-Series as the settings for IPAP and EPAP in this case.

[rested gal]

Your home health care RRT is responsible for knowing and understanding not only respiratory therapy but also the various CPAP, APAP and bi-level PAPs and what adjustments can and/or need to be made to make our PAP therapy "work" for us. Right off the bat, I am suspicious of the IPAP 25, EPAP 5 pressure settings. It sounds like some sleep doctor turned you loose w/an auto bi-level to auto titrate your pressure needs and then washed his hands of you. AND your home care company provided you w/the equipment, got the compliance data and payment for the equipment and washed their hands of you as well.

Sure sounds like that's what they did. Not the best way for a doctor to prescribe autotitrating bilevel therapy, imho, if that was to be permanent therapy.

If the machine and those settings were prescribed for a temporary "trial" titration period, both the DME and the doctor should have started checking the detailed data (not just compliance time) within the first week to see how things (especially leak) were going. And to adjust the pressure settings if need be. Just my opinion, though, and I'm not a doctor. There are no formal guidelines or requirements that they have to check anything the first week, but they really should.

Since they've given you two Philips Respironics bilevel autos and both are seemingly not "tracking" your breathing properly, I'd be inclined to ask them to let you try a ResMed S8 VPAP Auto 25. ("VPAP" is ResMed's trademark name for their bilevel machine...BiPAP is Respironics' trademark name for theirs.)

The ResMed machine handles "PS" (the special "pressure support" setting that both brands of bilevel auto machine have) quite differently from the way Respironics does. Might make a difference. But...good luck on getting a DME who keeps giving you Respironics machines to be willing to let you try a ResMed machine. I've used both brands of bilevel autos (including the M series you had) and get good treatment from either brand. I do prefer the ResMed S8 VPAP Auto 25 I'm using now.

[Slinky]

There! See! Even RobySue cares more about you and your therapy and understands more about your equipment than your DME provider's RRT and sleep doctor.

And RestedGal too!!!!

[Cathy2903]

I have to be honest, I have no idea what all these settings are that you are all talking about. I have severe pulmonary hypertension and was evaluated by the sleep lab at Temple University. I was put on BiPap because my CO2 was so high and from what I understand the Bipap brings my CO2 levels down to just slightly above normal because it forces me to take complete breaths. I have never asked about anything because it has worked fine and I slept like a baby with it until it burnt out. At the time I was put on the Bipap I was so seriously ill that I couldn't ask any questions and no one has ever explained anything to me. I do know my Dr asks about my Bipap use to see if I am having any issues everytime I go see him. I have blood gas studies done regularly to gauge how my treatment is working. I don't know what the particular model of the Remstar was as they had me bring it into their office to swap it out with the System One and they are going to return it to the manufacturer as it is still under warranty.

I guess on Monday I will call back and see if I can talk to a respiratory person instead of the customer service person and see if they can figure it out. Thanks for all the info and it occurs to me now I need to educate myself on the terminology and various settings.

[robysue]

Since they've given you two Philips Respironics bilevel autos and both are seemingly not "tracking" your breathing properly, I'd be inclined to ask them to let you try a ResMed S8 VPAP Auto 25. ("VPAP" is ResMed's trademark name for their bilevel machine...BiPAP is Respironics' trademark name for theirs.)

Given the fact that Resmed has released an S9 VPAP Auto, I would NOT recommend going with the older ResMed S8 VPAP Auto 25 at this point: The VPAP Auto 25 is based on the older, now outdated S8 series, and it uses an obsolete proprietary data card with an impossible-to-find data card reader for downloading the data into ResScan. If you want to switch from PR BiPAPs to Resmed, hold out for the newer S9 VPAP Auto in my opinion.

[Slinky]

Oooopsie!!!! Pulmonary hypertension is NOT plain ole vanilla OSA! By all means you should contact both your local DME provider's RRT "and" your sleep doctor and even pulmonologist if necessary to get your therapy straightened out and comfortable ASAP - like yesterday!

"They" won't consider it as such given it is the weekend, but you are almost in an "emergency" situation. PH is NOT something to play around with.

It is NOT Philips Respironics you need to talk to and call Monday. It is the sleep doctor at Temple and the DME supplier's RRT.

[robysue]

Cathy2903,

I agree with Slinky 100%: Pulmonary hypertension is NOT plain ole vanilla OSA!. And you do need to get in touch with your sleep doctor at Temple on Monday. And please speak with the DME's RRT about your situation. And see if the DME has a record of exactly how your old machine was set up two years ago.

I also think you need to get somebody to see you AND the new machine in person as soon as possible. And see if they're willing to see exactly what happens when you are breathing with with the machine. It could well be that some change in one or more of the algorithms used to switch from EPAP to IPAP (and back) or a change in the Auto algorithm (if you are using an auto adjusting BiPAP) may be adversely affecting your response to the newer System One BiPAP. What to do about it will depend on determining how the System One with it's settings is behaving differently than your old M-series BiPAP.

I have to be honest, I have no idea what all these settings are that you are all talking about. I have severe pulmonary hypertension and was evaluated by the sleep lab at Temple University. I was put on BiPap because my CO2 was so high and from what I understand the Bipap brings my CO2 levels down to just slightly above normal because it forces me to take complete breaths. I have never asked about anything because it has worked fine and I slept like a baby with it until it burnt out.

Two years is a long, long time to use a machine and never know what the prescribed settings actually were. But someone somewhere should have a copy of exacty how your old machine was set up. Start by having the RRT compare this machine's settings to the old machine's settings. And ask if the RRT is familiar with how Resprionics has changed the algorithms the machine uses to control how it adjusts the pressures.

And as you work on getting everything sorted out this time, have the RRT who sets up machine each time give you a WRITTEN copy of all of the machine's settings and keep that copy in a safe place. Think if it as keeping a copy of your eye glasses prescription around: Knowing what the prescriped settings on the OLD machine were will always help the tech get the NEW machine set up as close to the old machine as possible whenever something "bad" happens to your machine.

[rested gal]

Since they've given you two Philips Respironics bilevel autos and both are seemingly not "tracking" your breathing properly, I'd be inclined to ask them to let you try a ResMed S8 VPAP Auto 25. ("VPAP" is ResMed's trademark name for their bilevel machine...BiPAP is Respironics' trademark name for theirs.)

Given the fact that Resmed has released an S9 VPAP Auto, I would NOT recommend going with the older ResMed S8 VPAP Auto 25 at this point: The VPAP Auto 25 is based on the older, now outdated S8 series, and it uses an obsolete proprietary data card with an impossible-to-find data card reader for downloading the data into ResScan. If you want to switch from PR BiPAPs to Resmed, hold out for the newer S9 VPAP Auto in my opinion.

I'm sorry I was not clear. I wrote "try" as in "try out" an S8 VPAP Auto just long enough to see if Cathy could have a better experience breathing with a ResMed VPAP Auto than the two PR1 BiPAP Autos they've had her use. It's much more likely a DME who has been dispensing Philips Respironics machines might have an S8 VPAP Auto sitting around (if they have any ResMed machines at all) than the very recently introduced S9 model. If she experienced the same kind of problem breathing with "a" VPAP Auto there'd be no reason to consider a switch further.

Oooopsie!!!! Pulmonary hypertension is NOT plain ole vanilla OSA! By all means you should contact both your local DME provider's RRT "and" your sleep doctor and even pulmonologist if necessary to get your therapy straightened out and comfortable ASAP - like yesterday!

"They" won't consider it as such given it is the weekend, but you are almost in an "emergency" situation. PH is NOT something to play around with.

It is NOT Philips Respironics you need to talk to and call Monday. It is the sleep doctor at Temple and the DME supplier's RRT.

You've got that right, Slinky. Excellent advice.

Hope your doctor or an RRT will take a more active interest in how the bilevel therapy is going for you, Cathy.