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VikingGnome wrote:I have the ResMed S9 BiLevel. EPAP and IPAP will be 4 point difference but you can get an additional 1-3 by setting EPR. So that's a maximum difference of 7. So don't see how that would be any disadvantage over PR.

But I do not see how this machine can function as an APAP as some have said. You can set a maximum for IPAP and minimum for EPAP but pressure will ALWAYS be at exactly those levels. IPAP for inspirations and EPAP for exhalation. There are no changes if your breathing situation doesn't need it that high as an APAP does.

my two vpap auto machines, AND the clinician manual beg to differ, EPR is only available in cpap mode, not in vpap S or vpap auto mode.

as to how the machine works in auto mode, it's simple, you set a min epap, and a max ipap, and a set pressure support, and the machine can vary anywhere between them.

a vpap S can't do that, but a vpap auto can.

see the pressure changes?

Pugsy wrote:

VikingGnome wrote:I have the ResMed S9 BiLevel. EPAP and IPAP will be 4 point difference but you can get an additional 1-3 by setting EPR. So that's a maximum difference of 7. So don't see how that would be any disadvantage over PR.

Are you sure about this? Every Resmed VPAP I have seen doesn't offer EPR when in bilevel mode...it's only available in cpap mode on the VPAP machines.

Now the difference between EPAP and IPAP can vary greatly (from as little as 1 to 8 and maybe more as I can't remember exactly) but it has nothing to do with EPR at all.

you're quite right, Pugsy, the VPAP machines don't have EPR, what would be the point, since EPR is just a limited range, less configurable vpap ability.

pressure spport for the VPAP Auto is 0-10cm, in the VPAP S the specs are 4-25 for ipap and 3-ipap for epap. so, presumably, you COULD set the s to 25/3 if you wanted to be crazy

VikingGnome wrote:yes, EPR is available on my machine. I have it set EPR at 2 with IPAP at 22 and EPAP at 18. So I'm getting 6 point difference.

I'm afraid that we're going to have to call "pics or it didn't happen", please show us a setup screen showing those parameters.

Pesser wrote:The only thing left to ask is this: is there a sound difference between PR 760 and PR 560?

grayghost here on the forum recently bought a used 760, his wife has a 560, he says she thinks that something's wrong with his 760 because it makes more noise than her 560, as best as I've been able to figure out, it's not a lot of noise, but the motor does whine a bit, and at his higher pressures it's a little louder, and the sound changes more with his breathing and dual pressures than hers does with just the flex setting.

PaleRider...

Is Easy Breathe the same thing as EPR? I thought it was something different but then I haven't kept up with every little thing on these machines.

I don't remember ever seeing an Easy Breathe setting available on my S9 VPAP Auto and I sure don't have it on my Adapt but I see that VikingGnome mentions it and someone else has mentioned being about to turn Easy Breathe off or on or maybe make a setting change and I have never seen that option...but then my Adapt is 2 years old now and my VPAP Auto was older than that...so is this something new that is available on the newer VPAPs?

I sold my S9 VPAP Auto so can't go look on it for Easy Breathe...sure don't remember seeing it though and my S9 Adapt 36007 doesn't have it.
I know for sure that EPR was never available on my VPAP.

Pugsy wrote:PaleRider...

Is Easy Breathe the same thing as EPR? I thought it was something different but then I haven't kept up with every little thing on these machines.

I don't remember ever seeing an Easy Breathe setting available on my S9 VPAP Auto and I sure don't have it on my Adapt but I see that VikingGnome mentions it and someone else has mentioned being about to turn Easy Breathe off or on or maybe make a setting change and I have never seen that option...but then my Adapt is 2 years old now and my VPAP Auto was older than that...so is this something new that is available on the newer VPAPs?

I sold my S9 VPAP Auto so can't go look on it for Easy Breathe...sure don't remember seeing it though and my S9 Adapt 36007 doesn't have it.
I know for sure that EPR was never available on my VPAP.

no, easy breathe is *not* the same as EPR. EPR is a 1-3 reduction of pressure when not inhaling. (essentially a limited bilevel). Easy Breathe is a breath shaping mode that changes the way the machine cycles between pressures, but it doesn't CHANGE the pressures, the way EPR does.

here's a post from robysue about it on "another board" (as they say in tv land)

palerider wrote: no, easy breathe is *not* the same as EPR. EPR is a 1-3 reduction of pressure when not inhaling. (essentially a limited bilevel)

Gottcha, thanks for refreshing my memory. After reading Robysue's information I remember now. It's been a long time since I read about that stuff.

Pugsy wrote:

palerider wrote: no, easy breathe is *not* the same as EPR. EPR is a 1-3 reduction of pressure when not inhaling. (essentially a limited bilevel)

Gottcha, thanks for refreshing my memory. After reading Robysue's information I remember now. It's been a long time since I read about that stuff.

yeah, if it was the same as epr, then it'd have a numerical setting, which, according to the manual, and my playing with my vpap auto in S mode, it doesn't.

now, some of the confusion my have happened because resmed often talks about easy breathe when talking about epr. (and, they named their blower motor easy breathe, I think) so some people might think easy breathe = epr, but no, it's EPR *WITH* easy breathe, meaning epr with softer curves between the ipap and epap.

if I were sufficiently motiviated, I'd do a couple of traces of the mask pressure in sleepyhead with easybreathe on, and off, and see what the differences looked like... but I'm not that motivated at present

Easy-Breathe is an on or off setting. Unlike EPR there are no number settings.

In my opinion, S9 VPAP vs. AirCurve is probably about a tossup right now. The S9 VPAP has a good track record. The AirCurve doesn't have obvious quantum level improvements over S9. There's some risk of "teething pains" with a new model.

I think ResMed vs. PRS1 is about a tossup in terms of reliability and other problems.

i.e. I think any one of the 3 choices will be about equally good in general.

Can a minimum delta be specified in the Respironics autobilevel now?

jnk... wrote:Can a minimum delta be specified in the Respironics autobilevel now?

What's a delta?

If you mean minimum PS...yes...with the 760 model there are separate settings for minimum PS and maximum PS and we are no longer tied to the default 2 cm minimum default PS.

Pugsy wrote:

jnk... wrote:Can a minimum delta be specified in the Respironics autobilevel now?

What's a delta?

If you mean minimum PS...yes...with the 760 model there are separate settings for minimum PS and maximum PS and we are no longer tied to the default 2 cm minimum default PS.

Thanks, Pugsy!

With that change, then, I now have no reservations concerning anyone's use of that brand's autobilevels, since those machines, theoretically anyway, could be set up just as effectively as a ResMed for anyone now, I would think.

Previously, for some with obesity-hypoventilation issues, for example, a 2-cm-hardwired-minimum PS was bogus bilevel, IMO, back in those days. Technically, that brand's autobilevels didn't really have the ability to meet the AASM definition of dependably delivering a bilevel-pressure Rx (PS of 4 cm or higher).

Personally, when I tried Respironics' autobilevel some five years ago, it didn't follow my breathing very well, so the ResMed autobilevel turned out to be what was best for me. I believe, on the other hand, however, that others have found the opposite to be true for them--Respironics followed their breathing better than ResMed.

So my opinion (as nothing but an activist-leaning patient) is that ideally a patient should be allowed a few weeks with each autobilevel machine (provided, of course, that each machine was set up properly for that patient's particular issue[s]) before the patient chose which one was more effective and more comfortable for him or her.

Sadly though, little, if anything, in the DME-RT world is ideal these days--whether dealing with patients OR explaining differences in machine approaches to docs--none of whom seem to want to have to learn enough to be able to customize an Rx according to a particular technical approach by a manufacturer. And no RT wants to be responsible for assuming what the doc would want, even if (BIG IF) the DME-RT understood the differences between the manufacturers' approaches in their autobilevels. In my opinion, all of that makes the prescribing, and dispensing, of autobilevels problematic in the system as it now stands.

So, getting back to OP's question, there is no disadvantage to an autobilevel machine, provided you are willing to develop the expertise yourself (with the support of fellow patients here, of course) on how to optimize its settings for yourself--since few docs and RTs have the know-how, the desire, or the time to work together with each other, or with you, to help you do that.

In my opinion. And I do have some doozies. The above being one of them.

I have limited experience
I had a Resmed S9 Autoset with heated humidifier and heated hose, for 3 years and could never hear a sound from it.
I now have a PRS1 960TS ASV. From the first night the noise as it follows my breathing paterns has disturbed my sleep and my wife's sleep.

So I am predjudiced toward Resmed now.

It was the data retention differences that originaly led me to choose the PRS1. After a year with the new machine I still am not sure I made the best choice.

Resmed S9 Auto vs. PRS1 960TS ASV
you are comparing "apples to oranges"