Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

Thank you all for your posts. You have helped a lot and reinforced my understanding of the settings. Talking points with my doctor will include lowering both the EPAPmin, and the Pressure support min and raising the Max Pressure and the Pressure support max. The new settings will I hope provide lattitude for the machine to titrate but still be centered about my current settings. I have almost two months data with the current settings. I have come very close to chosing a prefferred mask. I am now accustomed to the airflow so my mouth and tongue are not desicated in the morning. Now seems a good time to put the BiPAP Auto SV Adv. technology to the test. I can always return to the current settings.

One other question. During the ramp period my machine starts at 16 and ramps up to 24 on average. At the same time the Minute volume and the Breaths per minute drop until the pressure levels off. The inverse relationship between these is really striking. Any comments?

mdboze wrote:nigh: I'm still figuring out my machine... I'm only a few months into this. But here is my 2 cents:

DSM & Banned: nghy mentioned that he was not diagnosed with Central/Complex apnea; and he selected this machine because he wanted a machine that could go up to 30cm. Indicating OSA.

For OSA shouldn't his machine be set as a bipap somthing like this:
Min EPAP = 16 ; Max EPAP = 30
Min PS= 1 ; Max PS= 1
Max Pressure = 30

Then, let the machine take care of him with its smart algorithms.
DSM, Banned, what do you think ? You know more about this than me.

------------------------------------------------------------------------------------

mdboze,

Not neccesarily. If nghy wants the benefit of SV support (machine tracking av peak flow) then SV mode is the right way.

The settings that you have put forward basically turns the expensive ASV machine into a Respironics Auto Bipap with the ipap/epap gap set to 1 CMs. That shapes up as a really odd combo. If you meant to suggest a straight Cpap Auto this would do it ...

MinEpap=16 MaxEpap=30 MinPS=0 & MaxPS=0 & Max Pressure=30 (the MinPS = MaxPS turns off the SV algorithm (so why even have an ASV machine ?) .

The Epap Max=30 effectively kills the machine as a Bilevel as does setting PSMin =1 & PSMax=1. So there goes yet another feature.

I believe many people who try SV support whether they do it in CPAP or BiLevel mode (remembering that some Mixed Apnea patients & almost all CompSA patients really need Cpap mode + SV). Will find the tracking of Av Peak Flow, to be a fantastic boost to their therapy. Kind of like a very big bonus. The SV algorithm in the Bipap Auto SV is a *great* therapy boost (IMHO).

Hope this clarifies things

Cheers

DSM

mdboze wrote:Update: I finally got a card reader. and am willing to tweak my settings again.

For the last 3 weeks, my settings have been:

Min & Max EPAP= 9
PS Min = 6
PS Min = 11

During that time:
Avg HYP Index = 5.0
Avg AHI = 6.3 (is this high ?)
Avg Patient Triggered breaths = 85.8%
I don't know what is good or bad ?

On the detailed graphs, almost every days shows patient triggered breaths drop below 5% for 20 to as long as 45 minutes a few times each night.

I want to improve my treatment if possible. Tips are welcome.

I am more than happy to offer tips BUT only if you promise to run them past your DR or R/T

If you agree, I'll deliver

DSM

mdboze, (& banned)

From the settings you have been using you could look at one change & then look at the effects.

This setting theoretically should be a simple one but because this machine is an SV and is set with SV active there may be unforseen side effects as to the best of my knowledge no one else has tried using self titrating Epap & SV at the same time & provided us with data of before & after.

The setting is the one banned has already suggested but not nearly as big a change as banned has proposed. I would only drop EpapMin from 9 to 7 and study the patterns from a few nights data. i.e. does the machine stay at 7 CMs for Epap ? - if it does do the numbers (Ai & HI etc: ) get worse or better ?.

Remember that if you were to drop EpapMin to say 5 as banned as suggested, which is a drop of 4 CMs, then Ipap also drops 4 as does the whole SV support range. It seems to me that is far too big a change to not expect disruption. So that is why I am suggesting no more than a drop of 2 CMs. Really what this experiment would achieve is to see if how the Auto titrating of Epap works & what effects lowering it has on the other pressures etc:.

One additional favour I would ask is that when you metion any of the suggestions here to your doc, to let us know his feedback on them.

Cheers

DSM

dsm wrote:I am more than happy to offer tips BUT only if you promise to run them past your DR or R/T

If you agree, I'll deliver
DSM

DSM,
I total agree; and always assumed that was understood.
With any tips given here; or any setting changes; I am choosing of my own accord to make these setting changes; and I always keep my Doctor in the loop. I have seen from others here that most peoples doctors are supportive of them taking control of their own therapy; as long as we keep our doctor in the loop.

Sharing information here is just small talk between people that have a common problem; sharing what has worked for them, and what has not worked. Sharing what we know to help others know, they are not alone. I an VERY glad I found this website. Today, I feel comfortable; less intimidated by being connected to a MACHINE to help me breath! This was scary at first.

Also, sharing tips is all on how we strategically word it...
GOOD: "If it were me, I would try the following settings...." ; or "I suggest changing settings to (whatever)..... be sure to confirm with your doctor"
NOT GOOD: "You should change your settings to ......"

Helping others in the open is good.

Thank you ALL for helping me; giving encouragement; and tips. I know I would not have stuck with this therapy without the support I got here. I would have given up months ago, overly frustrated with mask leaks and incorrect DME setup of my machine.

mdboze wrote:"I suggest changing settings to (whatever)..... be sure to confirm with your doctor"

I suggest changing settings to PS Min: 5..... be sure to confirm with your doctor

Banned

mdboze wrote:

dsm wrote:I am more than happy to offer tips BUT only if you promise to run them past your DR or R/T

If you agree, I'll deliver
DSM

DSM,
I total agree; and always assumed that was understood.
With any tips given here; or any setting changes; I am choosing of my own accord to make these setting changes; and I always keep my Doctor in the loop. I have seen from others here that most peoples doctors are supportive of them taking control of their own therapy; as long as we keep our doctor in the loop.

Sharing information here is just small talk between people that have a common problem; sharing what has worked for them, and what has not worked. Sharing what we know to help others know, they are not alone. I an VERY glad I found this website. Today, I feel comfortable; less intimidated by being connected to a MACHINE to help me breath! This was scary at first.

Also, sharing tips is all on how we strategically word it...
GOOD: "If it were me, I would try the following settings...." ; or "I suggest changing settings to (whatever)..... be sure to confirm with your doctor"
NOT GOOD: "You should change your settings to ......"

Helping others in the open is good.

Thank you ALL for helping me; giving encouragement; and tips. I know I would not have stuck with this therapy without the support I got here. I would have given up months ago, overly frustrated with mask leaks and incorrect DME setup of my machine.

mdboze, (& banned)

From the settings you have been using you could look at one change & then look at the effects.

This setting theoretically should be a simple one but because this machine is an SV and is set with SV active there may be unforseen side effects as to the best of my knowledge no one else has tried using self titrating Epap & SV at the same time & provided us with data of before & after.

The setting is the one banned has already suggested but not nearly as big a change as banned has proposed. I would only drop EpapMin from 9 to 7 and study the patterns from a few nights data. i.e. does the machine stay at 7 CMs for Epap ? - if it does do the numbers (Ai & HI etc: ) get worse or better ?.

Remember that if you were to drop EpapMin to say 5 as banned as suggested, which is a drop of 4 CMs, then Ipap also drops 4 as does the whole SV support range. It seems to me that is far too big a change to not expect disruption. So that is why I am suggesting no more than a drop of 2 CMs. Really what this experiment would achieve is to see if how the Auto titrating of Epap works & what effects lowering it has on the other pressures etc:.

One additional favour I would ask is that when you metion any of the suggestions here to your doc, to let us know his feedback on them.

Cheers

DSM

This is a research question for anyone who has a Bipap Auto SV Advanced and has the clin manual.

In looking at the settings, does it say quite clearly (as I understand that it does) that PS is added to the current active Epap, or gets added to the EpapMin setting or does it in fact say PS is added to EpapMax ?).

Reason I ask is that it just does not make sense to me to base all subsequent pressures off EpapMin or current Epap. The potential for disruption seems severe if indeed PS is added to EpapMin / Current Epap.

The Weinmann SOMmnovent CR appears to solve this issue of a floating epap affecting the other pressures, by leaving them as they are & only adjusting Epap in response to OSA events. Also the SOMMNOVent CR uses a novel technique of spreading epap & ipap apart equally when hypocapnia is detected (CO2 buildup & thus Centrals occuring) and when hypoventilation is detected (too much CO2 build up), it closes the gap equally between epap & ipap to the point that there is no gap (if that is needed).

As can be imagined, the interactions of all these pressures & events is extremely complex and depending on how each brand handles the matter of floating Epap independantly of the Ipap & SV pressure support, could have good & bad side effects for different users.

So the point I am seeking to establish is, does the Bipap Auto SV Adv tie current Epap (as it floats between EpapMin & EpapMax) to all the other pressures (Ipap & SV) or does it allow the other pressures to remain as they are while Epap is auto titrated.

DSM

dsm wrote:This is a research question for anyone who has a Bipap Auto SV Advanced and has the clin manual.

In looking at the settings, does it say quite clearly (as I understand that it does) that PS is added to the current active Epap, or gets added to the EpapMin setting or does it in fact say PS is added to EpapMax ?).

Reason I ask is that it just does not make sense to me to base all subsequent pressures off EpapMin or current Epap. The potential for disruption seems severe if indeed PS is added to EpapMin / Current Epap.

The Weinmann SOMmnovent CR appears to solve this issue of a floating epap affecting the other pressures, by leaving them as they are & only adjusting Epap in response to OSA events. Also the SOMMNOVent CR uses a novel technique of spreading epap & ipap apart equally when hypocapnia is detected (CO2 buildup & thus Centrals occuring) and when hypoventilation is detected (too much CO2 build up), it closes the gap equally between epap & ipap to the point that there is no gap (if that is needed).

As can be imagined, the interactions of all these pressures & events is extremely complex and depending on how each brand handles the matter of floating Epap independantly of the Ipap & SV pressure support, could have good & bad side effects for different users.

So the point I am seeking to establish is, does the Bipap Auto SV Adv tie current Epap (as it floats between EpapMin & EpapMax) to all the other pressures (Ipap & SV) or does it allow the other pressures to remain as they are while Epap is auto titrated.

DSM

PS Min and PS Max remain constant as added to EPAP Min. EPAP Max floats.

Banned

Banned wrote:

dsm wrote:This is a research question for anyone who has a Bipap Auto SV Advanced and has the clin manual.

In looking at the settings, does it say quite clearly (as I understand that it does) that PS is added to the current active Epap, or gets added to the EpapMin setting or does it in fact say PS is added to EpapMax ?).

Reason I ask is that it just does not make sense to me to base all subsequent pressures off EpapMin or current Epap. The potential for disruption seems severe if indeed PS is added to EpapMin / Current Epap.

The Weinmann SOMmnovent CR appears to solve this issue of a floating epap affecting the other pressures, by leaving them as they are & only adjusting Epap in response to OSA events. Also the SOMMNOVent CR uses a novel technique of spreading epap & ipap apart equally when hypocapnia is detected (CO2 buildup & thus Centrals occuring) and when hypoventilation is detected (too much CO2 build up), it closes the gap equally between epap & ipap to the point that there is no gap (if that is needed).

As can be imagined, the interactions of all these pressures & events is extremely complex and depending on how each brand handles the matter of floating Epap independantly of the Ipap & SV pressure support, could have good & bad side effects for different users.

So the point I am seeking to establish is, does the Bipap Auto SV Adv tie current Epap (as it floats between EpapMin & EpapMax) to all the other pressures (Ipap & SV) or does it allow the other pressures to remain as they are while Epap is auto titrated.

DSM

PS Min and PS Max remain constant as added to EPAP Min. EPAP Max floats.

Banned

Banned,

EpapMax can't 'float', it is a setting. Epap 'floats' (between EpapMin & EpapMax).

PS remains what ever it was set to - that is PSMin stays at min & PSMax stays at PSMax - The Ipap pressure varies between them as controlled by the SV algorithm while tracking Peak Av Flow.

The question is, does Ipap stay at a constant pressure (lets ignore SV adjustments to Ipap for this point) independant of Epap when Epap is being adjusted due to an OSA event, or does Ipap (ignoring SV adjustments to Ipap) stay exactly PSMin above the floating Epap.

Try to look at it this way. When Epap is being adjusted due to an OSA event, does it push Ipap along with it or does the machine adjust current Epap independantly. This was what happened in the Bipap Auto (with Biflex) machine (the pre SV Bipap Auto). It adjusted Epap seperately from Ipap. but it did have a minPS setting at which time if raising Epap meant the MinPS setting would be breeched, then it would raise Ipap along with Epap. Ipap Also had a PSMax.

The real point is do the SV pressures sit independantly of the 'floating epap' (as appears to happen with the SOMMNOVent CR) or does the machine shift the SV range upwards & downwards as epap floats when responding to OSA events.

The Bipap Autp SV Adv manualm should spell this out & I am looking for a page ref.

Thanks

DSM

dsm wrote: The question is, does Ipap stay at a constant pressure (lets ignore SV adjustments to Ipap for this point) independant of Epap when Epap is being adjusted due to an OSA event, or does Ipap (ignoring SV adjustments to Ipap) stay exactly PSMin above the floating Epap.

Short answer in your own language: Ipap stays at a constant pressure (lets ignore SV adjustments to Ipap for this point) independant of Epap when Epap is being adjusted due to an OSA event.

Banned

banned wrote:PS Min and PS Max remain constant as added to EPAP Min

That statement is close. Respironics graphically depicts auto-adjusting PS and auto-adjusting EPAP as operating independently of each other:



In the graph above we can see auto-adjusting CPAP as the base modality (depicted by the adjusting EPAP line). However, there are exactly two clusters on that graph of superimposed auto-adjusting PS (two servo-ventilation activity clusters). During those two clusters of servo-ventilation activity, we can see that PS proportionately fluctuates high, low, or somewhere in between as SV modality is prone to do in response to say Periodic Breathing. We can also see those automatic PS fluctuations are independent of EPAP: auto-adjusting PS is "added to EPAP" pressure delivery as banned mentioned. After that second servo-ventilation cluster of activity, auto-adjusting CPAP is then resumed as base modality until SV (fluctuating PS) is needed once again.

So the auto-adjusting EPAP will operate independently toward stenting airway obstruction; and the auto-adjusting PS will operate independently toward adjusting flow-based or targeted ventilation. Here is that manufacturer link for the above graph, where they describe the machine's operation:

http://bipapautosvadvanced.respironics.com/

Enjoy!

-SWS wrote:

banned wrote:PS Min and PS Max remain constant as added to EPAP Min

That statement is close. Respironics graphically depicts auto-adjusting PS and auto-adjusting EPAP as operating independently of each other:



In the graph above we can see auto-adjusting CPAP as the base modality (depicted by the adjusting EPAP line). However, there are exactly two clusters on that graph of superimposed auto-adjusting PS (two servo-ventilation activity clusters). During those two clusters of servo-ventilation activity, we can see that PS proportionately fluctuates high, low, or somewhere in between as SV modality is prone to do in response to say Periodic Breathing. We can also see those automatic PS fluctuations are independent of EPAP: auto-adjusting PS is "added to EPAP" pressure delivery as banned mentioned. After that second servo-ventilation cluster of activity, auto-adjusting CPAP is then resumed as base modality until SV (fluctuating PS) is needed once again.

So the auto-adjusting EPAP will operate independently toward stenting airway obstruction; and the auto-adjusting PS will operate independently toward adjusting flow-based or targeted ventilation. Here is that manufacturer link for the above graph, where they describe the machine's operation:

http://bipapautosvadvanced.respironics.com/

Enjoy!

SWS,

Thanks for adding that but I am still trying to figure out if what I am seeing in that chart is a floating Epap (responding to OSA) and that PS as shown in the two (one lower one higher) bursts is superimposed on the floating Epap. That is the way I have always read how this machine worked, but, that raises in my mind many issues to do with side effects if the SV bursts float with Epap vs if they were pegged to a fixed Ipap Min.

Allowing that EpaMIn & EpapMax are mere settings & the real Epap 'floats' between them. Then as I originally read the machine info, Bilevel (PSMin > 0) can be added as required and SV (PSMin < PSMax + limited by pressure Max) can be added but that Bilevel gap & SV variations then get superimposed on the current floating Epap.

I think we are saying the same thing but I began to have doubts about the possible side effects of allowing SV to range in step with Current Epap rather than have an independant Ipap (a bit like the Bipap Auto ranges).

Cheers & thanks

DSM

I would like to discuss with all of you the AUTO Algorithm Technology found at this Respironics URL.
http://sleepapnea.respironics.com/techn ... rithm.aspx

My BiPAP Auto SV has been set to a fixed minumum of 12 breaths per minute. I presume this same technology exists on the SV Advanced and I have a feeling that here again the DME has chosen a setting that bypasses one of the most important features available on this machine Shouldn't the setting be AUTO? My normal rate is 17.5 breaths per minute so a setting of 12 may be so low as to not really offer much support unless I really stop breathing for a while. Comments please.

Good luck getting your analytical paradigm sorted out, dsm.

nghy wrote:I would like to discuss with all of you the AUTO Algorithm Technology found at this Respironics URL.
http://sleepapnea.respironics.com/techn ... rithm.aspx

The above feature has nothing to do with the backup rate you mention below. A BiPAP autoSV Advanced will do the above as long as EPAP min and EPAP max are set at different values. The non-enhanced BiPAP autoSV's cannot do the above.

nghy wrote:My BiPAP Auto SV has been set to a fixed minumum of 12 breaths per minute. I presume this same technology exists on the SV Advanced and I have a feeling that here again the DME has chosen a setting that bypasses one of the most important features available on this machine Shouldn't the setting be AUTO? My normal rate is 17.5 breaths per minute so a setting of 12 may be so low as to not really offer much support unless I really stop breathing for a while. Comments please.

Again, auto backup rate---versus your fixed backup rate of 12----is an altogether different feature than what you have linked above. Setting backup rate to auto instead of some fixed value would keep the factory default setting for that backup feature. Ask your DME why a setting of 12 instead of auto. The DME performed extra work to set backup at 12, so perhaps there's a good reason.

I hope the description below adds at least some clarity about what IPAP and EPAP do on the new Enhanced BiPAP autoSV model:



Above, IPAP pressure delivery equals EPAP pressure delivery, except during those two clusters of servo ventilation activity. During those two clusters, EPAP equals the lower pressure-delivery line and IPAP equals the top pressure-delivery line for each narrow pulse (each single-breath).

If that EPAP line didn't automatically meander according to the obstructive-addressing auto algorithm, then we'd have a flat EPAP line. In that case we would have CPAP + SV (CPAP as the base modality). However, since the EPAP line above automatically meanders or adjusts, we have APAP + SV (APAP as the base modality).

The non-enhanced BiPAP autoSV offered these SV platforms: a) BiPAP + SV (BiPAP as base modality) or b) CPAP + SV (CPAP as base modality)

The new BiPAP autoSV Enhanced offers these SV platforms: a) APAP + SV (APAP as base modality), b) BiPAP + SV (BiPAP as base modality) or c) CPAP + SV (CPAP as base modality)

Dunno if that elucidates... But I hope it helps.