Newbie on AVAPS

Snoredog wrote:Doug: then I would leave it, not enough events to mess with, that last report looked pretty good.

How do you feel using those settings?

Pretty damned good

Actually have been using those settings for as long as I have had the Bipap Auto SV (close on 9 months). But about 6 weeks ago hit a road bump with the therapy. You may recall how I posted a chart in Bev's thread showing massive all night leaks - my comment was 'look at how well the Bipap SV copes with leaks' - well I was dead wrong - while those heavy leaks persisted my daytime wakefulness started a distinct downhill slide. At the same time we had a big change in weather (got very hot quickly) & I didn't know if the deterioration was the change in weather (increased spring air pollution) or attributable to the leaks or a change in bedding.

It took about 2 weeks to clear the leak problem (new hose, tightened & adjusted mask, refitted silicon plug between machine & H/H). It may just have been my mask going out of whack after I did the experiments using wife's hat block & the mask. There were too many variables for me to be sure what the real cause was, but it has only been in the past week that I have it all back under control & daytime drowsiness banished again.

I still don't fully know the real cause (of the daytime deterioration). Actually went to doc for blood test but he gave me a very good bill of health (just drop the cholesterol level a little).

DSM

dsm wrote: ..the machine reasonably scores as an AP event..

1) Normal sleep arousal (these occur at regular intervals through the night - perhaps around 8-10 or so)
2) Sleeper momentarily wakes & turns over or moves or whatever
3) Pulse Rate goes up (which is normal) as user takes a few deep breaths and moves
4) Then as user settles again respiration drops back quickly to slower & shallower breathing (post arousal central)
5) BUT machine reacts - RATE ALERT !!! - user is outside target rate range - ACTIVATE CYCLING !!!
6) Machine initiates a backup cycle
7) Machine scores AP event & registers a machine triggered breath

I'm sure those are some of the reasons they say 0-5 AHi are all good scores. I swim a mile several times a week about 2 hours before bedtime (they recommend no heavy exercise 6 hours before bedtime). Swimming may have accounted for my 5 AHi last night in PC AVAPS mode (Avg. Exhaled Tidal Volume: 531.7 ml), so I don't worry about it, too much.

Tonight I will change the Rise Time to 3 in PC AVAPS mode.

Side note: Apria delivered my six month mask today, an extra small Quattro, GBE! The cushion fits comfortably in the v of the chin with the bridge cushion slightly below the 'recommended' eye-point bridge of the nose. Great visibility, hopefully less air in the eyes, and no bridge redness (or at least the redness a little lower on the nose). There is nothing petite about an extra small Quattro. I've owned 2 Quattros (M, S,) before this new one, and none have leaked at the swivel joint (or anywhere else). I've always been curious what folks are doing to their Quattros to require plumber's tape?

Banned

Snoredog wrote:

StillAnotherGuest wrote: Without ballistocardiography or forced oscillation technique, how does it know they are central events? All that thing sees is a straight line.

SAG

My guess:

1. It assumes all obstructive events are taken care of by EPAP.
2. It clearly states BPM is only for control of central dysregulation.
3. It applies PS if it doesn't resolve it goes to BPM, that should also be seen in the report. Hey, I use
your old technique, I blow up the report and select the event.

Can you define specifically which "it" you are referring to in these scenarios? For instance, if

Snoredog wrote:It assumes all obstructive events are taken care of by EPAP.

that this "it" is the machine, then "it" would also be intelligent enough to know that Moe and Larry there don't have the smartz between the two of them to operate a fork, so "it" would never make that assumption.

If

Snoredog wrote:It clearly states BPM is only for control of central dysregulation.

that this "it' refers to the manual, that's intended for the operator. That means if you don't have "central dysregulation", don't start driving a rate in there, because you will. Given the right settings, you can generate "central dysregulation" in pretty much everybody.

And

Snoredog wrote:It applies PS if it doesn't resolve it goes to BPM, that should also be seen in the report.

cannot happen regardless which "it" was "it". If "it" applied PS, then "it" must have seen a breath, the rate clock would reset and no breath would be sent in. "It" would either continue to escalate IPAP to max with whatever algorithm and machine is being used in this bird's nest of



settings calculation or leave it as an incompletely-addressed event.

SAG

dsm wrote:Just wanted to add a comment re periodic breathing ..

This topic came up indepth during Bev's thread where she tried a Bipap AutoSV. There are two common topics to do with xPAP and types of respiration
one being VARIABLE breathing and the other being PERIODIC breathing

Just want to reiterate what came out of looking at published data on the meanings of these two types of breathing.

1) VB - Variable breathing (erratic breathing)
this is when the persons respiratory rate varies erratically - it may happen for a few minutes or it may continue for a few hours. The depth (or volume) of the breathing may not necessarily change much but the speed of respiration does change - breathing rate becomes erratic - Some AUTO CPAPs detect this erratic pattern (scored as VB in the data charts) and try to clear it by 1st moving pressure slowly in the opposite direction the machine was going in prior to detection & if that fails then trying the other direction & if that fails by locking pressure as it was for a while (say 15 mins). Erratic breathing can destabilize an AUTO machine so modern AUTOs try the above before locking.

2) PB - Periodic breathing (periods of breathing)
This is characterized as being waxing and waning of respiration and does involve varying volume. The real definition is periods of breathing typically with centrals in between. The classic form of periodic breathing (but not the only type) is Cheynes-Stokes Respiration (CSR) which typically occurs with people who have experienced Congestive Heart Failure (CHF). It is typified by a period of breathing that increases in intensity (waxes) then decreases in intensity (wanes) - often followed by a central - then the cycle repeats itself. S/T Bilevels used to be considered to be the solution for Periodic breathing but over time Resmed and Respironics in particular, perfected SV machines to handle this type of problem. SV is now considered the preferred therapy for periodic breathing. An SV machine will score it as PB in the data charts.

DSM

I don't have time to do our usual many-page debate, Doug. Only to say that after looking at the patent descriptions my interpretations sure seem to be different than yours. Periodic breathing and variable breathing are not one in the same. So here we agree. But many conditioned breathing patterns will get relegated to the Respironics Variable Breathing Controller. My interpretation is that both typical and atypical periodic breathing (there are many PB presentation types---right, Doug?) will contain sufficient statistical measure---regarding peak-flow standard deviation---to at least initially get relegated to the Variable Breathing Control layer. If or when intervening central apneas/hypopneas occur, then the algorithm is off to the higher-priority apnea/hypopnea control layer.

There is absolutely nothing in the algorithm to keep periodic breathing's peak-flow standard deviations away from the variable breathing controller... until higher-priority algorithmic detection criteria is met----such as the subsequent detection of apneas or hypopneas. Some medically recognized periodic breathing types do not entail intervening apneas or hypopneas. Those periodic breathing types will certainly be relegated to the variable breathing controller for extended stays. Other types either quickly or eventually work into a state of intervening apneas/hypopneas. Those latter periodic breathing presentations will thus quickly or eventually exit the VBC, in favor of the apnea/hypopnea control layer. And again, I am also of the opinion that less-than-frank or marginal periodic breathing (more subtle flow amplitude variations, very often w/out intervening frank A/H that is associated with more extreme presentations of ventilatory overshoot/undershoot) will also receive incidental treatment by the Respironics Variable Breathing Control layer in OSA-targeted APAP machines. Those marginal cases of biologic respiratory controller overshoot/undershoot are the cases that I suspect just may also respond favorably to SV compensation, toward more restorative sleep patterns.

But I want to make it very clear that as usual, everything on this page is but interpretive opinion. I'm sure it can be confusing to new readers when they read hard-stated opinions that almost sound like virtual certainties regarding interpretation of fact. And boy do we have a lot of that in both new and old posts about these machines.

Cheers to all opinionaters and readers!

SWS,

My description of PB & VB was taken from Respironics documents and was an honest attempt to provide an explanation that people might understand (maybe I should have called VB bifurication ).

It seems to me you prefer to confuse the hell out of everyone with explanations few can comprehend.

Which part of what I said is wrong ?

DSM

SAG

Which one of the three stooges are you ? - is it the one who kept belting the others around the ears & poking them in the eyes because that was all he could do when they were just having fun

DSM

StillAnotherGuest wrote:

Snoredog wrote:

StillAnotherGuest wrote: Without ballistocardiography or forced oscillation technique, how does it know they are central events? All that thing sees is a straight line.
SAG

I wasn't describing HOW "it" did it, I was describing what the machine SEEN based upon Doug's 10/1 Encore report. My interpretation was the Machine seen some events as obstructive and others as central, those seen as central caused machine to go from Patient triggered breathing to Machine triggered breathing as evidenced on the report by going to BPM mode, which they describe on this machine as backup mode in which its only function described in that mode is to control central dysregulation. If you subscribe to mfg. titration protocol that mode has a slower -2 BPM rate compared to Spontaneous BPM rate.

How does it know it is central? Both events if they occur are displayed the same on the Therapy Flag graph, the only way you know which the machine "seen" is by its response, that being from the report was going to BPM mode seen as a dip on the Patient Triggered Breathing graph.

My personal opinion is the machine is also looking at the deep inspiration cycle preceding the event since this machine primarily targets Periodic Breathing and it is based upon flow, however they state they use a multi-level algorithm to detect events and various technologies to control breathing, which one I don't know.

StillAnotherGuest wrote: Can you define specifically which "it" you are referring to in these scenarios? For instance, if

Snoredog wrote:It assumes all obstructive events are taken care of by EPAP.

I stand by that statement, Respironics wouldn't ask you as part of its titration protocol to input the CPAP pressure that eliminated all obstructive events if it meant otherwise. Since EPAP pressure is static on this machine, you better input the pressure that eliminates all obstructive events. So this means this machine is NOT going to respond to frank obstructive apnea period. Then why is "AP" Apnea Period shown on the reports?

Cousin Itt is the bald headed guy in the center, he does resemble Curly a little bit doesn't he?

https://www.youtube.com/watch?v=xL_9zdu4iVw

StillAnotherGuest wrote: that this "it" is the machine, then "it" would also be intelligent enough to know that Moe and Larry there don't have the smartz between the two of them to operate a fork, so "it" would never make that assumption.

As we know, whenever Moe and Larry can't figure something out they always give it to Curly for the Curly Shuffle. if the machine detects an event resembling an apnea, that apnea has to be either obstructive or central or a combination of both. Since this machine only offers CPAP as baseline support and does NOT have the ability to adjust and respond on the fly therefor machine treats that event as a central by switching to BPM mode. What's going to happen in BPM mode? It is going to use one of the 3 Backup Breath Rate Controls options found in the manual on 3.2.2. In Doug's case that was BPM=Auto, so it is picking up those settings from Spontaneous mode and the timings are therefor automatic.

StillAnotherGuest wrote: If

Snoredog wrote:It clearly states BPM is only for control of central dysregulation.

that this "it' refers to the manual, that's intended for the operator.

"it" refers to Respironics 2nd bullet point statement found on page 8 of 19 on the Respironics Power Point document with filename: biap-auto-sv-preso.pdf, which states:

BiPAP®autoSV™treats the central component of SDB with a timed back up rate(automatic or fixed).

StillAnotherGuest wrote: That means if you don't have "central dysregulation", don't start driving a rate in there, because you will. Given the right settings, you can generate "central dysregulation" in pretty much everybody.

[/quote]

I agree, you can generate central dysregulation in pretty much anybody and the object of this machine is to avoid that CA by controlling respiration. But when it cannot do that automatically possibly due to setup errors it switches to its Backup Breath Rate Controls which is either OFF, Fixed or Automatic. Since mfg. says that this backup mode is for controlling central dysregulation, I don't understand what you mean by "it" generating central dysregulation? It doesn't generate it, it controls central dysregulation by having a slower Respiratory Rate than seen in the automatic Spontaneous/SV mode. That rate (if fixed) is the avg. Spontaneous RR (Breaths Per Minute) minus -2. When you go from 16 BPM's avg in Spontaneous mode to 14 BPM's in backup mode that is going to slow your breathing down. Should also increase flow volumes seen. If you didn't have Centrals why would a patient even be on this machine?

Why would you want to use BPM=Off?
Why would you want to use BPM=Fixed as opposed to say Auto?

I would think that you would want to use BPM=Auto AND if Patient triggered breaths or spontaneous breathing did
NOT quickly return you resort to fixed settings known to control centrals. This is in the Respironics Titration protocol, if centrals persist, set BPM=10 (or -2 of spontaneous BPM rate), set IT=1.2 (minimum). What are they doing here? Slowing breathing down which resolves Central Dysregulation. Since long deep breaths can also generate central dysregulation, they are controlling inspiration with a fixed Inspiration Time. IT time can be anywhere from .5 to 3 seconds. It can never exceed 3 seconds on this machine.

StillAnotherGuest wrote: And

Snoredog wrote:It applies PS if it doesn't resolve it goes to BPM, that should also be seen in the report.

cannot happen regardless which "it" was "it". If "it" applied PS, then "it" must have seen a breath, the rate clock would reset and no breath would be sent in. "It" would either continue to escalate IPAP to max with whatever algorithm and machine is being used in this bird's nest of

[/quote]

Machine targets peak flow on inspiration, if that target is seen NOT being met such as with a hypopnea it will increase PS, this is why if the machine sees a "obstructive" hypopnea it will be eliminated. IF SV side is doing its job correctly HI will be at 1 or less. Any residual HI's seen on report are Central (assuming IPAP working pressure didn't bump into IPAP Max to skew that result).

If that hypopnea was central, there is NO inspiration, machine won't see that partial inspiration, the inspiration timer value will exceed the maximum time of 3 seconds and machine will trigger a breath (BPM mode). So when observing an Encore report and you see an HI, it will most likely be a central hypopnea. To confirm if that was what the machine saw, there will be a corresponding dip in the Patient Triggered breath graph.

The only options here are Patient Triggered Breaths and Machine Triggered Breaths. Machine Triggered Breaths are ones where you are NOT breathing.

I see this machine as 3 machines in one.

Machine 1: The first machine is Moe and Larry, they are CPAP baseline support (i.e Fixed EPAP, it is assumed Moe and Larry are going to keep the baseline CPAP pressure that eliminates ALL obstructive events like the mfg. titration protocol says it should). If you know what that pressure is either from a lab titration or CPAP, you input that pressure for EPAP. Once you do that, Moe and Larry will keep the compressor running and spend the rest of the time be bopping themselves in the head and poking out each others eye. No more obstructive apnea! yeah!

Machine 2: Machine 2 is (the SV side), it provides Pressure Support by having an Automatic control of IPAP set to function within a Minimum and Maximum range. If everything is set correctly, the multi-layered algorithm never fails it will control irregular and periodic breathing on a breath-by-breath basis by targeting peak flow. It will use target flow values based upon its prior sampling of spontaneous breathing on a moving 4 minute average. Since that same prior breathing "sample" may also be bad, its Automatic Servo Ventilation mode is not expected to be perfect. If this machine is doing its job and controlling breathing it should never advance from here. But the mechanical device is not perfect and humans are not all the same. So its developers along with others found that if you slow down a persons Respiratory Rate and breathing that you can manipulate Respiration and eliminate Central dysregulation. So if the Automatic SV algorithm happens to screw up and the patient still goes into central dysregulation what do you do? You send them over to Curly, he's not as bright as Moe and Larry, so he has only a part-time job as backup.

Machine 3: Machine 3 is Curly, he temporarily does Moe and Larry's job by taking over their baseline CPAP support. He also takes over part of machine 2's job but he is going to do #2's job at a fixed slower rate. IPAP working pressure is going to return to IPAP Min setting (it can only last 3 seconds max.). So Curly will have EPAP and IPAP Min, that may be CPAP if IPAP Min is the same, it may be BIPAP depending on delta between EPAP and IPAP Min. IF Machine's 2's RR was seen at 16, Curly will remove his socks and count backwards 2 toes to 14, if Machine 2 had an avg. IT timer of 1.8, Curly will have an IT time of 1.8. Peak and tidal volumes don't mean anything to Curly, he only has a Mickey Mouse watch he goes by. Curly is going to take that BPM rate and use the IT time to establish how long he should allow Inspiration. He's gonna take that BPM rate, divide it by avg BPM and come up with the timings for breath duration, subtract the IT time from it and let tidal land where it wants. When spontaneous breathing returns either from Curly's help in slowing it down or on its own, Curly will go Woop Woop Woop and hand it back to Moe and Larry and Machine 2.

The Curly Shuffle:
https://www.youtube.com/watch?v=AUwtaQ1 ... re=related

That's the way I sees it with a little common sense applied in the middle.

dsm wrote:SWS,

My description of PB & VB was taken from Respironics documents and was an honest attempt to provide an explanation that people might understand (maybe I should have called VB bifurication ).

It seems to me you prefer to confuse the hell out of everyone with explanations few can comprehend.

Which part of what I said is wrong ?

DSM

Doug, we're even... Because you confused me with your post at the top of this page.

It sure sounded like yet another reiteration of your past arguments that PB is patterned breathing, and therefore will not get relegated to the Variable Breathing Control layer, which is reserved for erratic breathing instead. I've read that position statement of yours a few times, and your post above kind of looked and sounded like those past repeated assertions. Sorry if I read the very similar sounding post at the top of this page incorrectly!

Incorrect interpretations via broad syllogisms are a definite recurring pattern of confusion on this message board as well. The bad news is that when we try to discuss the necessary details contained in the patent descriptions and medical literature, that often becomes confusing in an altogether different way.

Oh well... at least we try our best!

-SWS wrote:

dsm wrote:SWS,

My description of PB & VB was taken from Respironics documents and was an honest attempt to provide an explanation that people might understand (maybe I should have called VB bifurication ).

It seems to me you prefer to confuse the hell out of everyone with explanations few can comprehend.

Which part of what I said is wrong ?

DSM

Doug, we're even... Because you confused me with your post at the top of this page.

It sure sounded like yet another reiteration of your past arguments that PB is patterned breathing, and therefore will not get relegated to the Variable Breathing Control layer, which is reserved for erratic breathing instead. I've read that position statement of yours a few times, and your post above kind of looked and sounded like those past repeated assertions. Sorry if I read the very similar sounding post at the top of this page incorrectly!

Incorrect interpretations via broad syllogisms are a definite recurring pattern of confusion on this message board as well. The bad news is that when we try to discuss the necessary details contained in the patent descriptions and medical literature, that often becomes confusing in an altogether different way.

Oh well... at least we try our best!

I didn't get confused by Doug's explanifications to the above.

I see variable breathing as just periods of irregular breathing, no pattern to them.

I see Normal spontaneous breathing as a pattern of NO irregular breathing or PB.

I see Periodic Breathing as being Normal breathing with distinct periods of Inspiration waxing and waning resembling a pattern described as CSR with centrals intermixed between.

I think this machine sees a little of both as the same as it scores them under PB. How long in duration or breaths does that pattern have to appear before it is classified as Periodic Breathing.

To me they are no different, erratic breathing meaning something is out of whack. Let's assume a patient on this machine has CSR. Let's assume they don't have any other therapy flags, just CSR.

Wouldn't we see the opposite of that waxing and waning "pattern" on Encore Reports with IPAP working pressure?

Because this machine is going to target those inspiration breaths and add pressure support to bring them up to its peak target. So my thoughts are we should she the inverse of that happening with IPAP working pressure in SV mode (between the Min and Max).

But I guess since this machine can detect and correct that type of pattern within 2 to 6 breaths it may be impossible to see that with the condensed reports. To bad you couldn't magnify that pressure response graph out like Doug does with his S8.

I think the only thing that separates VB and PB as far as this machine is concerned is a pattern in some brochure because it will be targeting the same peak flow in either case. On the CPAP Auto it will increase pressure if it does anything, on this machine its only concern is making sure peak flow is meeting its target. So it will treat an irregular inspiration the same in either case is my opinion.

If you inhale and that inhale shows signs of flattening this machine is going to pump up IPAP to make sure it meets its target. Since that is done on a breath-by-breath basis there is no pattern for it to assemble here to become what we know as CSR. If you look at the pattern demonstrated to make up CSR it starts on Inspiration with a lower peak, next breath may be a higher peak, until it reaches its highest peak then begins going down on the other side of the hill, it will increase IPAP working as it goes up starting at the bottom lessing that IPAP as it reaches its peak and begin filling that on the way down the other side.

So when you are talking about VB you are only describing a "slice" of what makes up PB. Would it not treat that "slice" the same by providing PS where needed?

I see PB as being a more severe form of VB with a regular pattern to it when it does show up, that pattern is NO breathing in between.

Just like it is shown in the brochure.

SWS,,

Lets take some examples along with some commonsense.

1) Would you put someone with CSR on an AUTO ?
if answer no then score 10 points
if you answer yes take away 10 points

2) Is CSR erratic breathing (Variable Breathing) ?
if you said yes take away 10 points
if you said no add 10 points

3) Is CSR periodic breathing (periods of breathing - cyclic fluctuating volume & variable rate pattern) ?
if you answered yes add 10 points
if you answered no take away 10 points

4) Is CSR the only form of periodic breathing ?
if you answered yes than take away 10 points
if you answered no add 5 points (the answer is too obvious)

5) Is there a difference between VB and PB
if you answered yes add 10 points
if you answered no take away 5 points (some debate on this is acceptable even though the label alone is clearly different)

6) Does the Respironics AUTO VB algorithm look for erratic rate or for erratic volume ?
if you answered rate add 5 points
if you answered volume take away 10 points (debate welcomed)

7) Write an essay in 20 words on why Respironics address VB with an AUTO and PB with an SV machine.

DSM

Snoredog wrote:So when you are talking about VB you are only describing a "slice" of what makes up PB.

Since VB occurs for a variety of reasons, I think some cases of VB will be a slice of PB.

Snoredog wrote:Would it not treat that "slice" the same by providing PS where needed?

I agree that the variations in variable breathing's flow amplitude will get straightened out without discrimination.

Snoredog wrote:I see PB as being a more severe form of VB with a regular pattern to it when it does show up, that pattern is NO breathing in between.

Supposedly PB typically entails intervening apneas, presumably because of respiratory controller overshoot/undershoot. However, some PB will not have the intervening apneas---and yet is still medically defined as PB.

Snoredog wrote: Just like it is shown in the brochure.

I agree that the brochure shows an excellent stereotypical presentation of PB. However, my point of caution would be that this single frank presentation of PB not be universalized---such that all the other PB cases are excluded from our understanding of both patient and machine.

dsm wrote:1) Would you put someone with CSR on an AUTO ?

What does CSR have to do with all the other reasons that people experience PB---such as CSDB/CompSA? And isn't that latter phenotype about 20% or more of the population?

<argumentative over-reliance on the CSR phenotype snipped----CSR necessarily entails PB, but PB cases are not universally CSR>

5) Is there a difference between VB and PB

Doug, are you familiar with the age-old concept of two groups sharing an overlapping subset? Because the VB and PB groups contain an overlapping subset. Some, but not all cases of VB happen to be PB. In those subset cases they are one-in-the-same.

6) Does the Respironics AUTO VB algorithm look for erratic rate or for erratic volume ?

It's looking for multiple criteria. Didn't I already clearly state that peak flow standard deviation was one of the criteria---for which PB matches? Isn't that worth at least twelve-and-a-half points?

7) Write an essay in 20 words on why Respironics address VB with an AUTO and PB with an SV machine.

Both machines necessarily cope with either breathing condition----when those two breathing conditions inevitably present across a vast SDB population. (exactly 20 words). The idea is for clinicians to get the correct or best machines to the correct patient. When PB that is related to mild-to-severe CSDB occurs on an APAP, the VB control layer will attempt cope with that PB by design. That's not to say the APAP is the ideal machine in those cases. Rather, the crux of what I have been contending is that some irregular breathers on APAP will perhaps fare better on the ASV machine.

-SWS wrote:
<snip>

Snoredog wrote: Just like it is shown in the brochure.

I agree that the brochure shows an excellent stereotypical presentation of PB. However, my point of caution would be that this single frank presentation of PB not be universalized---such that all the other PB cases are excluded from our understanding of both patient and machine.

SWS,

If we do agree that there are other cases than CSR to represent PB - that what are they ?

For each of the non CSR cases, are they common or very obscure ?

If common, how come we have such difficulty finding Resmed & Respironics literature that explains them clearly ?

**************************************************************************************************************************************

The fact is CSR is the common representation of Periodic Breathing and for us simple plebs CSR does the job *and* both Resmed and
Respironics stated that the primary goal of their SV machines going back in Resmed's case to the Resmed (Sullivan) Autoset CS machine in 2001
and for Respironics their HeartPAP machine in 2001 - was for CHF & CSR. So I consider it very normal to refer to PB as primarily representing
CSR just as they do. I can't help feeling it is nit picking in the extreme to argue that PB should not be primarily associated with CSR when
it comes to discussions among us CPAP plebs !.

DSM

RESMED Autoset CS - Year 2001 (now called the Vpap Adapt SV or the Autoset CS2)
===========================
http://www.talkaboutsleep.com/sleep-dis ... utoset.htm
http://www.resmed.com/en-en/clinicians/ ... clinicians
http://err.ersjournals.com/cgi/content/full/16/106/115
http://www.atse.org.au/index.php?sectionid=447
EXCERPT FROM ABOVE LINK
>>The most 'intelligent' of all AutoSet devices is undergoing clinical trials for the treatment of Cheyne-Stokes respiration. This is a highly irregular non-OSA form of sleep disordered breathing, with episodes of crescendo and decrescendo breaths alternating with central (non-obstructive) apneas. It occurs in late stage congestive heart failure and indicates a poor prognosis. AutoSet CS takes control of the breathing to restore it to normal within minutes. The effect on disease outcome and patient quality of life is under study.<<

RESPIRONICS HEARTPAP - Year 2001 (now called the Bipap Auto SV)
===============================

http://prnewswire.com/cgi-bin/stories.p ... 182&EDATE=

>>"Our HeartPAP(TM) initiative, focused on the treatment of congestive heart
failure patients, continues to make progress. Short-term feasibility testing
to validate our treatment algorithm and device safety is well underway and we
anticipate that long-term testing will begin shortly after this initial trial
phase is completed," said Mr. Liken.<<


http://www.prnewswire.com/cgi-bin/stori ... 291&EDATE=

>>As an example of the complementary R&D and technology, Liken highlighted
the Respironics HeartPAP(TM)* ventilator, designed with a smart algorithm to
rapidly detect and treat Cheyne-Stokes Respirations for Congestive Heart
Failure patients. "We intend to further develop Novametrix' NICO technology
for introduction into cardiologists' offices to support our overall HeartPAP
initiative. Over the next 12 to 18 months we will investigate potential market
opportunities, reimbursement pathways and development initiatives to introduce
this innovative product to the cardiology community."<<

-SWS wrote: I agree that the brochure shows an excellent stereotypical presentation of PB. However, my point of caution would be that this single frank presentation of PB not be universalized---such that all the other PB cases are excluded from our understanding of both patient and machine.

Hey I couldn't agree more, that is like someone showing up here with only 2 CA's seen on their 8 hr sleep report session and the next post is:

OMG! you have CSA like christinequilts!!

quick someone grab the defibrillator CLEAR!!!

(with all due respect to christinequilts) it ain't the same nor is 2 CA's the same as christine's disorder or severity.

The more I learn about this disorder the more I still say CA's are not from any neurological disorder, they are a normal result response from erratic breathing, just like a bad habit. I also believe that how you breathe during the day carries over to sleep and influences nocturnal breathing. It is also my belief that people experiencing these complex breathing patterns needs to see a professional to learn how to control their breathing with bio-feedback techniques and/or other means concentrating on daytime breathing. You can correct it at night with a mechanical device but if you go right back to that poor breathing pattern during the day it will remain that night.

There is a reason so many Americans end up having Hypertension and these sleep disorders, they are all inter-related. Go on any kind of xPAP machine and it controls your breathing to some extent. That control of breathing is what lowers essential hypertension after a patient goes on CPAP therapy for any amount of time.

I'm going to run that theory by my buddy Dr. Don Silverberg in an email and see what he says.

dsm wrote:If we do agree that there are other cases than CSR to represent PB - that what are they ?

For each of the non CSR cases, are they common or very obscure ?

If common, how come we have such difficulty finding Resmed & Respironics literature that explains them clearly ?

That's why I love firm medical conclusions via syllogisms.

If before 2005 we could find virtually no literature whatsoever about CSDB.... and that same CSDB runs highly prevalent and common at greater than 20%.... then why would you employ the above syllogistic criteria to consolidate virtually all PB into CSR? By that argument, prior to 2005 we had no CSDB phenotype in the patient population for lack of Google returns. After all everyone obviously fell into the large bulk of whatever Google or Google Scholar happened to render. Right?

When I said above that I don't have time for our usual many-page debate, I meant it! I would encourage you to look back on all those equally adamant positions you maintained in the past starting with the words "I am sure..." that eventually got reversed. We shall have to agree to disagree, my friend. I honestly don't have time for yet another of our typical 10-page debates.... as much as I enjoy those. Take care, my friend!

p.s. I know you're going to continue this regardless...