Philips Respironics Launches BiPAP autoSV Advanced Sleep Sys

mdboze wrote:... I figured a small PS change for both settings, while leaving my previous mod of EPAP Min = 7, EPAP Max =12 alone. ... These new PS settings stopped the mouth leaks that would occur thru the night... I now assume it was because PS Min was too high. ... I'll let you know what the people at my DME say it should be.

If you need a high PSmax range (to help fight central apneas) then you may NEED a high PSmax. Use the data from the data card to see if you still have apneas and/or periodic breathing. If so, you may need to switch to a full face mask. Otherwise enjoy! Glad it is getting better for you.

As a note, remember to reset the values if you return to the DME when the finally figure out that it needs some adjustment. If not, continue to enjoy the therapy it provides. Fortunately, if you need to return to your doctor you will be able to SHOW why you made adjustments and show how it corresponds with how you feel.

dsm wrote:... Have you *ever* seen SV pressure support for you go higher than 20 CMs ? (allowing the epap is say 10 CMs) - if yes then you would have a real dose of *severe* cental apnea. I think JohnBFisher has said his can (23) - that is *very* high & reflects a serious effort by the machine to 'inflate' the user. ...

Yes, DSM, I can confirm that my machine will swing my pressure from EEP (equivalents to EPAP on Respironics) to EEP + almost PSmax. (I regularly see between 20 and 23cm H2O as the top number). So, as I fall asleep, I just stop trying to breathe. It takes over. Though it still can awaken me, I *REALLY* do not mind the effort the ASV machine makes to compensate for my failure of my central nervous system to trigger nomral breathing.

On the downside of this high pressure swing, my mask can leak like a sieve. And there is no doubt there is a correlation between the leak rate and how I feel the next day. Good or better and I can function the next day. Poor or worse and I'm a basket case. Good or worse and I wake up with a headache. (I should really check my O2 saturation and heart rate during the night).

Why do I think these strong swings indicate a failure of my central nervous system? When I look at the data from my ASV unit, I see that I have those wild swings for a long time (60 to 90 minutes), then it suddenly settles down into a very small swing range (EEP to EEP+PSmin). That lasts for about 30 to 60 minutes. Then it heads back to the strong swings. And back to the low swings. And repeats until I awaken.

That almost certainly is following my sleep stages. It also indicates that I am probably not breathing well at all during Stage 1 and Stage 2. But I seem to suddenly transition to good breathing pattern. I assume (based on the duration) this is during deep sleep and REM sleep. Of course, without a full sleep study, I don't know for certain. This is just a guess based on the reading I've done over the past 20 years. But add to this that I have a known neurological condition that can impact the brain stem, and I would be willing to put some money on this horse.

Add to this that my pulmonary function tests indicate I have problems due to my obesity, which diminishes the volume I can breathe. I don't rule out Obesity Hypoventilation Symdrome (OHS). Decreased volume does NOT help. I understand that complicates my case. However, that normally only causes increased central apneas during deep sleep (Stage 3 of Non-REM sleep) and REM sleep. Central nervous system issues cause an increase in central apneas during Stage 1 and Stage 2 of Non-REM sleep. That seems to be what is occurring.

Plus the ABG test seems to show that hypoventilation occurs even during the daytime and it occurs due to lack of drive. There's lots of data in the ABG test that I don't understand as thurough as I would like. But it definitely indicates it is not just "anxiety" on my part. It's an issue while I am awake. And in this instance, those readings occurred 30 minutes after walking a couple of miles.

So, this is just one example of why I recommend people with problems with their therapy use a fully data capable machine. The information you can SEE with the graphs is amazing and very helpful.

Short answer: Unfortunately, yes a swing from EEP to EEP + PSmax is possible. It's not common. But it does happen.

Hmmm... This whole exercise got me thinking. I went back to the ResMed provider manual and note the following table:

ResMed VPAP Adapt SV Enhanced
Parameter........Min...Max...Def...Cur
EEP (cm H2O).......4....15....5......8
MIN PS (cm H2O)*...3.....6....3......3
MAX PS (cm H2O)*...8 .....16...15.....15

Obviously, I added my current settings. So:

• my current range if no problems = 8 to 11 (EEP + Min PS)
• my current range if problems = 8 to 23 (EEP + Max PS)

So, when I have problems, I am in fact "topping out" my machine. Yikes! I think this will be a topic of discussion with my sleep specialist!

JohnBFisher wrote:Hmmm... This whole exercise got me thinking. I went back to the ResMed provider manual and note the following table:

ResMed VPAP Adapt SV Enhanced
Parameter........Min...Max...Def...Cur
EEP (cm H2O).......4....15....5......8
MIN PS (cm H2O)*...3.....6....3......3
MAX PS (cm H2O)*...8 .....16...15.....15

Obviously, I added my current settings. So:

• my current range if no problems = 8 to 11 (EEP + Min PS)
• my current range if problems = 8 to 23 (EEP + Max PS)

So, when I have problems, I am in fact "topping out" my machine. Yikes! I think this will be a topic of discussion with my sleep specialist!

John,

I haven't looked at my own data for a long while but will start to look more closely at it again. Have had 2 nights trying to tame my mask after the seal tore 2 nights ago & using a new quattro std seal last night.

My wife has commented tht I was going off to sleep ok but some time in the middle of the night she says the mask started leaking. I kept tightening it. By morning it seemed pretty well ok, but as you highlight, those different stages of sleep may well trigger some instability for some of us.

Good luck with your analysis.

DSM

mdboze wrote:

Banned wrote:
We both agree that his PS Min 7 is excessive, but if he is happy, I'm happy.

Banned

Actually I'm not happy the the PS MIN =7 and PS Max =7 setting. Air leaks out my mouth when using the nasal pillow.

Last night, rather than wait to hear back from the DME to confirm the correct settings, I tried the following:
PS Min = 5
PS Max = 10
I figured a small PS change for both settings, while leaving my previous mod of EPAP Min = 7, EPAP Max =12 alone.

I use a Nasal PIllow. These new PS settings stopped the mouth leaks that would occur thru the night... making my lips flap occasionally & dry out my mouth and throat badly.
I now assume it was because PS Min was too high.

Setting are Getting noticeably better. I'll let you know what the people at my DME say it should be.

The PSMin & PSMax are the pressure gap range that SV can operate in. If that gap is very small (say 3-4 CMs) then SV is very tightly constrained. As banned has commente previously, a min 10 CMs for that gap is normal. i.e. Psmin=3 PSMax=13

Good luck

DSM

JohnBFisher wrote: my current range if no problems = 8 to 11 (EEP + Min PS)
my current range if problems = 8 to 23 (EEP + Max PS)
So, when I have problems, I am in fact "topping out" my machine. Yikes! I think this will be a topic of discussion with my sleep specialist!

John , with your ResMed VPAP Adapt SV Enhanced
When you have problems, aren't you only potentially "topping out" your machine.
As you mentioned your "current range if problems = 8 to 23, It would only get to the upper part of the range (23) if nesessary.

Do you have smart card readings to track how high it does go throughout the night ? If so, how hight has it been going ?

I have a smart card, but no reader (Later, I plan to tap directly into the RS232 port to log everything to my PC).

One question I would like to answer is to better understand how the Vpap Adapt SV applies its SV pressure. I have been able to test & observe the way the Bipap Auto SV does & what I found was consistent with comments in the patent application - but haven't found adequate data explaining how much of a rise and how quickly (over how many breaths) the Vpap Adapt SV applies pressure in an SV event, It feels like it adds pressure breath-by-breath over 2 or so breaths just like the Bipap Auto SV.

I am hoping that I can look at my data later & see an event from last night where it applied SV pressure & hopefully it will show the pattern.

If anyone has any info. for example a statement like 'The Vpap Adapt SV attempts to normalize PB within three breaths' - I have such a statement for the Bipap Auto SV. Because the Vpap Adapt SV targets volume, it may well try to normalize in a single breath ?

Thanks

DSM

mdboze wrote:... John , with your ResMed VPAP Adapt SV Enhanced ... When you have problems, aren't you only potentially "topping out" your machine. ...

Yeah, I know. Oh, I can raise Max PS, but that would allow it to go to 24cm H2O. And I can raise EEP. Then it will reach 25cm H2O. So, there's a grand total of 2cm H2O "left to go". But that's small. Who cares?

The fact is that it swings quite strongly in an effort to be certain I breathe properly. So, I suspect it's time to check my O2 saturation so I can see if those "bad" night correlate to poor O2 saturation.

mdboze wrote:... As you mentioned your "current range if problems = 8 to 23, It would only get to the upper part of the range (23) if nesessary. ... Do you have smart card readings to track how high it does go throughout the night ? If so, how hight has it been going ? ...

That's just the thing. It goes there most every night. Sigh! I will post some reports so others can see the type of pattern I mean. It's very distinctive.

mdboze wrote:... I have a smart card, but no reader (Later, I plan to tap directly into the RS232 port to log everything to my PC).

You can get the smart card reader from CPAP.com, but they aren't cheap:

https://www.cpap.com/productpage/Respir ... r-USB.html

dsm wrote:... If anyone has any info. for example a statement like 'The Vpap Adapt SV attempts to normalize PB within three breaths' - I have such a statement for the Bipap Auto SV. Because the Vpap Adapt SV targets volume, it may well try to normalize in a single breath ? ...

Depends on the problem and severity of the problem. But I think it does it "gradually" IF you call 3 breaths "gradual".

For me, it always seems to ramp up pressure. So, as I'm falling asleep I note that my breathing becomes shallow. The pressure seems to ramp up in inverse correlation to my breathing volume.

Now, if you have periodic breathing, I would think it would do similar work to try to reestablish normal breathing. Ramp up the pressure until the body kicks back into the normal swing of things.

By the way, the way the Respironics unit does this tended to cause a sudden increase for me. We all tend to build a pattern of breathing (short breaths, deep breaths, short breaths, deep breath, short ...). Well, as they were titrating me with that machine, I found that as I fell asleep I would just fail to take one of those deep breaths. The machine would try to follow the pattern ... it would awaken me ... and we started all over again ...

At least that's how it seemed to work to me. Now that I've used the ResMed ASV unit for a while, I might not have as much problem with it.

mdboze

You mention an RS232 port on your Bipap Auto SV advanced.

I haven't seen anything like that on the recent models does it mention it in the manual ?
Reason I ask is it seems so unlike Respironics to add RS232 to a model that hasn't had it for many years ?

Thanks

DSM

JohnBFisher wrote: The fact is that it swings quite strongly in an effort to be certain I breathe properly. So, I suspect it's time to check my O2 saturation so I can see if those "bad" night correlate to poor O2 saturation.

John, how do you chack your O2 saturation ?

I am looking for a way to monitor my O2 levels through the night, to verify that the machine is doing its job.
From the sleep study, my O2 levels dropped below 75%. They used an O2 monitor taped to my finger.

Are these available to purchase or rent ?

mdboze wrote:... how do you chack your O2 saturation ? ...

I am seriously considering purchasing the following:

http://www.oximetersonline.com/cms50e-w ... met50.html

Just be certain the "clocks" are synchronized between the ASV unit and the Pulse Ox. You can then at least visually compare and contrast the charts.

mdboze wrote: Last night, rather than wait to hear back from the DME to confirm the correct settings, I tried the following:
PS Min = 5
PS Max = 10
I figured a small PS change for both settings, while leaving my previous mod of EPAP Min = 7, EPAP Max =12 alone.

I use a Nasal PIllow. These new PS settings stopped the mouth leaks that would occur thru the night... making my lips flap occasionally & dry out my mouth and throat badly.
I now assume it was because PS Min was too high.

Setting are Getting noticeably better. I'll let you know what the people at my DME say it should be.

Good Job, mdboze,

Remember that EPAP + PS = IPAP, so as you lower PS Min, IPAP will also lower. Lower IPAP means no more mouth leaks. I think you are now getting PS Min in its proper range. You can eventually experiment with PS Min = 4. The Sleep Medicine Community recommends that settings at or above PS Min = 4 provide the best Bi-Level therapy. PS Min 7 was probably excessive, and worse case if it was not, your device will automatically adjust for proper PS Min.

Which brings me to PS Max. PS Max is the gap that will most effectively counter any Central Apnea issues. I've reconsidered. I think adjusting to PS Max = 15 (as dsm suggested) is a good idea. Tonight I would like to see you adjust PS Max to 15cm. This will give your device optimum latitude to mitigate centrals, which you may like (and no, it will not blow the mask off your face as it attempts to mitigate those centrals).

Which brings me to your DME. At this point, your limited knowledge of your device probably far surpasses what your DME will ever learn. What you really need is the SW and the Card Reader to determine your own therapy. I encourage you to get these tools and post your results.

I have enjoyed hearing about your experience with this device and I appreciate the opportunity to get learn how it functions, with you. I want one!

Banned

Banned wrote: Which brings me to PS Max. PS Max is the gap that will most effectively counter any Central Apnea issues. I've reconsidered. I think adjusting to PS Max = 15 (as dsm suggested) is a good idea. Tonight I would like to see you adjust PS Max to 15cm. This will give your device optimum latitude to mitigate centrals, which you may like (and no, it will not blow the mask off your face as it attempts to mitigate those centrals).

Which brings me to your DME. At this point, your limited knowledge of your device probably far surpasses what your DME will ever learn. What you really need is the SW and the Card Reader to determine your own therapy. I encourage you to get these tools and post your results.
Banned

Banned, I'll try that tonight; Setting the PS max to 15
I realize last nights settings may not have been optimal; as I've been VERY TIRED all day today & a bit short tempered due to the tiredness.
Last nights settings were: PS Min = 5 PS Max = 10 EPAP Max =12 - EPAP Min = 7

Regarding the DME: they still haven't called me back to confirm the settings.

I'm going to find the results of my sleep study, and see if I can apply it to the conversion guide:
The BiPap AutoSV Conversion guide is here:
http://bipapautosvadvanced.respironics. ... _Guide.pdf
From that Document:

To convert a current BiPAP autoSV prescription to the BiPAP autoSV Advanced
settings, the following table can be used:
EPAPmin = EPAPmax (perhaps when they had set EPAP min and EPAP max both to 12, it was not a mistake )
Example:
EPAPmin = 8 cm
EPAP max = 8 cm

PSmin
Example:
PSmin = 2 cm
(Calculation: IPAPmin – EPAP)

PSmax:
Example:
PSmax = 17 cm
(Calculation: IPAPmax – EPAP)

mdboze wrote: Banned, I'll try that tonight; Setting the PS max to 15
I realize last nights settings may not have been optimal; as I've been VERY TIRED all day today & a bit short tempered due to the tiredness.
Last nights settings were: PS Min = 5 PS Max = 10 EPAP Max =12 - EPAP Min = 7

If you are tired and irritable tomorrow, go back to PS MIn = 7 and see if you feel better. I've been known to be wrong before.

PS Max = 15 would make "IPAP Max = 22", according to your guide. PS Max = 15 should be a good number, and puts your machine in SV mode to address centrals.

Banned