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Or buy a Honda gas generator that delivers true sine wave AC power.

Good enough for laptops, computes, photo lights. Just plug the cPAP in as usual.

You can also run anthng else you need to. Lights, charge cell phones, etc. Add xtra gas and just keep going. The 1000 watt unit is quiet and costs about $800 if think. But mulipupose , instead of dedicated

unadog wrote:... Or buy a Honda gas generator that delivers true sine wave AC power. ...

By the way, if anyone invests in a generator, I *highly* recommend purchasing and installing a manual generator power transfer switch, such as the shown in the following URL:

http://www.gen-tran.com/eshop/10Browse. ... ry=MTS6-10

Though this costs more to install (you need to purchase it and have it professionally installed), the advantages FAR outweigh the disadvantages. First, it completely isolates your house from outside power. This is a safety issue for you and others, such as linemen working on power in your neighborhood. It also helps protect your house from power surges when power is restored. Second, it allows you to pre-plan what circuits to run BEFORE you have the power outage.

Just an idea for anyone who considers using a generator ...

The Rest of the story.....

nghy wrote: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.

It took from 3/4/2010 to 3/16/2010 to get my new prescription from the doctor to the DME. While I could have made the prescription changes myself, I did not want controversy with my Doctor or DME. So I went through channels. Now, I have three weeks experience with the new settings.

The new settings centered about my prior prescribed pressures but allowed my biPAP to adjust to greater or lesser pressures. The machine logic has chosen a lower average EPAP and Support Pressure. During times when I stop voluntary breathing the biPAP auto SV advanced kicks in with higher pressures and backs off when my breathing gets back on track. I do not sense this support as much as I did with the prior fixed backup breathing rate. In general the whole therapy seems more comfortable. I don't know whether this comfort results from the machine settings or my getting used to the therapy. Other interesting facts are that the total hours of sleep per night has dropped by about 45 minutes. The AHI average has dropped from 4.5 to 2.5. I am now able to relate the evening's data and the quality of sleep to other factors such as exercise and diet.

The SPO2 readings from my oximeter now show distinct trends from circa 93% to circa 97% over the course of the evening, so I am getting more oxygenated as the night progresses.

The current EPAPmin is 14. While the biPAP sometimes adds 1 or 2 to the pressure there are long periods where it is pegged at 14. I am thinking of asking to reduce this setting to 12 or 13 to see what happens. The Support pressure can vary from 5 to 8 but most often it averages 6. These results are surprising to me because the sleep center results indicated I might need higher pressures than the EPAP =16 and Pressure Support = 6 to 8.

My current settings are: EPAP min = 14, EPAP max = 18, Support Pressure max = 9, Support Pressure min = 5, Max Pressure = 27, Backup Breathing = auto, Flex =3, Ramp = on, 15 minutes.

It's great to hear the new settings are serving you well. Hopefully you will continue to attain good sleep.

nghy,

Am pleased the therapy has settled down & that the SV is doing its stuff for you.

That Epap is a high one & if the machine rarely or never raises Epap from EpapMin, I agree it is worth suggesting to doc to take EpapMin (& perhaps EpapMax) down by 1 CMs each (that spread of 2 between EpapMin and EpapMax is a very very sensible max spread, esp if the machine shows it rarely gets exercised).

The SV algorithm will work out what PS is best & that should be unrelated to minor adjustments to EpapMIn. The only real concern re EpapMin is that if it is too low it can possibly interfere with respiration & thus have pressure support (SV) working more than needed to compensate.

Good going.

DSM

dsm and JohnB thank you for your kind words and valuable advice.

Regards,
Aaron

Hi All, I'm at that piont where I need to consider replacing some parts for the PAP sysrem. Which parts need regular replacement (other than filters) and at what schedule?

Also I have several masks that I tried during my original sleep studies. These were used for a few hours at most. It seems a shame to throw then out. Can these be recycled? How would I go about doing this?

Aaron

dsm wrote:nghy,

Am pleased the therapy has settled down & that the SV is doing its stuff for you.

That Epap is a high one & if the machine rarely or never raises Epap from EpapMin, I agree it is worth suggesting to doc to take EpapMin (& perhaps EpapMax) down by 1 CMs each (that spread of 2 between EpapMin and EpapMax is a very very sensible max spread, esp if the machine shows it rarely gets exercised).

The SV algorithm will work out what PS is best & that should be unrelated to minor adjustments to EpapMIn. The only real concern re EpapMin is that if it is too low it can possibly interfere with respiration & thus have pressure support (SV) working more than needed to compensate.

Good going.

DSM

I took your advice and lowered EPAPmin to 12. The machine most often wants to set EPAP=14 and SUPPORT PRESSURE =5. This outcome is surprising as the original sleep tests indicated I would need still higher pressures to reduce the AHI below 4 -5.

Other pleasant surprises are 1) the average AHI last week dropped to 2.3; 2) the average percent of patient triggered breaths has increased to 99.8%; and with the lower pressures the time spent with large leaks has dropped to minimal levels.

The auto titration features provide just the pressures I need. The extrensive recorded information shows the dynamic adjustments of my therapy. Some nights EPAP averages 13 and others EPAP averages 15.

The most pleasant outcome has been the increase in the level of comfort when all of the comfort features of this wonderful machine come into play.

MY new settings are EPAPmin = 13; EPAPmax = 18; minPS = 4; maxPS = 8; maxPressure = 24; Flex = 3; Ramp = 15 min.: Backup = auto

Aaron

Aaron

Good going & it sounds like you have this machine working very well for you.

Very pleased to hear that.

Cheers

DSM

PS Aaron, leaks with ASVs are a big issue that easily messes up the effects of the therapy & likely to produce all sorts of odd side effects. Getting the leak to bare minimum is essential whatever it takes - D

dsm wrote:Aaron


DSM

PS Aaron, leaks with ASVs are a big issue that easily messes up the effects of the therapy & likely to produce all sorts of odd side effects. Getting the leak to bare minimum is essential whatever it takes - D

Would you flesh out this last point. How much leak is troublsome. What side effects? Do the problems stemming from the leaks affect the machine beyond the periods when they occur? Can you point to articles on this subject?

Regards,
Aaron

nghy wrote:

dsm wrote:Aaron


DSM

PS Aaron, leaks with ASVs are a big issue that easily messes up the effects of the therapy & likely to produce all sorts of odd side effects. Getting the leak to bare minimum is essential whatever it takes - D

Would you flesh out this last point. How much leak is troublsome. What side effects? Do the problems stemming from the leaks affect the machine beyond the periods when they occur? Can you point to articles on this subject?

Regards,
Aaron

Aaron

My comments re leaks are really based on 2 years of using two brands of ASV & over time looking at differences between them & some side effects that later went away once I found a very effective method of eliminating even the smallest leaks.

The manufactures (esp Resmed) have commented that the their ASV machines need a leak free environment. The Bipap Auto SV, due to how it works, is more leak tolerant than the Vpap Adapt SV.

I posted some data in this thread that shows on my charts the difference between bad leaking (messing up my nights and days) and what happened once I had found a way of stoping the leaks.

viewtopic.php?f=1&t=51543

I'll see what else I can find.

DSM

I studied you links. Thanks for the help.

As far as I can determine, the Respironics bipap autoSV advanced is not particularly affected by substantial leaks. The threshold for reporting large leaks as such seems to be about 70 liters per min. Typically my large leak numbers range between 55 and 65 liters per minute. The machine is not flagging these levels for special comment.

I use the PAPcap chin strap to keep my mouth closed and my cheeks from puffing out. I use the REMZzzs cloth mask liners to help the mask seals. The liners seem to leak air naturally through the cloth, but at the same time the liner wisks away any moisture and oils that break the seal with "burps" and vibrations. I find the liners also add to my comfort.

At this point I am using a ResMed Small Shallow Mirage Ultra FF mask. It has worked best for me at my high pressures.

As I reported just recently, my results seem to be really very good. I am pleased with the comfort level and the quality of sleep I get.

nghy wrote:
<snip>

As I reported just recently, my results seem to be really very good. I am pleased with the comfort level and the quality of sleep I get.

That is without doubt a good arbiter of the therapy - Since I sorted out my leaks (as linked to) I have *no* issues with the Vpap Adapt SV any more & the therapy is excellent.

Nice place to be

Cheers

DSM

FWIIW, I fond this article in the CPAPtalk Wikipedia

wiki/index.php/Mask_Leaks

Aaron

I have been using the Respironics BiPap auto SV Advanced for approximately 2 months. When I first go to sleep the machine and I get along fine, but sometime during the night I wake up because of a constant flow of air rushing thru the hose causing noisy leaks around my FFM. If I turn off the machine a few minutes and restart, the flow is "normal" but later the constant rush of air again. Anyone have a suggestion as to what gives here?