My Initial Bipap/ST Titration results...

[Zzzzzzzzzzz...]

So had my 2nd titration last night. The tech (huge improvement over the last one) I had seemed certain she was successful in treating me and my centrals with Bipap ST. Didn't see ANY reason to switch to ASV at any point. I don't have any data, or details yet, as she's not permitted to share a diagnosis or feedback with me beyond the fact that I did really well on Bipap ST. So here's the question. I've been using an S9 APAP since the start of my treatment. When I speak with my PA/DME do I stick with Resmed and go with an S9 Bipap ST? I was titrated using a PR System, but frankly, there was something about the pressure delivery or maybe the algorithm that bugged me. The pressures didn't feel consistent throughout my entire breath on inhale and exhale (ASIDE from the nature of Bipap which I know utilized different pressures on inhale and exhale- but I assume they're CONSISTENT pressures throughout each breath). When I mentioned it felt that during my inhale I'd go from "breathing through a hose to having to push through the feeling of breathing through a cocktail straw" she said she's never heard of that and it just takes getting used to. It felt as though my nasal pillows were collapsing in my nose for moments at a time and it took more effort for me during those times to inhale. Odd. I also felt pulsing pretty often. Is this due to the different type of machine? Would the S9 Bipap be similar?

Looking for advice and suggestions on which machine to request. I'm leaning towards wanting the S9 Bipap ST, since I'm used to that brand, climate line, etc...

Thanks all!

Z

PS: I don't get my results til next week, for now staying with my S9 on CPAP with 7cm 0 EPR... I was doing well on it for the past few days. Unless I hear from the clinic sooner...

[Tom W]

BiPAP will take a little while to get used to.

I was on CPAP for 12+ years before I switched to BiPAP and it took me several weeks to adjust.

Because of the dynamics of the friction of the air running through the hose and having to purge the air through the relief vents in the mask with CPAP inhalation pressure always feels lower than exhalation pressure.

With BiPAP with a few CM difference between ipap and epap the pressures are reversed with the inhalation pressure pressure feeling higher than exhalation pressure.

I'm running BiPAP with a setting of 18/12 and when the inhalation pressure hits, it hits hard. In time you'll get used to that.

I have NO experience with the timed breathing aspect of your new machine so I can't help you there.

I'm traveling down the same path as you but I took a brief stop at BiPAP. Had my BiPAP S/T ASV titration last week.

Best of Luck.

[jnk]

. . . do I stick with Resmed and go with an S9 Bipap ST? . . .

I would.

[JohnBFisher]

There is a difference between Resmed S9 technology and the PR S1 technology. Resmed uses their patented "Easy Breathe" technology. It provides the pressure in a gentle curved ramp up of the pressure. This was initially developed in conjunction with their older VPAP Adapt SV unit. It was incorporated into all of the S9 units. I find it a bit easier to breathe with it than with the PR S1 type technology. Respironics uses a "Flex" technology that modifies the waveform, but it feels much more "hard edged" than the Resmed "Easy Breathe" technology. But you would get used to it.

Here's a pointer to the Resmed Easy Breathe technology incorporated into the S9 series:

http://www.resmed.com/us/products/s9_se ... nc=dealers

It's great to hear that the BiPAP S/T did the trick. It's easier to get used to it than an ASV unit. I also agree that if you like the S9 technology, then it makes sense to stick with them for the S9 VPAP ST unit:

http://www.resmed.com/us/products/s9_vp ... nc=dealers

[Zzzzzzzzzzz...]

Thanks all for the posts. Seems the S9 is the way to go. Here's hoping that once I get the data download/feedback from my PA, I find the settings and treatment necessary to finally get on a consistent road to success... (that is if she agrees with the tech's observations and the charts themselves this time, ha, ha) fortunately, I've got the mask and leaks sorted out already...

Z

[Zzzzzzzzzzz...]

There is a difference between Resmed S9 technology and the PR S1 technology. Resmed uses their patented "Easy Breathe" technology. It provides the pressure in a gentle curved ramp up of the pressure. This was initially developed in conjunction with their older VPAP Adapt SV unit. It was incorporated into all of the S9 units. I find it a bit easier to breathe with it than with the PR S1 type technology. Respironics uses a "Flex" technology that modifies the waveform, but it feels much more "hard edged" than the Resmed "Easy Breathe" technology. But you would get used to it.

Here's a pointer to the Resmed Easy Breathe technology incorporated into the S9 series:

http://www.resmed.com/us/products/s9_se ... nc=dealers

It's great to hear that the BiPAP S/T did the trick. It's easier to get used to it than an ASV unit. I also agree that if you like the S9 technology, then it makes sense to stick with them for the S9 VPAP ST unit:

http://www.resmed.com/us/products/s9_vp ... nc=dealers

Hey John, if you have a second could you please explain the S/T part of this specific BiPap equation? And what makes it different than NON S/T types?

Thanks,

Z

[JohnBFisher]

... if you have a second could you please explain the S/T part of this specific BiPap equation? And what makes it different than NON S/T types? ...

I'll modify an answer that I provided to someone else recently ...

BiPAP S/T units typically have four therapy modes of operation: "CPAP, S, S/T, T". The S9 VPAP ST also includes a VPAP Auto mode. Now for a quick explanation of those terms...

CPAP - That's one you know. It's a Continuous Positive Airway Pressure (CPAP). It would be the same therapy that you currently use.

S - That's one of the BiLevel therapy modes. That is, instead of just a Continuous pressure, it provides two pressures, one for inhalation (Inhalation Positive Airway Pressure or IPAP) and one for exhalation (Exhalation Positive Airway Pressure or EPAP). The "S" indicates that the BiLevel unit (or BiPAP, which is a trademarked name for Respironics) changes according to your "Spontaneous" change from inhalation to exhalation and back again. Most BiLevel units operate as Spontaneous devices (BiPAP S).

S/T - That the next level of therapy mode from this device. Instead of just following your breathing, the unit can be set to ascertain that you breathe at least a certain number of times per minute. If your breathing rate falls below that (or you fail to inhale), then the unit will automatically switch from one pressure to another (normally that is from EPAP to IPAP, but it could be the other way around). This typically is used for someone with mild central sleep apnea. The switch in pressure helps remind your body to breathe at least as often as the preset Breaths Per Minute (BPM). The BPM rate is usually set for 12 or 10 . Since you do have problems with central sleep apnea, you will probably receive a prescription for an S/T unit that includes a backup rate (a BPM setting). This will help set a pace for your breathing. Initially with the BiPAP S/T you might see more instances when the machine must remind you (your Patient Triggered Breathing or PTB will be lower). But as you start using your S/T unit, you will see an improvement of the Patient Triggered Breathing. Ongoing use seems to help us breathe more consistently. Of course, with only a few days without your S/T unit you would return your current sleep patterns (and PTB would plummet.

T - This is the final level of therapy offered by this device. Instead of following you, the unit only uses the Timed BPM to determine when to switch from one pressure to the next. Since most people do NOT breathe at the same rate, this is normally NOT employed unless there are serious problems with the pacing of someone's breathing.

Hope that helps explain and clarify the technology.

[Zzzzzzzzzzz...]

... if you have a second could you please explain the S/T part of this specific BiPap equation? And what makes it different than NON S/T types? ...

I'll modify an answer that I provided to someone else recently ...

BiPAP S/T units typically have four therapy modes of operation: "CPAP, S, S/T, T". The S9 VPAP ST also includes a VPAP Auto mode. Now for a quick explanation of those terms...

CPAP - That's one you know. It's a Continuous Positive Airway Pressure (CPAP). It would be the same therapy that you currently use.

S - That's one of the BiLevel therapy modes. That is, instead of just a Continuous pressure, it provides two pressures, one for inhalation (Inhalation Positive Airway Pressure or IPAP) and one for exhalation (Exhalation Positive Airway Pressure or EPAP). The "S" indicates that the BiLevel unit (or BiPAP, which is a trademarked name for Respironics) changes according to your "Spontaneous" change from inhalation to exhalation and back again. Most BiLevel units operate as Spontaneous devices (BiPAP S).

S/T - That the next level of therapy mode from this device. Instead of just following your breathing, the unit can be set to ascertain that you breathe at least a certain number of times per minute. If your breathing rate falls below that (or you fail to inhale), then the unit will automatically switch from one pressure to another (normally that is from EPAP to IPAP, but it could be the other way around). This typically is used for someone with mild central sleep apnea. The switch in pressure helps remind your body to breathe at least as often as the preset Breaths Per Minute (BPM). The BPM rate is usually set for 12 or 10 . Since you do have problems with central sleep apnea, you will probably receive a prescription for an S/T unit that includes a backup rate (a BPM setting). This will help set a pace for your breathing. Initially with the BiPAP S/T you might see more instances when the machine must remind you (your Patient Triggered Breathing or PTB will be lower). But as you start using your S/T unit, you will see an improvement of the Patient Triggered Breathing. Ongoing use seems to help us breathe more consistently. Of course, with only a few days without your S/T unit you would return your current sleep patterns (and PTB would plummet.

T - This is the final level of therapy offered by this device. Instead of following you, the unit only uses the Timed BPM to determine when to switch from one pressure to the next. Since most people do NOT breathe at the same rate, this is normally NOT employed unless there are serious problems with the pacing of someone's breathing.

Hope that helps explain and clarify the technology.

Completely, clearly and utterly understand it now. Thank you SO much. Last question... I assume since the S/T isn't associated with the Resmed S9 series Bilevel machines that the "S9 VPAP Auto" is the one I should be asking for if given a choice? (which I plan on being given, thank you!) And that it has these additional features as well? Or is the S/T reserved solely for the PR system?

[Zzzzzzzzzzz...]

Just came across an S9 Vpap ST... perhaps I'm looking at an old site/page for Resmed. Hmm.

[JohnBFisher]

Let's try this again ..

... then it makes sense to stick with them for the S9 VPAP ST unit:

http://www.resmed.com/us/products/s9_vp ... nc=dealers

Yup. You want the S9 VPAP ST unit. "BiPAP" is a trademark of Respironics. BiLevel is the type of machine. VPAP is Resmed's trademark name for a BiLevel unit.

Hope that helps.

[Pugsy]

I am currently using the S9 VPAP auto....don't need the ST model...just wanted to let you know that I imagine you will really like it.
I happen to be lucky enough to have both brands of bilevel machines..while I don't have any need for the Timed response thing...I really like the Bilevel part of these machines. First time I used one I thought...man, I really like this...funny it was awake comfort that sold me on it and I stumbled onto the "miracle" (feeling hugely better the next day) just because I happened to really like the awake comfort that bilevel offers. While my overall data is not hugely different from when I used APAP (got great numbers) when I used the bilevel machine the very first time I felt hugely better the next day and the pressures weren't even optimal. It may or may not be the same for you but comfort wise...it is sure sweet.

[jnk]

Here is my thinking:

Hopefully, if insurance is on board, there will be a rental period for a trial of the machine, during which the first brand of ST home machine that is dispensed could (theoretically) be changed out for another brand of ST if it turns out that the first brand dispensed seems to you to be less effective for some reason, as far as algorithm compatibility to you as a unique patient. That is why I would tend to ask for the brand I was used to breathing with, or assumed to be more comfortable for me, first, but would then be ready to ask for the other brand later during the first month if there was any indication that my therapy wasn't as good as what I seemed to get during titration.

Stated again, in a slightly different way:

I believe that once a particular ST is dispensed, if it then later turns out the other machine is preferred, it might be easier to make the argument for a change of machines for efficacy reasons than it would be to try to make the argument for changing machines for mere comfort reasons. That is why I would go with what I assumed to be more comfortable, or what was closest to what I was used to breathing with, first. I could always then later argue for the other brand on the basis of the need for more effective treatment rather than on the basis of comfort, if it turned out I needed to. Docs and insurance tend to be more about "effective treatment" than "comfort," since they don't get the fact that we patients understand so well--that often those two concepts are very closely related when it comes to PAP therapy.

My thinking is not always standard on such matters, though.

[Zzzzzzzzzzz...]

I am currently using the S9 VPAP auto....don't need the ST model...just wanted to let you know that I imagine you will really like it.
I happen to be lucky enough to have both brands of bilevel machines..while I don't have any need for the Timed response thing...I really like the Bilevel part of these machines. First time I used one I thought...man, I really like this...funny it was awake comfort that sold me on it and I stumbled onto the "miracle" (feeling hugely better the next day) just because I happened to really like the awake comfort that bilevel offers. While my overall data is not hugely different from when I used APAP (got great numbers) when I used the bilevel machine the very first time I felt hugely better the next day and the pressures weren't even optimal. It may or may not be the same for you but comfort wise...it is sure sweet.

Great to hear P. I imagine the ST unit would give me the same comfort level, only with the added benefit of a feature to help sort out my occasional CA's...

And thanks again for the clarification John. I'm assuming the VPAP Auto wouldn't benefit me as well...

Z

[Zzzzzzzzzzz...]

Here is my thinking:

Hopefully, if insurance is on board, there will be a rental period for a trial of the machine, during which the first brand of ST home machine that is dispensed could (theoretically) be changed out for another brand of ST if it turns out that the first brand dispensed seems to you to be less effective for some reason, as far as algorithm compatibility to you as a unique patient. That is why I would tend to ask for the brand I was used to breathing with, or assumed to be more comfortable for me, first, but would then be ready to ask for the other brand later during the first month if there was any indication that my therapy wasn't as good as what I seemed to get during titration.

Stated again, in a slightly different way:

I believe that once a particular ST is dispensed, if it then later turns out the other machine is preferred, it might be easier to make the argument for a change of machines for efficacy reasons than it would be to try to make the argument for changing machines for mere comfort reasons. That is why I would go with what I assumed to be more comfortable, or what was closest to what I was used to breathing with, first. I could always then later argue for the other brand on the basis of the need for more effective treatment rather than on the basis of comfort, if it turned out I needed to. Docs and insurance tend to be more about "effective treatment" than "comfort," since they don't get the fact that we patients understand so well--that often those two concepts are very closely related when it comes to PAP therapy.

My thinking is not always standard on such matters, though.

Makes sense to me. Thanks! My clinic has already noted my preferred machine for the Rx.

Z

[JohnBFisher]

... I'm assuming the VPAP Auto wouldn't benefit me as well ...

To my knowledge the S/T mode only has a fixed IPAP/EPAP value. If it has a range, it might be interesting to try it. But I doubt that it does, since typically with central apneas changing pressure can trigger more central apneas.

But an "S9 VPAP Auto" unit is NOT what you need. It does not address the central apneas. It does not have the S/T mode.