Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

John and Muffy,
Thank you both very much for the clarification. I have read hundreds of pages of the manufacturers "marketing fluff" and after a while it seems like they all try to describe every unit as an answer to everything. Johns links were perfect, and accurately showed each company's ST and AVS units so now I know for sure.
I hate extra gov regulations as much as the next guy, but I wish there were required standards for what they can and cannot call their products so it does not take a PHD to distinguish them. Kind of like automobiles. Not hard to tell an auto transmission from a standard and no amount of fluff makes a stick sound like an auto. The "nut and bolts" stuff should be obvious to any average Apnea educated patient without a decoder ring .
I have one last stupid question, not really related to the discussion. I understand the difference in what Cpap's do. And I understand how BiPaps deliver 2 different pressures (inhale/exhale). Not talking about SV's or ASV's but simple BiPaps. What is the big difference from an advanced CPAP with C-flex, or EPR, or whatever they want to call it, to a regular BiPap ? They both provide a measured relief on exhale. I understand on the Bipap it may be part of the required therapy, while on the Cpap it is mostly considered for comfort, but don't they perform the same function ?
The reason I ask that, is I use a Remstar M Pro with Cflex. Not previously knowing I had a problem with centrals, I was not using any cflex as I did not need it at pressures of 10-12. The drop off in pressure of Cflex even at 1, felt unatural and I did not like it so I turned it off a while back. Last night I turned it back on thinking it would be more similar to BiPap therapy. My Ai has been averaging 15 for the last 20 days and last night it dropped to 9.9 from 16.2 the previous night, with no other changes on my side. I document everything on a spreadsheet from tightness of masks, to meds, to pillows, to you name it. I made absolutely no other changes last night and the Ai dropped to 9.9. The Hi's increased slightly to 2.2 and it is usually under 1. I know, "one night does not a trend make", but any thoughts? Would a trend in this effect indicate simple BiPap may work for me? Not that 9.9 and 2.2 are great but they are better than my avg so far.
Thanks,
Don

nghy wrote: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.

The manufacturers target ASV's adaptive IPAP for those problems you first mentioned. Additionally, the likes of peer review, empiricism, and scientific method in general are in the process of supporting ASV for those applications.

nghy wrote:Do these machines pose any detrimeent to users who do not show central and/or mixed apneas and periodic breathing, etc.?

Logic alone might suggest that ASV machines are probably not a detriment to SDB conditions such as UARS or ordinary OSA. However, scientific methodology has yet to support that assertion.

However, IMHO this crucial question currently remains unanswered by manufacturers and independent researchers alike: Are there ANY long-term adverse effects (in either the obstructive SDB or normal populations) to continuous proportional maintenance of inspiratory volumes?

The difference between relying on highly fallible logic, versus adding the rigors of empiricism and scientific methodology to the medical problem-solving process: reason alone once lead doctors to conclude transfusing readily-available cow blood into sick humans MIGHT save lives; modern empiricism and rigorous scientific methodology strive to avoid making those kinds of "well reasoned" medical mistakes.

Muffy wrote:...

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

I do believe that acronym stands for adaptive servo ventilation.

Muffy

Ah! My apologies. I am but an egg, who hopes that at some time in the future he can turn into a baked good and be more like muffy.

Though he's constantly amazed at how well Muffy manages to type in these answers.

Seriously, thanks for catching that. You are, of course, correct. Now, let's see if I can change that card where I store that ...

[ Imagine jbf climbing up into a dusty skull shaped room that turns out to be full of old card catalogs. he discovers that besides lots of dust and grime, many of the cards have incorrect translations. fortunately, due to input from Muffy, he knows to change "auto-servo ventilation" to "adaptive servo ventilation". But jbf pulls a card at random and wonders, is it "continuous positive airway pressure" or "constant positive airway pressure". Then jbf jerks his head away from the card and his contemplation as he hears a slightly rough voice start to intone ... "There is a room in which a lonely researcher sits. Imagine a card room, which stores what our researcher calls knowledge. Little snippets of information. But a room that, as you can see, leaves much to be desired. ...." < camera and sound fade out ... > ]

DoninOrlando wrote:... I have one last stupid question, not really related to the discussion. ...

Now repeat after me, class. What is actually the stupid question? That's right. The one not asked.

Seriously, it's good that you do ask.

DoninOrlando wrote:... I understand the difference in what Cpap's do. And I understand how BiPaps deliver 2 different pressures (inhale/exhale). Not talking about SV's or ASV's but simple BiPaps. What is the big difference from an advanced CPAP with C-flex, or EPR, or whatever they want to call it, to a regular BiPap ? They both provide a measured relief on exhale. I understand on the Bipap it may be part of the required therapy, while on the Cpap it is mostly considered for comfort, but don't they perform the same function ? ...

I agree, they FEEL as if they are the same thing. However, I will turn to our host who put out the following online newsletter article:

https://www.cpap.com/DisplayNewsletter/ ... ue-19.html

It states, in part, the difference is how the pressure change is measured, not how it feels:

So, if EPR reduces the expiratory pressure by a controlled 1, 2, or 3 centimeters, what is the difference between EPR and BiPAP (tm) or Bilevel?

Bilevel machines are categorized as "ventilatory devices". They use rapid pressure changes to expand and contract lung volume. EPR uses slower pressure changes, so there is little ventilatory effect. However, EPR does feel very much like a Bilevel to the patient.

DoninOrlando wrote:... My Ai has been averaging 15 for the last 20 days and last night it dropped to 9.9 from 16.2 the previous night, with no other changes on my side. I document everything on a spreadsheet from tightness of masks, to meds, to pillows, to you name it. I made absolutely no other changes last night and the Ai dropped to 9.9. The Hi's increased slightly to 2.2 and it is usually under 1. I know, "one night does not a trend make", but any thoughts? Would a trend in this effect indicate simple BiPap may work for me? Not that 9.9 and 2.2 are great but they are better than my avg so far. ...

Eh, eh, eh! That's TWO questions!

If the trend continues, it may indicate that just a BiPAP unit will help improve your therapy. You might want to see if your doctor would write a prescription for an BiPAP Auto. This would allow you to change pressure to meet your needs. Though with centrals most doctors tend to avoid BiPAP Autos, since an increase in pressure might make the centrals worse. But with your insurance situation and how well you are monitoring your sleep, your doctor might relent.

John,
I got a good laugh at my own expense with your previous reply to Muffy. I took your reply literal and was actually thinking you kept all your answers on little index cards, in a box somewhere.
I hope that oximeter comes quick as I am now thinking the O2 depletion is worse than I previously thought
There is a movie I once saw that escapes me at the moment (proof of oxygen desat), but it shows a guy actually climbing stairs and ladders in an old dusty multiple story library, that is his brain. He is hiding something from an alien entity that took over part of his brain, it really was a good movie............ Maybe one day, with more O2................
Anyhow,
Thanks again and I think I am done with the questions previously too stupid to ask.
Don

[quote="-SWS
However, IMHO this crucial question currently remains unanswered by manufacturers and independent researchers alike: Are there ANY long-term adverse effects (in either the obstructive SDB or normal populations) to continuous proportional maintenance of inspiratory volumes?

The difference between relying on highly fallible logic, versus adding the rigors of empiricism and scientific methodology to the medical problem-solving process: reason alone once lead doctors to conclude transfusing readily-available cow blood into sick humans MIGHT save lives; modern empiricism and rigorous scientific methodology strive to avoid making those kinds of "well reasoned" medical mistakes.[/quote]

Thank you. This is important information to keep in mind when I lobby my doctor to allow my BiPAP Auto SV advanced to manage pressures that are now fixed to a narrow range. IMO, I see the current settings mimic a Bilevel PAP with intermittent mandatory ventilation (IMV). (EPAP max and min =16, PS range 6 tp 8, Breaths per minute = 12) I am trying to establish in my mind whether these settings were the result of older concepts prevailing by virtue of familiarity or concious descisions made with understanding of the current machine's capabilities.

JohnBFisher wrote:

Muffy wrote:...

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

I do believe that acronym stands for adaptive servo ventilation.

Muffy

Ah! My apologies. I am but an egg, who hopes that at some time in the future he can turn into a baked good and be more like muffy.

Though he's constantly amazed at how well Muffy manages to type in these answers.

Seriously, thanks for catching that. You are, of course, correct. Now, let's see if I can change that card where I store that ...

[ Imagine jbf climbing up into a dusty skull shaped room that turns out to be full of old card catalogs. he discovers that besides lots of dust and grime, many of the cards have incorrect translations. fortunately, due to input from Muffy, he knows to change "auto-servo ventilation" to "adaptive servo ventilation". But jbf pulls a card at random and wonders, is it "continuous positive airway pressure" or "constant positive airway pressure". Then jbf jerks his head away from the card and his contemplation as he hears a slightly rough voice start to intone ... "There is a room in which a lonely researcher sits. Imagine a card room, which stores what our researcher calls knowledge. Little snippets of information. But a room that, as you can see, leaves much to be desired. ...." < camera and sound fade out ... > ]

Dreamcatcher ! That's the movie that scene came from! Guy climbing dusty stairs...searching for something he knows is there on a shelf somewhere.....in a locked room.... in his brain......where is it.....

If you like Stephen King stuff and Morgan Freeman, you need to see it....even if just for that one scene......
Don

DoninOrlando wrote:

JohnBFisher wrote:[ Imagine jbf climbing up into a dusty skull shaped room that turns out to be full of old card catalogs. he discovers that besides lots of dust and grime, many of the cards have incorrect translations. fortunately, due to input from Muffy, he knows to change "auto-servo ventilation" to "adaptive servo ventilation". ... < camera and sound fade out ... > ]

Dreamcatcher ! That's the movie that scene came from! Guy climbing dusty stairs...searching for something he knows is there on a shelf somewhere.....in a locked room.... in his brain......where is it.....

If you like Stephen King stuff and Morgan Freeman, you need to see it....even if just for that one scene......
Don

That's funny. I had never seen it. If someone is interested, here's a pointer to information about that movie:

http://www.imdb.com/title/tt0285531/

I will need to see it. Thanks for getting back with the title.

As you can imagine from the way I presented that scene, I was remembering so many of the Twilight Zone shows that Stephen King probably also saw.

nghy wrote: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 detriment to users who do not show central and/or mixed apneas and periodic breathing, etc.?

nghy

Few people here are keen to make any comment re use outside the designated (FDA approved) SDB modalities. The reasons are that no research has been done or published that clears them for use by regular users. It is also unlikely that such research will get done as no vendor has a need to do it or finance it & few clinics would see any benefit in such a study. That doesn't mean they might be very helpful for some non-designated folk or for that matter harmful to some who don't set them up properly.

So for any user who has not been given a prescription for an ASV machine (I sat down with my doc & helped him write mine), few regulars/professionals will be willing to make any comment. If anything the 'wise/safe' advice will always be non-committal.

If anyone asks me for help I am willing to explain how the machine works & possible harm that can be done by bad settings. i.e. An example being anyone diagnosed with CompSA who sets EpapMIn to 4 or thereabouts and EpapMax to 10 or thereabouts. I would call that very troubling. Some such user may be tempted to try it but if I could add a warning to the Clin guide, I'd state that anyone with CompSA should only ever seek medical advice in regard to EpapMin / EpapMax settings.

I am more than happy to discuss the ASV machines via PM or direct email with anyone who would like advice such as how the machine works etc:.

Cheers

DSM

PS Just wanted to add that my Doc is an Adjunct Professor of Medicine at the University of Western Sydney so is not a 'dumb doc' just doing my bidding.

dsm wrote:

nghy wrote: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 detriment to users who do not show central and/or mixed apneas and periodic breathing, etc.?

nghy

Few people here are keen to make any comment re use outside the designated (FDA approved) SDB modalities. The reasons are that no research has been done or published that clears them for use by regular users. It is also unlikely that such research will get done as no vendor has a need to do it or finance it & few clinics would see any benefit in such a study. That doesn't mean they might be very helpful for some non-designated folk or for that matter harmful to some who don't set them up properly.

So for any user who has not been given a prescription for an ASV machine (I sat down with my doc & helped him write mine), few regulars/professionals will be willing to make any comment. If anything the 'wise/safe' advice will always be non-committal.

If anyone asks me for help I am willing to explain how the machine works & possible harm that can be done by bad settings. i.e. An example being anyone diagnosed with CompSA who sets EpapMIn to 4 or thereabouts and EpapMax to 10 or thereabouts. I would call that very troubling. Some such user may be tempted to try it but if I could add a warning to the Clin guide, I'd state that anyone with CompSA should only ever seek medical advice in regard to EpapMin / EpapMax settings.

I am more than happy to discuss the ASV machines via PM or direct email with anyone who would like advice such as how the machine works etc:.

Cheers

DSM

PS Just wanted to add that my Doc is an Adjunct Professor of Medicine at the University of Western Sydney so is not a 'dumb doc' just doing my bidding.

Thanks agin for you insightful comments.

-SWS wrote:...reason alone once lead doctors to conclude transfusing readily-available cow blood into sick humans MIGHT save lives; modern empiricism and rigorous scientific methodology strive to avoid making those kinds of "well reasoned" medical mistakes.

What, bovine blood is fine, whether you're saving lives:

Hemopure

Having lunch:

Hmm, boy! Kiska!

Or dancing around after saving lives and having lunch, singing along with old favorite ethnic tunes:

Par-tay!!

The only time guys got into trouble was when they were "tranfusion wingin' " or overcooked the kiska (singing off-key was never a problem, since kiska was usually accompanied by a fairly liberal quantity of Siwucha, so like, who cares?)

Muffy

ANOTHER LITTLE-KNOWN MUSICAL FACT: Van Halen had planned a cover of "Who Stole The Kiska" on their self-titled debut album, but this was dropped at the last minute in favor of "Atomic Punk" when Eddie felt he just couldn't get a good "sausage image" out of his Frankenstrat.

Muffy

Muffy wrote:ANOTHER LITTLE-KNOWN MUSICAL FACT: Van Halen had planned a cover of "Who Stole The Kiska" on their self-titled debut album, but this was dropped at the last minute in favor of "Atomic Punk" when Eddie felt he just couldn't get a good "sausage image" out of his Frankenstrat.

Muffy

Hey, Muffy,

I went to high school (last two years) with Eddie Van Halen, but I never saw his Frankenstrat.

Bev

I started the BiPAP therapy 1/4/2010 so today marks the end of two months. I had a very successful follow-up meeting with my doctor earlier today. I have had 100% compliance which pleased the doctor no end. To date I have eliminated the EDS (excessive daytime sleepines) and any Narcolepsy. My diabetes has been much easier to control. My personal energy and sense of wellbeing has been restored.

Getting back to the doctor visit, I brought along the compliance reports, graphs of recent sleep activity including the SPO2 records, my suggestions for changes in my pressure prescription and a list of grevances with the DME the sleep center assigned to supply the machine and services. The information provided by everyone here and especially rested gal, dsm, sws and mdbose were instrumental in my being able to formulate an intelligent discussion.

To make a long story short the doctor will 1) provide the compliance report so Medicare will purchase the machine; 2) will write a new prescription for me along the guidelines I suggested to provide my BiPAP autoSV Advanced greater latitude to dynamically adjust EPAP and Pressure Support; 3) speak to the DME about his negligent performance and especially about not filling the prescription for Encore Pro software; and 4) will assist me in finding a more suitable DME. The doctor was very intent listening to me and took notes about the white bacteria filer I use and the solutions for manageing the Large Air Leak issue (papcap, and REMZzzs).

It was a good day.