What do you think of Auto BiPAP BiFlex?

[nmevan]

I'm a newbie with a respironics BiPAP Auto Bi-Flex machine

pressures running as high as 17 at times

the machine supposedly figures out and delivers whatever pressure you need to keep your airway open...instead of a continuous pressure

also...it backs off on pressure to make it easier to exhale

what are the positives and the negatives to this system? Is this a smart choice for someone who might need higher pressures?

thanks again!!!

evan

[Slinky]

Well,, first off, you are NOT going to get a BPAP w/o a script for a bi-level.

I was fortunate to use a PR SystemOne BPAP Auto w/Bi-Flex for some 6-7 months. I found it very comfortable, no problems exhaling, smooth transitions from IPAP to EPAP. I didn't use the Bi-Flex settings at all. I just didn't need it.

[GumbyCT]

I'm a newbie with a respironics BiPAP Auto Bi-Flex machine

pressures running as high as 17 at times

the machine supposedly figures out and delivers whatever pressure you need to keep your airway open...instead of a continuous pressure

also...it backs off on pressure to make it easier to exhale

what are the positives and the negatives to this system? Is this a smart choice for someone who might need higher pressures?

thanks again!!!

evan

BiPap is the ultimate in exhale relief BUT it doesn't figure out your pressures and needs to be setup correctly.

[packitin]

I've used mine for 2 nights, so I'm not an expert yet. I asked my sleep doc if I could try one for 2 weeks to see if it helped me. He agreed, so Apria loaned me one with 62 hours on it. I get to keep it if the numbers turn out to show that I have improved. It is set at 4/20 pressure. My Autoset was set at 7.8/12.4 pressure. I probably should change the settings on my bipap, but I'm afraid that if I mess with the settings, the DME will "hit the ceiling". Anyway, I am getting used to it, and hope I will be able to keep it. I love the fact that the humidifier self adjusts, and it seems to be just as quiet as my Autoset.
Jay

[Slinky]

GumbyCT, the BPAP Auto w/Bi-Flex "can" be used for auto-titrating bi-level IPAP and EPAP pressure needs. Usually one would set the Pressure Support at 4 cms. IPAP and EPAP can then free range as needed according to their settings EXCEPT that they can not get any closer together than 4 cms (or whatever the PS is set at).

[GumbyCT]

GumbyCT, the BPAP Auto w/Bi-Flex "can" be used for auto-titration bi-level IPAP and EPAP pressure needs.

IF it is setup correctly, sure. I wouldn't start at 4cm either.

[Slinky]

Pressure Support is NOT the staring pressure. It is a "range" of pressure that IPAP and EPAP can not get closer to each other than its setting.

For instance, IPAP 17, EPAP 8, Presure Support 4. Pressure during the night could then vary any where between 8 and 17 excpet that IPAP and EPAP could never get closer together than 4 cms. Or to put it another way, IPAP could range anywhere from 13 to 17 as needed and EPAP could range anywhere from 8 to 12 as needed.

At least that's my understanding.

[GumbyCT]

Pressure Support is NOT the staring pressure. It is a "range" of pressure that IPAP and EPAP can not get closer to each other than its setting.

For instance, IPAP 17, EPAP 8, Presure Support 4. Pressure during the night could then vary any where between 8 and 17 excpet that IPAP and EPAP could never get closer together than 4 cms. Or to put it another way, IPAP could range anywhere from 13 to 17 as needed and EPAP could range anywhere from 8 to 23 as needed.

At least that's my understanding.

I think that is never get farther apart than 4cm of course if you set pressure support at 6cm then 4cm apart would be within those parameters.

[rested gal]

Pressure Support is NOT the staring pressure. It is a "range" of pressure that IPAP and EPAP can not get closer to each other than its setting.

You're right about "Pressure Support" not being the starting pressure.

However, I believe it is what prevents the IPAP/EPAP from getting farther apart from each other than whatever number the "pressure support" is set for. I don't think the "max press sup" setting is to prevent IPAP and EPAP from getting closer to each than that number. At least, that's my understanding of the way it is in Respironics machines. In ResMed machines the pressure support setting works differently.

As an aside...Jeff (jnk) described beautifully the difference in the way the two brands handle "pressure support" in the topic:
ResMed VPAP Auto 25 Clinician's manual
viewtopic.php?p=376749#p376749

Back to the Respironics BiPAP Auto and Philips Respironics System One BiPAP Auto, when the machine is being used in autotitrating bilevel mode, max IPAP and min EPAP can be set as close as 3 cm to each other, and they will actually operate as closely as 2 cm apart.

No matter how where you set the max IPAP / min EPAP pressures, the machine (in autotitrating bilevel mode) will begin each sleep session blowing an IPAP pressure only 2 cms higher than whatever the "min EPAP" was set for.

For instance, IPAP 17, EPAP 8, Presure Support 4. Pressure during the night could then vary any where between 8 and 17 excpet that IPAP and EPAP could never get closer together than 4 cms.

With the Respironics and Philips Respironics machines, IPAP and EPAP can get closer together than 4 cm. They can get as close as 2 cm to each other. That's where those two pressures start out (2 cm apart) each time the machine is used. They just can't get farther apart from each other than 4 cm if "Max Press Sup" is set for 4 cm.

Or to put it another way, IPAP could range anywhere from 13 to 17 as needed and EPAP could range anywhere from 8 to 23 as needed.

At least that's my understanding.

I think you typo'd IPAP/EPAP reversed, but even with those words corrected I don't think that's the range either of those pressures could use in the example of max IPAP 17, min EPAP 8, max press sup 4.

In that example settings scenario, I think it would go this way....

IPAP could range from 10 to 17. If IPAP did, on its own initiative (so to speak) go to 17, EPAP would have been dragged up to 13 -- in order to keep them no farther apart than the 4 cm that was set for "maximum pressure support."
10 would be as low as IPAP could go, assuming EPAP was rocking along down there at the min EPAP of 8.
17 would be as high as IPAP could go, since that's what "max IPAP" was set for. 17.

EPAP could range from 8 to 15. If EPAP did, on its own, go up to 15, IPAP would have been pushed up to 17, in order to keep no less than 2 cm between them.

IPAP and EPAP can operate as close as 2 cm to each other. They just can't range more than 4 cm apart from each other -- if the Max Press Sup is set for 4 cm. The word "Max" in the "Max Press Sup" setting of the Respironics BiPAP Auto machine is the key word. That setting governs the maximum difference that IPAP/EPAP can travel apart from each other. A built-in difference of 2 cm allows them to snuggle as closely as two cm with each other.

Two cms apart is the way the machine will start each session, no matter how high the max IPAP is set, and no matter how much you set the "Max Pressure Support" for. The most the Max Press Sup setting can be set for is 8 cm -- that is if the max IPAP and min EPAP are set far enough apart to allow 8 cm difference between them.

That's my understanding anyway, but I sure could be wrong or be stating it incorrectly.

[nmevan]

you certainly have added a lot of information about the machine I have.

just wondering if you think it is a good machine? and for what reasons?

or would you suggest something else for someone whose sleep study showed 53 AHIs per hour and who needs a high pressure of around 17
at times

thanks

evan

[ozij]

The "best" machine is the one that gives you the best therapy. A machine can give best therapy to 95% of the people, but if you belong to the 5%, you need another one.

[rested gal]

evan, I don't actually need bilevel treatment, or even autotitration. But I like the nearly instant drop in pressure when I breathe out that bilevel gives. And I like autotitration for occasions when I might need more pressure than the straight "11" that would do a good job for me the majority of time.

I personally just like using a bilevel machine whether I set it for bilevel mode or for autotitrating bilevel mode.

Either brand (Respironics or ResMed) of bilevel or bilevel auto would suit me fine.

Everyone is different, so what type of machine and what mode of operation suits a particular person best can be different. Generally speaking, I'd think a bilevel or autotitrating bilevel (either one) would probably be more comfortable to breathe out against for most people who need a pressure of 17 at times.

I think you have a good BiPAP (Respironics trademark name for their bilevel machines.) So do the people who have "VPAP" machines (ResMed's trademark name for their bilevel machines.)

[Slinky]

Bless you, RG, for clarifying the Pressure Support information!

I've used both the Resmed VPAP Auto and the PR SystemOne BPAP Auto w/Bi-Flex and done well w/both devices. I can't even say that I prefer one over the other as there are features about both that I like. For "just" therapy, I really couldn't pick one over the other. There was a "learning curve" w/the VPAP Auto, but not w/the PR S1 (which I had the opportunity to use AFTER having used the VPAP Auto for some 12-13 months). My likes and dislikes had more to do w/the software, the data available, the method of the data availability via the LCD screen, the integrated humidifiers, etc.

I liked the additional data of the S1 but hated the limited availability of that data via the LCD screen. I liked the visibility of the VPAP's humidifier tank, I hated the extremely limited visibility of the S1 humidifier tank. (I don't empty and refill my humidifier tank each day, I just top the water level off). I preferred the ResScan software to the EncorePro software.

I had difficulties w/the VPAP Auto in Spontaneous (straight bi-level) mode w/the "comfort feature" settings being too complicated for me to find a smooth, easy transition between IPAP and EPAP pressures and my "professionals" not being knowledgeable enough about the new VPAP Autos to do so either. HOWEVER, that was easily remedied by using it in Auto mode and limiting the Pressure Support to the exact setting between IPAP and EPAP settings. This allowed the EasyBreathe technology to take over and the pressure transistions between IPAP and EPAP were comfortable, smooth and easy breathing. I had no such problems w/the S1. From the very beginning pressure transition in straight bi-level mode was smooth and easy and comfortable w/no need for any adjustments.

Frankly, the Mask Selection options of both devices were a .... PITA, IF you didn't use one of that manufacturerer's own masks. This was especially true w/the S1 BPAP rather than the VPAP as determining which mask was which setting was considerably more difficult w/the S1. IF you don't find and use the correct mask selection your data is one big fat lie and not reliable w/either device.