M Series Bipap Auto with Biflex Operating Modes

[GeneS]

Does anyone know what modes the Respironics M BiPap Auto with Biflex will operate in. Can it be used as an Auto Apap with A Flex then changed to operate as a bipap if higher pressures are required? Which machine do you recommend.
GeneS

[GumbyCT]

In my manual "Available Therapies" on pg 4-1 - Aflex is another machine.

http://global.respironics.com/UserGuide ... serMan.pdf

[rested gal]

Does anyone know what modes the Respironics M BiPap Auto with Biflex will operate in. Can it be used as an Auto Apap with A Flex then changed to operate as a bipap if higher pressures are required? Which machine do you recommend.
GeneS

The BiPAP Auto cannot be operated as just an "autopap" nor does it have "A-flex." The "flex" feature is similar, but it's "Bi-flex" in the bilevel machine and "A-flex" in the autopap.

The BiPAP Auto is first and foremost always a "bilevel" machine and has to have an inhale (IPAP) and EPAP (exhale) pressure set. It delivers a higher pressure for inhaling and a lower pressure for exhaling. It never can be used as "just" an autopap. It can be operated in these modes:

Bilevel == one fixed IPAP (the higher Inhale pressure) and one fixed EPAP (the lower Exhale pressure.) Bi-flex can be turned on if you wish.

Bi-flex is like icing on the cake for the already lower exhale pressure, dropping the START of the exhale down even a bit more. Makes it very easy to get breathing out started each time you exhale. If bi-flex is not turned on, then another setting will appear later in the menu... a setting called "Comfort Rise" that lets you set how quickly (in milleseconds) the machine will deliver the FULL IPAP pressure each time you start to inhale.

You can use "bi-flex" OR a "Comfort Rise (time)" -- you can't use both at the same time. You can also have both turned off.

Auto Bilevel -- a minimum EPAP that will vary as needed and a maximum IPAP that will vary as needed. No matter how high you set the maximum IPAP, the machine will start out each time using only 2 cms more than the EPAP you've set. Again, you can choose bi-flex or comfort rise, if you wish.

When in Auto Bilevel mode, there's an additional setting called Max Pres Sup (maximum pressure support) which governs how far away from EPAP the IPAP is allowed to go. For an explanation of the "PS" or "Max Pres Sup" (same thing) check out these topics:

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

CPAP The bipap (and the bipap auto) machine can also be set to operate as if it were a straight cpap. Put it in bilevel mode and set the IPAP/EPAP pressures to the same number, like both set for 10. If you turn bi-flex on, you'll get some drop at the beginning of each exhalation, much like the feeling of C-flex in a cpap.

Actually an "autopap" is really just a cpap, delivering one straight pressure at any given time. An autopap (APAP) is an "autotitrating" cpap machine...varying the one single pressure as needed. Even though a range of pressure is set (like 10 - 20) an autopap uses only one pressure at a time.

[xyz]

> The BiPAP Auto is first and foremost always a "bilevel" machine and has to have an inhale (IPAP) and EPAP (exhale) pressure set.

But can't you set the "max pressure difference" (whatever that term is in Respironics-speak) down so that, in effect, it is operating similarly to how an apap operates? e.g., a difference of 2-3 cm or whatever. 8 is the max difference, I think, and 2 the min.

Not that I can see any reason to do this, but it addresses the question of whether the bipap can operate in apap mode. "Kinda, sorta, but not exactly."

Related to this, I now wonder if I could have gotten by with an Auto M apap by using the max amount of aflex instead of the Auto m bipap (which I like a lot). I have turned down whatever the bipap calls its aflex-like capability to the minimum 1. With the drop in pressure that is due to the bipap feature, I could never detect any difference, or indeed any effect, of flex settings of 1, 2, or 3.

[rested gal]

> But can't you set the "max pressure difference" (whatever that term is in Respironics-speak) down so that, in effect, it is operating similarly to how an apap operates? e.g., a difference of 2-3 cm or whatever. 8 is the max difference, I think, and 2 the min.

Not that I can see any reason to do this, but it addresses the question of whether the bipap can operate in apap mode. "Kinda, sorta, but not exactly.

Good point, xyz. Yes, the machine could be put into auto bilevel mode, set the Max IPAP at 20, the min EPAP at 8 (for example), and the "max press sup" at the lowest gap you can set for that... "3 cm H2O." That would keep IPAP and EPAP fairly close together no matter what either of those pressures needed to do during the night.

The machine would start out at EPAP 8, IPAP 10 since in auto bilevel mode it always starts out at a 2 cm difference even if you set the "max press sup" for as low as you can...a 3 cm gap. Whichever of those two (IPAP/EPAP) had to go up during the night would drag (or push, as the case might be) the other up, too.

So, yes, what you described, xyz, would come as close as anything a person could do to get a bipap auto machine to work "kinda, sorta, but not exactly" like a pure autopap. And with at least two to three cms of pressure relief for exhaling all the time.

It can't ever be used as a true autopap "only", but those settings could make it work "kinda" like an APAP. Thanks for thinking of that, xyz. I knew it was a versatile machine. You just made it even more versatile!

[GeneS]

Thanks for the information on the M type machines. I have been thinking of trying a M Type with A Flex but I am close to 20 cm now and my pressure could go up making the machine ineffective. Although pressure does not seem to bother me a lot I would probably be better off with a bipap. It will go to 25 cm. I do not think my software would know if I am having central apneas. I would be less likely to have them with bipap. I have used bi paps in the past but they did not have aflex or cflex. I am doing ok right now with a Tank Auto CPap with C Flex but need to look to the future.
GeneS
GeneS

[jerryinpa]

Is it OK for a dumb question?

I have a Respironics Auto Bi-PAP, M Series, with Bi-flex.... same exact machine as the original poster.

First, I have to say that the folks here consistently humble me with your awesome amount of knowledge. I sincerely mean this, and I appreciate all the help I've received.

My sleep Doc had it set to start at 5 and 7 when I first got it a few months ago. It ramps up on the Auto Function to whatever the computer inside it needs and I don't do anything with it except sleep.

The fellow from the DME provider thought that the Doc would establish different starting pressure when I went for my first visit around 30 days into therapy, but the Doc just said to leave it on Auto, BiPap, and the same 5 and 7 starting settings.

Again, all I do is sleep with it. It seems to work. I feel fine.

Is the Doc being lazy? Am I being lazy?

It seems to be an incredibly sophisticated machine... capable of so much.

Is there anything wrong with me just using it in the fully automatic mode and nothing more?

Jerry.

[xyz]

> My sleep Doc had it set to start at 5 and 7

Do you have a sleep study that recommended a certain pressure? Or the doctor might have just taken a stab at it.

> The fellow from the DME provider thought that the Doc would establish different starting pressure when I went for my first visit around 30 days into therapy

That should certainly be the case if there was no initial sleep study.

> the Doc just said to leave it on Auto, BiPap, and the same 5 and 7 starting settings

There is a potential problem with that, mentioned here often by others. By starting with a too low pressure, it takes a machine too long to get up to a pressure that is most effective for you. By reading my card data I found that I was sitting too long at a too low pressure. I bumped it up by just 1 and my H, OA, and AHIs were lowered.

But I wouldn't do that blindly -- without having before and after card data.

Your doctor should help you with this. Is your doctor a sleep specialist?

[jerryinpa]

[quote="xyz"]> My sleep Doc had it set to start at 5 and 7

Do you have a sleep study that recommended a certain pressure? Or the doctor might have just taken a stab at it.

> The fellow from the DME provider thought that the Doc would establish different starting pressure when I went for my first visit around 30 days into therapy

That should certainly be the case if there was no initial sleep study.

> the Doc just said to leave it on Auto, BiPap, and the same 5 and 7 starting settings

There is a potential problem with that, mentioned here often by others. By starting with a too low pressure, it takes a machine too long to get up to a pressure that is most effective for you. By reading my card data I found that I was sitting too long at a too low pressure. I bumped it up by just 1 and my H, OA, and AHIs were lowered.

But I wouldn't do that blindly -- without having before and after card data.

Your doctor should help you with this. Is your doctor a sleep specialist?



Yes, I did have two sleep studies. First night they just established that I had 26 average per hour. Second sleep study they put me on two different masks and worked with the pressures. I suppose this is where he got the 5 and 7 pressures. After a month on the machine and reading the smart card report, he said to leave everything where it was.... 5 and 7, and the machine fully automatic. The odd thing in my mind was that the 90% values per the machine's report were 6 and 9... and that's what the DME therapist sort of thought the Sleep Doc would go to.... but he didn't. Go figure?

I'm feeling OK right now, but if I ever don't feel so well, I think I'll drag the smart card over to my DME and ask him to read it and give me his off-the-record thoughts on it. I'm only about 60 days into therapy and overall I'm doing well, so I don't want to rush into anything too fast. I'm elated to just feel as well as I do after so many years of feeling so tired.

I'm suspecting, as you said, that starting too low might just give less time for the pressures to get where they need to be.

Thanks for your thoughts,

Jerry.

[rested gal]

After a month on the machine and reading the smart card report, he said to leave everything where it was.... 5 and 7, and the machine fully automatic. The odd thing in my mind was that the 90% values per the machine's report were 6 and 9... and that's what the DME therapist sort of thought the Sleep Doc would go to.... but he didn't. Go figure?

Since you're using a BiPAP Auto, it sounds like the machine is set in auto bilevel mode with min EPAP set at 5. You'd have to look at your settings (in the therapy setup menu) or ask your DME or look at your prescription to see what the max IPAP is set for....likely "20".

With a report of 90% EPAP 6 and 90% IPAP 9, I don't think it's strange at all that the doctor would leave your min EPAP setting at 5. That's close enough to the "6" EPAP you need 90% of the time.

And the machine's IPAP is not having to go up very far from the "7" it starts out at, to get to the "9" it's using for you 90% of the time.

Sounds like your settings are fine as they are.

All that said, it probably wouldn't hurt at all, and might help to raise the min EPAP to 6. The machine will start out using 6 for exhaling and 8 for inhaling. Not that different from what it's starting out for you anyway.

It apparently doesn't take an very high pressure to keep your airway open. You're lucky.

Jerry, if you'd like to have the Provider manual for your machine so you could go through the menu and check the settings yourself, PM me your email address. I'll be glad to send you a PDF of it.

[jerryinpa]

After a month on the machine and reading the smart card report, he said to leave everything where it was.... 5 and 7, and the machine fully automatic. The odd thing in my mind was that the 90% values per the machine's report were 6 and 9... and that's what the DME therapist sort of thought the Sleep Doc would go to.... but he didn't. Go figure?

Since you're using a BiPAP Auto, it sounds like the machine is set in auto bilevel mode with min EPAP set at 5. You'd have to look at your settings (in the therapy setup menu) or ask your DME or look at your prescription to see what the max IPAP is set for....likely "20".

With a report of 90% EPAP 6 and 90% IPAP 9, I don't think it's strange at all that the doctor would leave your min EPAP setting at 5. That's close enough to the "6" EPAP you need 90% of the time.

And the machine's IPAP is not having to go up very far from the "7" it starts out at, to get to the "9" it's using for you 90% of the time.

Sounds like your settings are fine as they are.

All that said, it probably wouldn't hurt at all, and might help to raise the min EPAP to 6. The machine will start out using 6 for exhaling and 8 for inhaling. Not that different from what it's starting out for you anyway.

It apparently doesn't take an very high pressure to keep your airway open. You're lucky.

Jerry, if you'd like to have the Provider manual for your machine so you could go through the menu and check the settings yourself, PM me your email address. I'll be glad to send you a PDF of it.

Thanks RG,

Maybe I'm just splitting the hairs a little too fine... an EPAP of 6 is indeed close to EPAP of 6.... I'm only 60 days into this and I'm still learning this new field of knowledge!

As so many of us newbies here are always saying... this group, and you ma'am, are a Godsend.

I'll PM you for the PDF file.

Thanks,

Jerry.