CPAPtalk.com

Quoting from the Owner's Manual, "The DeVilbiss Intellipap Auto Adjust System automatically adjusts air pressure by measuring your snoring and breathing patterns on a breath-by-breath basis, and compensating to meet your pressure needs. Your breathing patterns are continuously analyzed, stored and used to make any pressure adjustment."

I guess I'm reading into this that if it, "measures...your breathing pattern...(this would include exhale?) ...continuously analyzes and makes pressure adjustments", that would include the exhalation portion of your breathing. Not sure. It does not exhale as easily as A-Flex on 3, however it does seem to know you are exhaling....and make compensation....(my guestimate).

Georgio

I was one of the participants in this study (posted as Philip B.), and am honored by the opportunity to offer potentially helpful insights to buyers as well as feedback to manufacturers. I’d like to offer a few further observations with regard to discussion points in this thread.

1. The sample size may have been small, but I think it would be a mistake to dismiss the results as insignificant. What is quite striking to me is the consistency of the reports with respect to various features. I did not compare notes with other evaluators or discuss my trial with anyone, yet I found myself almost always in agreement with the factual aspects of the reviews, regardless of which product was ultimately preferred. To me, this indicates that a reader can approach the results with a high degree of confidence in the accuracy of the information. As others have pointed out, there are many performance and design aspects that potential buyers may not have considered that are worth taking into consideration.

2. The total subjective “thumbs up” or “thumbs down” tallies are to me the least useful aspect of the report. I don’t view this study as a popularity contest, and I think someone would be doing themselves a real disservice to base a buying decision on that basis. It is far more beneficial for potential buyers to consider the factors identified and make an informed decision based on which ones would be most significant to them. Consequently, I am really not comfortable about concluding that one product has “defeated” another in any meaningful sense. I think there are plenty of ideal candidates for each product. Which brings us to:

3. Exhalation relief is the most controversial issue here. Some dismiss its importance, while others see it as the make-or-break criterion. In reading this discussion thread, if I were a newbie I could easily conclude it’s purely a matter of personal preference because there doesn’t seem to be an objective basis for determining whether it would matter to me. However, I think we’ve overlooked a critical factor here: pressure level, which I would be willing to bet would prove a very reliable predictor of how important A-Flex or C-Flex would be.

Quite simply, I believe that the higher your pressure, the more likely you are to benefit from exhalation relief. For someone with relatively low pressure requirements, the variance between inhale and exhale pressure may not even be noticeable, whereas for someone blowing into a wind tunnel, the relief might make all the difference in their ability to tolerate treatment. This may seem self-evident, but it hasn’t been stated anywhere in this thread, and I think it would be a useful rule of thumb to apply in a buying decision.

In my case, as I wrote in my comments, I found the IntelliPap a better designed unit in almost every respect, but my pressure requirements are quite high (12-16) and for me A-Flex relief trumped every other consideration. It would be interesting to correlate others’ weighting of this feature with their own pressure requirements.

4. Finally, with regard to Georgio’s comments about the IntelliPap possibly having some kind of exhalation relief, I respectfully disagree. There is nothing in the manufacturer’s wording about breathing pattern measurement to suggest this is anything more than auto-titration. On the contrary, I think the words “breath-by-breath” are pretty clear that it’s analyzing variance between breaths, not within each single breath. If this device had anything that even remotely qualifies as exhalation relief, you can bet the DeVilbiss marketing department would be shouting it from the rooftops. It’s interesting, though, that your pressure requirements are relatively low--at a relatively constant 6.9 cm, one might speculate if it has some exhalation relief, but at an average of 13 believe me you would know it doesn’t. I don’t think there’s any need to fuel speculative rumors, especially when there’s such a wealth of solid factual information in these study results.

Again, I would urge readers not to discount these results based on sample size. I think the quality of information in these reports is among the best I’ve read in any online user reviews of any product.

Cheers,
Philip

Georgio wrote: I did carefully examine my nightly data from the Intellipap. What it showed was that it stayed at 6.9 all night with little or no change in pressure to respond to my sleep events, I.e. the pressure chart showed a flat line....with maybe one increase some nights. My speculation is that the machine did not respond to my "lesser" sleep events like flow limitations and hypopneas.

Okay, that's all well and good, but let's talk about those blue lights and that damned power brick. And which machine looked cooler?

Seriously, you need to get your priorities straight. Give it another couple of weeks of brick free therapy before you start resorting to minor things like pressure algorithms and effective therapy...

Sharkbait I got side tracked and didn't get to the testing my M-series without A-flex. I promise I will do that and get back to you. Evenings get kind of hectic at my house but I will do it!

SharkBait -- Just because the Intellipap's algorithms didn't work well for Georgio, doesn't mean they are inferior. I remember that at least one tester mentioned that they felt more rested on the Intellipap. I've never tried the Respironics Auto A-Flex, but the Intellipap algorithms work well for me. From what I've observed, the machine responds immediately and aggressively to snoring or to an apnea preceded by hypopneas. Clusters of hypopneas produce a more gradual pressure increase, and lone apneas and hypopneas not preceded by other events don't appear to provoke a response at all. The software doesn't show flow limitations, so I don't know how/if the machine responds to them. I just know that I feel better than I did with my previous machine, a basic CPAP running at my sleep lab titrated pressure of 10cm, especially since I bumped up the minimum pressure to the 90% auto-titrated value of 9cm. At that pressure, I don't think I'm missing anything by not having exhalation relief.

Johhny of cpap.com -- since you have the ear of DeVilbiss, perhaps you could convince them to release a firmware update to address the excessive light issue. I'd prefer that they douse the backlit display and button lights about 20 seconds after the last button press when the machine is running.

Philip,

Point taken with respect to no exhaust relief. At your higher pressure you were certainly in a better position to judge. It may be as you state, that at my lower pressure the difference (while I noted was not as easy to exhale) was not that noticable. Again, even in this thread, these are very usefull discussions that will help people make better choices in their equipment selection.

I am curious how many people's data showed their pressure staying flat line constant at one pressure almost all night? My opinion is the Intellipap only responded to my apneas (which I might only have one a night), not any flow limitations or hypopneas (which I have many). The data seemed to support this. Comments are welcome.









Georgio

dieselgal wrote:Sharkbait I got side tracked and didn't get to the testing my M-series without A-flex. I promise I will do that and get back to you. Evenings get kind of hectic at my house but I will do it!

I hear you.

I tried it yesterday for about 15 minutes while I was testing Babette's Nasal Aire II and it wasn't really that bad... I went ahead and put it back because I'm trying a new mask but I could probably do okay on 10 cm without it now that I'm an "old vet" of 6 weeks...

El Pap wrote:SharkBait -- Just because the Intellipap's algorithms didn't work well for Georgio, doesn't mean they are inferior.

Agreed. I was making another point but really don't know why. I'm sure they're both great machines and as long as people are using SOMETHING it's all good...

El Pap, thanks for your comment. I rounded up a few random examples of M-Series data:







Let me know what you think.

Georgio

Georgio wrote: I am curious how many people's data showed their pressure staying flat line constant at one pressure almost all night? My opinion is the Intellipap only responded to my apneas (which I might only have one a night), not any flow limitations or hypopneas (which I have many). The data seemed to support this. Comments are welcome.

I am one of those whom you describe here, mentioned this in my feedback comments regarding the IntelliPAP trial. I found myself double/triple checking to assure that the IntelliPAP was indeed in Auto mode, since the pressure never changed, always flat lined, stayed at the lower range pressure. My M Series always increases pressures throughout the night in response to events. This, I presume, resulted in my AHI jump of 5 to 6 times the norm for me, from 0.4 average over time with my M Series to 2.5 average with the IntelliPAP. I supposed that machines, like masks, really are a matter of personal fit and preference as well. The non-responsive auto mode/resulting higher AHI in tandem with the discomfort I experienced due to lack of exhalation pressure relief/A-FLEX certainly would prevent me from choosing the IntelliPAP.

My AHI didn't vary that much from machine to machine.....only the way I felt.

I did contact DeVilbris and learned that the machine cannot be adjusted to change how it responds to events, only how it reports the events.

I'd be really interested in people's comments, when they compare Georgio's data on the Auto A-Flex with his data on the Intellipap.

I can't figure why his pressure line shows straight with the Intellipap and pressure changes are very evident with the Auto A-Flex, while the events and the AHI appear quite similar on both machines. Given the fact that he said he felt like pre-cpap days after a short period on the Intellipap, I wonder what that means.

It almost suggests that machines can be as individual as masks. If that is true, then how would a machine be chosen by the doctor or the individual? What would be the criteria and who would set the criteria?

I know that all machines (especially autos with their different algorithms) report differently for different people but, do they also influence the effectiveness of therapy for different individuals that much?

A comparison of how a Respironics machine and a Resmed machine detect and report events was posted earlier (not sure if it was this thread or not). I'd be interested in such a comparison with the Repironics auto, Remsed auto and Intellipap auto, and I guess, the Sandman auto and all the other auto machines out there along with some idea of how each might affect therapy.

Georgio wrote:El Pap, thanks for your comment. I rounded up a few random examples of M-Series data:

Let me know what you think.

Georgio

Interesting... Looking at the Respironics data, it looks like that machine is mostly responding to vibratory snores (and to a lesser extent flow limitations). I know that the Intellipap responds to snores -- that's the event that most frequently pushes my pressure up; but it appears the Intellipap is missing most of yours. Comparing the charts, it looks like at 9cm (on average) the M series is seeing you snore more in one hour than the Intellipap sees all night -- I'll bet that's the reason the machine didn't work for you.

Oops, forgot to type my username. The above comment is mine. (I guess I should register for this forum, huh?)