Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

mdboze · Post by **mdboze** » Sat Feb 27, 2010 3:53 pm

Banned wrote:
dsm wrote:Remember that if you were to drop EpapMin to say 5 as banned as suggested,
You keep bringing this up and I don't recall suggesting that.
What I do recall suggesting is Mboze change to PS Min: 5.
Which Mboze did and seems to be giving him some success.
Please, I don't want you to ruin my credibility with RG!

Banned

I did change PS Min = 5, along with others below - to see how good this machine can AUTOMATICALLY do its ADVANCED stuff:
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

AHI Dropped from 7 (2 month average)
Down to AHI=3 last night. Lowest night ever for me.
Last nights detailed Data from my Respironics BiPAP autoSV Advanced:

The people at Respironics really know what they are doing.

rested gal · Post by **rested gal** » Sat Feb 27, 2010 4:02 pm

JohnBFisher wrote:
-SWS wrote:... One overriding concern IMHO is that many readers here DO NOT check with their doctors or RTs when reading threads and attempting machine changes. ...
-SWS, I definitely agree with your concern. Let me be very, very clear why I am so concerned for anyone using an ASV unit. If you are on an ASV unit, then you were most probably diagnosed with one of the following conditions:

Central Sleep Apnea (CSA)

Complex Sleep Apnea Syndrome (ComplexSAS)

Cheyne-Stokes Respiration (CSR)
If you have central sleep apnea ONLY - and that is EXTREMELY rare - then you might not introduce problems by making changes. Of course, without any other measurement tool you won't know for certain things are still stable.

If you have a obstructive with CSA, then you need to be certain that changing one does not adversely impact the other.

If you have ComplexSAS, then you need to be VERY, VERY careful that changing a setting does not cause the max pressure to rise and suddenly introduce lots of central apneas. At the same time, you need to be certain the "lower end" settings don't introduce problems with the obstructive problems the machine addresses.

But if you have CSR, then changing settings - without the input from your medical team - can be a very bad idea. You don't want to add any more strain on the heart than already exists.

Well said, John. I share the concerns you and -SWS express.

It can be difficult to find a medical team -- doctor and RT -- who are thoroughly familiar with the ASV machines, their settings, and especially how a change to one particular setting or another can affect the therapy for better or worse.

I always appreciate the well thought-out contributions made by you, -SWS, and ozij regarding ASV machines -- what they are designed to treat and how they go about it.

dsm · Post by **dsm** » Sat Feb 27, 2010 4:08 pm

mdboze wrote:
Banned wrote:
dsm wrote:Remember that if you were to drop EpapMin to say 5 as banned as suggested,
You keep bringing this up and I don't recall suggesting that.
What I do recall suggesting is Mboze change to PS Min: 5.
Which Mboze did and seems to be giving him some success.
Please, I don't want you to ruin my credibility with RG!

Banned
I did change PS Min = 5, along with others below - to see how good this machine can AUTOMATICALLY do its ADVANCED stuff:
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

AHI Dropped from 7 (2 month average)
Down to AHI=3 last night. Lowest night ever for me.
Last nights detailed Data from my Respironics BiPAP autoSV Advanced:

The people at Respironics really know what they are doing.

mdboze

That is looking pretty good. Has your doc made any comments on the changes you have applied.

Cheers

DSM

nghy · Post by **nghy** » Sat Feb 27, 2010 4:28 pm

timbalionguy wrote:
nghy wrote:
By setting the Breaths per minute to a fixed value far below my normal breathing rate, the machine's ability to detect when I needed a breathing assist is disabled, causing a fixed delay of ten seconds before that assist was available.
nghy,
I think the BPM setting doesn't disable the sensing of when you need a breath. It sets what the breathing rate should be if you do indeed need SV support. Auto lets the machine choose the right rate, based on you recent breathing history over the past (I think 4) minutes. Manual BPM sets a fixed breathing rate, and also allows some other peramaters related to breathing rate be set. This, I think, is for patients where CO2 saturation control is imporetant in managing their therapy. By managing breathing rate, and the ratio of inpiratory to expiratory time, the veltilation level can be set such that not too much CO2 gets washed out of the bloodstream. This is the usual cause of CSRs.
The one thing missing in your analysis of the BiPAP SV Advanced algorithm is the SV part. The machine manages IPAP in such a way that if there is an event the machine suspects is a central (or CSR), it will boost the IPAP while also cycling between IPAP and EPAP to encourage the patient to breathe. Note that the IPAP value changes above the sum of EPAP and PS. Normally, IPAP is at IPAP min unless the SV support is needed. Then, the pressure can increase-- quite rapidly if need be-- to IPAP max or PRES max, whichever is lower. Note that with an auto BiPAP modality set, IPAP tracks EPAP by the difference of PS. But IPAP can only vary in a range between EPAPmin + PS and EPAPmax + PS. The SV IPAP variation happens on top of this. So, this machine can make some fairly complex manipulations of pressure.

On a completely different note, but related to the BiPAP SV advanced, I wonder if many patients who do not have CSA, CompSAS or CSR, etc. wouldnb't benifit every now and then from a machine with an SV algorithm. Like DoninOrlando, my original sleep study showed a lot of centrals, and in fact, they limited the titration that could be performed. But because I had never experienced xPAP before, my doctor thought it best to start out with an autoadjusting CPPAP machine. She was right in that the centrals disappeared very quickly, and now I only seem to experience a 'baseline few' of them, which most CPAPers do. However, there is something about my OSA that causes me to have nights where the AHI fluctuates significantly. I started out with an IntelliPAP autoadjust (my choice), which tended to not respond fast enough, and then overcorrect (otherwise, a fine machine). So, I switched to a machine with a much faster response, the ResMed VPAP auto 25. This machine has helped significantly, in that it is much more comfortable to breathe against (and I am using it as a straight auto with no bilevel modality at this point). I also don't really notice the pressure changes, nor do they tend to overshoot. My average AHI dropped from about 7 to just above 5. But I still have nights where my AHI is above 10. What is interesting about those nights is that AI is often much higher than typical. Typical AI for me is .1 to .2. The AI when my overall AHI is higher is typically .4 to .6. This suggests that 1.) The A10 algorithm in these machines is limiting the ability of the machine to catch all obstructive apneas, or 2, some of these might really be centrals. I will know more when my card reader finally shows up. (I was shipped late last week). Still though, I think I made the right decision to switch machines.

But to get back to the point I was trying to make. An occasional shot of high IPAP might clear some of these residual events, even though I have not been officially diagnosed with any of the more complex SDB disorders. And I think this is where Respironics was going when they said that SV style machines are the future of sleep apnea therapy some years back.

You are correct, of course... I was being sarcastic and exaggerating.

dsm · Post by **dsm** » Sat Feb 27, 2010 6:17 pm

timbalionguy wrote:
<snip>

On a completely different note, but related to the BiPAP SV advanced, I wonder if many patients who do not have CSA, CompSAS or CSR, etc. wouldnb't benifit every now and then from a machine with an SV algorithm. Like DoninOrlando, my original sleep study showed a lot of centrals, and in fact, they limited the titration that could be performed. But because I had never experienced xPAP before, my doctor thought it best to start out with an autoadjusting CPPAP machine. She was right in that the centrals disappeared very quickly, and now I only seem to experience a 'baseline few' of them, which most CPAPers do. However, there is something about my OSA that causes me to have nights where the AHI fluctuates significantly. I started out with an IntelliPAP autoadjust (my choice), which tended to not respond fast enough, and then overcorrect (otherwise, a fine machine). So, I switched to a machine with a much faster response, the ResMed VPAP auto 25. This machine has helped significantly, in that it is much more comfortable to breathe against (and I am using it as a straight auto with no bilevel modality at this point). I also don't really notice the pressure changes, nor do they tend to overshoot. My average AHI dropped from about 7 to just above 5. But I still have nights where my AHI is above 10. What is interesting about those nights is that AI is often much higher than typical. Typical AI for me is .1 to .2. The AI when my overall AHI is higher is typically .4 to .6. This suggests that 1.) The A10 algorithm in these machines is limiting the ability of the machine to catch all obstructive apneas, or 2, some of these might really be centrals. I will know more when my card reader finally shows up. (I was shipped late last week). Still though, I think I made the right decision to switch machines.

But to get back to the point I was trying to make. An occasional shot of high IPAP might clear some of these residual events, even though I have not been officially diagnosed with any of the more complex SDB disorders. And I think this is where Respironics was going when they said that SV style machines are the future of sleep apnea therapy some years back.

Timbalionguy

I share your thinking on this.

In 2 years of very succesful therapy with ASV machines and excellent physical & mind results, there is no way I would go back to a machine without SV support other than for travel.

Cheers

DSM

DoninOrlando · Post by **DoninOrlando** » Sat Feb 27, 2010 6:19 pm

JohnBFisher wrote:BLAST! My computer ate my response to you. Don, Here's a quick recap.

However, it all depends on what is causing the problem.

Additionally, if someone has just OSA, they certainly can achieve an AHI values that is less than 5. It takes time for the body to adjust and to get things "just right". And as I noted, as the stress on your body decreases, it can then lessen the CSA events.

IF that happened for you, it would be the cheapest option. So, your doctor provided a good medical path forward. Unfortunately, you now need to head to the next step.

You should consider an ASV machine. Unfortunately, there are two new costs with it. You will need another sleep study and they units are VERY expensive. Though you can often find them for much less on the CPAPauction.com site. Of course, you can also sell your existing unit there. Or you can keep it as an emergency backup.

Hope that helps.

John, what are your thoughts on the S8 VPAP ST with heated humidifier? I know it it yeterdays technology without the bells and whistles of the $5-6000 units you are discussing. But in 2 years they will be yesterdays technology. THis one sells for $2800 but I found one for $850 new in box.
Thanks, Don

JohnBFisher · Post by **JohnBFisher** » Sat Feb 27, 2010 7:03 pm

DoninOrlando wrote:... Wow, Another sleep study. That is almost as much as the new machine. My DME said the machine I need to treet my condition is around $4000. That sound about right ? They did not say what unit. I doubt it is that newest model. ...

I suspect at that price it was an S/T (spontaneous / timed) BiPAP. And yes, they really need to test with the machine to be certain you do not have adverse problems with it.

But you should be able (especially in the Orlando, FL area) work with a sleep lab to have a test done for a LOT less than $4K. The going price for most insurance companies ranges from $1,000 to $3,000. $4K is too much. Talk with the sleep labs. Let them know you don't have insurance and need the best price possible.

Talk with your doctor. He may be able to recommend an alternative approach.

DoninOrlando wrote:... Do you strive for and achieve AHI under 5 with Central APneas and an ASV machine? Is that expected ? ...

Yes! My AHI *with* my BiPAP went from the 20s - mostly central - to 0. Yes. That's ZERO. You would not believe how bad I was and how much better I feel. I still have a long way to go. But the therapy makes a HUGE difference.

Take a look at the following paper:

http://chestjournal.chestpubs.org/conte ... l.pdf+html

In it you will see that consistently the only thing that makes much of a difference is the ASV unit. The graphs on page 5 tell the story. See graph C, which I add a couple notes to highlight below:

As you can see, ASV removed almost all central apneas. BiPAP S/T helps, but is nowhere near as effective. And CPAP does not treat them at all.

But the real question is do you need an ASV! An S/T unit might just do fine. You will note the middle line in the bar above. It means that on average it is almost as effective as ASV. And since you are feeling so much better, it might be just enough to make it worth your while.

DoninOrlando wrote:... I just don't want to borrow and spend $6-8,000 I do not have for marginal results. ...

Oh, they are not marginal, as you can see. But the question is do you need the ASV unit. Perhaps not.

DoninOrlando wrote:... I have had considerable improvements from pre cpap such as no more night pee trips, no more falling asleep watching tv or driving, my BP has gone down from around 135/90 to 120/80 avg and 110/75 at last dr visit. That's with a little dieting and almost 0 excercise as I had a knee injury preventing excercise until now. ...

See, just addressing the obstructive part of your problems helps a lot.

DoninOrlando wrote:... I have a recording Oximeter on order so I will soon know if Ox sats are good. I was down to as low as 50% precpap. I am thinking with my results it may be ok now. Not the deciding factor but a big one. ...

The recording pulse oximeter can be a big help to sort out your sleep problems. If you continue to have severe desaturations, then the more expensive unit might be worthwhile. Otherwise, the S/T might be a better choice.

DoninOrlando wrote:... Would a new sleep study be with an ASV and show if it reduces Centrals ? So I would not buy the machine for nothing ? Your Thoughts ? ...

Yes. Mine sleep study showed it eliminated my central apneas. The data from the machine confirms that, though it shows a high degree of dysregulation of my breathing. But that's due to my neurological condition and not something you would likely face.

DoninOrlando wrote:... What are your thoughts on the S8 VPAP ST with heated humidifier? I know it it yeterdays technology without the bells and whistles of the $5-6000 units you are discussing. But in 2 years they will be yesterdays technology. THis one sells for $2800 but I found one for $850 new in box. ...

It's a good option. And it might be just enough for now. You can also find "lightly used" ASV units over at CPAPauction.com. One recently went for about $800. And you might find S/T units there as well.

Hope that helps.

DoninOrlando · Post by **DoninOrlando** » Sat Feb 27, 2010 9:13 pm

John,
That is a big help. I appreciate the time you spent to answer my questions. The $4000 was what my DME said the machine would cost. Not sure what machine. Could have been simple BiPap. I think the sleep study is $2000. My dr won't help me find anything cheaper as the lab is his and I suspect he gets something from the DME too. I have seen units on cpapauction.com. But the new ones are usually not the most advanced.
In simple terms, what is the difference in an ASV and ST and how they work?
Don

JohnBFisher · Post by **JohnBFisher** » Sat Feb 27, 2010 10:02 pm

DoninOrlando wrote:... I have seen units on cpapauction.com. But the new ones are usually not the most advanced. ...

Oh, the cpapauction site often has the ResMed Adapt SV Enhanced units as well the Respironics BiPAP Auto SV units. There are none there now, but they do sometimes have them.

DoninOrlando wrote:... In simple terms, what is the difference in an ASV and ST and how they work? ...

Well, if you don't mind, I will pull from the following article that does a pretty good job explaining the differences:

http://sleep-disorders.suite101.com/art ... s_machines

The BiPAP (Bilevel Positive Airway Pressure)

The BiPAP, or bilevel positive airway pressure machine, is very similar to the CPAP. While a CPAP machine treats sleep apnea with one continuous air pressure, a BiPAP uses two different air pressures.

When the sleeper inhales, the BiPAP uses air pressure similar to that produced by a CPAP. As the sleeper exhales, however, the air pressure drops, making it easier to empty the lungs. The two air pressures alternate on a set timer.

A more complicated version of the BiPAP goes by the long and intimidating name of the bilevel continuous airway pressure spontaneous timed machine, or BiPAP ST (thank goodness for acronyms!). The BiPAP ST works like a regular BiPAP machine, but has a back-up response if the user stops breathing. If an apnea occurs and breathing stops for a predetermined amount of time the BiPAP responds with a higher pressure airflow to stimulate breathing. It is important to remember, however, that the BiPAP does not actually breathe for you.

Until recently a BiPAP S/T unit was all that was available for someone with central sleep apnea. It helped. but as you saw from the graph I posted, it is not as effective as an ASV unit.

The same article notes:

ASV (Adaptive Servo-Ventilation)

The adaptive servo-ventilation machine (ASV) is one of the most recent sleep apnea treatment options, and certainly one of the most complex. A CPAP machine provides a continuous flow of air. A BiPAP has two alternating air pressures. The ASV, however, monitors and responds to every breath you take.

Rather than providing the same air pressure (or mixture of air pressures) the adaptive servo-ventilator adjusts air pressure as needed. When sleep apnea occurs, the ASV responds with air pressure that mimics approximately ninety percent of the patient's normal breathing. As the apnea ends, the ASV slowly stops providing breathing support. The result is a sleep apnea treatment that is more in tune with the sleeper's normal breathing pattern.

It does not take over breathing as is the case with a ventilator. You've heard that when someone has been on a ventilator they often need to be weaned off it and learn to breathe on their own. That is not the case with an ASV unit. However, because it does provide some level of breathing support, it helps regulate the breathing. The result is an almost complete elimination of sleep apnea.

DoninOrlando · Post by **DoninOrlando** » Sat Feb 27, 2010 10:24 pm

John,
Thanks again. I think I understand the differences now. Is either term ST or ASV owned by Resmed or Respironics ? It is confusing when they each call them diferent terms since some terms are copyrighted. The Respironics are pretty clear on theirs. I saw a Resmed go off the auction earlier today with no bids asking $850. I looked it up and it is no longer sold on cpap.com. It was the one I mentioned to you earlier. Here is part of the description:

A combination of AutoSet and VPAP Adapt SV technologies, the S8 VPAP Auto merges ResMed's latest innovations achieving an extremely comfortable therapy and also makes sure to deliver the pressure you need, when you need it.

SInce it says "adapt SV technologies" is that an asv ? I didn't think they had them that long ago. This unit was replaced by the S8 VPAP Auto 25 BiLevel Machine.
Thanks, Don

JohnBFisher · Post by **JohnBFisher** » Sat Feb 27, 2010 10:43 pm

DoninOrlando wrote:... Is either term ST or ASV owned by Resmed or Respironics ? ...

ST (spontaneous-timed) and ASV (auto-servo ventilation) were the medical terms used during the work within the various research hospitals. Respironics and ResMed then came out with their machines and their own unique twists on the algorithms to make them work.

The Respironics units are:

BiPAP ST - http://bipapst.respironics.com/
BiPAP AutoST Advanced - http://bipapautosvadvanced.respironics.com/

The ResMed units are:

VPAP ST - http://www.resmed.com/us/products/vpap_ ... c=patients
VPAP III ST-A - http://www.resmed.com/us/products/vpap_ ... c=patients
VPAP Adapt SV - http://www.resmed.com/us/products/vpap_ ... c=patients

DoninOrlando wrote:... It is confusing when they each call them diferent terms since some terms are copyrighted. The Respironics are pretty clear on theirs. ...

Yes. It adds some confusion to get the marketing people and lawyers into the mix.

DoninOrlando wrote:... I saw a Resmed go off the auction earlier today with no bids asking $850. I looked it up and it is no longer sold on cpap.com. It was the one I mentioned to you earlier. Here is part of the description:

A combination of AutoSet and VPAP Adapt SV technologies, the S8 VPAP Auto merges ResMed's latest innovations achieving an extremely comfortable therapy and also makes sure to deliver the pressure you need, when you need it.

SInce it says "adapt SV technologies" is that an asv ? ...

If it was the S8 VPAP Auto, then I fear the marketing people got involved again. Yes, it uses technologies they learned when the put together the Adapt SV. However, it is NOT an ASV unit. Nor does it provide anything that resembles ASV therapy. It's just an BiPAP unit with auto titration capability.

DoninOrlando wrote:... I didn't think they had them that long ago. This unit was replaced by the S8 VPAP Auto 25 BiLevel Machine. ...

Yes. This helps confirm my thought. In fact, the lesson learned from the Adapt SV unit is teh "Easy Breathe Technology". Here's what the VPAP Auto 25 states"

Quiet Comfort with Easy-Breathe Technology

Featuring Easy-Breathe, ResMed’s exclusive comfort technology, VPAP Auto 25 offers nearly silent therapy and greater pressure stability so patients sleep comfortably throughout the night. VPAP Auto 25 uses Easy-Breathe pressure delivery and synchronizes with the patient’s normal respiration so that breathing feels more natural and comfortable.

The ResMed S8 AutoSet II includes the following information:

Easy-Breathe waveform … the most natural breathing experience

ResMed has taken the clinically effective and patient-preferred comfort of EPR2 and combined it with Easy-Breathe technology to create an exceptional pressure relief system that offers natural breathing comfort.

The Easy-Breathe waveform is based on a revolutionary algorithm used in ResMed’s most sophisticated products, including the VPAP Adapt SV™ and VPAP™ Malibu.

The Easy-Breathe waveform intelligently recreates a patient’s individual breathing pattern, so breathing feels more natural.

Hope that helps explain why they munged together the phrases. It's more marketing speak than it is that it provides ASV technology.

However, as I've noted, you can sometimes find the ASV units at a reasonable price at CPAPauction.com.

Hope that helps.

ozij · Post by **ozij** » Sat Feb 27, 2010 10:49 pm

Stated writing a reply -- but John beat me to it - so I can just confirm what he wrote.

Muffy · Post by **Muffy** » Sun Feb 28, 2010 6:40 am

ozij wrote:Stated writing a reply -- but John beat me to it - so I can just confirm what he wrote.

Right, pretty slim pickin's after John gets through, but

John wrote:... ASV (auto-servo ventilation)

I do believe that acronym stands for adaptive servo ventilation.

Muffy

Muffy · Post by **Muffy** » Sun Feb 28, 2010 7:01 am

JohnBFisher wrote:
DoninOrlando wrote:... I saw a Resmed go off the auction earlier today with no bids asking $850. I looked it up and it is no longer sold on cpap.com. It was the one I mentioned to you earlier. Here is part of the description:

A combination of AutoSet and VPAP Adapt SV technologies, the S8 VPAP Auto merges ResMed's latest innovations achieving an extremely comfortable therapy and also makes sure to deliver the pressure you need, when you need it.

SInce it says "adapt SV technologies" is that an asv ? ...
If it was the S8 VPAP Auto, then I fear the marketing people got involved again. Yes, it uses technologies they learned when the put together the Adapt SV. However, it is NOT an ASV unit. Nor does it provide anything that resembles ASV therapy. It's just an BiPAP unit with auto titration capability.

A closer examination of that item:

http://www.cpapauction.com/viewImage.php?ImageId=380749\

shows it to be a 25, so it doesn't have a "T" mode. No "T", and no ability to attack centrals in any format.

Muffy

nghy · Post by **nghy** » Sun Feb 28, 2010 8:57 am

Most descriptions of ASV (AV) machines immediately go into discussions of central and/or mixed apneas and periodic breathing, heart failure patients etc. and never comment about these machines for those with lesser sleep problems. Do these machines pose any detrimeent to users who do not show central and/or mixed apneas and periodic breathing, etc.?

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

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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