Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

[dsm]

mdboze & banned,
The most trecent settings are looking better but I must admit I would be *very* reluctant to *ever* see my epap set below 9 even if it is being auti titrated.

I agree with you dsm,

Let's get Mdboze back to 'feeling' normal (which is probably EPAP Min 7, EPAP Max 12, PS Min 7, and PS Max 15).

Then I would ask Mdboze to trial EPAP Min 9, EPAP Max 12, PS Min 5, and PS Max 15. These settings would raise his EPAP mildly while maintaining his 'IPAP Min' at 14cm.

Banned

Banned:
On my BiPAP AutoSV Advanced, I tried the settings you suggested: EPAP Min 9, EPAP Max 12, PS Min 5, but with PS Max 13 instead of 15; Since my total pressure Max is set at 23cm, I set PS max = 13, (EPAP Min 9 + PS Max 13 = 22cm), I probably should have set it to 14, so I could at least reach the max pressure if needed while EPAP was at its min 9.

Morning Report:
I slept though the night and feel ok. I just wish I could have slept longer, but its my turn to get up with our 3 year-old and he woke up at 6am. Hmm-mm is there a setting in the machine for that ? lol.
Overall these settings worked ok; I woke up a few times; felt uncomfortable when dozing off every time, as if I was not getting enough air. Or if I held my breath, I didn't feel like it helped "strongly enough", fast enough giving me a slight urge to gasp for air. Possibly this is due to the IPAP-EPAP differece being as low as 5; causing it to take a few auto-breaths to ramp up, to get me the air I needed at a comfortable level.

I also determined that PS Max should not be above 15cm. From the BiPap autoSV reference guide, tritation protocol section: it says to stop increasing IPAP max if it is greater than 15mc above EPAP.

The "PS" setting is the pressure difference from inhalation to exhalation (IPAP to EPAP). They probably know that greater than a 15 cm difference would be too uncomfortable or somehow bad for you.

Just to clarify, in titration they increase PS MAX 'while observing PB & Centrals. If the PB & Centrals are not being adequately dealt with when the SV algorithm kicks in, the clinic will increase PSMax. The PS Max number is used by the Servo Ventilation algorithm, it isn't part of the normal epap-ipap gap. The normal epap-ipap gap is set with PSMin. If no PB or Centrals were to occur your machine would spend the night at epap & normal ipap (epap + PSMin). During the night, if your breathing rate shifts from the current target cycling kicks in (cycling is switching from epap to ipap to epap ...), or your peak average flow looks like it won't reach the current target, SV kicks in & increases the nominal epap-ipap gap for each breath that SV activity remains active. If both rate target and Av Peak Flow target are below the current targets, the machine does both cycling and activating SV pressure support.

On the advanced Auto SV there are two very important algorithms, the epap auto titrating algorithm (very slow acting - takes minutes to raise the epap pressure in response to detected osa events), and the SV algorithm, which can boost ipap by 3 CMs in a single breath in response to PB & Centrals events. SV being raised & lowered quickly & by a big gap, is very acceptable when it is being used to overcome centrals (& PB).

As I have said before, your EpapMin is rather low & thus that plus PSMin have you breathing at a very low pair of epap/ipap settings. You are relying on the slow auto titration algorithm to fix that but it takes minutes to raise epap. The SV algorithm will do it in split seconds. I suspect that setting EpapMIn so low is creating problems of its own for you adjusting to this machine. Again, if it were me, I'd get the SV algorithm running to satisfaction before activating EpapMIN / EpapMAX as that is clearly already skewing what you are experiencing.

My best advice then is deactivate the Epap Auto titration by setting EpapMin = EpapMax = whatever your clinic previously recommended as your 'normal' epap setting. I believe it was around 9 ?. By taking slow acting epap auto titration out of the procedure, you can concentrate on adapting to the machine as a bilevel with SV (fast acting). The Epap auto titration adds too many complexities at a time you are learning to get used to the machine. You can very easily activate it later. My main point - epap auto titration takes minutes to raise epap & if you have it as low as 7 or 8, you are undermining the SV algorithm.

I just realized that since the sleep study, I've lost about 10 pounds (now at 180, down from 190 lbs); With less soft tissue (ie. fat) to cause OSAs, this is probably why a EPAP Min = 7 works for me; possibly lower EPAP Min setting could work as well, while leaving the EPAP max =12 to let it auto-titrate if needed.
(from document 1032940_BiPAPautoSV_RefGd_EnglishA4.pdf)

Learning more about this every day.

Good luck with this and yes - there is so much to learn - what a journey

#2 removed ref to weight as I misread it (that old lbs vs kg conflict)

[mdboze]

As I have said before, your EpapMin is rather low & thus that plus PSMin have you breathing at a very low pair of epap/ipap settings. You are relying on the slow auto titration algorithm to fix that but it takes minutes to raise epap. The SV algorithm will do it in split seconds. I suspect that setting EpapMIn so low is creating problems of its own for you adjusting to this machine. Again, if it were me, I'd get the SV algorithm running to satisfaction before activating EpapMIN / EpapMAX as that is clearly already skewing what you are experiencing.

My best advice then is deactivate the Epap Auto titration by setting EpapMin = EpapMax = whatever your clinic previously recommended as your 'normal' epap setting. I believe it was around 9 ?. By taking slow acting epap auto titration out of the procedure, you can concentrate on adapting to the machine as a bilevel with SV (fast acting). The Epap auto titration adds too many complexities at a time you are learning to get used to the machine. You can very easily activate it later. My main point - epap auto titration takes minutes to raise epap & if you have it as low as 7 or 8, you are undermining the SV algorithm.

DSM: Thank you for the clarity. I'm understanding more every day.
For now I will set EPAP min = EPAP max until I get the SV algorithm running to satisfaction and figure this out.
Now, to figure out what settings....

A review from my logbook (settings used, how I felt, successes, problems)
Prescription was: (for a Resmed VPAP Auto)
Pressure support Max 23, Min 12, EPAP 7

Dec 15, 2009 : Original DME setup: (on my BiPAP autoSV Adv)
Pressure Max 23, EPAP Max12, EPAP Min12, PS Max7, PS Min7
....Lots of nonstop various issues; was ready to give up, dreaded going to bed.
Jan 14 new nasal mask + new positive attitude - the last mask (full mask) made bridge of nose bleed.
Jan 17 Changed to Nasal Pillow because nasal mask made bridge of nose bleed in a different spot.
Jan 21 Nasal Pillow, changed to small (from large), this fixed all the constant leaks
First changes Jan.25th
Pressure Max 23, EPAP Max12, EPAP Min7, PS Max7, PS Min7
.... Was best night so far. More comfortable, no mouth leaks
Jan.27th
Pressure Max 23, EPAP Max12, EPAP Min7, PS Max10, PS Min5
.... All went well, unit tries harder if I hold breath; But felt VERY tired most of the day. Just didnt feel right in the head & a bit faint a few times that day.
Jan.28th (increasing pressure for CSAs)
Pressure Max 23, EPAP Max12, EPAP Min7, PS Max15, PS Min7
.... Mask leaks, all good after 4am after I adjusted/fixed leaks. Felt good, but tired.
Jan.29th
Pressure Max 23, EPAP Max12, EPAP Min7, PS Max14, PS Min7
.... Pressure seemed too high at some events during the night, waking me.
Jan.30th
Pressure Max 23, EPAP Max12, EPAP Min9, PS Max13, PS Min5
.... Settings were comfortable; a few times while dozing off felt like not getting enough air when inhaling.
Jan 31 (Tonight, setting EPAP min = EPAP max until I get the SV algorithm running smooth)
Pressure Max 23, EPAP Max9, EPAP Min9, PS Max14, PS Min6
....Good night all & thank those of you for sharing your knowledge.
Added UPDATE: Feb 07, 2010
It has now been one week at the same settings EPAP Max9, Min9 PS Max14, Min6
These settings are working good for me. However still needs to be verified by reviewing AHI index results logged to the smart card. Even though it seems better, it may not be optimal.

[dsm]

mdboze

When you were on the auto - what was the pressure the machine spent most epap time at (or the average).

The epap pressure figure that addresses your OSA component is what I am recommending. I am inclined to
believe it will be between 8-10 for you. This figure would have showed up in the data from those sessions.

As said before you can activate auto titrating epap any time you want & so to get stable on the ASV the
epap should be what was 'optimum' in your prior data.

Cheers

DSM

[Muffy]

Both of these parts can be ordered from this online catalog: (a popular electronics part distributor)
http://mouser.com/catalog/catalogUSD/641/1325.pdf

Yeah, but once you order anything from them they send you this phone book of a catalog every 6 months that has to be put in the "recylcables" bin.

Does anyone know if the smart card reader uses the same 7pin round connector ?

Yes.

Muffy

[dsm]

mdboze

Take a look at this set of posts.

viewtopic.php?p=259935&sid=6120dd045a40 ... 64#p259840

The 1st pic you see is of a Respironics 'SleepLink' - I have one but not the cable. The cable though looks like it may have the connector you mention and is possibly the very cable that plugs into the machine as well.

Further down is another pic showing what Respironics call a 'SleepLink modem system' - that shows how an SpO2 probe can be connected and as per the description, with sleeplink, the RT can download compliance data only or compliance & SpO2 data simultaneously. Am not sure if that is of much use as really what we users want is detailed data + oximetry.

Muffy mentioned the port on the Bipap Auto SV may be an input port - if so it may allow an SpO2 module to be connected to the Bipap Auto SV in some configuration. I suspect this could be the case on my older Bipap Auto SV & the SleepLink card may be where the extra data is held & sent via the serial cable as shown in pic #1.

Cheers

DSM

PS I have some of these (Nonin xPods & iPods) - tried to interface one to a Resmed ResScan module - 3-wire serial interface but I could't get it to work

http://www.nonin.com/documents/ipod%20S ... ations.pdf

[mdboze]

mdboze

Take a look at this set of posts.

viewtopic.php?p=259935&sid=6120dd045a40 ... 64#p259840

The 1st pic you see is of a Respironics 'SleepLink' - I have one but not the cable. The cable though looks like it may have the connector you mention and is possibly the very cable that plugs into the machine as well.

Further down is another pic showing what Respironics call a 'SleepLink modem system' - that shows how an SpO2 probe can be connected and as per the description, with sleeplink, the RT can download compliance data only or compliance & SpO2 data simultaneously. Am not sure if that is of much use as really what we users want is detailed data + oximetry.

Muffy mentioned the port on the Bipap Auto SV may be an input port - if so it may allow an SpO2 module to be connected to the Bipap Auto SV in some configuration. I suspect this could be the case on my older Bipap Auto SV & the SleepLink card may be where the extra data is held & sent via the serial cable as shown in pic #1.

Cheers

DSM

PS I have some of these (Nonin xPods & iPods) - tried to interface one to a Resmed ResScan module - 3-wire serial interface but I could't get it to work

http://www.nonin.com/documents/ipod%20S ... ations.pdf

Good info DSM,

What we need is to build or buy the Data cable / Sleeplink cable.
I already ordered some of the parts to start building a few cables. But I need more connectivity information to complete the cables.

From the thread you sent me:

Probably only 3 wires in actual use on that cable, tx, rx, and signal ground. Got a scope? take that sucker apart and see what wires are used, I'm sure it traces down to the SIM chip normally found on the card, you can do the same thing with the SmartCard if you know what you are doing, do it wrong and you 99 the SmartCard, but with that interface you bypass that problem.

Question DSM: Did you ever take it apart like Snordog mentioned ?
If I can determine what pins connect to what, inside the device, I can build us a cable.

Question DSM: Is the receptacle on your Sleep Link card, exactly the same as the communications port on the back of a BiPap AutoSV ?
If it is, it should look like this:


We will figure it out.

Today I ordered a smart card reader. I found one for $17 at CDW:
http://www.cdw.com/shop/products/defaul ... DC=1586022
For now.... I can't get the Encore Pro software to install. I think its because I'm running 64bit Windows Vista.

Build Cable(s)... Install Software... Setup card reader....
-----------------------------------------------------------------------------------------
Oh. By the way,
The pressure settings are mostly working for me.
EPAP Max:9 - EPAP Min:9 ... PS Max: 14 -----PS Min:6
(It would not let me set PS Max to 15, only as high as 14, because it would have exceeded the "Max Pressure=23 setting )
Either way, I think 23 max presure is too much for my Resmed nasal pillow. In the night, as it ramps up to about 23cm, I get loud leaks that wake me up.
I'll leave all my settings alone for awhile. They are working. I am getting good sleep.

[Kiralynx]

My main point - epap auto titration takes minutes to raise epap & if you have it as low as 7 or 8, you are undermining the SV algorithm.

DSM,

While I don't pretend to understand many of the terms you and Banned are throwing around, EPAP of 9 is not necessarily low.

Please recall that my settings were originally EPAP=10, MinIPAP=10 and MaxIPAP=14. I remember you commenting that I ought to find that quite comfortable.

I didn't.

I struggled with that EPAP of ten for more than a week, fighting to breathe out again it. Many times, I choked and coughed because I could not swallow against it.

After noting that I kept waking up, and that I had event clusters at the time of awakening, I called my RT, and explained that I felt too high an EPAP was causing centrals. She agreed. My prescription was changed to the one I'm using now. EPAP=6, MinIPAP=10 and MaxIPAP=14. The apneas went away. I have a few hypopneas now and again, but otherwise, my therapy seems to be going well.

Remember -- there's no such thing as too low or too high a pressure. It's whatever works to keep an individual's throat open without causing centrals.

[dsm]

My main point - epap auto titration takes minutes to raise epap & if you have it as low as 7 or 8, you are undermining the SV algorithm.

DSM,

While I don't pretend to understand many of the terms you and Banned are throwing around, EPAP of 9 is not necessarily low.

Please recall that my settings were originally EPAP=10, MinIPAP=10 and MaxIPAP=14. I remember you commenting that I ought to find that quite comfortable.

I didn't.

I struggled with that EPAP of ten for more than a week, fighting to breathe out again it. Many times, I choked and coughed because I could not swallow against it.

After noting that I kept waking up, and that I had event clusters at the time of awakening, I called my RT, and explained that I felt too high an EPAP was causing centrals. She agreed. My prescription was changed to the one I'm using now. EPAP=6, MinIPAP=10 and MaxIPAP=14. The apneas went away. I have a few hypopneas now and again, but otherwise, my therapy seems to be going well.

Remember -- there's no such thing as too low or too high a pressure. It's whatever works to keep an individual's throat open without causing centrals.

Kiralynx,

Perhaps a missread - I am sure I was recommending that mdbose use an epap as recommended by his clinic (I said I thought that was 9?) before that he was setting EpapMin to 7 CMs (which in real terms on that machine is 6 CMs and EpapMax to 12 or so. He eventually went to 9 and now says it is working for him.

I will *always recommend a person gets properly titrated & goes by the RT's recommended settings. We can comment on what we think of some settings but that is different from telling someone to go change their settings. mdboze came here because his clinic made a mess of the numbers & asked for advice & got it. By the way - that 7 he was using was not his 'normal' epap it was a deliberately low epap intended to rise as OSA events were detected. I gather you did read his comment about how he was struggling to get air ?.

Again, I go back to my post where I suggested he set epap to what was normal and to deactivate epap auto-titration by setting EpapMin = EpapMax.

Cheers

DSM

[ozij]

mdboze & banned,

The most trecent settings are looking better but I must admit I would be *very* reluctant to *ever* see my epap set below 9 on a Bipap Auto SV even if it is being auto titrated (EpapMin set below EpapMax).
One characteristic of the Bipaps I have not dwelt on here, is that the CMs numbers are typically overstated by approx 1 CMs.

By this I am saying that measued with a dial manometer, the pressure at the mask is typically 1 CMs below what the LCD on the machine says. Whereas, the Vpap Adapt SV is accurate at both the mask & machine (difference is because the vpap adapt sv samples pressure at the mask).

So, when the Bipap Auto SV says 9 CMs it is pretty well for sure the actual pressure is 8. 1 CMs can be a big difference when playing around down in the epap zone. I am offering caution on trusting the epap titration at this earlyb stage. I'd get the other values (base epap, ipap & SV PS support) working smoothly 1st & then start exploring how low I can set EpapMin below EpapMax & trust it. My real point here is am instinctly nervous at the thought of epap being set so low - even if it will adjust up if OSA events are detected.
Good luck

DSM

(added emphasis mine)

I read this post the same way kiralynx did - a sort of general statement, not specifically connected to mdboze, and therefore, worthy of the comment made by kira:

Remember -- there's no such thing as too low or too high a pressure. It's whatever works to keep an individual's throat open without causing centrals.

I would never tell anyone I feel uneasy at seeing their pressure set at 11 or 15 or 20 -- even though those pressures are utterly wrong for me.

However, there's been a flurry of such comments about low pressures recently -- which is why what kiralynx said is so important for all readers and all members.

[dsm]

Ozij

Many thanks for your clarification - as I was sure I was replying to mdboze & Kiralynx's point got lost on me. I was hearing mdboze say how he was struggling with his breathing & he had already explained that the EpaMIN setting was the bottom of an epap min/max range.

I would also ask Kiralynx if I ever told her to set her epap to a particular value ? (unless I or we were being asked to suggest it) - I make a practice of not doing that if the person concerned has a sleep doctor or clinic & if I did I need to correct what I said.

I may well have & probably still will, express an opinion about epaps around 6 CMs as seeming to bevery low. BUT, I would never want to challenge a sleep clinic or a sleep doctor who has titrated someone to such an epap value.

I do trust that people coming here can see when opinions are expressed vs telling someone to set a machine to a particular value (unless directly requested), I agree very much that actual setting advice needs to be left to professionals (& I often wish banned understood this).

Cheers

DSM
(Maybe I'll stick to PM such advice as what I passed on to mdboze re that auto titrating epap challenge - but one time I did PM someone you (Ozij) specifically asked that we keep communications in the open )

[mdboze]

Ozij
DSM
(Maybe I'll stick to PM such advice as what I passed on to mdboze re that auto titrating epap challenge - but one time I did PM someone you (Ozij) specifically asked that we keep communications in the open )

Naaa... A good open forum is helpful to a lot of people.

I understood that you were specifically talking about my situation with the following posts:

My main point - epap auto titration takes minutes to raise epap & if you have it as low as 7 or 8, you are undermining the SV algorithm.

And

The most trecent settings are looking better but I must admit I would be *very* reluctant to *ever* see my epap set below 9 on a Bipap Auto SV even if it is being auto titrated (EpapMin set below EpapMax).

I could see how others thought it was a general rule to follow.

A open forum is good learning for many. Thanks for your contiunous adivce to me and others.

Anyway... we have more important things to do... like build a SleepLink cable

[Kiralynx]

I would also ask Kiralynx if I ever told her to set her epap to a particular value ? (unless I or we were being asked to suggest it) - I make a practice of not doing that if the person concerned has a sleep doctor or clinic & if I did I need to correct what I said.

I may well have & probably still will, express an opinion about epaps around 6 CMs as seeming to bevery low. BUT, I would never want to challenge a sleep clinic or a sleep doctor who has titrated someone to such an epap value.

DSM,

The one comment was when I first got my Bipap ASV -- you asked about my pressures, which, at that time, were 10, 10, and 14. You said I ought to find that very comfortable, and I said that I did not. You never got back to me on that -- I believe there were some family issues around that time.

You may not have intended your comment to be a generic recommendation to anyone using an ASV, but the chief issue with on-line communications is that, despite emoticons, we don't have the body language and/or verbal intonations that would go with a statement to make it clear that you actually said what you apparently thought you said, as opposed to what I perceived, and Ozij perceived.

That's why I wished to be certain that someone whose pressures are set lower than 9 or 10 should recognize that there may be nothing wrong with that.

It's true that some people whose pressures are set low need a higher pressure. It's equally true that some people whose pressures are set high actually need something lower.

This is the reason I strongly advocate, along with the majority of people in this forum, including you, that it is critical for cpapusers to have daily access to their detailed data. One night in an unfamiliar room, wired for sound and light, is only a snap shot of necessary treatment.

The titration is the starting point. It is dependent on communication between all members of the treatment team, including the patient, so that glitches such as the machine not being set in accordance with the prescription are less likely to occur.

As this discussion demonstrates.

[dsm]

Kiralynx
Point taken, I am glad you clarified the original circumstance. I really am a strong believer in everyone
finding a professional/clinic they can work with and that it is the professionals who should always be
consulted.

I also believe cpaptalk is a place where we can discuss how the therapy works and how we go about our own
therapy management. That is what makes this place so unique.


mdboze
I looked for the sleep link card but no luck - I have several places to work through & it may be this w/e
before I get a good look. As mentioned I have a collection of Nonin xPods & iPods with type #2 data streaming.
I have the pinouts for them as well. Here's hoping we can get something worked out


Cheers - DSM

[Muffy]

Is the receptacle on your Sleep Link card, exactly the same as the communications port on the back of a BiPap AutoSV ?
If it is, it should look like this:

It is not.

Muffy

[Banned]

Pressure Max 23, EPAP Max9, EPAP Min9, PS Max15, PS Min6
....Good night all

So, how was it? and how was 8/6?

Banned