BackUp for Bipap Auto SV

At three months plus with my Bipap Auto SV, I've been one hundred per cent compliant, and doing really well.

However, last night I encountered a problem I wasn't expecting: my mother in the hospital.

My Dad took Mom to the Emergency Room Friday evening. I was going to go up, but Dad said I should get a good night's sleep as he'd want to get some rest once he knew what was what.

He called at 7a to say Mom was being admitted to ICU, but they had no ICU beds, so they were keeping her in the Emergency Room. (Oh, those comfy ER beds!) Note: specialty hospital beds are still at a premium in post-Katrina New Orleans.

At 3p, they were still in the ER. Mom was to have an emergency colonoscopy (imagine getting the clean-out via nasal tube... ewww!) to trace the source of the bleeding. At 7p, I went up to relieve Dad and send him home to get some sleep -- he'd been up for 36 hours at that point. Darned stubborn German father! Don't need HIM in hospital, too.

AT 9p, they finally got Mom into a room -- though the doctor said she no longer needed ICU.

Nurses were very nice and helpful -- it was a double room, and the nurse said I could use the other bed if I wanted. I said, "Uhm, I have complex sleep apnea, and don't have my Bipap with me..." She blinked, nodded, and said, "You'll want this recliner then, and some pillows...."

So that's how I spent my first non-compliant night. I just grabbed about 4 hours at home with the Bipap, and plan to grab a few more before I go back up to the hospital.

It's too much of a pain to disassemble and reassemble my main machine... BUT, I need the auto SV for the CSDB.

Is there another, less expensive machine I could obtain that would be usable for such events as this? I suspect, sadly, that nights at the hospital will become more frequent, not less. How do other CPAPers with elderly parents manage hospital nights?

My EPAP is 6, my MinIpap is 10, my MaxIpap is 14.

Kiralynx

This issue is one I deal with as well. When I travel I don't take either on the SVs (both just too big).

I obtained an S8 with EPR - the S8 II EPR is even better. I run the machine in cpap mode with
pressure set to the same as Bipap SV epap. I set the EPR=3 that at least gives a bilevel type
capability but not the PS, that I get by without. Why I particularly like EPR is that it acts like
a timed mode in that if you have a central, it reverts to the higher pressure (whereas normal
bipaps & vpaps revert to the lower pressure). It does this within about 6 secs which is like a
back-up rate of 60secs/6secs = 10 BPM.

It isn't as good as SV but thus far has worked for me for the short number of nights I use it.

DSM

dsm wrote:This issue is one I deal with as well. When I travel I don't take either on the SVs (both just too big).

I obtained an S8 with EPR - the S8 II EPR is even better. I run the machine in cpap mode with
pressure set to the same as Bipap SV epap. I set the EPR=3 that at least gives a bilevel type
capability but not the PS, that I get by without. Why I particularly like EPR is that it acts like
a timed mode in that if you have a central, it reverts to the higher pressure (whereas normal
bipaps & vpaps revert to the lower pressure). It does this within about 6 secs which is like a
back-up rate of 60secs/6secs = 10 BPM.

It isn't as good as SV but thus far has worked for me for the short number of nights I use it.

Thanks for the recommendation. I admit that I was wondering if there was a Respironics model that would work as I already have the card reader and software, and it would be easier to keep track of data with the same equipment.

A recommendation by the pulmonologist who read my titration study was for the Sandman Auto at 8 and 4 (which puzzles me, since I was titrated at 10 and 14). I know that the Epap of 6 is easy to breathe against, and I do not use ramp because there just wasn't enough air at the lower pressures.

You may recall that when I got the BipapAuto SV, it was originally set at EPAP 10, MinIpap 10, and MaxIpap 14 -- and that I simply could not breathe out against it.

That's my chief concern with a straight CPAP... if I have the pressure up to where it will do some good without causing centrals, I can't breathe out against it.

But I'm definitely looking for a travel machine, because, as I said, I fear that with my mother 86 and my father 84, overnight stays in hospital with one or the other of them are going to become more frequent. (My father insisted on staying with Mom tonight, so I will have my Bipap tonight, but, preparation....)

Are you sure he wasn't talking / thinking of the Sandman Duo?
http://www.puritanbennett.com/prod/prod ... SPT&S2=CBI

O,

ozij wrote:Are you sure he wasn't talking / thinking of the Sandman Duo?
http://www.puritanbennett.com/prod/prod ... SPT&S2=CBI

No, I'm not -- I never laid eyes on the pulmonologist. I can only go by what was in my sleep study, in which it was stated, "It is felt that the patient would be best treated with auto-CPAP with a minimal setting of 8/4 cm with a maximal pressure of 14/10 cm. This patient could also use the Sandman Home auto Bipap which controls for central as well as obstructive hypopneas. Close follow-up is recommended."

Let's see... also says I was titrated to 14/10 with a Biflex of 3.

Fortunately, I think, for my success in treatment, I had a good RT who recommended the Bipap Auto SV for the complex SDB. It's an amazingly easy to use machine, and I sleep well with it. It's just a trifle expensive to have two of!

Strange, since an auto CPAP cannot have a minimum at 4/8 and a maximum at 14/10. That kind of separate yet variable rage can only be set up on an automatic BIPAP.

Maybe that C in CPAP was a slip of the tongue or finger... and he meant automatic bipap...

The problem, for you, with most automatic machines would be that they can't distinguish a pressure induced apnea from an obstructive one. Sandman machines do that better than most - although not perfectly. A Sandman auto will not raise pressure when it senses a central apnea. Some people's central apnea can be sensed by the Sandman. But not everyone's. In other words: When a Sandman decide an apnea is an open airway apnea - it is always right. But it doesn't sense all of them - and there's a variability between people - for some of them, every open airway apnea is accompanied by the sound of their hear beating (cardiogenic oscillations in the air column) for others, open airway apneas are not accompanied by cardiogenic oscillations.

Both Mindy and Browser seem to do better with the Sandman's Auto algorithm than with the Respironics' Auto. And the Sandman is very very light.

O.

DSM, i was interested in your suggestion too I am doing well with the Resmed vpap adapt SV but i have needed to use enough other medical equipment such as electric wheelchairs etc to know that they do break down occaisionally so a back up is a good idea, also i do hope to go on vacation and the machine is a bit big especially since i have to take shower chairs and a variety of equipment so the idea of a small cheaper option as back up is a good idea (once i recover from paying for this one!)

ozij wrote:Strange, since an auto CPAP cannot have a minimum at 4/8 and a maximum at 14/10. That kind of separate yet variable rage can only be set up on an automatic BIPAP.

Maybe that C in CPAP was a slip of the tongue or finger... and he meant automatic bipap...

The doctor is a "she," actually -- it's interesting how, even yet, so many of us (me included) assume a doctor is male until advised otherwise. Though you're correct -- it's possible that what was meant was a Bipap auto. Pity that our hosts don't appear to carry the one you pointed out above.

The problem, for you, with most automatic machines would be that they can't distinguish a pressure induced apnea from an obstructive one. Sandman machines do that better than most - although not perfectly. A Sandman auto will not raise pressure when it senses a central apnea. Some people's central apnea can be sensed by the Sandman. But not everyone's. In other words: When a Sandman decide an apnea is an open airway apnea - it is always right. But it doesn't sense all of them - and there's a variability between people - for some of them, every open airway apnea is accompanied by the sound of their hear beating (cardiogenic oscillations in the air column) for others, open airway apneas are not accompanied by cardiogenic oscillations.

Right, that's a primary concern. In classic CSDB style, I had no centrals on the diagnostic PSG, but on xPAP, I had 28 centrals in non-REM sleep.

Both Mindy and Browser seem to do better with the Sandman's Auto algorithm than with the Respironics' Auto. And the Sandman is very very light.

That certainly would seem to meet my requirements for small and light, and the package which CPAP.COM has here

https://www.cpap.com/productpage-bundle ... undle.html

also meets the criteria for less expensive than a second Bipap Auto SV.... though not, alas, for using the same software and card reader.

I'm just wondering how it would be set up to compare with the Auto SV pressures. Or if, in fact, I would have to seek out someone who carries the Sandman Bipap. Which, to be honest, I'd rather not do. This purchase would be out of pocket, and I'd prefer to give my out-of-pocket monies to our hosts.

Kiralynx wrote:

ozij wrote:Strange, since an auto CPAP cannot have a minimum at 4/8 and a maximum at 14/10. That kind of separate yet variable rage can only be set up on an automatic BIPAP.

Maybe that C in CPAP was a slip of the tongue or finger... and he meant automatic bipap...

The doctor is a "she," actually -- it's interesting how, even yet, so many of us (me included) assume a doctor is male until advised otherwise. Though you're correct -- it's possible that what was meant was a Bipap auto. Pity that our hosts don't appear to carry the one you pointed out above.

That's funny, because I often do say she or he whe it isn't clear - but in this kind, I had the pulomonoligist I had met, in mind...
I'm not sure the Duo is a bilevel auto.

I'm just wondering how it would be set up to compare with the Auto SV pressures. Or if, in fact, I would have to seek out someone who carries the Sandman Bipap. Which, to be honest, I'd rather not do. This purchase would be out of pocket, and I'd prefer to give my out-of-pocket monies to our hosts.

You could ask cpap.com when they're getting it.
According something SAG (that's "StillAnotherGuest" for new members who may be reading) posted, some people actually get over the central apneas once they get used to the pressure.

O.

ozij wrote:That's funny, because I often do say she or he whe it isn't clear - but in this kind, I had the pulomonoligist I had met, in mind...I'm not sure the Duo is a bilevel auto.

Mmm. I use "s/he" a good bit of the time... less to type! (And I kinda giggled when I saw "the Duo" because I use that term for a pair of standard longhaired dachshunds....)

You could ask cpap.com when they're getting it.
According something SAG (that's "StillAnotherGuest" for new members who may be reading) posted, some people actually get over the central apneas once they get used to the pressure.

Well, that's an interesting question. Of course, anyone at CPAP.COM isn't allowed to recommend machines, as they're not RTs or doctors, but they do know the machines they carry well.

So people do get over the central apneas, huh? That's interesting. I know that we had to lower my EPAP because I was still struggling to breathe against the original setting, and that was apparently causing apneas. Makes me wonder what would happen if I were to raise the Epap again, a bit at a time. Although now, when my Mom's in hospital, is probably not the best time for such experimentation. I'm still getting things back on track since my leak rates were (in my view) out of site during our visit to my sister, but have dropped back to normal ranges when I'm back in my own bed.

Any back up is going to be relatively expensive, that's for certain. It's just HOW expensive is the question. And whether the backup can do what's needed, at least for short periods of time.

The main thing about an SV machine that no other can emulate is that these machines are tuned to increase pressure instantly (well, verrry quickly - within 1-3 breathing cycles - which can be as little as 5-15 secs - as much as 3-9 Cms ( 9 CMs could be achieved if needed to maintain Vt target, at 3 CMs per breath)).

Autos aren't any help at all to SV users. Bilevels are, to a degree, but a lot depends on what condition the SV is addressing for that user.

For myself, it is not a big problem for me to use a bilevel (or bilevel like) smaller machine for a few nights but after about 5 nights on my travel machine I am starting to feel heavy & a bit sluggish. It is always nice to get back on with the pressure support.

I am waiting for Respironics to produce a smaller SV or Resmed to put one in an S8 case - I think they will eventually.

DSM

dsm wrote:The main thing about an SV machine that no other can emulate is that these machines are tuned to increase pressure instantly (well, verrry quickly - within 1-3 breathing cycles - which can be as little as 5-15 secs - as much as 3-9 Cms ( 9 CMs could be achieved if needed to maintain Vt target, at 3 CMs per breath)).

Autos aren't any help at all to SV users. Bilevels are, to a degree, but a lot depends on what condition the SV is addressing for that user.

Doug,

I've noticed this a time or two -- how quickly the Auto-SV responds. So a regular auto -- like, say, the Sandman referenced above wouldn't work? Or, perhaps, a Respironics auto with A-flex?

I spoke with the RT who originally recommended the Auto SV for me, and she seemed to think I might be able to manage on a Respironics set at 11 and a flex of 3 IF I could tolerate the effective EPAP of 8 created by the flex. I legitimately don't know: I've never tried straight CPAP as I couldn't tolerate it -- I was titrated on bilevel with a Biflex of 3.

For myself, it is not a big problem for me to use a bilevel (or bilevel like) smaller machine for a few nights but after about 5 nights on my travel machine I am starting to feel heavy & a bit sluggish. It is always nice to get back on with the pressure support.

<wry grin> I feel heavy and sluggish as it is after a night or two of sleeping lightly in a chair and being alert for any little change in the person in the next bed over. I can identify with that wish to get back to the pressure support.

I am waiting for Respironics to produce a smaller SV or Resmed to put one in an S8 case - I think they will eventually.

Heh. I wonder why this thought makes me feel like a person in need of instant gratification -- "I don't want it eventually.... I want it NOW!"

I suspect you're right about the development of a smaller unit. I acknowledge, though, that with hurricane season only three months away, I'd like a smaller unit which is also battery powered!

"Later" regrettably doesn't help, either, when trying to select a possible travel machine for now to help deal with Mom's hospitalization. (My husband says he has this dread feeling I will end up with several, like the computers. I pointed out that they take up less space than his sailboat...)

Kiralynx,

The flex is a momentary dip in pressure just as exhalation starts. The dip is very short & not like a bilevel effect. EPR does dip by fixed CM amounts (1 2 & 3 CMs) & is like a bilevel effect.

An ordinary Auto is of little help to SV users because it delivers the one pressure but tries to float that one pressure down as far as it can - in order to minimize side effects (discomfort in breathing out, mouth leaks, mask leaks etc:). It is interesting how many Auto users complain about their therapy when the doc sent them home with the low pressure range set to 4 !.

Autos also take minutes to raise pressure by any noticeable amount as they do so when the sense possible patterns of OSA events coming (snores, hypopneas, flow-limitations etc:).

Doug

dsm wrote:The flex is a momentary dip in pressure just as exhalation starts. The dip is very short & not like a bilevel effect. EPR does dip by fixed CM amounts (1 2 & 3 CMs) & is like a bilevel effect.

Doug,

So what you're saying is that a Respironics machine with flex can't mimic a bilevel, but a Resmed machine with EPR can, to a certain extent? What does Biflex do for a Respironics bilevel?

An ordinary Auto is of little help to SV users because it delivers the one pressure but tries to float that one pressure down as far as it can - in order to minimize side effects (discomfort in breathing out, mouth leaks, mask leaks etc:). It is interesting how many Auto users complain about their therapy when the doc sent them home with the low pressure range set to 4 !

.

I know I've seen plenty of discussions about the inanity of setting a regular auto wide open to 4 and 20 since beginning to read the board. If I have understood those discussions correctly, the lower end should be set as close to a titrated pressure as possible. I also have recollections of pressure spreads, like 3 & 4 cm, but I haven't yet learned enough to fully understand the how and why of that.

Autos also take minutes to raise pressure by any noticeable amount as they do so when the sense possible patterns of OSA events coming (snores, hypopneas, flow-limitations etc:).

I'm beginning to understand why the RT originally recommended the Bipap Auto SV for me, with its flexibility and speed of response. My patterns of SDB, based on the data from the SV, are more hypopneas and breath drop-outs than actual apneas, although I do occasionally have some periodic breathing, at least with the Bipap Auto SV.

Problem is, it seems to suggest that an SV machine is specifically what I need, and there is no less expensive alternative which could be used as a back-up or travel machine.

Kiralynx,

i think that you are not having apneas BECAUSE you have the SV, I rarely have any apneas since I started using the SV. With it's quick response time, the SV nearly eliminates apneas. Last night, I used my Auto because the electricity kept flickering out and the Auto will come on by itself, whereas the BiPap Auto SV has to be manually turned on. I had 4 apneas last night, more than I have had in a month on the SV.

I wish there was a smaller version of the SV, too, as I am not willing to risk traveling with it. It's too expensive to replace.

Bev