Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

[mdboze]

For the Respironics BiPAP autoSV Advanced
Can anyone help explain the PS Max: 7 -----PS Min:7 settings?
What is the PS setting ?
Why a Min and Max ?
What it the Min and Max are set to the same number ?

Since the DME made a mistake on my EPAP min/Max settings (setting them both to 12, instead of 7min, 12max),

I am concerned that my DME made a similar mistake on the PS Min and PS Max settings.

A picture of my settings.

Anyone reading this: DO NOT USE THE ABOVE SETTINGS AS A REFERENCE - This machine was setup incorrectly.

[JohnBFisher]

... For the Respironics BiPAP autoSV Advanced ... Can anyone help explain the PS Max: 7 ----- PS Min: 7 settings? ... What is the PS setting ? .... Why a Min and Max ? ....What it the Min and Max are set to the same number ?

Since the DME made a mistake on my EPAP min/Max settings (setting them both to 12, instead of 7min, 12max),

I am concerned that my DME made a similar mistake on the PS Min and PS Max settings. ...

Using the Respironics manuals, at:

http://bipapautosvadvanced.respironics. ... Manual.pdf
http://bipapautosvadvanced.respironics. ... otocol.pdf
http://bipapautosvadvanced.respironics. ... _Guide.pdf

I will take a running stab at it. Sorry I had missed that question in your ealier post.

From what I see, the Respironics BiPAP AutoSV Advanced uses Pressure Support (PS) to add to the EPAP (exhalation positive airway pressure) to reach the IPAP (inhalation positive airway pressure). PSmin is the minimum addition over EPAP (whatever the current EPAP value). PSmax provides the maximum increase over EPAP (again whatever the current EPAP value). Your DME did what the Respironics rep suggested. They set the minimum increase during inhalation (PSmin) to 7. They also set the maximum increase during inhalation (PSmax) to 7. The titration guide starts at PSmin of 0cm H2O (CPAP mode) and increases that to make breathing more comfortable / effective. It also starts the PSmax at 15cm H2O and increases that 2cm H2O at a time if continued problems with periodic breathing (or central apneas) are noted.

Short answer: It appears your DME mangled the PSmin and PSmax settings. I would discuss this with your sleep doctor.

I found the following note from one of your prevous posts:

I was persistent to the point of finding and contacting the local Respironics sales rep. He helped them convert the setting from the sleep stud results to be used with the BiPAP autoSV Advanced. And I got the one I wanted !

Since he converted from the ResMed VPAP Adapt SV unit to this, the result was a bit strange. I would probably make the PSmin a minimum of 4 (this allows enough seperation of EPAP to IPAP to provide BiLevel support. This is important if you have CSA, as straight CPAP can trigger CSA events. I would then probably increase PSmax to 15 ... But I *HIGHLY* recommend you do that in stages, working with your doctor and RT, and monitor your therapy by using EncoreViewer to see if the high end seems to trigger more apnea events.

By the way, depending on the severity of your condition PLEASE be very careful when you adjust these settings. You really should include your doctor and RT in the process. You should also CLOSELY monitor your progress with the data. You only note you have CSA, not any cardiac problems. So, making such changes is probably not too bad for you. But it is possible to make changes on this machine that makes it hard to breathe at night. If you had a cardiac problem that could actually be quite dangerous.

So, I always suggest that anyone using an ASV unit should include their doctor and RT in the decision to change the therapy settings.

Hope that helps.

[Banned]

I am concerned that my DME made a similar mistake on the PS Min and PS Max settings.

You are correct, they did make a mistake.

You will want to increase PS Max.

Your PS Max should read 22cm, not 7cm.

The (22cm) increase will put PS Max at 10cm above your EPAP Max 12cm.

10 cm is the generally recognized sleep medicine standard for separation between EPAP Max and PS Max.

Banned

[Slinky]

WhiteBeard, at apneasupport.com, is the most experience user of the Adapt SV and Adapt SV enhanced that I know and so my comments were based on his experience w/the two. I know he would be willing to discuss his experience w/both w/you. I'm outta my league since I left CPAP for VPAP.

[dsm]

As banned has pointed out, someone got the PS settings wrong as well.
It is a worry. This machine is now extraordinarily complex to set.

DSM

[mdboze]

Thank you:

JohnBFisher,
Banned,
dsm,

for your feedback regarding the PS settings on my PiPap autoSV Advanced.

Rather than just make the PS change myself, I called my DME who set it up the unit to confirm the correct settings, they will call me back tomorrow.

Since I know they set EPAP min=12 ; EPAP max=7 (which was backwards) whch caused both min and max setttings got set to 12.
I'm 95% sure they also got the PS settings backwards and set PS min=20 and PS max=7, which caused both PS max and min to get set to 7.

But to be sure.... I'll wait for their call tomorrow.

Hmm-mmm...
If the DME found out that I know how to get into the setup mode; I bet they will think I changed it, and not take ownership of the screwup.
Anyone known if accessing the setup is logged on the smartcard ?

[dsm]

Thank you:

JohnBFisher,
Banned,
dsm,

for your feedback regarding the PS settings on my PiPap autoSV Advanced.

Rather than just make the PS change myself, I called my DME who set it up the unit to confirm the correct settings, they will call me back tomorrow.

Since I know they set EPAP min=12 ; EPAP max=7 (which was backwards) whch caused both min and max setttings got set to 12.
I'm 95% sure they also got the PS settings backwards and set PS min=20 and PS max=7, which caused both PS max and min to get set to 7.

But to be sure.... I'll wait for their call tomorrow.

Hmm-mmm...
If the DME found out that I know how to get into the setup mode; I bet they will think I changed it, and not take ownership of the screwup.
Anyone known if accessing the setup is logged on the smartcard ?

mdboze

I don't believe so - the card can be used to change the settings but it doesn't create an activity log of what you do on the machine other than the internal data does show what settings were on each day.

The way the EpapMin & EpapMax work from what I understand after looking at the titration guide (this is only my interpretation) ...

A:
EpapMin = starting Epap Pressure & thus the base pressure off which other pressures happen
EpapMax = the pressure the machine will go up to if OSA events are detected and dealt with

B:
PSMin = gets added to epap. Thus, sets the gap between epap & ipap (in this case, epap is what ever pressure the machine is currently at allowing A: above)
PSMax = gets added to the current epap to determine the max pressure that the SV support will ramp up to if SV events are being responded to. SV will only work if PSMax is greater than PSMin.


Assuming the above is correct then it probably means the following will happen ...

If EpapMin were set to say 8 CMs & EpapMax were set to say 12 CMs then the machine has a 4 CMs range to adjust epap if it detects snoring & obstructive (close airway) apneas.

If PSMin were set to say 3, then when epap=8, ipap would be at 8+3 but as epap gets raised by detected OSA events ipap would also rise with epap. Thus if after 4 hrs sleep the machine had raised epap to 10 CMs in response to OSA events, then ipap would be running at 13 CMs at that time. If EpapMax (12) got reached then ipap would nominally be at 15 CMs.

If PSMax is set to the same value (or less) than PSMin then SV support is not active.
If PSMax is set to a value above PSMin, then SV is activated & if PB or CA (open airway apnea) or other monitored activity is detected the SV algorithm will kick in. SV while doing its support will stop when it reaches PSMax above current (instantaneous) epap pressure.

So if we set PSMin to say 3 and PSMax to say 15, then at the start of the night we would see ...
epap=8 - ipap=11
epap auto titration would have the potential to increase epap from 8 to 12 as required, if osa gets detected & epap gets raised, both epap & ipap will be increased by the same pressure value as already indicated.

SV would be able to add up to 15 CMs above what ever the current epap was at the moment SV got activated.

SV attempts to bring the user back to target (normalize) av peak flow within 3 breathing cycles.


DSM

[dsm]

Here is an example of how I would set up such a machine based on my Vpap Adapt SV settings being
EEP = 10 (equiv to epap) & PS=3 (On the Vpap Adapt PS defaults to 3).

1st I would set EpapMin to a value of 9 (1 under what I know works well for me)
2nd I would set epapMax to 11 as I know that is all I would ever need for epap
3rd I would set PSMin to 3 CMs
4th I would set PSMax to 15 (That limits the max that SV would ramp up to as 9+15 thru to 11+15)

The result would be EpapMin set to 9, EpapMax set to 11, & PSMin & Max as indicated above.
I would then set risetime to 3. & BPM=Auto.

At this point I would be satisfied that the Bipap Auto SV was pretty close to what I would have had on the Vpap Auto SV. Except, that I have activated the epap auto titration for OSA events & that isn't available on the Vpap.

DSM

[Banned]

3rd I would set PSMin to 3 CMs
4th I would set PSMax to 15 (That limits the max that SV would ramp up to as 9+15 thru to 11+15)

I'm beginning to see where you are coming from.
I was originally thinking the Respironics BiPAP Auto SV Enhanced used Ps Min = IPAP Min. Conversely, PS Max = IPAP Max.

But you are probably correct. Respironics may well have STOLEN the page from ResMed that says EPAP Min (EEP) + PS Min = IPAP Min.

In which case, Mdboze's current PS Min 7cm is probably excessive and should be lowered to 4cm. Conversely, I would adjust his PS Max to 10cm.

I need mdboze's machine, even if it means tearing the mask off his face and walking away with it! LOL!!
What I really need is the Provider's Manual for this device.
The BiPAP Auto SV Enhanced definitely sounds intriguing.

Sounds like a great machine for long-haul flights where you can't lie-flat.

Banned

[mdboze]

Good explanation dsm, I think I understand how the settings work now.

I created a Graph to show the Pressure range based off of the numbers from dsm:
EPAP min=8 EPAP max=12 PSMin=3 PSMax=15



The Image Below is based off the settings used by my DME setting of: EPAP min=12 EPAP max=12 PSMin=7 PSMax=7


Which one do you think would has the most potential to help CSA !
From what I understand how it works now, the way they set it up, the machine can't provide a dynamic range for the "SV" and "Advanced" features to do anything. As the graph above shows.

Even for a machine that is setup wrong, It is very smooth, and doen't try to take control.
Tonight, I talked with the DME person who setup my unit. She said she used numbers from the Respironics rep. who used an algorithm to calculate the settings. From the wrong terminology she used when referring to the settings, I know she is not familiar with this machines settings, (it is very new). When I told her I thought it was setup wrong, I could tell she did not like that. She will contact Respironics tomorrow and get back with me to confirm the settings. Meanwhile, I emailed her the picture I took of the machines setting.
I look forward to seeing what this machine can do when setup right.

I already noticed a BIG difference over the last 2 nights, after I changed EPAP Min from 12 to 7.

Here is the Site I used to create the graphs
http://nces.ed.gov/nceskids/createagrap ... 748d04c115
That directly link you to the first graph, if you want to modify it.

[dsm]

3rd I would set PSMin to 3 CMs
4th I would set PSMax to 15 (That limits the max that SV would ramp up to as 9+15 thru to 11+15)

I'm beginning to see where you are coming from.
I was originally thinking the Respironics BiPAP Auto SV Enhanced used Ps Min = IPAP Min. Conversely, PS Max = IPAP Max.

But you are probably correct. Respironics may well have STOLEN the page from ResMed that says EPAP Min (EEP) + PS Min = IPAP Min.

In which case, Mdboze's current PS Min 7cm is probably excessive and should be lowered to 4cm. Conversely, I would adjust his PS Max to 10cm.

I need mdboze's machine, even if it means tearing the mask off his face and walking away with it! LOL!!
What I really need is the Provider's Manual for this device.
The BiPAP Auto SV Enhanced definitely sounds intriguing.

Sounds like a great machine for long-haul flights where you can't lie-flat.

Banned

Banned,

I don't think Respironics stole anything - the settings are basically an amalgam of the Bipap Auto (with Biflex) and the Bipap Auto SV. Just some of the names have changed & setting (PSMin) was added plus setting EpapMax was added. Otherwise we are looking at one machine married from two very successful & proven machines.

It always looked like a high probability to me that Respironics would add the AUTO (OSA detection & treatment) algorithm to the Bipap Auto SV epap setting. In looking into it though it seems possible that they actually added the Bipap Auto SV's SV algorithm to the Bipap Auto - But, what ever they did they married the two & both have a good track record. IIRC, The Bipap Auto (with BiFlex) came out in 2006 & was a big hit almost immediately.

DSM

[dsm]

mdboze

That is a very good chart & illustrates the various parts of the pressure settings well.
I sure want to believe we got it right & that kind of says we did.

Of course, that lighter green band squashes & rises in the range of 8 to 12 (EpapMin & EpapMax, based on OSA monitoring & all the colors above rise & fall based on what epap is doing at any point in time. The vertical aspect of that chart would be accurate when epap has been adjusted up to EpapMax.

Cheers

DSM

Some other possibilities ...

To dissable AUTO (epap) support just set EpapMin to 8 & EpapMax to 8 (thus no OSA AUTO adjusting will take place). This
could be done in any of the below suggestions.


To run it as a Cpap AUTO (epap) I would
Set EpapMin to say 8 or 9
Set EpapMax to say 15 or 16
Set PSMin=0 & PSMax=0
That should run as an AUTO


To set it as CPAP AUTO (epap) with SV support
Set EpapMin to say 8 or 9
Set EpapMax to say 12 or so
Set PSMin=0 & PSMax=10 to 15 (no ipap but SV is activated which creates an ipap as required if SV algorithm detects events)
That would run as a CPAP AUTO with SV activated


To set it as a Bipap with AUTO (epap) Support & no SV support
Set EpapMin to say 8 or 9
Set EpapMax to say 15 or 16
Set PSMin=3 & PSMax=3 (ipap 3 above epap but no SV support)


To set it up as a Bipap with AUTO (epap) support and SV support
Set EpapMin to say 8 or 9
Set EpapMax to say 11 or 12
Set PSMin=3 & PSMax=15
To set it up as a Bipap with AUTO support & SV support

[Banned]

To set it up as a Bipap with AUTO (epap) support and SV support
Set EpapMin to say 8 or 9
Set EpapMax to say 11 or 12
Set PSMin=3 & PSMax=15
To set it up as a Bipap with AUTO support & SV support

We both agree that his PS Min 7 is excessive, but if he is happy, I'm happy.

So, why would you choose PS Max 15 over PS Max 10?
I thought you were an advocate for the party line about 10 cm maximum between EPAP (in this case EPAP Max) and IPAP Max.

Banned

[dsm]

To set it up as a Bipap with AUTO (epap) support and SV support
Set EpapMin to say 8 or 9
Set EpapMax to say 11 or 12
Set PSMin=3 & PSMax=15
To set it up as a Bipap with AUTO support & SV support

We both agree that his PS Min 7 is excessive, but if he is happy, I'm happy.

So, why would you choose PS Max 15 over PS Max 10?
I thought you were an advocate for the party line about 10 cm maximum between EPAP (in this case EPAP Max) and IPAP Max.

Banned

Banned,

The machine doesn't ramp up pressure by 10 CMs in one breath. Also, I am a convert to the fact that when needed, epap to ipap gaps of 10-15 are ok *if used to get you breathing* - if you have stopped or are stoping breathing, then a short burst of 10+ CMs is entirely viable.

Have you *ever* seen SV pressure support for you go higher than 20 CMs ? (allowing the epap is say 10 CMs) - if yes then you would have a real dose of *severe* cental apnea. I think JohnBFisher has said his can (23) - that is *very* high & reflects a serious effort by the machine to 'inflate' the user.

Now if you had epap set at 10 CMs on a Bipap Auto SV & set PS max to 15 (which becomes 10+15 and whatever the EpapMin/EpapMax gap might add ) then you have a generous range.

NOTE - THIS IS MY 'educated' OPINION ...
As I understand the Bipap Auto SV, when in SV response mode, doesn't raise pressure more than approx 3 CMs in one breath & no more than approx 9-10 CMs in any one SV event (3 breaths to normalize). These numbers are my best approximate from tests I have done & are consistent with data in the patents & the other product data looked at. If after one event a user is still not responding I believe the Bipap Auto SV will start another 3-breath cycle which technically adds a further 9-10 cms (if it is available via PSMax & the machine 30 CMs max). BUT, it is also possible that the machine doesn't start the 2nd cycle I just mentioned because it also seems feasible that it already hit max pressure for the current event by dividing what pressure was available, at the start of the event, by 3 & just kept adding that number until 3 breaths had occured. I am still looking into this.

The Vpap Adapt SV is different, I believe it can ramp up pressure even higher & quicker (which is why leaks are so critical). My quattro mask (18 months old) actually tore last night & I had to go back to a Mirage F/F and the night went pear shaped (frustration supreme) as that mask never did work well with the Vpap Adapt SV. All I got was squeaks & pharts & leaking. The Vpap Adapt SV can be quite miserable if the mask doesn't match it or the leaks are excessive. But, when the mask matches it is like flying high. ChistineQuilts (a very informed past member) described it (IIRC) as being like a perfect waltz.

When I say the Vpap Adapt SV is 'commanding' I believe that is because it will ramp pressure higher faster than the Bipap Auto SV & why the mask seal is critical & why the proximal pressure sensing line up to the mask is so important to how it works.

Again, each machine has its uniqueness. I really appreciate the two models covered but would love to get my hands on a Weinmann SOMMNOvent CR

DSM

[mdboze]

We both agree that his PS Min 7 is excessive, but if he is happy, I'm happy.

Banned

Actually I'm not happy the the PS MIN =7 and PS Max =7 setting. Air leaks out my mouth when using the nasal pillow.

Last night, rather than wait to hear back from the DME to confirm the correct settings, I tried the following:
PS Min = 5
PS Max = 10
I figured a small PS change for both settings, while leaving my previous mod of EPAP Min = 7, EPAP Max =12 alone.

I use a Nasal PIllow. These new PS settings stopped the mouth leaks that would occur thru the night... making my lips flap occasionally & dry out my mouth and throat badly.
I now assume it was because PS Min was too high.

Setting are Getting noticeably better. I'll let you know what the people at my DME say it should be.