Snoredog wrote:-SWS wrote:There's no doubt in my mind that it works MUCH better for you than CPAP and APAP modalities.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!
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.
Using a Bipap Auto SV and using a Vpap Adapt SV
Report On Using Vpap Adapt SV & Bipap Auto SV
Hi Banned SWS - I have done three days on the Vpap Adapt SV but am now back to the Bipap Auto SV.
These are the settings I ended up with & the data extracted from both machines seems to match very well (comparing the 3rd night on the Vpap SV with a typical night on the Bipap SV).
Bipap SV. Epap 11 & IpapMIN = 14.0 IpapMax=20 Risetime=3 BPM=auto
Adapt SV. EEP = 10 & MinPS = 3.4 & MaxPS=10 (which when compared,
is equiv to Epap 10 & IpapMIN = 13.4 IpapMax=20 on a Bipap Sv)
These settings are near to being the same (the Bipap SV differs by 1 CMS for epap & ipap from the Vpap SV at the mask & this reflects the use of proximal line on the vpap SV which means it measures pressure at the mask while the Bipap SV measures pressure at the machine & there is a known 1 CMS loss over a 6' hose at 10 CMS pressure. The data from both pretty well confirms the similarity of settings.
The trial of both has been a big eye opener for me but is not finished yet.
I have some different masks coming & also a reslink & already have an SpO2 module that attches to Reslink so plan to do further heavy hitting analysis of both machines.
Firstly I have to say that the Bipap Auto SV is my current 'dream machine' - I look forward to using it & sleep long deep and well. I was not able to achieve that with the Vpap Adapt SV despite getting very close matching data from both machines after some tweeking. If you had asked me to bet on the outcome before I started either I would have willingly bet on the Vpap SV as delivering me the best nights sleep.
I note though that Banned is telling us he gets good results from his use of the Vpap Auto SV. We have traded PMs re some of the issues & the thing that does intrigue me is that the reasons I thought the Vpap SV wasn't working for me, seem to match Banned's condition. That is we both have severe nasal constriction. I found the Vpap Adapt felt very difficult unless I used the heavy hitting Otrivin spray & taped my mouth.
The Bipap SV seems to tolerate me breathing out my nose, my mouth, both (I'd swear it would let me breath out my ears if I had a mask that reached them )
The sleep I get with the Bipap Auto SV is deep restful and energizing & I love it.
The sleep I got from the Vpap Adapt SV was strained, shallow, but it was energizing in that once up & head cleared I had a good day, but after just one day debated if I would use it again right away, I decided I would (but had the Bipap SV ready & loaded in case I abandoned the Vpap SV quickly).
The Vpap SV data tended to show lots of leaks & my mask sure squeaked. On night 2 I used a new mask (Ultra Mirage FF) just to eliminate a weak seal.
After each night I download the data via serial link & stowed a copy on my web site. Anyone wanting to view my most recent detailed data can go to
http://www.internetage.com/cpapdata/ Choose items 1 or 2 to see each nights data - in the case of the Bipap SV, apart from a few lost nights (forgot card) I have 6 weeks of data. There was a short gap when I went to NZ & that daa is item 3 on the menu off an S8 Vantage in EPR mode. For the Vpap SV there is only 3 nights data.
The most recent nights data from each machine is very close in what the machine was doing. The av Ipap is close to the same (don't confuse what Resmed call the 'mean' Ipap with the average Ipap) , The number of times the machie went to max Ipap is typically the same.
So what do I think makes the difference ?
Firstly I found the Vpap SV too finely tuned for me. Like a formula 1 racer, the slightest breathing change & it reacted. It would 'pulse' me if my breathing slowed or stopped, each pulse got stronger. It seemed to be 'in my face' so to speak I am thinking that for what it was designed for it must be excellent. If I had a heart condition or some other breathing irregularity like Cheyens-Stokes, am sure it would be my lifeline.
The Vpap Adapt SV was soooo smooth in its operation. And it is soooo quiet my wife said the room was eerily quiet. The Bipap SV does have a steady drone but it never ever bothered me & later in the night seems to not be there. My wife did move rooms but has returned & is willing to get used to the Bipap SV based on it being the better therapy for my situation.
On the otherhand, the Bipap SV (unlike earlier trials with Bipap Pro II & Bipap S/T), never objected to my restricted nasal breathing nor my multi- mode breathing. It seems to have a lag in its responses & in my case that lag seems to give my symptoms a better run.
The Bipap SV is without doubt far more leak tolerant (certainly for me). I felt I never got my leaks under control with the Vpap Adapt SV. I have 2 more masks coming (the Quattro & Liberty) to trial with it & see if they help.
The Vpap SV is by far the simpler to set up. As Banned has told us before, just set EEP & stick with the defaults for all else. Then when ready to use run the mask training step. This is simple, you attach the mask, fill the H/H, then put the mask on the bed so it is unobstructed (you don't put it on) & run the training test. That test sends increasing pressures of air out the mask & I understand the proximal sensor feeds data back that allows the machine to calibrate to the air circuit. It has *nothing* to do with the mask leak holes as they only get exercised if the mask is worn. It has a lot to do with what H/H you are using & the type & length of the hose. & the air outlet (be it nasal prongs or F/F mask).
The Vpap Adapt SV will allow you to use a seperate H/H such as the F&P HC150, you just have to run the training circuit. The Bipap SV also let me use my HC150 & doesn't change its results in any way that I could tell.
With the Bipap Sv I sterted out with a F&P Hc150 H/H but switched to an integrated H/H - with the Adapt SV I only used the integrated H/H.
Each day after using either machine I was very alert. The major difference was what I saw as my quality of sleep. I felt I wasn't getting much with the Vpap Adapt SV & found myself reluctant to want to use it again. I really missed the 'delightful' sleep I feel I get from the Bipap SV.
The major thing that I see in the data from both machines is that both would go to max pressure between 10-16 times per night & that has to be because they both interpret my breathing as failing regularly. What I see in the data is what looks like responding to centrals except I have never shown a single central in any sleep studies (1990, 2005 & 2007).
So, one might ask, "are you having centrals because you are using SV (or bilevel) machines" - a fair question that I am posing to myself. My answer is, "I used cpap & after 3 months the benefits started to fade & I got alarmed & then despondent. It seemed that what I thought was a solution was slipping away". For work reasons & health reasons I became determined to search out more info on my issues.
Then I went Auto & got a bit of a lift for 3 months or so then again saw the improvement slipping away, that really bothered me. I figured there had to be an answer. Then I went Bilevel with a slow timed rate (BPM=6 - PB330 Knightstar) and I felt so much better and, lsot a load of weight, did loads of exercise - this continued for about 18 months - wife also said I seemed to sleep & breathe better. Then early this year started to feel like I wasn't getting enough air but my SpO2 data always seemed to show I was ! - I began to again feel things weren't right. Wife started saying to me "don't sleep on your back, your breathing goes funny".
I began looking into the SV class machines & I dub them tri-levels, they work at Epap (which needs to be set high enough to preempt outright obstructions when you breathe out), then they got to a set Ipap when you breathe in (just like a bilevel) BUT these machines monitor your airflow & if they believe it is inadequate or your rate of breathing has suddenly dropped too much, will go from Ipap (min) to a higher pressure that can be as high as Ipap Max (or PS max), within 1 breath, & keep going higher until you start to maintain a reasonable airflow (thus they got to a third level of pressure & why I call them tri-levels).
Where the Vpap SV differs from the Bipap SV is that the Vpap SV starts 'pulsing' you to try & ventilate tyou at the rte it believes is needed whereas the Bipap SV just pushes more air into you to get your peak flow up & it doesn't (AFAICT) try the 'pulsing' that I felt from the Vpap SV.
SUMMARY:
Each of these machines offers a unique approach to irregular breathing & I am assuming that each targets a different SDB population (I know SWS & I think SAG have said this many times ) Well guys I did the suck-it-and-see test & you appear to be spot on.
So I would say both machines are innovators and high achievers in the cpap therapy stakes for people with special needs. Both concepts appeal to me but the physical machine that worked for my internal air circuits thus far, is the Bipap SV. But take it from Banned that the Vpap SV has sure given him the boost he needed - the pair of us are enthusiasts for SV technology but I am in no doubt that these are highly specialized machines and require a very brave experimenter or someone with a researchers approach who can do enough tests to work out the what & why.
DSM
PS. Any legitimate cpap researchers have my permission to use my data extracted from the various machines asn part of their research. If you wish to use my name, please obtain that in advance.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, bipap, mirage, hose, CPAP, seal, auto
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, bipap, mirage, hose, CPAP, seal, auto
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, bipap, mirage, hose, CPAP, seal, auto
These are the settings I ended up with & the data extracted from both machines seems to match very well (comparing the 3rd night on the Vpap SV with a typical night on the Bipap SV).
Bipap SV. Epap 11 & IpapMIN = 14.0 IpapMax=20 Risetime=3 BPM=auto
Adapt SV. EEP = 10 & MinPS = 3.4 & MaxPS=10 (which when compared,
is equiv to Epap 10 & IpapMIN = 13.4 IpapMax=20 on a Bipap Sv)
These settings are near to being the same (the Bipap SV differs by 1 CMS for epap & ipap from the Vpap SV at the mask & this reflects the use of proximal line on the vpap SV which means it measures pressure at the mask while the Bipap SV measures pressure at the machine & there is a known 1 CMS loss over a 6' hose at 10 CMS pressure. The data from both pretty well confirms the similarity of settings.
The trial of both has been a big eye opener for me but is not finished yet.
I have some different masks coming & also a reslink & already have an SpO2 module that attches to Reslink so plan to do further heavy hitting analysis of both machines.
Firstly I have to say that the Bipap Auto SV is my current 'dream machine' - I look forward to using it & sleep long deep and well. I was not able to achieve that with the Vpap Adapt SV despite getting very close matching data from both machines after some tweeking. If you had asked me to bet on the outcome before I started either I would have willingly bet on the Vpap SV as delivering me the best nights sleep.
I note though that Banned is telling us he gets good results from his use of the Vpap Auto SV. We have traded PMs re some of the issues & the thing that does intrigue me is that the reasons I thought the Vpap SV wasn't working for me, seem to match Banned's condition. That is we both have severe nasal constriction. I found the Vpap Adapt felt very difficult unless I used the heavy hitting Otrivin spray & taped my mouth.
The Bipap SV seems to tolerate me breathing out my nose, my mouth, both (I'd swear it would let me breath out my ears if I had a mask that reached them )
The sleep I get with the Bipap Auto SV is deep restful and energizing & I love it.
The sleep I got from the Vpap Adapt SV was strained, shallow, but it was energizing in that once up & head cleared I had a good day, but after just one day debated if I would use it again right away, I decided I would (but had the Bipap SV ready & loaded in case I abandoned the Vpap SV quickly).
The Vpap SV data tended to show lots of leaks & my mask sure squeaked. On night 2 I used a new mask (Ultra Mirage FF) just to eliminate a weak seal.
After each night I download the data via serial link & stowed a copy on my web site. Anyone wanting to view my most recent detailed data can go to
http://www.internetage.com/cpapdata/ Choose items 1 or 2 to see each nights data - in the case of the Bipap SV, apart from a few lost nights (forgot card) I have 6 weeks of data. There was a short gap when I went to NZ & that daa is item 3 on the menu off an S8 Vantage in EPR mode. For the Vpap SV there is only 3 nights data.
The most recent nights data from each machine is very close in what the machine was doing. The av Ipap is close to the same (don't confuse what Resmed call the 'mean' Ipap with the average Ipap) , The number of times the machie went to max Ipap is typically the same.
So what do I think makes the difference ?
Firstly I found the Vpap SV too finely tuned for me. Like a formula 1 racer, the slightest breathing change & it reacted. It would 'pulse' me if my breathing slowed or stopped, each pulse got stronger. It seemed to be 'in my face' so to speak I am thinking that for what it was designed for it must be excellent. If I had a heart condition or some other breathing irregularity like Cheyens-Stokes, am sure it would be my lifeline.
The Vpap Adapt SV was soooo smooth in its operation. And it is soooo quiet my wife said the room was eerily quiet. The Bipap SV does have a steady drone but it never ever bothered me & later in the night seems to not be there. My wife did move rooms but has returned & is willing to get used to the Bipap SV based on it being the better therapy for my situation.
On the otherhand, the Bipap SV (unlike earlier trials with Bipap Pro II & Bipap S/T), never objected to my restricted nasal breathing nor my multi- mode breathing. It seems to have a lag in its responses & in my case that lag seems to give my symptoms a better run.
The Bipap SV is without doubt far more leak tolerant (certainly for me). I felt I never got my leaks under control with the Vpap Adapt SV. I have 2 more masks coming (the Quattro & Liberty) to trial with it & see if they help.
The Vpap SV is by far the simpler to set up. As Banned has told us before, just set EEP & stick with the defaults for all else. Then when ready to use run the mask training step. This is simple, you attach the mask, fill the H/H, then put the mask on the bed so it is unobstructed (you don't put it on) & run the training test. That test sends increasing pressures of air out the mask & I understand the proximal sensor feeds data back that allows the machine to calibrate to the air circuit. It has *nothing* to do with the mask leak holes as they only get exercised if the mask is worn. It has a lot to do with what H/H you are using & the type & length of the hose. & the air outlet (be it nasal prongs or F/F mask).
The Vpap Adapt SV will allow you to use a seperate H/H such as the F&P HC150, you just have to run the training circuit. The Bipap SV also let me use my HC150 & doesn't change its results in any way that I could tell.
With the Bipap Sv I sterted out with a F&P Hc150 H/H but switched to an integrated H/H - with the Adapt SV I only used the integrated H/H.
Each day after using either machine I was very alert. The major difference was what I saw as my quality of sleep. I felt I wasn't getting much with the Vpap Adapt SV & found myself reluctant to want to use it again. I really missed the 'delightful' sleep I feel I get from the Bipap SV.
The major thing that I see in the data from both machines is that both would go to max pressure between 10-16 times per night & that has to be because they both interpret my breathing as failing regularly. What I see in the data is what looks like responding to centrals except I have never shown a single central in any sleep studies (1990, 2005 & 2007).
So, one might ask, "are you having centrals because you are using SV (or bilevel) machines" - a fair question that I am posing to myself. My answer is, "I used cpap & after 3 months the benefits started to fade & I got alarmed & then despondent. It seemed that what I thought was a solution was slipping away". For work reasons & health reasons I became determined to search out more info on my issues.
Then I went Auto & got a bit of a lift for 3 months or so then again saw the improvement slipping away, that really bothered me. I figured there had to be an answer. Then I went Bilevel with a slow timed rate (BPM=6 - PB330 Knightstar) and I felt so much better and, lsot a load of weight, did loads of exercise - this continued for about 18 months - wife also said I seemed to sleep & breathe better. Then early this year started to feel like I wasn't getting enough air but my SpO2 data always seemed to show I was ! - I began to again feel things weren't right. Wife started saying to me "don't sleep on your back, your breathing goes funny".
I began looking into the SV class machines & I dub them tri-levels, they work at Epap (which needs to be set high enough to preempt outright obstructions when you breathe out), then they got to a set Ipap when you breathe in (just like a bilevel) BUT these machines monitor your airflow & if they believe it is inadequate or your rate of breathing has suddenly dropped too much, will go from Ipap (min) to a higher pressure that can be as high as Ipap Max (or PS max), within 1 breath, & keep going higher until you start to maintain a reasonable airflow (thus they got to a third level of pressure & why I call them tri-levels).
Where the Vpap SV differs from the Bipap SV is that the Vpap SV starts 'pulsing' you to try & ventilate tyou at the rte it believes is needed whereas the Bipap SV just pushes more air into you to get your peak flow up & it doesn't (AFAICT) try the 'pulsing' that I felt from the Vpap SV.
SUMMARY:
Each of these machines offers a unique approach to irregular breathing & I am assuming that each targets a different SDB population (I know SWS & I think SAG have said this many times ) Well guys I did the suck-it-and-see test & you appear to be spot on.
So I would say both machines are innovators and high achievers in the cpap therapy stakes for people with special needs. Both concepts appeal to me but the physical machine that worked for my internal air circuits thus far, is the Bipap SV. But take it from Banned that the Vpap SV has sure given him the boost he needed - the pair of us are enthusiasts for SV technology but I am in no doubt that these are highly specialized machines and require a very brave experimenter or someone with a researchers approach who can do enough tests to work out the what & why.
DSM
PS. Any legitimate cpap researchers have my permission to use my data extracted from the various machines asn part of their research. If you wish to use my name, please obtain that in advance.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, bipap, mirage, hose, CPAP, seal, auto
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, bipap, mirage, hose, CPAP, seal, auto
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, bipap, mirage, hose, CPAP, seal, auto
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
Ok, that's it! I'm going to have to trial a Respironics BiPAP Auto SV. I agree with dsm's characterization that the sleep I get with the Adapt SV is strained and shallow, however, once awake and up, all's well. I also agree with the mask leak issue although I find the small Quattro works better for me than the medium Quattro. Maybe the Adapt SVs 'pulsing' is what keeps me just at the edge of a restful sleep. Thank you for a well thought out and well articulated report.dsm wrote: The sleep I get with the Bipap Auto SV is deep restful and energizing & I love it.
The sleep I got from the Vpap Adapt SV was strained, shallow, but it was energizing in that once up & head cleared I had a good day, but after just one day debated if I would use it again right away, I decided I would (but had the Bipap SV ready & loaded in case I abandoned the Vpap SV quickly).
The Vpap SV data tended to show lots of leaks & my mask sure squeaked.
So what do I think makes the difference ?
Firstly I found the Vpap SV too finely tuned for me. Like a formula 1 racer, the slightest breathing change & it reacted. It would 'pulse' me if my breathing slowed or stopped, each pulse got stronger. It seemed to be 'in my face' so to speak I am thinking that for what it was designed for it must be excellent. If I had a heart condition or some other breathing irregularity like Cheyens-Stokes, am sure it would be my lifeline.
The Vpap Adapt SV was soooo smooth in its operation. And it is soooo quiet my wife said the room was eerily quiet. The Bipap SV does have a steady drone but it never ever bothered me & later in the night seems to not be there. My wife did move rooms but has returned & is willing to get used to the Bipap SV based on it being the better therapy for my situation.
On the otherhand, the Bipap SV (unlike earlier trials with Bipap Pro II & Bipap S/T), never objected to my restricted nasal breathing nor my multi- mode breathing. It seems to have a lag in its responses & in my case that lag seems to give my symptoms a better run.
The Bipap SV is without doubt far more leak tolerant (certainly for me). I felt I never got my leaks under control with the Vpap Adapt SV. I have 2 more masks coming (the Quattro & Liberty) to trial with it & see if they help.
Where the Vpap SV differs from the Bipap SV is that the Vpap SV starts 'pulsing' you to try & ventilate tyou at the rte it believes is needed whereas the Bipap SV just pushes more air into you to get your peak flow up & it doesn't (AFAICT) try the 'pulsing' that I felt from the Vpap SV.
Banned
AVAPS: PC AVAPS, EPAP 15, IPAP Min 19, IPAP Max 25, Vt 520ml, BPM 10, Ti 1.8sec, RT 2 (Garage)
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
DSM, et al
I've been reading this post with great interest. I have been on APAP since November and have not had one night of good sleep. I have an appointment with my sleep Dr. on Monday. How difficult will it be for me to get him to write a presciption for a BiPAP Auto SV? What are the parameters that the Dr. must go by? I've been titrated on a BiPAPls and had 80 obstructive and 27 centrals during that titration. Is this enough to qualify me?
If so, why didn't my doctor already have me on a SV? I want to have the best possible machine if there is a possibility that the best machine will provide restful sleep. It sounds as though the BiPAP Auto SV would be the answer for me and if not, If I tried it and it failed, at least I would know.
Bev
I've been reading this post with great interest. I have been on APAP since November and have not had one night of good sleep. I have an appointment with my sleep Dr. on Monday. How difficult will it be for me to get him to write a presciption for a BiPAP Auto SV? What are the parameters that the Dr. must go by? I've been titrated on a BiPAPls and had 80 obstructive and 27 centrals during that titration. Is this enough to qualify me?
If so, why didn't my doctor already have me on a SV? I want to have the best possible machine if there is a possibility that the best machine will provide restful sleep. It sounds as though the BiPAP Auto SV would be the answer for me and if not, If I tried it and it failed, at least I would know.
Bev
Diagnosed 9/4/07
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1
[quote="OutaSync"]DSM, et al
I've been reading this post with great interest. I have been on APAP since November and have not had one night of good sleep. I have an appointment with my sleep Dr. on Monday. How difficult will it be for me to get him to write a presciption for a BiPAP Auto SV? What are the parameters that the Dr. must go by? I've been titrated on a BiPAPls and had 80 obstructive and 27 centrals during that titration. Is this enough to qualify me?
If so, why didn't my doctor already have me on a SV? I want to have the best possible machine if there is a possibility that the best machine will provide restful sleep. It sounds as though the BiPAP Auto SV would be the answer for me and if not, If I tried it and it failed, at least I would know.
Bev
I've been reading this post with great interest. I have been on APAP since November and have not had one night of good sleep. I have an appointment with my sleep Dr. on Monday. How difficult will it be for me to get him to write a presciption for a BiPAP Auto SV? What are the parameters that the Dr. must go by? I've been titrated on a BiPAPls and had 80 obstructive and 27 centrals during that titration. Is this enough to qualify me?
If so, why didn't my doctor already have me on a SV? I want to have the best possible machine if there is a possibility that the best machine will provide restful sleep. It sounds as though the BiPAP Auto SV would be the answer for me and if not, If I tried it and it failed, at least I would know.
Bev
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
If there is a chance that an SV will help me then I am willing to pay to be part of the experimental stage. How do I get my Dr. to write a prescription so I can get one on cpap.com?
Diagnosed 9/4/07
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1
Ohh.. I like this girl! Somebody who is ready to regain control of her life, at least 1/3 of it. There is no such thing as, "a chance that an SV will help". it will help you. You might suggest to your sleep doctor that you have been waking up, tearing the mask off your face, and gasping for air, and feeling like crap during the day (always exaggerate the symptoms). And that you would like to be titrated on a SV or Bi-level device. If he goes for it, great! If he needs some encouragement, tell him you will be purchasing a machine on your own and you would like him to specify 'BiPAP Auto SV' and, "patient is self-pay" on the order. I'm not quite sure why dsm characterizes SV's as 'experimental', but I do like his aptly coined term "Tri-Level'OutaSync wrote:If there is a chance that an SV will help me then I am willing to pay to be part of the experimental stage.
Banned
AVAPS: PC AVAPS, EPAP 15, IPAP Min 19, IPAP Max 25, Vt 520ml, BPM 10, Ti 1.8sec, RT 2 (Garage)
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
I missed the above. Have him write the order, BiPAP Auto SV, Patient is Self-Pay.OutaSync wrote: I've been titrated on a BiPAPls and had 80 obstructive and 27 centrals during that titration. Is this enough to qualify me?
AVAPS: PC AVAPS, EPAP 15, IPAP Min 19, IPAP Max 25, Vt 520ml, BPM 10, Ti 1.8sec, RT 2 (Garage)
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
That is what I will do. I just didn't know if he has to follow some arbitrary guidelines. I wouldn't have to exaggerate any symptoms. I can honestly say that I have never woken up feeling refreshed, and I can remember back to age 8 or so. On work days I have 3 alarms to wake me up, and on weekends and vacations when I don't have anybody to wake me up, I sleep 12 hours or more with my APAP. I'm guessing I wake up 20 to 30 times a night with mask leaks, back pain, stomach filled with air, flatulance. My current machine starts to climb in pressure with an apnea and when it hits an NR, it will immediately drop the pressure, leaving me hanging up there with apnea after apnea and no pressure. How is that supposed to help? I'm thinking that an SV would be able to handle a situation like that. Yes?
Bev
Bev
Diagnosed 9/4/07
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1
My thanks to DSM as well for that well articulated report!
A common theme adopted by quite a few members of this message board:
If something doesn't work after giving it a fair try, then try something else.
Bev, if I were in your shoes I would also want to trial the BiPAP autoSV. I would simply ask the doctor for a trial and honestly explain why I wanted that trial. If he/she insisted on making me stay with treatment that doesn't work well, then I'd look for a new doctor.
A common theme adopted by quite a few members of this message board:
If something doesn't work after giving it a fair try, then try something else.
Bev, if I were in your shoes I would also want to trial the BiPAP autoSV. I would simply ask the doctor for a trial and honestly explain why I wanted that trial. If he/she insisted on making me stay with treatment that doesn't work well, then I'd look for a new doctor.
Banned wrote:Ohh.. I like this girl! Somebody who is ready to regain control of her life, at least 1/3 of it. There is no such thing as, "a chance that an SV will help". it will help you. You might suggest to your sleep doctor that you have been waking up, tearing the mask off your face, and gasping for air, and feeling like crap during the day (always exaggerate the symptoms). And that you would like to be titrated on a SV or Bi-level device. If he goes for it, great! If he needs some encouragement, tell him you will be purchasing a machine on your own and you would like him to specify 'BiPAP Auto SV' and, "patient is self-pay" on the order. I'm not quite sure why dsm characterizes SV's as 'experimental', but I do like his aptly coined term "Tri-Level'OutaSync wrote:If there is a chance that an SV will help me then I am willing to pay to be part of the experimental stage.
Banned
Last edited by dsm on Sat Jun 14, 2008 8:48 pm, edited 1 time in total.
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
The SV will will cure you of any periodic breathing issues, whether it is incidental to the SV's design (as SWS has aptly suggested), or not. Your Doctor does not have to follow any guidelines to order an SV for a patient who is 'self-pay', other than to write your BiLevel settings for EPAP and IPAP.OutaSync wrote:That is what I will do. I just didn't know if he has to follow some arbitrary guidelines. I wouldn't have to exaggerate any symptoms. I can honestly say that I have never woken up feeling refreshed, and I can remember back to age 8 or so. On work days I have 3 alarms to wake me up, and on weekends and vacations when I don't have anybody to wake me up, I sleep 12 hours or more with my APAP. I'm guessing I wake up 20 to 30 times a night with mask leaks, back pain, stomach filled with air, flatulance. My current machine starts to climb in pressure with an apnea and when it hits an NR, it will immediately drop the pressure, leaving me hanging up there with apnea after apnea and no pressure. How is that supposed to help? I'm thinking that an SV would be able to handle a situation like that. Yes?
Banned
AVAPS: PC AVAPS, EPAP 15, IPAP Min 19, IPAP Max 25, Vt 520ml, BPM 10, Ti 1.8sec, RT 2 (Garage)
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
Some further guidance to anyone wanting to experiment with an SV machine.
These points are my opinion based on using a variety of machines leading up to the SVs...
1) If you have good normal airflow through your nose & don't mouthbreathe I would say you could try either machine & should get equally good results.
2) If you can keep your obstructive apneas well under control by 10 CMS (Epap) then the Vpap SV and Biap SV are candidates. If your OSA requires higher Epap then go for the Bipap SV as it will go higher. SV machines are no better than a standard cpap at OSA control & Epap needs to be set to a pressure level that eliminates the worst OSA events & leaves the airway splinted (open) so that the Ipap & Tri-pap (extra pressure) can deal with maintaining peak airflow/breathing volume.
SV machines don't monitor snores or other typical OSA pre-cursor events. They do monitor how much air you are breathing and your general pattern of breathing (such as rate) and work to maintain that pattern. This means that if your airway is open & you quickly (IIRC, under 3 mins) begin to change your breathing with say hypopneas or flow-limitations - the SV machine will boost the pressure & may also try to speed up your breathing rate. They become active ventilators that try to control your breathing to bring the pattern back within the limits they are set for. Standard Cpaps, Autos & non-timed Bilevels don't try to do this, they can't. An SV machine can change its pressure by several CMs within a single breathing cycle & they will.
My nightly charts show repeatedly how the Bipap SV will go from say 15 CMS to 20 CMS in a few breaths. I am very prone to hypops & flow-limitations & this is why I am sure the machine is working so well for me.
3) If noise is a big issue then the Vpap SV is so quiet you can't hear it. You will hear the air from your mask exit holes rather than any noise from the Vpap SV. The Bipap SV does drone but it is low frequency and constant and as the night progresses it drops away. The noise does return momentarily if you stop & start the machine in the night. Anyone who has tried a tank (Remstar style pre-M series units) Bipap will be familiar with the drone I speak of. It does vary by machine (even of the same type) & seems to be a manufacturing matter.
The motor in these Bipaps is run at constant speed & the air is controlled by a very fast sliding 'airvalve' that sends part of the air out to the sleeper & part back to the motor. It is a very reliable & precise mechanism for air control.
The Vpaps use a varying speed combined motor-blower (a revolutionary new dual-impeller low-inertia high-acceleration low-noise design).
4) If you are a mixed nose / mouth breather and have a F/F mask & perhaps also have lots of nasal congestion, I would steer you toward the Bipap SV. It is extraordinarily tolerant of mixed breathing. The Vpap SV AFAICT, is less so.
5) If you have centrals, and mixed apneas, (and breath without nasal restriction) perhaps the Vpap SV is choice #1 & Bipsp SV choice #2 but I am speculating on this. I will have to wait for a period of no nasal congestion or use a better mask before I can test which might be best in this respect.
6) Both machines (I have the older Vpap SV model) provide excellent data for download but the Bipap SV includes AHI data whereas only the newer Vpap SV includes that. I am more than happy with what I am getting from this older Vpap SV & have no inclination to want any extra data. The AHI data is kind of irrelevant compared to the ventilation & pressure & rate info. To be honest I do not trust & would not trust the straight AHI info from either machine as I believe it is not entirely accurate or meaningful. The really meaningful data is how well you sleep & how good the machine treats your symptoms and that your leak rate is acceptable. SpO2 data of course, is very helpful and meaningful.
DSM
These points are my opinion based on using a variety of machines leading up to the SVs...
1) If you have good normal airflow through your nose & don't mouthbreathe I would say you could try either machine & should get equally good results.
2) If you can keep your obstructive apneas well under control by 10 CMS (Epap) then the Vpap SV and Biap SV are candidates. If your OSA requires higher Epap then go for the Bipap SV as it will go higher. SV machines are no better than a standard cpap at OSA control & Epap needs to be set to a pressure level that eliminates the worst OSA events & leaves the airway splinted (open) so that the Ipap & Tri-pap (extra pressure) can deal with maintaining peak airflow/breathing volume.
SV machines don't monitor snores or other typical OSA pre-cursor events. They do monitor how much air you are breathing and your general pattern of breathing (such as rate) and work to maintain that pattern. This means that if your airway is open & you quickly (IIRC, under 3 mins) begin to change your breathing with say hypopneas or flow-limitations - the SV machine will boost the pressure & may also try to speed up your breathing rate. They become active ventilators that try to control your breathing to bring the pattern back within the limits they are set for. Standard Cpaps, Autos & non-timed Bilevels don't try to do this, they can't. An SV machine can change its pressure by several CMs within a single breathing cycle & they will.
My nightly charts show repeatedly how the Bipap SV will go from say 15 CMS to 20 CMS in a few breaths. I am very prone to hypops & flow-limitations & this is why I am sure the machine is working so well for me.
3) If noise is a big issue then the Vpap SV is so quiet you can't hear it. You will hear the air from your mask exit holes rather than any noise from the Vpap SV. The Bipap SV does drone but it is low frequency and constant and as the night progresses it drops away. The noise does return momentarily if you stop & start the machine in the night. Anyone who has tried a tank (Remstar style pre-M series units) Bipap will be familiar with the drone I speak of. It does vary by machine (even of the same type) & seems to be a manufacturing matter.
The motor in these Bipaps is run at constant speed & the air is controlled by a very fast sliding 'airvalve' that sends part of the air out to the sleeper & part back to the motor. It is a very reliable & precise mechanism for air control.
The Vpaps use a varying speed combined motor-blower (a revolutionary new dual-impeller low-inertia high-acceleration low-noise design).
4) If you are a mixed nose / mouth breather and have a F/F mask & perhaps also have lots of nasal congestion, I would steer you toward the Bipap SV. It is extraordinarily tolerant of mixed breathing. The Vpap SV AFAICT, is less so.
5) If you have centrals, and mixed apneas, (and breath without nasal restriction) perhaps the Vpap SV is choice #1 & Bipsp SV choice #2 but I am speculating on this. I will have to wait for a period of no nasal congestion or use a better mask before I can test which might be best in this respect.
6) Both machines (I have the older Vpap SV model) provide excellent data for download but the Bipap SV includes AHI data whereas only the newer Vpap SV includes that. I am more than happy with what I am getting from this older Vpap SV & have no inclination to want any extra data. The AHI data is kind of irrelevant compared to the ventilation & pressure & rate info. To be honest I do not trust & would not trust the straight AHI info from either machine as I believe it is not entirely accurate or meaningful. The really meaningful data is how well you sleep & how good the machine treats your symptoms and that your leak rate is acceptable. SpO2 data of course, is very helpful and meaningful.
DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
[quote="OutaSync"]DSM, et al
I've been reading this post with great interest. I have been on APAP since November and have not had one night of good sleep. I have an appointment with my sleep Dr. on Monday. How difficult will it be for me to get him to write a presciption for a BiPAP Auto SV? What are the parameters that the Dr. must go by? I've been titrated on a BiPAPls and had 80 obstructive and 27 centrals during that titration. Is this enough to qualify me?
If so, why didn't my doctor already have me on a SV? I want to have the best possible machine if there is a possibility that the best machine will provide restful sleep. It sounds as though the BiPAP Auto SV would be the answer for me and if not, If I tried it and it failed, at least I would know.
Bev
I've been reading this post with great interest. I have been on APAP since November and have not had one night of good sleep. I have an appointment with my sleep Dr. on Monday. How difficult will it be for me to get him to write a presciption for a BiPAP Auto SV? What are the parameters that the Dr. must go by? I've been titrated on a BiPAPls and had 80 obstructive and 27 centrals during that titration. Is this enough to qualify me?
If so, why didn't my doctor already have me on a SV? I want to have the best possible machine if there is a possibility that the best machine will provide restful sleep. It sounds as though the BiPAP Auto SV would be the answer for me and if not, If I tried it and it failed, at least I would know.
Bev
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
Well, glowing reviews from Banned about the Resmed VPAP Adapt SV and from DSM about the Respironics BiPAP AutoSV (that he is discussing/comparing in this thread).
Respironics offers a BiPAP AutoSV FAQ page at the following address: http://bipapautosv.respironics.com/faq.aspx
Please bear in mind that some of the advice and opinions offered above differ from that of the manufacturer.
So PS fluctuation all the way up to IPAP max is all about automated central ventilation on any SV platform. According to both manufacturers, Servo Ventilation's fluctuating PS is not about automatically addressing obstruction.
A promising technology in my opinion as well!
.
Respironics offers a BiPAP AutoSV FAQ page at the following address: http://bipapautosv.respironics.com/faq.aspx
Please bear in mind that some of the advice and opinions offered above differ from that of the manufacturer.
Please note above that the manufacturer design does not profess to provide the obstructive SDB component with any automated treatment. Rather Respironics wants to see a clinician first manually titrate the obstructive component away with either CPAP or BiPAP fixed airway inflation. According to Respironics the automatically adjusting PS component is to ventilate---not alleviate obstructions.BiPAP® autoSV™ Frequently Asked Questions wrote:Question-Does the BiPAP autoSV operate like an Auto CPAP or Auto Bi-level device for treating obstructive events?
Answer- No – The device does not have an auto-titrating algorithm to alleviate obstructive events. The innovative algorithm was designed to treat complex apnea and periodic breathing. The obstructive component of SDB is treated utilizing a clinician adjustable CPAP or BiPAP pressure level.
Please note above that the manufacturer views their BiPAP AutoSV platform as a modality to treat either central dysregulation or central dysregulation accompanied by an obstructive component. Respironics did not design their Servo Ventilation machine for (unmixed cases of) obstructive apnea patients. Nor does Respironics presently recommend this SV machine for pure cases of OSA.BiPAP® autoSV™ Frequently Asked Questions wrote:Question- Which patient types can utilize the device?
Answer- The device is designed to treat complicated breathing patterns. Complicated breathing patterns are mixed breathing patterns with OSA, Central, Mixed/Complex Sleep apneas and periodic breathing components, such as Cheyne-Stokes Respiration (CSR).
Please note that since Servo Ventilation was designed and targeted for central and mixed patients, that titration in the lab is highly recommended.BiPAP® autoSV™ Frequently Asked Questions wrote:Question- Is it necessary to titrate these patients?
Answer- Yes. To treat the complexity of this patients as well as establish a baseline CPAP or BiPAP pressure for OSA, an in lab titration is necessary.
Banned, this machine automatically treats periodic breathing and other central issues by design. So I would contend that automatic alleviation of obstructive events via Servo Ventilation's fluctuating PS would be incidental treatment---and not at all by design. Rather the obstructive component is addressed with the manually titrated CPAP or BiLevel settings during a PSG.BiPAP® autoSV™ Frequently Asked Questions wrote:Question-How long does it take before the patient’s periodic breathing is stabilized?
Answer-After 2 – 4 cycles of periodic breathing the patient’s breathing pattern is typically stabilized.
So PS fluctuation all the way up to IPAP max is all about automated central ventilation on any SV platform. According to both manufacturers, Servo Ventilation's fluctuating PS is not about automatically addressing obstruction.
Aside from not being a suitable/targeted platform for pure cases of obstructive SDB, there are a few other conditions for which this Servo Ventilation platform is not intended.BiPAP® autoSV™ Frequently Asked Questions wrote:Question-Is it possible to use BiPAP® autoSV™ patients with COPD, OHS and NMD?
Answer-The BiPAP® autoSV™ is designed to treat complicated breathing patterns in sleep patients. Nevertheless, utilizing the 3 different pressure settings and a standard backup rate of 4 -30bpm, the device can be set similar to that of a standard S/T device. The ASV algorithm is not able to assure a volume which would be most beneficial for these types of patients.
BiPAP® autoSV™ Frequently Asked Questions wrote:Question-Can an identified candidate w/ Complicated Breathing Patterns, Central, and/or Mixed Apneas or Periodic Breathing (CSR), be put on the device w/o coming into the sleep lab?
Answer-If the CPAP or BiPAP pressure is already determined in lab, the patient can be put directly on BiPAP autoSV. To assure that the patient is being properly treated it is a good idea to download the SmartCard data after 7-10 days.
As DSM mentioned above, previous BiLevel values can tentatively serve as a starting point for BiPAP AutoSV treatment.BiPAP® autoSV™ Frequently Asked Questions wrote:Question- What settings should be used in this case?
Answer-For the set up of these patients it is advisable to use the CPAP or BiPAP pressure from the “old” unit,set the IPAPmax 10cmH2O above the CPAP or BiPAP pressure and set the back up Rate to Auto.
A promising technology in my opinion as well!
.