Using a Bipap Auto SV and using a Vpap Adapt SV

rested gal wrote:

dsm wrote:RG,

I would take it from the data shown the original settings I have adopted of 10/13 are optimal.

The EPAP 10 / IPAP 20 you have the machine set for looks like it's doing fine for you.

If I changed anything, I'd probably put the EPAP at 11 to see if that might knock out all the apneas. But as scattered and insignificant in number as they are, you really don't need to change anything. Looks very good.

RG,

Tonight I'll be back on the Bipap AutoSV. That SV machine really seems to be a terrific normalizer. I only tried the Bipap Auto because I found that with nose as it is now, I could use the other Bipaps & feel quite comfortable. The past 2 nights on the Auto were fine but I do like it when I can set a 3 CMS epap ipap gap although the stats show the machine did that anyway for part of the night..

Tks

DSM

Am going to add another PDF report taken from my S8 Vantage used while doing the recent 2 week rally to Adelaide. Reason I am including it is to show just how much higher my AIs and HIs were prior to going on the Bipap AutoSV. It covers about 10 days & the data is consistent (with high HIs).

This report may seem unusually highly detailed to other Resmed users but I use a Reslink attached to the S8 and it captures far more detail than shows in a normal S8 report. I like it because I can put the smartcard it uses into any PC I own whereas the Resmed datacard can only be read by a special card reader that costs nearly as much to buy here in Australia as a reslink from the US so the reslink won out over using the small Resmed datacard.

This will be of use to any interested researchers looking for comparisons. But, I don't have any SpO2 data for this period (am still working on obtaining an xpod oximeter that plugs into the reslink, for a cost that is a lot less than the $US 1,200 charged for it and a finger probe - of which the cost is downright and patently ridiculous, by any measure !!!)

DSM

This is a 29 page Rescan pdf report so is big (5.4MB big) but it is a progressive download so like most PDF docs the 1st page will show reasonably quickly.

http://www.internetage.com/cpapdata/dsm ... 7apr08.pdf

Resmed definitions ...

An apnea is the temporary absence or cessation of breathing. An apnea is
scored when there is reduction in breathing by 75% of the baseline breathing
for at least 10 seconds.

Hypopnea A hypopnea is an episode of shallow or slow breathing during sleep. Ahypopnea is scored when there is a reduction in breathing by 50% of
baseline breathing for 10 seconds or more. The event is scored after 10
seconds of the hypopnea.

AHI The Apnea-Hypopnea Index (AHI) is calculated by adding together the total
number of apnea and hypopnea events over a period of time.
For statistics, it is the total number of events divided by total Daily Usage.
For graphs, the AHI count is incremented at the occurrence of every event
and reset every hour.


_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): bipap

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, bipap

Last report in this sequence - back to 'normal' - actually I doubt that results can be much better than this except to not have any Apneas.

http://www.internetage.com/cpapdata/dsm ... 8apr08.pdf

There is no SpO2 report as that machiner has now been shelved for the time being. Also last night I switched from the F&P HC150 H/H to the normal integrated Respironics unit.

What really stands out in these BipapSV reports is that the machine is working constantly at raising the CMS (see top graph on page 4) in order to keep peak airflow up - the CMS has hit 20 a few times in the night - and the net result is that only 2 apneas get scored for the whole night (from what I see in the data). This makes the machine look pretty good.

DSM

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): respironics

Nice looking data.

Interesting that you have the EPAP for the Auto SV set at 11.

Would be interesting, if you have ever occasion to try the BiPAP Auto (non-SV) again, if you would also set that machine's EPAP at 11, instead of the EPAP 10 you had been using with it.

Nonetheless, your recent reports using either machine look very good.

rested gal wrote:Nice looking data.

Interesting that you have the EPAP for the Auto SV set at 11.

Would be interesting, if you have ever occasion to try the BiPAP Auto (non-SV) again, if you would also set that machine's EPAP at 11, instead of the EPAP 10 you had been using with it.

Nonetheless, your recent reports using either machine look very good.

RG,

Perhaps will try it this coming week end. After wife's complaint about the room starting to look like a hospital ward, I tidied everything up & put the Ohmeda away & got rid of the multitudes of sensor & power cables (My HC150 was connected to a biggish 240 to 120 VAC transformer as was the Ohmeda pulseox).

The thing that caught my eye in the SpO2 data captured when on the BipapAuto is it looked like my pulse rate & SpO2 adjusted upwards as the Bipap Auto took Ipap from 12 to 13. The 2 nights SpO2 data when on the Bipap Auto tracks very similarly.

D

RG,

A couple of thoughts - one reason I left epap at 10 on the AutoBipap was to see if it lifted that setting based on any detected events. I am happy to try 11 in a test (probably fri night + I will rollout my SpO2 machine again to gather that data as well.

Because it didn't appear to change epap I figured the the AutoBipap was happy with it.

One other question you may have comment on is that the AI score of 1.0 for a night seems very high allowing that the chart shows only 2 AI events for the whole night. Surely the score for the night would be more like 0.1 or even lower ?

I have the impression that the Bipaps only score for the night in multiples of 1.0 as I haven't seen a night's HI or an AI scored any other way except they do show 1.x type numbers for long term trends and the AutoBipap does show 1.x numbers in the CMS pressure columns.

So just out of curiosity am wondering why my AI & HI scores for a particular night are either 0.0 or 1.0 etc: no matter how few events are scored.

Beyond those queries, the BipapAutoSV data is very easy to read and to follow. I like it. The AutoBipap is a tad more difficult to work through but provieds a good range of very useful info.

All in all I give them both high marks.

DSM

DSM, do you EVER have nights like the data I sent you?

Am I the only one on the forum with numbers like this?

I know one thing, the Oxycodone for the pain really plays havoc with my ability to breathe.

What is the highest scores you have had with the SV? I keep thinking someone else will come along and have Encore Pro data like mine.

Bedtime I think, almost 3am. The toothaches have subsided, TTUL, Dave

dsm,

A while back you stated somewhere that you were thinking of a trial with a ResMed VPAP Adapt SV. Did anything ever come of that?

Banned

Banned, I can't remember if you were going to trial another machine. I'm thinking one of your doctors may have mentioned trialing the BiPAP Auto (primarily obstructive SDB treatment) or the BiPAP AutoSV (primarily central and/or mixed SDB treatment).

Have you had a chance to try anything else after the VPAP Adapt SV? And if so did you have any luck? As good as things were going with your VPAP Adapt SV, I can't say I'd blame you for sticking with what works well.

I have been following Doug's two SV trials via PM. He has some interesting observations to share about what seems to work well for him. But I'm not going to spill the beans ...any more than I already have!

A drum roll for Doug's somewhat surprising answer to your question...

-SWS wrote: Have you had a chance to try anything else after the VPAP Adapt SV? And if so did you have any luck? As good as things were going with your VPAP Adapt SV, I can't say I'd blame you for sticking with what works well.

You have a good memory, SWS! Funny thing about my 'titration' to the Respironics BiPAP Auto SV that was supposed to take place this past April. I never heard back from my 'doctor'. I'm sleeping pretty good, feeling pretty good during the day, so I get complacent and don't follow-up. Thanks to you, dsm, and others on this forum, I no longer believe that one machine fits all. I now believe one of two SV machines fits all. I would definitely like to trial a Respironics BiPAP Auto SV. With dsm's, dilfo's, and Laryssa's endorsements I'm sure it's a great machine!

Banned

Banned wrote:Thanks to you, dsm, and others on this forum, I no longer believe that one machine fits all. I now believe one of two SV machines fits all. I would definitely like to trial a Respironics BiPAP Auto SV. With dsm's, dilfo's, and Laryssa's endorsements I'm sure it's a great machine!

I can't tell you how ecstatic I am to hear that your VPAP Adapt SV works as well for you as it does. I won't spill the beans about Doug's experience. But Laryssa's story is just phenomenal. She's running BiLevel with auto-backup, and her doctors have the future option of employing SV mode if they think it's appropriate.

Doug's undoubtedly going to re-enter this thread with his observations and thoughts about both SV machines. Undoubtedly this is the thread where I will expound on the fact that "automated PS" in SV mode thus far has been optimized only for central ventilation. Any "automated" obstructive treatment you receive from PS while in SV mode is incidental obstructive treatment, and not by design.

Rather, both SV manufacturers ask that a fixed EPAP-equivalent or fixed CPAP-equivalent be manually titrated to address any obstructive components. And if you're primarily an obstructive SDB patient (versus a central or mixed SDB patient) while getting such great incidental OSA results on an SV machine, then that sure begs some very interesting questions about either your unique SDB pathophysiology or some very under-explored SDB epidemiology.

This thread is as good as any to further explore/speculate just what might be happening for some obstructive patients regarding SV modality...





.

-SWS wrote: Any "automated" obstructive treatment you receive from PS while in SV mode is incidental obstructive treatment, and not by design.

Irrespective of a 'mild' sleep apnea CPAP diagnosis, and never having been diagnosed for centrals, I would be the first person to admit that the "automated" obstructive (upper airway obstruction, lousy turbinates, restricted throat size) treatment that I receive from PS while in SV mode maybe incidental. But it still works for me!

Banned

Banned wrote:

-SWS wrote: Any "automated" obstructive treatment you receive from PS while in SV mode is incidental obstructive treatment, and not by design.

Irrespective of a 'mild' sleep apnea CPAP diagnosis, and never having been diagnosed for centrals, I would be the first person to admit that the "automated" obstructive (upper airway obstruction, lousy turbinates, restricted throat size) treatment that I receive from PS while in SV mode maybe incidental. But it still works for me!

Banned

Banned wrote:Irrespective of my 'mild' sleep apnea CPAP diagnosis, and never having been diagnosed for centrals, I would be the first person to admit that the "automated" obstructive (upper airway obstruction, lousy turbinates, restricted throat size) treatment that I receive from PS while in SV mode maybe incidental. But it sure works for me!

There's no doubt in my mind that it works MUCH better for you than CPAP and APAP modalities.

The compelling question in my mind is, do we attribute that efficacy increase to: 1) incidental treatment of obstructive SDB (static airway inflation), 2) enhanced ventilation offered by that leading-edge of the stepped pressure function in PS (via pressure equalization), or 3) some incidental and optimal mix of the above two?

The SV machine algorithms are not presently optimized for "automated" treatment of obstructive SDB components. Can you imagine the increased versatility and efficacy when simultaneous "automated" treatment of both central and obstructive components becomes possible?

Again, that's not to say that some people such as yourself aren't already better off with SV compared to other modalities.

-SWS wrote:

Banned wrote:Irrespective of my 'mild' sleep apnea CPAP diagnosis, and never having been diagnosed for centrals, I would be the first person to admit that the "automated" obstructive (upper airway obstruction, lousy turbinates, restricted throat size) treatment that I receive from PS while in SV mode maybe incidental. But it sure works for me!

There's no doubt in my mind that it works MUCH better for you than CPAP and APAP modalities.

The compelling question in my mind is, do we attribute that efficacy increase to: 1) incidental treatment of obstructive SDB (static airway inflation), 2) enhanced ventilation offered by that leading-edge of the stepped pressure function in PS (via pressure equalization), or 3) some incidental and optimal mix of the above two?

The SV machine algorithms are not presently optimized for "automated" treatment of obstructive SDB components. Can you imagine the increased versatility and efficacy when simultaneous "automated" treatment of both central and obstructive components becomes possible?

Again, that's not to say that some people such as yourself aren't already better off with SV compared to other modalities.