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NIGHT 2

Set the LPM alarm to 0.0 & that fixed that problem.

The machine went very well. I would rate it as by far the best Bipap I have used. It had no trouble handling breathing via nose or mouth. The transitions were very smooth.

At one point I woke up & was aware the machine was increasing the ipap pressure and pushing me to breathe which is what this particular machine is designed to do. It also seemed to be nudging my breathing rate up a bit as am inclined to get into long slow shallow breathing.

The noise from the machine is the same as any of the 'tank' style Bipaps & being constant is more like 'white noise' in fact during the night I could not hear it which was what used to happen with my original Remstar Auto. My wife says it makes a drone but she never had any problems with the Remstar & I know she will be used to it within about 2 nights (whereas she would never accept the whine from the Vpap III I was using - she would go sleep in the spare room).

What I really like about this machine is that it will maintain a breathing rate just like a Bipap S/T or Vpap III S/T or PB330 A/C - at one of the points I woke up I allowed myself to breathe out slowly & stopped my airflow - within 4 secs the machine switched to ipap & pushed me right back into breathing. This is why this machine is such a good unit for clearing CAs - the push to breath that it provides is very effective and strong (really does ventilate). My PB330 in A/C mode would do this as does my S8 Vantage in EPR mode, but I would have to say that this Bipap AutoSV seems to be the most effective of the three. The best word I can think of to describe the transitions is 'smooth'.

The one effect I try to avoid with any xPAP is aerophagia - that becomes a real PITB (pun intended) & this Bipap AutoSV does not create this problem. With my S8 I have lowered the CMS setting just a little as when I use it the aerophagia factor rises over what I am used to with the PB330. So on the matter of not introducing aerophagia this Bipap AutoSV scores top marks.

I still want to analyze the data from the machine to see how it behaves & to correlate that data to a nights SpO2 data. Last night I had intended using my Ohmeda 3740 SpO2 unit as well but will try to do that tonight.

All in all I am very happy with this machine already & consider it a successful product with a good range of adjustments and will go as far as to say it is very easy to set up & understand for anyone familiar with Bilevels. I plan to shelve my excellent PB330 in favor of this BipapSV.


DSM

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

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

So, when you say the transitions are smooth, does that mean you are getting those nice shark-fin gradations? Let us know how you like epap 10cmH2O. I think raising ipapMax to 20cmH2O was a good idea. I would keep ipapMax over 5cmH2O and not over 10cmH2O of ipapMin. Hopefully you can avoid some of the runaway 30cmH2O. Still mystified at how dilfo could tank (3) BiPAP Auto SVs in 8 months.

Banned

[quote="Banned"]So, when you say the transitions are smooth, does that mean you are getting those nice shark-fin gradations? Let us know how you like epap 10cmH2O. I think raising ipapMax to 20cmH2O was a good idea. I would keep ipapMax over 5cmH2O and not over 10cmH2O of ipapMin. Hopefully you can avoid some of the runaway 30cmH2O. Still mystified at how dilfo could tank (3) BiPAP Auto SVs in 8 months.

Banned

Night three.

Very effective and continuing to do what it was built to do. I still haven't set up the SpO2 unit (had guests for dinner last night).

So last night was a night where the Bipap AutoSV had to work overtime to counter the effects of the wine we had for dinner.

I woke up a few times to find the machine force feeding air to me was really quite amusing, in a funny sort of way it puts a headlock on you opens your nose/mouth & forces you to take deep measure breaths - this is Servo Ventilation in operation. After several breaths (it is about 5) it relaxes & expects you to behave again but is ready to pounce on you if you don't.

This is quite an experience & a great confidence booster as you get to feel that the machine is damned well going to keep you breathing at a firm measured flow volume & for me that is the best of what xPap therapy is about including not having the unwanted side effects like aerophagia & mask leaks which this machine seems to avoid surprisingly well.

Re mask leaks - one reason I had set this machine to max 17 ipapMax was because I was concerned that if it did try to ventilate me & went to 17 CMS that my mask would float (hovercraft effect) & starte squeaking & then wake me. Last night I set ipapMax to 20 and I am certain it was using all 20 CMS during several forced breathing periods but the mask held on & the face seals held & it never leaked or squeaked that I was aware of.

Since going on this machine am feeling that am getting a deeper sleep - haven't felt any daytime tiredness which was happeneing prior to using it, even with my PB330 set to 13/10 ipap/epap.

One other observation is that when setting CMS the machine only does so in 1 CMS increments (same as my PB330) whereas the Resmed Vpap Adapt SV can be set in 0.2 increments. Also on my S8 Vantage I have found that being able to adjust in such small increments is very useful & it would be nice if this machine had that fine adjustment. But this is a minor issue.

Again, during the night I can't hear the machine. Wife is still in the same room so I know she is already used to it and not ready to register any big protest against the different noise.

So the more I use the machine the more I appreciate what it does & how it does it and I like it.

DSM

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

NIGHT 4

Last night was relatively uneventful other than my Ohmeda SpO2 unit seems to have a battery failure (I put a new gell cell in it 2 years ago). These things obviously need to be used regularly as it is about 4 months since I last turned it on.

The Bipap AutoSV does get quieter (distinctly) after it has been running a while - I have noticed this with other Respironics Bilevels.

Am still using my HC150 H/H in preference to the integrated Rspironics H/H. I doubt it is making any great difference but I do have 2 extra 18in lengths of hose (Bipap to HC150 & another extra bit on my mask). The extra hose bits add 3 ft which will have some minor effect on the working of the Bipap AutoSV but not enough to cause me any concern.

Definitely feel like am getting 'sounder' sleep than before going on this unit.

This will be the last nightly report unless I get the SpO2 unit running in which case I'll add a graph of a night's SpO2 data. Also I may add some charts of nightly data extracted from Encore Pro but these machines present quite different data & in a quite different way so it may not be useful nor understandable to other than respiratory folk.

DSM

Last night I performed open heart surgery on my Ohmeda 3740 SpO2 unit (removed its gell cell & used a car charger to kick it back into life - the Ohmeda's internal charger just wasn't doing it & the unit won't run if the battery isn't at full 12 V).

So I managed to get a full night's data plus I have downloaded via Encore Pro, the machine data. Just observing some of the data - it looks like the SpO2 reading may be among the better charts I have recorded, if so the BipapSV machine appears to be doing a great job.

I'll put together a chart marrying the nights Bipap AutoSV data and the output from the Ohmeda. But it is interesting to see how often the ipap SV chose to go to IpapMax on the 1st night of use versus how few times it did so last night.

There may well be a period where we users adapt to this therapy & the more we do so the more settled the response of the machine.


The data that is of most interest to me is that while I have set IpapMin to 13 CMS, the average IpapMax is typically 14 (one night it went to 15). This plus the bar graph showing IpapMax rises, indicate to me that this machine sees the need to boost my respiration peak volume many times during a night's sleep. That to me is the BipapSV clearing hypopneas.

AV PEAK FLOW
The average peak flow looks to be a surprisingly high 42.5 litres per min.

TIDAL VOLUME
The tidal volume though, at 650 ml/min is pretty close to the data I was getting from my other non SV machines which typically show 600-800 ml per min.

BREATHS PER MIN (BPM)
Av breaths per min seems a bit on the low side at 14.4 per min but is acceptable. I may experiment one night by setting BPM to 18BPM to see what effect that has.

AHI AVERAGE
Other interesting data is the AHI scores ...
Night 1 = (as mentioned at the top, alarms ended that night early)
Night 2 AHI = 5.0 (AI = 4.0 - HI = 1.0)
Night 3 AHI = 5.0 (AI = 4.0 - HI = 1.0)
Night 4 AHI = 2.0 (AI = 1.0 - HI = 1.0)
Night 5 AHI = 3.0 (AI = 2.0 - HI = 1.0)

So the very high hypopneas (HI) I am used to scoring on non SV machines appear to be fully under control. That for me is what I was hoping this machine would address & the evidence thus far is it does it & does it well.


TUNING THE BIPAP SV
Now is a good time for me to make further adjustments and I will do so as follows ...

A) Will increase epap from 10 to 11 (I would much prefer to do this in 0.2 increments but this machine only allows 1 CMS increments but 1 CMS is a big jump for fine tuning)

B) Will increase IpapMin from 13 to 14 (again would prefer 0.2 CMS increments)

If these 2 adjustments drop the AIs & HIs down lower then that will be great progress for my therapy and a testament to how straight forward this machine is to adjust.

C) IpapMax is fine at 20 CMS & while the BipapSV did reach IpapMax when it was set to 18 CMS, it hasn't done so since I set it to 20 CMS so it seems that about 18 CMS peaks are all the machine really needs to go to for my sleep needs.

On the 1st 2 full nights the machine was accepting 98% patient triggered breaths whereas last night it accepted 99% - this again indicates to me an adjustment on my part to the machine's different algorithms.

SUMMARY
For people who don't have big AI (obstructive apnea) scores but do score very high HIs (hypopneas) the BipapSV looks to be a very effective machine for getting your SDB under better control than can be achieved with an Auto or even a Bilevel (straight Bipap). The SV machine has the ability to push you to breathe as soon as you start a hypopnea cycle & it does it in real time and it does it well.

DSM

Very happy customer

PS: The data charts from the BipapSV really are excellent as they actually show the time and duration of each AI & HI scored. They even include marks to show when Periodic Breathing has occurred (in my case, not very often).

#2: Another interesting and very nice side effect is that I seem to be able to sleep on my back more than I ever did before as this machine's SV capability deals with the worsened AI HI environment that typically occurs when sleeping on one's back. That makes sleeping much more comfortable.

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, Encore Pro, AHI, Hypopnea, auto

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, Encore Pro, AHI, Hypopnea, auto

dsm wrote:A) Will increase epap from 10 to 11 (I would much prefer to do this in 0.2 increments but this machine only allows 1 CMS increments but 1 CMS is a big jump for fine tuning)

I'd expect increasing EPAP a full cm will, indeed, lower the number of full apneas that have been sneaking through despite treatment.

I'd make just that one change (raising the min EPAP) and see what the results are, rather than changing EPAP and min IPAP both at the same time. Unless min IPAP absolutely has to be raised if EPAP is raised. But you probably already did plan just "one change", since you've been going about this pretty methodically so far, and that's good.

dsm wrote:For people who don't have big AI (obstructive apnea) scores [etc.]

I don't know if that qualification necessarily applies. It might just be a matter of getting the settings right -- primarily the EPAP setting, which is usually supposed to be set "high enough" to take care of obstructive apneas when using regular bipaps, or even (imho) when using the bipap auto (non-SV).

dsm wrote:BREATHS PER MIN (BPM)
Av breaths per min seems a bit on the low side at 14.4 per min but is acceptable. I may experiment one night by setting BPM to 18BPM to see what effect that has.

I hope you don't mix that experimental change in along with the change you plan for EPAP. Or during the change for min IPAP either. I'd check those out one at a time before changing the BPM.

Your reports have been interesting to read, Doug. Thanks for posting them.

RG,

Very good points - I was actually going to up epap & IpapMin at the same time mainly because I have long got used to a 3 CMS epap ipap gap, but your suggestion to stick to 1 raise is a good one & i'll just up the epap & see what the data shows for the night before playing with IpapMin.

The change of BPM will definitely be one for the future as I am not convinced it is a super smart idea to do it but I am willing to do so for experimental & research reasons.

Also, now that I have my Encore Pro updated to accept SV data, I have been able to go back and look at some reports from Dave (dlfo) and have sent him an email as I am somewhat worried at what his charts show. When Dave said his machine staying at 30 CMS I just couldn't see it doing that unless it was defective but sure enough he has a solid 15 minute apnea scored & the machine at 30 CMS and the ventilation pretty close to 0.
I am quite concerned about Dave from that chart plus another he sent me that depicts similar events.

The data provided from these SV machines is pretty specific & unambiguous.

RG, many thanks for your input. I value it.

DSM

#2 If anyone wants to see what a Bipap AutoSV report looks like my one can be downloaded (pdf doc) from here. Only the nights marked 16th Apr to 20th Apr are mine. 16th shows only a very short use due to a misunderstood alarm.

The earlier night (16th March) was a friend trialling the machine in the US.

D

http://www.internetage.com/general/repo ... -20apr.pdf



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

dsm wrote:Also, now that I have my Encore Pro updated to accept SV data, I have been able to go back and look at some reports from Dave (dlfo) and have sent him an email as I am somewhat worried at what his charts show. When Dave said his machine staying at 30 CMS I just couldn't see it doing that unless it was defective but sure enough he has a solid 15 minute apnea scored & the machine at 30 CMS and the ventilation pretty close to 0.
I am quite concerned about Dave from that chart plus another he sent me that depicts similar events.

Yes, he sent me those reports, too, and they were extremely concerning to see. I understand his desperation, but I think he really needs to get back to Natl Jewish as soon as he can to have the sleep lab there work on his SDB. My heart goes out to him. He has so many serious health issues going on.

NIGHT 6

The SpO2 report from night 5 was actually very normal - did drop to 90 at one small spot but mostly around 94-95. Will post that plus last nights later today Aust time.

The BipapAutoSV report for last night showed improvement after upping epap to 11. Instead of clearing all AIs it cleared all HIs & left a very insignificant AI of 1.0.

So just that one change has achieved something I don't think I have seen before on my charts HI = 0 !

http://www.internetage.com/cpapdata/dsm ... 2apr08.pdf 21st Apr

http://www.internetage.com/cpapdata/dsm ... 1apr08.pdf Prior 5 nights

Tonight I'll go ahead & up the iPapMin to 14. Theoretically I'd expect such a change to do more about HIs than AIs & they now seem to be gone.

DSM

Added the SpO2 data from the past 2 nights - the second set of data (21st to 22nd Apr) shows the same improvement & stable data that the BipapAutoSV data shows for that night.

http://www.internetage.com/cpapdata/dsm ... pr08-2.jpg 20-21 April 08

http://www.internetage.com/cpapdata/dsm ... pr08-2.jpg 21-22 April 08

DSM

Also, I am sure that the CMS settings from the Bipap AutoSV are lower than what I am used to for the same CMS settings on the PB330 - it has occurred to me that based on my own past tests there is a 1 CMS loss from machine to mask in any 6ft tube. Also the PB330 has an internal pressure sensing tube that accurately detects the CMS at the mask while the Bipap AutoSV doesn't have this & thus it (the PB330) is going to be very accurate as to what CMS setting is at the mask & showing on the screen of the blower unit.
This is no big deal but can cause some mix ups if comparing one machie settings to another where one has mask pressure sensing & the other doesn't.


So while I have upped epap to 11 CMS and will up iPapMin to 14 CMS, I am certain just from the feel, plus the other evidence presented above, that this is merely bringing the BipapAutoSV to the same real CMS settings I am used to from the BP330.

D

Night 7

The changes last night (upping IpapMin to 14) didn't improve AI as that went up to 2.0 but HIs are still showing as 0.0

Tonight I'll drop IpapMin back to 13 CMS on the dial & see if AI alters in step.
Also later today (Aust time) will post the SpO2 data for this night.

DSM

http://www.internetage.com/cpapdata/dsm ... 3apr08.pdf Bipap AutoSv

#2 Hmmmm, IpapMin still showing as 13 in the pdf report ??? - musn't have saved the change to 14. Will have to repeat that experiment.

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

Interesting stuff Doug.
My HI numbers are higher than my AI numbers but I don't have too much concern at this point as my combined AHI number averages 2.7 (AI has been averaging around 0.5, so it tells you that my HI number isn't that high).

But again, I read this thread with great interest. Thanks for posting such detailed info on your experiment!!!!

cheers
goose

I have always got high HI numbers - often HI would be between 3.0 & 7.0
& hypopneas best describes the nature of my SA.

My AIs have been typically below 0.5 mostly 0.2 & 0.3.

But, as we have often discussed in cpaptalk, the Resmeds score HIs much higher than Respironics machines. This has been consistent across many models I have used (S7, S8, Vpap III and Remstar Auto, Bipap Pro II, Bipap Auto & I also think the Bipap AutoSV).

I have my own theories about why Resmeds score HIs higher - I tend to regard the Resmed's HI scoring as more accurate for hypopneas but any debate on the topic seems to provoke more brand loyalty than scientific evaluation

Glad the info has been informative - it has been very interesting from my perspective too as I admit I was a bit skeptical about the outcome based on experience with 4+ other model Bipaps I have, but, the Bipap AutoSV has won me over as a very effective & tuneable machine & I am not bothered that it doesn't use a proximal sensor line (like the AdaptSV) as I can see that its peak flow measurement approach doesn't really need one.

DSM

goose wrote:Interesting stuff Doug. Thanks for posting such detailed info

Yeah, I'm so moved it's even bringing tears to my eyes. i had to dig out , dust off, and fire up the old REMstar Plus with C-Flex so I could remember what it was like in the old days. You will never get to EPAP 11 and IPAP 13 on the Adapt. The closest the Adapt will get you is EEP 10 + MIN PS 3 = (IPAP) 13.

Banned