Using a Bipap Auto SV and using a Vpap Adapt SV

[-SWS]

Doug, just wanted to see what else you might have picked out of that algorithm

Should I go back to finishing the Resmed fuzzy logic rules or is that too esoteric and dry for this thread? I personally find the freestyle exchange of opinions more satisfying.

So I have no qualms about leaving dry patent description excerpts out of this thread. Served as a holding pattern while you were visiting Anne in the hospital.

I do think the majority of SDB people are, indeed, plain vanilla OSA'ers.

I would hope that somebody in this thread would maintain that view. Because it might be right!

I love it when any group amicably fosters diverse opinions, rather than herding diverse views into consensus thinking. I think our social species has a tendency to do the latter. But to this message board's credit we strive to do the former---let alone with open arms and laughter so often!
.

[sleepindividual]

These observations about the SV machine could be compiled, would make an interesting coffee table book.

[rested gal]

Doug, I think you ought to ponder a little more the points -SWS raised in this post in particular:

viewtopic.php?p=275656#275656

Respironics' statement explicitly says that this machine is intended to treat a compounded condition: a primary breathing condition compounded with a secondary breathing condition---and that they will use a compounded treatment approach (which I have expounded on in great detail rather than ignore).

However, your logic takes that Respironics explicit wording and decouples that compounded condition. You proceed to assert that if this machine can treat a compounded primary and secondary breathing condition, that it can surely treat the primary condition alone!

---

Back to logic, my friend. Here's where your logic starts plugging in inferences. Once you have decoupled the machine's design intent from treating a compounded condition to optionally treating only the primary condition, you imply that the primary condition will somehow be treated with increased OSA benefits. You then infer that OSA gets "tidied up".

And think about this a bit more, too:

But how do you have the slightest clue that SV is "tidying up" your obstructions as opposed to doing exactly what it was designed for, let alone at the measured backup rate of 40 to 70 times per hour?

(bold red emphasis mine)

The BiPAP Auto SV using "SV" (as opposed to being set for just bilevel mode) is "doing exactly what it was designed for" -- being used to correct periodic breathing problems IN ADDITION TO being used to prevent purely obstructive events through EPAP/IPAP settings arrived at through traditional bilevel titration.

So, since you find that the BiPAP Auto SV used with servo ventilation settings lets you sleep better and feel better than you have slept and/or felt when using non SV machines, do you not realize your good results might...just might...indicate that you, yourself, don't have just plain vanilla OSA? And that other Sleep Disordered Breathing issues you might be having occasionally (totally apart from plain OSA) are what the SV part of the treatment is addressing for you - as it is designed to do. Designed to do for people who don't have plain vanilla OSA.

I'm fully aware that the Respironics BiPAP Auto SV can be used as "just a bilevel machine" for treatment of plain vanilla OSA. However, that has not been the point you seem to keep making. You seem to think that servo ventilation should be promoted by the manufacturer for more effective treatment across the board -- even for people with plain OSA.

I'm a believer in "the proof of the pudding is in the eating." For you, Doug, since the BiPAP Auto SV (using servo ventilation) seems to treat you better than non-SV machines, I'd strongly believe that you don't have just plain OSA and that's why the SV suits you....mainly treating your OSA and secondarily treating your other occasional breathing issues....just as it is designed to be used.

Treating periodic breathing (centrals) is quite different from treating residual obstructive problems better. Quite different from "tidying up" obstructive issues, as you seem to think the machine is doing for you. Perhaps the better treatment you get from the BiPAP Auto SV, using its servo ventilation, is handling some degree of periodic breathing you may have. Not dealing with residual obstructive issues. Dealing with periodic breathing issues, in addition to what it is already doing through traditional bilevel settings for the obstructives.

Or in other words, the SV part is not doing a thing for the obstructives. Not "tidying up" obstructive stuff at all. The SV part is doing something completely different -- handling only the periodic breathing episodes.

Your sleep studies, as I recall, found "just OSA" for you. But, as ozij and -SWS have pointed out, who knows how many people who have been diagnosed with "OSA" but actually have more (read periodic breathing) going on at some times during some nights, under some conditions. As you seem to have.

My point has been that IF a person does have JUST plain OSA, there are non-SV machines that can treat them better than the BiPAP Auto SV will treat them with servo ventilation turned on.

[Banned]

Doug, since the BiPAP Auto SV (using servo ventilation) seems to treat you better than non-SV machines, I'd strongly believe that you don't have just plain OSA and that's why the SV suits you....mainly treating your OSA and secondarily treating your other occasional breathing issues....just as it is designed to be used.

I'd have to agree that it is dsm's periodic respiratory controller gain that the SV is tidying-up. Whatever those periodic respiratory controller episodes are, they are not enough to preclude Doug from getting relief on his back-up Vantage (which I found impossible).

My point has been that IF a person does have JUST plain OSA, there are non-SV machines that can treat them better than the BiPAP Auto SV will treat them with servo ventilation turned on.

I agree with dsm that there would be no reason why anyone would not bemefit form an SV, but only in the context that it is probably unlikely that anybody has JUST plain OSA. In other words and inspite of the PSGs to the contrary, ya'all got some periodic respiratory controller gain somewhere. I remember when I suggested to Slinky that she was mature enough to slip into something a little more comfortable (like an SV). Hey, Slinkies happy with her VPAP, dsm uses a Vantage for his travel machine. Clearly, most people do not need an SV, but dsm sleeps better with a SV, why wouldn't you?

Banned

[-SWS]

These observations about the SV machine could be compiled, would make an interesting coffee table book.

Thank you for the kind words, sleepindividual. But I can see it now...

Title: "A Tale of Two SV Machines: Pictures & Essays for the Coffee Table"

Total Sales/Circulation: 11
(proud mothers included in that sales figure)


.

[dsm]

SWS / RG,

More detailed reply later but in short order, the data I have gathered from experiments and including a PSG in 2006 plus a second in 2007 and inspection of me by my esteemed RT (who originally predicted I would show no significant OSA) really don't show anything outside of Vanilla OSA. No Centrals No periodic breathing. But as has been repeated muchly - cpap & auto benefits did not 'seem' to last longer than a few months. Am willing to accept there may be other issues but that takes me back to the 2 PSGs and that they did not see anything beyond a lot of hypopneas & a steady AIs.

To throw those two recent PSGs out is to claim that sleep clinics can't diagnose other than vanilla OSA even if the patient has other factors.
What we have here is SWS & RG saying that in your opinions, the PSGs results aren't acceptable but based on what ? - me saying I get a remarkable improvement from having tried a Bipap SV.

The obvious variation for me is nasal congestion that can cause very slow breathing - I have now learned to switch between nose & mouth & that is ok on a vanilla OSA machine because it doesn't care and for travel will do. But Bilevels do get a bit worked up if the sleeper changes the characteristics of their breathing. The Bipaps prior to the BipapSV seemed very intolerant of my nasal breathing. Other brands weren't.

I am still trying to figure out what it is you are seeking to prove ?

SWS, your point seems to be that yes you will accept that the BipapSV is working well for me but this must be abberrations - you don't seem willing to accept my comments that an SV machine seems to smooth lots of things out (ref SpO2 & Pulse & Sleep etc: ).

RG, not sure really what your point is - I think we all understand that SV machines are sold as expensive solutions (just as the Bilevels used to be) that have been built with algorithms that can normalize irregular breathing and can address centrals. If we accept that my PSGs were correct that Centrals are not a main issue for me. and if we look at any chart from the past few months (off the BipapSV), there is only rarely a score for PB so based on the data from the BipapSV I don't believe we can say that PB is what it is correcting in any measure.

I come back to the results experienced from the use of the machine. These being ...

1) Look at the difference in stability and consistency in the SpO2 / pulse data
2) Look at the consistently low AHI scores (hypops are all but non-existent - although they do show more on non SV machines incl BipapAuto).
3) For me, the nice smooth feeling in switching from Epap to Ipap
4) The clearly deeper and more restful sleep (this has not really altered since day 1)
5) The noticeable (to me ) improvement in alertness and ability to cope with stress

#5 is a winner of a reason for me but I am sure #5 was begat by #4

When I started out to use the BipapSV I was quite convinced it would just be another case of "here's another Bipap that switches from Ipap to Epap partway through my breathing & will go on the shelf" - I expressed my reservations to banned (privately) & he has my permission to confirm that. So it came as a very pleasant awakening (no pun ) after day one to say, hey that was a great night's sleep and that machine was sooo smooth in its Epap-Ipap-Epap transitions. The sleep was deep and restful.

The rest is now history and our ongoing debating about just what has happened

DSM

_________________

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

[-SWS]

I agree with dsm that there would be no reason why anyone would not bemefit form an SV, but only in the context that it is probably unlikely that anybody has JUST plain OSA. In other words and inspite of the PSGs to the contrary, ya'all got some periodic respiratory gain somewhere. I remember when I suggested to Slinky that she was mature enough to slip into something a little more comfortable (like an SV). Hey, Slinkies happy with her VPAP, dsm uses a Vantage for his travel machine. Clearly, most people do not need an SV, but dsm sleeps better with a SV, why wouldn't you?

Your thoughts echo a lot of mine, Banned. I have been wondering how many of us OSA'ers have some kind of irregular breathing---either irrespective of our obstructions or because of our obstructions.

No one breathes perfectly cyclical sinusoids throughout the night. So we all suffer irregular breathing to some natural extent. The question in my mind becomes when does irregular breathing become pathological? I would assume when sleep, biological health, and/or cognition becomes impaired because of that irregular breathing.

Does Doug suffer pathology because of slightly irregular breathing? Perhaps. Does everyone suffer pathology because of slightly irregular breathing? My guess is that they do not. Perhaps there is stratification here similar to UARS: many in the general population presumably suffer high upper airway impedance, but just a subset are sufficiently symptomatic or pathological to suffer UARS.

Perhaps some of the vanilla OSA crowd will enjoy better sleep on either SV model, benefiting from consolidation of breath rate and achieving target volumes. I personally suspect the majority of us OSA patients will not benefit by controller gain compensation. If we all do, then the entire general population could use that SV machine as well.

I think Resmed and Respironics would have very easily discovered that trend by now with their own in-house experiments. And their marketing effort$ would have very eagerly reflected that kind of O$A-efficacy-univer$alism by now (as opposed to Doug having to single-handedly discover it fifteen years later with his highly trusty vanilla OSA diagnosis).




Doug, I thought you earlier cited and agreed with ozij's refrigerator light comment. So now you're saying that your two PSG's can accurately see the refrigerator light whenever the door is closed?

[dsm]

A simple question

Why should anyone do a PSG ?

Can the data be trusted ?

DSM

[-SWS]

A simple question

Why should anyone do a PSG ?

Because a PSG is far better than no diagnostics whatsoever. Sometimes state-of-the-art or gold standard methods still manage to fall short---very short. And PSG's certainly fit that category. Look at all the patients clamoring on all the message boards about that state-of-the-art PSG!

Can the data be trusted ?

Absolutely not. Otherwise a PSG would return 100% sensitivity and 100% specificity for the diagnostic identifications it attempts to perform. And we all know that PSG's do not achieve that---not even close.

Yet another simple question: Do you think your doctor gave you a 100% sensitivity and 100% specificity test for anything?
Answer: certainly not for central dysregulation of all things; nor for mildly complex SA of all things.

SWS, your point seems to be that yes you will accept that the BipapSV is working well for me but this must be abberrations Smile - you don't seem willing to accept my comments that an SV machine seems to smooth lots of things out (ref SpO2 & Pulse & Sleep etc: ).

I think the machine is in all likelihood smoothing out your central respiration. But a complex stimulus/response machine-related sequence may have been inducing some airway narrowing as well.

Now exactly why can't spontaneous BiLevel give you a smoothly inflated airway? Regarding airway physics: inflation is inflation regardless of platform.

So what's really getting smoothed out here by a machine designed to smooth out central respiration, Doug? If not central regulation alone, then you're also smoothing out a physiologically defensive airway reflex. That's not vanilla OSA either by the way.

[dsm]

The blue notes are my responses. I have put a summary at the bottom.

DSM

Doug, I think you ought to ponder a little more the points -SWS raised in this post in particular:

viewtopic.php?p=275656#275656

Respironics' statement explicitly says that this machine is intended to treat a compounded condition: a primary breathing condition compounded with a secondary breathing condition---and that they will use a compounded treatment approach (which I have expounded on in great detail rather than ignore).

The manual states that the machine treats OSA as a primary condition and Centrals and Irregular breathing as a secondary condition. The machine can be run in CPAP or Bipap or SV modes. Respironics tell you how to do it - so you can run the machine how you like

However, your logic takes that Respironics explicit wording and decouples that compounded condition. You proceed to assert that if this machine can treat a compounded primary and secondary breathing condition, that it can surely treat the primary condition alone!

My 'logic' is that I tried using the SV feature & found a lot of very helpful results. I never made a special point that the SV machine could treat Vanilla OSA better than any other OSA machine). This is a misunderstanding on your part & one I addressed more than once in past posts. It probably equals some others & combined with PS active, might better them but that needs further testing - care to do any

---

Back to logic, my friend. Here's where your logic starts plugging in inferences. Once you have decoupled the machine's design intent from treating a compounded condition to optionally treating only the primary condition, you imply that the primary condition will somehow be treated with increased OSA benefits. You then infer that OSA gets "tidied up".

I didn't decouple I quoted from Respironics material. The machine can do CPAP, Bipap & SV modes.

And think about this a bit more, too:

But how do you have the slightest clue that SV is "tidying up" your obstructions as opposed to doing exactly what it was designed for, let alone at the measured backup rate of 40 to 70 times per hour?

(bold red emphasis mine)

SWS invented this 40-70 'events' per hour - the data states that patient initiated breaths are 99.2% - the 0.8% are merely the back-up rate 'tidying my BPM' and are meaningless in proving anything to do with my breathing (other than the PS capability works very well).

' So 'tidying-up' was merely a way of trying to describe what I saw happening. That perception still stands.

The BiPAP Auto SV using "SV" (as opposed to being set for just bilevel mode) is "doing exactly what it was designed for" -- being used to correct periodic breathing problems IN ADDITION TO being used to prevent purely obstructive events through EPAP/IPAP settings arrived at through traditional bilevel titration.

So, since you find that the BiPAP Auto SV used with servo ventilation settings lets you sleep better and feel better than you have slept and/or felt when using non SV machines, do you not realize your good results might...just might...indicate that you, yourself, don't have just plain vanilla OSA? And that other Sleep Disordered Breathing issues you might be having occasionally (totally apart from plain OSA) are what the SV part of the treatment is addressing for you - as it is designed to do. Designed to do for people who don't have plain vanilla OSA.

Yes it might, but who do I trust, my PSG studies or opinions of non-professionals who seem determined to discredit what I am finding ?. Also we keep agreeing that the machine was not released on the market to deal with Vanilla OSA - clearly it is a very expensive way to do so but Respironics state it can do it. !

I'm fully aware that the Respironics BiPAP Auto SV can be used as "just a bilevel machine" for treatment of plain vanilla OSA. However, that has not been the point you seem to keep making. You seem to think that servo ventilation should be promoted by the manufacturer for more effective treatment across the board -- even for people with plain OSA.

Great - at last you agree it can address vanilla OSA - but as already pointed out - very expensively

I'm a believer in "the proof of the pudding is in the eating." For you, Doug, since the BiPAP Auto SV (using servo ventilation) seems to treat you better than non-SV machines, I'd strongly believe that you don't have just plain OSA and that's why the SV suits you....mainly treating your OSA and secondarily treating your other occasional breathing issues....just as it is designed to be used.

This is an opinion. You may well be right but who do I believe, your 'opinion' as a layperson or the PSGs done in our country's best sleep clinic

Treating periodic breathing (centrals) (periodic breathing is not the same as 'centrals' - look at Respironics manual for the Bipap SV) is quite different from treating residual obstructive problems better. Quite different from "tidying up" obstructive issues, as you seem to think the machine is doing for you. I speculated that it might be doing that. For me I don't really mind what it is tidying up, but do care a lot about the results & they have won me over completely. Perhaps the better treatment you get from the BiPAP Auto SV, using its servo ventilation, is handling some degree of periodic breathing you may have. ( that is speculation not backed up by any data from of the charts I published) Not dealing with residual obstructive issues. Dealing with periodic breathing issues, (see comment above) in addition to what it is already doing through traditional bilevel settings for the obstructives.

Or in other words, the SV part is not doing a thing for the obstructives. Not "tidying up" obstructive stuff at all. (but you are ignoring positional apneas ! and Post arousal centrals (that many of us get) The SV part is doing something completely different -- handling only the periodic breathing episodes. Again this is an opinion. There are next to no PB episodes shown in the charts I published - where are you getting your data from to back your opinion ? - it is merely that, your opinion.

Your sleep studies, as I recall, found "just OSA" for you. But, as ozij and -SWS have pointed out, who knows how many people who have been diagnosed with "OSA" but actually have more (read periodic breathing) going on at some times during some nights, under some conditions. As you seem to have. Ozij made the point that maybe many of us have more than vanilla OSA - I thought it a very valid point. So who can really guess what is being 'tidied up' - I can at best can suggest ideas as I have done.

My point has been that IF a person does have JUST plain OSA, there are non-SV machines that can treat them better what is better than a Bipap - perhaps you mean you think there are machines that can equal the SV's Bipap capability - what machine 'might' do it better ?. I agree other machines can do it cheaper.) than the BiPAP Auto SV will treat them with servo ventilation turned on.

DSM


SUMMARY:

Rested Gal your position is (from what I read) - "DSM must have Periodic Breathing or Central Apnea or Complex Apnea" - the basis for your position is that "DSM is getting good therapy from an SV machine therefore he must have one of the conditions the machine was designed for and is listed in the marketing literature". The facts you use to back this up include - opinion, guesswork, rejection of two PSGs conducted by the country's foremost sleep clinic and overseen by the senior staff adviser (respiratory surgeon), and no facts (you don't refer to any of the 3 years of machine data & SpO2 & pulse info I have supplied - you just rely on your amateur opinion. You offer no research of your own but do fall back on some of SWS's 'opinions'.

SWS: The most that SWS has put forward is his opinions along very similar lines plus a peculiar theory where he takes the data from one chart that says 'patient triggered breaths of 99.2%' and turns this into the machine handling 40-70 'events' per hour. SWS, that is patent BS (male cow droppings) - all that statistic tells you is that my average BPM is 14 and that when it varies (as it will for most sleepers) outside the tight target (tracked for 4 mins by the SV algorithm) it will step in and use PS to bring me back to the tracked target. It does not say my breathing is periodic ! - there are probably only 4 charts in 60 nights that show 1 score per night of PB !!!. If however you were to produce statistics from someone else's SV that backed up your unusual theory then it could be looked at as having some sort of merit but without substantiating data it is just an idea (and in my opinion a wild one).

Rested Gal, when you want to claim that I have PB, or Centrals you should support that with some substantiating facts. Pure opinion is just not the way to claim an authoritative point. I have gone to a lot of effort to publish years of data and use that to support my points. When you want to make claims and do so without any research or facts or even data extracted from my own published info, you are only ever expressing your 'opinion'. Facts always trump opinion. It is ridiculous for you, a lay person, or SWS, to tell me my PSG studies (from #1 sleep clinic in the country etc: etc: etc: ) are to be ignored and can't be trusted but that your (& SWS's) unsubstantiated (no supporting facts) opinion should take precedence

In summary this thread was started so I could offer my objective experience in using a Bipap SV and then an Adapt SV - I never started down the path of claiming anything other than what I was experiencing. You & SWS have both turned it into a theme of 'DSM you are not supposed to use an SV if you only have OSA - therefore you clearly don't have just OSA'.

If you have an issue I still don't know what it is other than to repeat my previously posted challenge to you about who is reversing roles in regard to honest lab-ratting vs vendor or medical profession oppression of innovation and open commentary on experience.



Cheers DSM




_________________

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

[dsm]

Tonight have gone back to the Adapt SV and added a reslink.

EEP=10

MinPS=5

MaxPS will default to 20 CMS.

DSM

[-SWS]

SWS invented this 40-70 'events' per hour - the data states that patient initiated breaths are 99.2% - the 0.8% are merely the back-up rate 'tidying my BPM' and are meaningless in proving anything to do with my breathing (other than the PS capability works very well).

Basic algebra is no invention of mine. Credit goes to an ancient Yemeni or Babylonian scholar for that one. But thanks for the complement!

http://www.internetage.com/cpapdata/dsm ... 5jun08.pdf
There we have something very different than OSA-targeted platforms deliver. Even OSA-targeted BiLevel does not rely on timed backup rates. Rather OSA-targeted BiLevel is purely spontaneous. You, my friend, rely on a timed backup:

Average Breaths Per Minute=14.1
Average Patient Triggered Breaths: 99.2%
Therefore Average Breaths Per Hour=846
Therefore Average Machine-Triggered Breaths Per Hour=68

Here, for instance, the BiPAP autoSV machine literally initiates Doug's late or missed breaths 68 times per hour. So are we smoothing out obstructions as Doug suggests, or are we smoothing out respiratory control by consolidating breath rate (exactly as the machine is designed to do)?

And speaking of inventions, I'm having a heck of a hard time finding "OSA tidy up" and even "tri-level" in the medical literature. No credit for any ancient Middle-Eastern scholars there!

SWS invented this 40-70 'events' per hour - the data states that patient initiated breaths are 99.2% - the 0.8% are merely the back-up rate 'tidying my BPM' and are meaningless in proving anything to do with my breathing (other than the PS capability works very well).

Timed backups at the rate of 68 per hour prove that PS is working very well? Algorithmic maintenance of any pressure support magnitude (on any machine) has absolutely nothing to do with algorithmic delivery of timed back ups.

Not only do all the patent description documents bear that fact, but the Power point marketing literature you cited even underscores a significant functional difference for those two.


Cheers, my good friend!
.

[Banned]

all that statistic tells you is that my average BPM is 14 and that when it varies (as it will for most sleepers) outside the tight target (tracked for 4 mins by the SV algorithm) it will step in and use PS to bring me back to the tracked target. It does not say my breathing is periodic !

So, in summation.. Since periodic respiratory gain is not the same as smoothing out respiratory control (irregular breathing), and since everyone has irregular breathing, the SV should be perfectly suited for everybody, and also explain why most people can be happy on any machine, but happier on an SV!

Banned

[Guest]

So, in summation.. Since periodic respiratory gain is...

Not sure what you mean by periodic respiratory gain---since in control loop theory any controlled or dyscontrolled system has gain. The SV algorithm compensates gain-related dyscontrol by responsively addressing both freqeuncy (via back up rates) and amplitude (by adaptively varying the magnitudes of PS).

not the same as smoothing out respiratory control (irregular breathing)

If the above isn't smoothing out respiratory control by design, then I don't know what is.

...and since everyone has irregular breathing, the SV should be perfectly suited for everybody

That's assuming that irregular breathing always entails symptomology or patholgy. And I doubt you will find anybody in the field of medicine or science who will agree with that statement.

Just my take. So take it with a grain of salt. I hope everyone takes every single opinion in this thread with a grain of salt.
.

[Banned]

Not sure what you mean by periodic respiratory gain--

Periodic respiratory controller (disorder).

DSM emphatically states that his world class PSGs show no periodic respiratory controller disorder, but the SV smooths out his irregular breathing. Assuming irregular breathing does not entail symptology or pathology, would the SV still help?

Banned