First couple of nights with biPAP Auto.

I got my biPAP auto delivered on monday and have slept with it for the past couple of nights. I debated for a while what settings to use. I decided to leave it with the range of 4cm to 20cm of pressure in auto w/biflex = 2 mode.

Almost right away when I put the mask on and tried to breath I realised that having my floor value so low was a huge mistake. With that little of pressure I felt like I wasn't getting enough air. Could be that I am just used to being at 17cm of pressure. In any event I decided to set the min epap to 10cm and leave the max ipap at 20cm. That worked out much better for me.

The next thing I noticed was the way it affected my Activa mask. With the straight cpap the "active cel" air cushion would inflate and stay constant. With the biPAP auto the initial pressures were low and the "active cel" air cushion did not feel inflated, this caused the mask to feel extra loose and I got a little nervous this would cause leak problems. I went with it anyway. As I lay there awake and breathing, I could feel the different pressures and how they affected the mask. The effect was to have the mask accordion up and down on my face. There was a little studder in the masks up/down movement that I just now realized was probably the biflex kicking in. The effect was definately very distracting, but thankfully I am a heavy sleeper and was able to get used to it.

I have a loud air conditioner in my bedroom so I cannot comment on the units noise level. I don't remember hearing anything at all though so I suspect this is a quiet machine.

The machine setup was easy, the only mildly challenging aspect was installing the air filter. It took me a few minutes to figure out which way the filter cap snapped in, but it was no big problem.

The first night went really smoothly, after I got used to the mask movement I went to sleep and expeiranced no problems. The second night I developed the rainout effect in my mask. I thought I had a runny nose at first but eventually I realized it was water condensing in the mask. That was the first time I experianced rainout. I had some trouble figuring out how to change the heated humidifer's tempature setting. It was late so I just turned it off and used passive humidification to keep things comfortable. That worked like a champ and I woke up again today feeling great.

One of the primary reasons I wanted a new machine was to get usage data. I followed the directions and installed Encore Pro 1.6i and the drivers for the smartcard reader. Everything worked fine and I was able to download my first nights data without trouble. The only problem was that I could not find any of the details that I was interested in. I wanted to see my leakrate, AHI, AI, HI and other details. All I could get was hours of usage and pressure values.

I searched around and thought my problem might have been that I left the database password blank. I uninstalled everything and re-installed with a password. Still no data. I ended up installing MyEncore (great application!!) and it was able to get at the info I was interested in!

I went to download my data from last night and what do you know, the smartcard reader got into a state where the software couldn't detect it. I found a great thread (viewtopic.php?t=5269&postdays=0&postorder=asc&start=75) that had some directions for unistalling and re-installing everything to overcome that problem. I think the part that did it was having the smartcard reader unplugged at the appropriate times.

In the process of looking for that info I found some posts that detailed how to get access to the "detailed info" I was looking for! In EncorePro's patient homepage there is an "interaction list" menu. If you double click "Sleep Therapy Compliance Download" and select "full details", you get a report that has ALL the data in it. Very handy tip.

Here is the data I gathered my first two nights:

First Night:
7 hours 44 mins of use
17.6cm Avg 90% ipap pressure
13.8cm Avg 90% epap pressure
0.0 Total Obstructive Apneas
2.0 Total Hypopneas
81.0 Total Snores
0.3 AHI (events/hour)
0.0 NRAI
0.0 OAI
0.25 HI
NA FLI
10.5 SI
104.8 Max mask leak
45.0 90% average mask leak
42.9 Average mask leak
0 min Average Large Leak
Fraction of Night in Variable Breathing: 30.7%

Second Night:
8 hours 09 mins of use
17.2cm Avg 90% ipap pressure
14.3cm Avg 90% epap pressure
1.0 Total Obstructive Apneas
7.0 Total Hypopneas
127 Total Snores
1.0 AHI (events/hour)
0.0 NRAI
0.12 OAI
0.86 HI
NA FLI
15.6 SI
92.0 Max mask leak
44.0 90% average mask leak
41.0 Average mask leak
0 min Average Large Leak
Fraction of Night in Variable Breathing: 30.7%


Nothing really jumps out at me except the snore values, but I don't really understand them yet. I don't know what is normal and what is abnormal with snores.

I was concerned about the leak rate at first as well, but I saw in another thread that under 25 is excelent, under 50 is ok, and 50-75 is not so hot, and above 75 is really bad. I also saw that the mask's exshaust contributes to the leak rate and you should factor that in....though to be honest I am not sure where you get the information to see what your mask's leak rate should be. lol. Those two statistics are what I plan to reseach next.

One of the reasons I wanted to get a biPAP was because I wake up with a sore back on occasion. I have always attributed this to the extra exercise those muscles get breathing out against the pressure. I am hoping the biPAP will help with that. The first night I did wake up with the sore back, but it wasn't that bad. I had a very mild case last night so it could be helping. The problem did go away over time for me when using cpap, then my mask would start leaking and I would replace it eventually. When I replace it and get a good seal is when the problem would re-crop up. Still, I suspect it is the biPAP helping rather than just me getting used to the pressure again.

One thing is for sure, I already feel better knowing that I will be able to track my progress via the software rather than guesswork. The peace of mind that brings alone is worth the purchase price. Thanks to everyone here I feel like I have much greater control over my therapy. Whoo hoo! Thanks!

Great Review Will,
I am moving from a BiPapPro2 in the next month so I will be very interested in your comprehensive reports.
Thanks.
michael

Thanks Micheal, I hope everything goes well for you with the new machine when you get it!

It has been a couple of more days and things are still looking pretty consistant. I have my computer downstairs and I managed to forget to bring the smartcard back upstairs to my biPAP the night before lastnight. I didn't gather any data but felt no real changes in my "awakeness"...of course that doesn't really say much as I am not good at detecting that sort of thing.

I am getting more and more used to the "acordion" mask movement. It never really bothered me all that much but I barely even notice it now so I feel lucky. I still have not quite figured out the way to set the humidifier heat level, I suspect I need to turn the machine on to be able to set it. I have had good luck with leaving the humidifer off and just using passive humidification. That is makes the air almost too moist so I haven't needed more yet. I am not really having any problem with it, just not motovated to figure it out.

One major difference that I have noticed more often over the past couple of days, is the tightness of my mask. The biggest difference between cPAP and biPAP auto for me so far is the mask behavior. With cPAP the constant pressure keeps the activa mask inflated and it feels secure on my face. It doesn't press hard but it feels snug. With the biPAP and the moving pressures the activa feels extra loose. It almost feels too loose and like it might not stay on or maintain a good seal.

The numbers say the leak rate stayes at 45ish as an average for the 3 nights I have data, also my other numbers seem good which indicateds the machine is doing it's job. I am just going to have to get used to the loose fitting mask, I think most people would consider that a feature and I am expecting that I will as well after I make the adjustment.

I am very glad to have the biPAP auto for another reason too. The first two nights had my 90% pressure for inhales set to around 17.5cm. My cPAP pressure is 17cm. Last nights data put the 90% pressure for inhales at 19.9, which is enlightening. I suspect that I was in a different sleep position that required a higher pressure. The data showed only one apnea last night so whatever it did worked. I also had a dream last night, which while midly disturbing, I managed to remember it in the morning. That combined with the numbers makes me feel like I got good sleep last night....I feel good today too, not abnormally good...just good.

This makes me think, gee if I had been using my cpap at 17cm last night I might have gotten more apneas and gotten poor sleep. If I needed the 19.9 then I wouldn't have gotten it.

The fact that I hit the 20cm max I programmed in makes me think I should consider upping the max to closer to the 25cm the machine is capable of. I have not decided on that yet, but I am glad to have the data to help guide me. I am very encouraged by how things are working out so far.

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, humidifier, activa, CPAP, seal, auto

Will - Leak rates for masks vary a great deal. Doesn't your mask manual (sounds like a super-hero) have a chart for the leak rate. I'm looking at a Hybrid manual, and it say the leak rate at 15 cm/H2O is 60 liters/minute.
Your average leak rate should be very close to the mask's published leak rate.

Will,

Terrific review. I'm sure that many people will find this helpful. Just curious -- how is your mom doing?

Shelley

OOps! Sorry, the previous 'guest post' was me...

Hi Will. Glad Shelley asked about your Mom because I was wondering too. Also, I wanted to say how motivating it is to see someone new taking the bull by the horns with understanding the data and equipment. Thanks for your input.
Kathy

Lol, I ended up throwing out my mask manual, I figured there wasn't much to know about putting on a mask. The activa even came with a CD/DVD that had some video on it, I got a chuckle and figured that it was one of those "no need to read the manual" devices. I don't think I have taken out that trash yet so I might have to go rescue it. hehe. I suspect my leak rate is ok, but it never hurts to know for sure. If I can't find the mask I am sure I can dig up the information somewhere.

Thanks for the concern about how things are working out with my mom. She has not been using her mask this week, she lost one of the nasal pillows for her current mask and has yet to go to the DME to get a replacement and hopefully pick up a new mask altogether. I am anxious to have her get started with more effective therapy, and I think the tips in the other thread are going to help with that. She has been busy with other things this week. My inpulse is to tell her that she should make time for something this important, but she isn't as excited about cpap therapy as I am.

I am trying to walk the line between being helpful and being annoying. I don't want her to feel like I pester her about it every single time we speak. I am forcing myself to wait till at least monday before I start gently suggesting that she pick up the replacement pillows and hopefully try on a few masks while she is at the DME. I might even be extra sneaky about it and have my sister offer to take her or something to get the ball rolling.

Will,
They are doing tests concerning snoring and the carotid artery. They think heavy snoring slows the flow of blood to the brain. More studies will follow,
but I have been curious about the snoring issue also.

My wife and I have Auto Bipaps. They are wonderful. I even used mine like an "iron lung" while in Anacortes, WA. Due to severe asthma problems, I could not breathe. I took my prednisone and put my mask on. If it worked I continued the vacation, if not I was headed for ER. It worked.

Oh yeah, my wife set a record for sleep last night. Using the Comfortlite II,
she slept almost 9 hours. She has never slept that well since she was an adult.

Our machines are set on full auto. Good luck with yours....