Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

nghy · Post by **nghy** » Fri Feb 26, 2010 11:01 pm

-SWS wrote: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.

The DME did not have to do any work or thinking. The provider manual clearly describes the three available settings: 1. off 2. fixed rate betwee 4 an 30 breaths per minute 3. Auto. From the Respironics description, I don't think this setting has anything to do with adjusting EPAP or IPAP which is governed by a different technology. This algorithm senses the breathing rate and flows to determine whether to provide an extra assist. I believe this is the feature that helps when the patient induced breathing falls or when hypopneas occurs or in your case a central/complex apnea event. Section 3.2.2 of the provider manual covers "Breath Rate Controls" clearly states that this feature is in addition to the other pressure controls. Unfortunatly, the pdf of the manual does not permit copying text and I can't seem to paste the image here.

-SWS · Post by **-SWS** » Fri Feb 26, 2010 11:03 pm

nghy wrote: The DME did not have to do any work or thinking.

Since the factory default for backup rate is auto the DME actually took steps to set it at 12 for you. If the DME didn't perform those extra steps, then you would now be set up at auto instead of 12---that is unless you have a used machine with the previous patient's backup rate of 12.

-SWS · Post by **-SWS** » Fri Feb 26, 2010 11:19 pm

I don't think this setting has anything to do with adjusting EPAP or IPAP which is governed by a different technology.

Backup rate allows the machine to automatically transition from EPAP to IPAP when a breath is missing or late.

This algorithm senses the breathing rate and flows to determine whether to provide an extra assist. I believe this is the feature that helps when the patient induced breathing falls or when hypopneas occurs or in your case a central/complex apnea event.

So backup rate is for apneas, but not hypopneas---since hypopneas will trigger that machine transition from EPAP to IPAP. It's the same exact backup scheme that Respironics uses on all their BiPAP S/T machines---including AVAPS.

Backup rate is a very basic feature for nudging you to start a breath when your breath is late or missing. If you set backup rate to "off" then you are running the machine as if it were a more basic spontaneous-mode BiPAP machine. In that case, the machine would transition from EPAP to IPAP only when your spontaneous breaths tell the BiPAP to trigger. There would be no backup rate as a safety net for central apneas.

nghy · Post by **nghy** » Fri Feb 26, 2010 11:25 pm

-SWS wrote:
I don't think this setting has anything to do with adjusting EPAP or IPAP which is governed by a different technology.
Backup rate allows the machine to automatically transition from EPAP to IPAP when a breath is missing or late.

This algorithm senses the breathing rate and flows to determine whether to provide an extra assist. I believe this is the feature that helps when the patient induced breathing falls or when hypopneas occurs or in your case a central/complex apnea event.
So backup rate is for apneas, but not hypopneas---since hypopneas will trigger that machine transition from EPAP to IPAP. It's the same exact backup scheme that Respironics uses on all their BiPAP S/T machines---including AVAPS.

Not according to Respironics http://sleepapnea.respironics.com/techn ... x#hypopnea

Backup rate is a very basic feature for nudging you to start a breath when your breath is late or missing. If you set backup rate to "off" then you are running the machine as if it were a more basic spontaneous-mode BiPAP machine. In that case, the machine would transition from EPAP to IPAP only when your spontaneous breaths tell the BiPAP to trigger. There would be no backup rate as a safety net for central apneas.

-SWS · Post by **-SWS** » Fri Feb 26, 2010 11:39 pm

Nghy, I think that understandable confusion lies in the fact that Respironics uses the word "auto" for their "auto adjusting" algorithm and they also confusingly use the word "auto" for one of their backup rate options. That is confusing to newcomers IMHO. However, you're linking to a part of the algorithm that has absolutely nothing to do with backup rate. It's the auto-algorithm feature instead.

So you're pointing out procedures in the manual that have to do with an altogether different feature called backup rate. In other words, the manual's BPM= off, auto, or fixed options have absolutely nothing to do with the link you have above. BPM settings are backup rate. And that's not the feature you linked to.

P.S. If you have the original or non-enhanced BiPAP autoSV, then it does not offer the type of auto-adjusting feature you linked to.

mdboze · Post by **mdboze** » Fri Feb 26, 2010 11:47 pm

Regarding the functionally the AutoSV Adv.
I understood that the BiPap AutoSV Adv works as follows:
IPAP = current EPAP + Current PS ; but won't exceed the "MAX PRESSURE" setting.
Where "current EPAP" is floating between EPAP min and EPAP max, automatically to eliminate OSAs
and "Current PS" floats between PS Min and PS max; quickly changing to coverr CSAs

Now that I can monitor by results with my new Smart Cart reader... I can help confirm this
Last Night, I changed my setting to determine how good it can AUTOmatically help me.
New Settings:
MAX Pressure = 20 (I selected 20 because my LT Nasal Pillow only supports up to 20cm max)
EPAP Min = 6 ; Max = 10
PS Min = 5 ; Max = 14 (14 is the MAX It would let me set, since MAX Pressure=20 (EPAP min 6 + PS Max 14 = 20) )

Results below from first Night at this setting, confirms above.

No OSA or CSAs ; and I felt rested in the morning and felt good all day.

But this was just one night. I'll leave it and see how it goes.

-SWS · Post by **-SWS** » Sat Feb 27, 2010 12:02 am

mdboze wrote:Every time EPAP increased, IPAP increased with it.

I disagree. Please look at what happens over at hour six: EPAP increases but IPAP clearly does not. There are other examples like that in your graph as well. Additionally, we can see on your graph that IPAP sometimes independently increases for the sake of flow targeting---irrespective of what EPAP happens to be doing for the sake of obstruction.

Here's the prevalent trend on your graph: EPAP causes IPAP to increase every time PS min forces an IPAP push to maintain that 5cm spread (your PS min setting).

Also, I'd like to point out that your graph does not entail the fine granularity required to see those individual breaths that Respironics depicts in the two SV-activity bursts below:

Thanks for posting that Encore graph and good luck with your therapy!

nghy · Post by **nghy** » Sat Feb 27, 2010 12:43 am

-SWS wrote:Nghy, I think that understandable confusion lies in the fact that Respironics uses the word "auto" for their "auto adjusting" algorithm and they also confusingly use the word "auto" for one of their backup rate options. That is confusing to newcomers IMHO. However, you're linking to a part of the algorithm that has absolutely nothing to do with backup rate. It's the auto-algorithm feature instead.

So you're pointing out procedures in the manual that have to do with an altogether different feature called backup rate. In other words, the manual's BPM= off, auto, or fixed options have absolutely nothing to do with the link you have above. BPM settings are backup rate. And that's not the feature you linked to.

P.S. If you have the original or non-enhanced BiPAP autoSV, then it does not offer the type of auto-adjusting feature you linked to.

I do have the Advanced and if you look at my first post on this subject, you will find I used the the correct term and provided the correct url.

-SWS · Post by **-SWS** » Sat Feb 27, 2010 12:58 am

Well, here's your first post on the subject:

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

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.

Congratulations on having the enhanced model. But the URL that you linked to has nothing whatsoever to do with these settings you pulled out of the manual: BPM= off, auto, or fixed. Those are two completely different features. Both of those features use the word "auto". Again, what I have in red above has absolutely NOTHING to do with your URL.

You can set your backup rate to "auto" and still have the above-described "auto algorithm" disabled on your Enhanced model. Conversely, you can set your backup rate to fixed 12, and have the above-described "auto algorithm" enabled just by having EPAP min set at a different value than EPAP max. So if your EPAP min and max settings differ, than THOSE are the parameters that enable the "auto algorithm" you linked to.

By contrast BPM= off, auto, or fixed deals with NOTHING but your machines backup rate. However, that backup rate can be automatically calculated based on a sliding recent-average of spontaneous breaths.

mdboze · Post by **mdboze** » Sat Feb 27, 2010 1:01 am

-SWS wrote: Congratulations on having the enhanced model. But the URL that you linked to has nothing whatsoever to do with these settings you pulled out of the manual: BPM= off, auto, or fixed.

Its a simple mistake.

nghy owns a "BiPAP autoSV Advanced"
but has a Provider Manual for the "BiPAP autoSV"
not the "BiPAP autoSV Advanced"

Hence the mix up.

rested gal · Post by **rested gal** » Sat Feb 27, 2010 1:03 am

I was very relieved to see -SWS come into this thread. In my opinion, he has the best understanding of anyone in this forum about how all these therapy machines work.

He helped me immensely when I was getting started six years ago. Anyone who has an ASV machine is very fortunate to have -SWS sharing his thoughts.

-SWS · Post by **-SWS** » Sat Feb 27, 2010 1:09 am

mdboze wrote: nghy owns a "BiPAP autoSV Advanced"
but has a Provider Manual for the "BiPAP autoSV"
not the "BiPAP autoSV Advanced"

Hence the mix up.

Well, that BPM=off, auto, fixed feature should be in both of those manuals. And it's important to understand both features using the word "auto" since we have so many new dial-wingers reading these threads.

The URL that nghy linked to describes the "auto algorithm" that is enabled or limited by the EPAP min and EPAP max settings---and not the BPM settings he might have pulled out of either manual. By contrast those BPM settings deal ONLY with backup rate---which can be automatically calculated on-the-fly.

dsm · Post by **dsm** » Sat Feb 27, 2010 1:17 am

Seems to me the overiding concern is that changes are checked with the doc or R/T. I thought we had that well understood.

Cheers

DSM

mdboze · Post by **mdboze** » Sat Feb 27, 2010 1:21 am

-SWS wrote:
mdboze wrote: nghy owns a "BiPAP autoSV Advanced"
but has a Provider Manual for the "BiPAP autoSV"
not the "BiPAP autoSV Advanced"

Hence the mix up.
Well, that BPM=off, auto, fixed feature should be in both of those manuals. And it's important to understand both features using the word "auto" since we have so many new dial-wingers reading these threads.

The URL that nghy linked to describes the "auto algorithm" that is enabled or limited by the EPAP min and EPAP max settings---and not the BPM settings he might have pulled out of either manual. By contrast those BPM settings deal ONLY with backup rate.

Thanks for the clarity SWS.

As a new "dial-winger" myself, I really appreciate the feedback in this thread; Its not easy to figure out and understand the settings without having the "Advanced" Prov. Manual.

dsm · Post by **dsm** » Sat Feb 27, 2010 1:31 am

-SWS wrote:Good luck getting your analytical paradigm sorted out, dsm.
<snip>

Steve,

It works as I always understood it did but the point I was making is that that mode of working raises in my mind issues as to the value of shifting the whole SV pressure range up and down with epap.

Epap is addressing OSA events by stenting the airway. To hang both bilevel pressure variance and SV pressure variance off a fluctuating epap just looks like it will create problems for anyone who gets used to particular pressure ranges.

The other question in my mind is why does Ipap & SV pressure ranging have to depend on a floating epap ?.

I believe the SOMMNOVent CR isolates the SV support from the floating epap by introducing an eepap & IIRC it is the eepap that deals with OSA while the normal epap/ipap respond as bilevel (if activated) & SV (when activated) and this ranging does not 'float' with eepap on that machine.

I would suspect that 'floating' bilevel & SV ranging is not a good idea ? - leaving epap to float on its own seems like the smarter & safer choice.

What triggered this line of thinking was >any thought< of suggesting setting MinEpap to 5 & that kind of horrified me because it meant all the above pressures would be (in that example) 4 CMs below where they previously were. Then when I thought about the consequences, it reminded me of the battle we went through to alert people to NOT set their Autos to 4 CMs & 20 CMs in the naive belief the Auto algorithm would always zap in and fix things.

I fear we are heading down that path again with that floating epap & people suggesting it be set around the 4-5 mark. !

Cheers

Doug

#2 Removed incorrect ref to 'banned' comment re EpapMin as his original comment was about PSMin.

Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

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Re: Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

Re: Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

Re: Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

Re: Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

Re: Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

Re: Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

Re: Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

Re: Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

Re: Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

Re: Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

Re: Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

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Re: Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

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