Respironics Bipap Auto First Night Impression

That sounds correct from what I have seen. Also, for those who have the Encore software, the update can be downloaded now. You will probably need a high speed connection since it is 108 megabytes. Took me 10 minutes to download, probably lots getting it.

http://software.respironics.com/cgi-bin ... ge=[Encore]

My point was to confirm that the PSmin was lower than 3cm which is what was being said earlier in the thread. Zero is great.

My other point was to ask why someone would buy an expensive BiPap Auto to turn it into an AutoCpap by dumbing it down. The statement was made 'so you cant turn it into a CPAP.' because at the time it was thought that PSmin was 3cm

I am thrilled with the prospects of the AutoBiPAP and will get my doc to prescribe one next week.

Skim reading the Patent article was very exciting, as much as I could digest.

You have a lot of great contributions if you are always the same person, why do you contribute so much as GUEST?

Sometimes, people end up being guest if they don't sign in. You can set it to auto sign in too. I guess on occassion some prefer to be "guest" and not known. Anyway, that could be why some sometimes sign in as guest.
I think I may like this auto. It's sort of like the ramp setting on a regular bipap, starting low and increasing...with the exception that it titrates to whatever pressure is needed.

Point well taken about dumbing it down, Jondough. Most people would not want to. However, setting EPAP=IPAP while this machine is in traditional BiLevel mode will allow this machine to run as a straight CPAP machine. PS Max is not a limiting parameter in traditional BiLevel mode. PS Max is available only in AutoBiLevel mode or AutoBiLevel mode with BiFlex.

Setting this machine up in AutoBIPAP mode, without BiFlex mode, and a PS Max of 3 cm is as close as this machine is going to get to a conventional AutoPAP. Setting this machine up in AutoBiPAP mode, with BiFlex mode, and a PS Max of 3 cm is as close as this machine is going to get to running like a REMstar Auto with C-Flex. I would think this machine should approach a therapeutic ideal more closely than a traditional AutoPAP or REMstar Auto with C-Flex----even for the ordinary apnea patient. That is if this machine meet's it's design objectives regarding overall efficacy. The jury is still out regarding overall efficacy, but I expect this machine to provide better therapy than the traditional AutoPAP or (spontaneous mode) BiLevel.

P.S. Sorry about the multiple geust posts. I felt the concepts discussed were vastly more crucial than identity. Besides, I like guest towels and soap!

Thanks you SWS

Guest2 wrote:Thank you SWS

"Guest" is too lacking in modesty to be _SWS... unless he has an alter ego.

wading thru the muck! wrote:

Guest2 wrote:Thank you SWS

"Guest" is too lacking in modesty...(

Verrry sorry to have come off as immodest...

Exit guest...

Guest, thanks for your courteously presented insights. I didn't think you were immodest at all. I enjoy learning and welcome finding out when I'm wrong about something.

You were perfectly polite in your explanations. I was very glad you posted and hope you don't feel "run off." Please keep contributing to what was a very interesting discussion!!

WOW!

Knocked down a few notches by rested gal... not a good place to be.

My comments were in no way a "cut" on Guest. My comment was akin to saying "not as Holy as Mother Theresa" ... I don't expect anyone to live up to that standard. I was just doubting that Guest and _SWS are the same person. I may be wrong... just as I may be wrong regarding the function of the auto-BiPAP. I don't "KNOW" anything about this machine or whether or not Guest is _SWS. My posts where just in defense of my rationale regarding my educated guesses.

The _SWS I know would not have written this condesending sentence:

"That is because PS min is hard coded to be exactly 0, Wader!"

I used the Bi-pap Pro 2 Auto in the auto mode last night for the first time. Just as Ted stated, very nice. No hesitation from ipap to epap or epap to ipap. Extremely smooth transitions between the two, never a bump. I set the min at 4, maybe bump that up to 6 so it doesn't start out so low. It is so smooth it's like its not blowing at all, very quiet too. The 1.5 Encore is slightly different in appearance so will have to figure that out. Derek's My Encore won't open now. This is the best one out so far. I highly recommend it for anyone looking for a Bi-pap. (At least for now, just had it two days but very impressive.)

Any more feedback? I am very interested. Thanks.

The minimum setting for the bipap auto EPAP is 4 cm. The Max IPAP is 25 cm. The Max PS is between 3-8. Therefore, the EPAP will never go below 4 and IPAP never above 25. A more logical setting is somewhere in between. The machine default settings are 4 cm EPAP, 20 cm IPAP and 4 cm Max PS. This will work for anyone. The Max PS sets the differential not to exceed what you set the value for, not a minimum. Therefore, 4 being the default, the difference between IPAP and EPAP will never be more than 4 cm of H20. The minimum difference starts at 2 so it will therefore titrate between the 2 and 4 to reach a comfortable and theraputic level of treatment. If the Max PS was set at 8, it would allow it to opperate with a 2-8 cm differential. (Which I seriously doubt it ever would.) Usually the IPAP/EPAP is somewhere between 3-5 cms for most people. The EPAP will never equal the IPAP so therefore it cannot be considered equal to a CPAP machine but only a Bipap. At the beginning of a session, the machine always starts at the minimum setting for EPAP plus 2 for IPAP. It then begins reading a persons breathing and adjusts the pressures, both, for the best therapy to reduce Apneas and Hypoapneas and Snoring at the lowest cm's H20 to prevent mask leaks and better comfort from higher pressures. The Bipap auto will also work in the Bilevel mode only in which you set points for IPAP and EPAP. What else do you need to know or what do you not understand?

"Guest"
Thanks for the great reply. This is good info to forward to my doc.
michael

...Enter original guest.

The machine default settings are 4 cm EPAP, 20 cm IPAP and 4 cm Max PS. This will work for anyone.

When the Remstar Auto first came out it was also purported that running the full 4-to-20 cm range will work for anyone. Very many anecdotes here proved that quite a few patients needed to narrow their range considerably to get good treatment. I think the jury is "still out" on this algorithm's efficacy, especially regarding a "wide open" range.

The Max PS sets the differential not to exceed what you set the value for, not a minimum. Therefore, 4 being the default, the difference between IPAP and EPAP will never be more than 4 cm of H20. The minimum difference starts at 2 so it will therefore titrate between the 2 and 4 to reach a comfortable and theraputic level of treatment.

Yes, it's clearly a variable (not fixed) delta and it's clearly going below that 3 cm barrier discussed earlier. However, your particular results perhaps cannot be accurately generalized to a 2 cm barrier, either. At the low end of your pressure range it brings your IPAP to within 2 cm of your EPAP for the sake of comfort. That 2 cm may be the lowest delta for this particular scenario (comfort scenario). However, more patient data or even manufacturer clarification shall tell if the EPAP/IPAP delta might not go all the way to zero---such as in the case of heavy or atypical expiratory obstruction, when EPAP would actually move up to approach IPAP.

If the Max PS was set at 8, it would allow it to opperate with a 2-8 cm differential. (Which I seriously doubt it ever would.) Usually the IPAP/EPAP is somewhere between 3-5 cms for most people.

I suspect that will be the usual-case trend too. However, Respironics would not have a PS max setting of 8 cm if it were never to be algorithmically achieved.

The EPAP will never equal the IPAP so therefore it cannot be considered equal to a CPAP machine but only a Bipap.

See your description below for a question.

...will also work in the Bilevel mode only in which you set points for IPAP and EPAP.

Since PS max, IPAP max, and EPAP min do not come in to play in straight BiLevel mode, CPAP mode can be achieved is straight BiLevel mode by setting IPAP=EPAP. Or have you perchance noticed a restriction setting in provider setup mode that would preclude setting IPAP equal to EPAP?

Thanks in advance for your follow up comments.

First, the rules:
* The device will not allow a Max PS setting outside the range of 3.0 to 8.0 cm H2O, and the device will prohibit other settings to ensure that this rule is not violated.
* Within the range of 3.0 to 8.0 cm H2O, any setting can be chosen for Max PS, but it is further subject to the following rule: The Max PS setting cannot exceed Max IPAP setting minus Min EPAP setting.
* If the Min EPAP setting is incremented greater than Max IPAP setting minus Max PS setting, it will force the Max PS to decrease. The Max PS setting will only decrease down to the minimum setting of 3.0 cm H2O, so Min EPAP setting cannot be incremented greater than Max IPAP setting minus 3.0.
* If the Max IPAP setting is decremented less than Min EPAP setting plus Max PS setting, it will force the Max PS to decrease down to the minimum setting of 3.0 cm H20, so Max IPAP setting cannot be decremented less than Min EPAP setting plus 3.0.

When the Remstar Auto first came out it was also purported that running the full 4-to-20 cm range will work for anyone. Very many anecdotes here proved that quite a few patients needed to narrow their range considerably to get good treatment. I think the jury is "still out" on this algorithm's efficacy, especially regarding a "wide open" range.

I don't have a cpap so I don't know anything about them. What I understand you saying compared to my statement is: The default setting is Min. 4 cm EPAP and the Max IPAP is 20 cm and the Max PS 4 cm. Therefore, if over a weeks time, my maximum and minimum titrated levels are 6 EPAP and 15 IPAP, if I narrowed my range to min 6 and max 15, I would get considerable better treatment? Please explain how that would happen to me?

Yes, it's clearly a variable (not fixed) delta and it's clearly going below that 3 cm barrier discussed earlier. However, your particular results perhaps cannot be accurately generalized to a 2 cm barrier, either. At the low end of your pressure range it brings your IPAP to within 2 cm of your EPAP for the sake of comfort. That 2 cm may be the lowest delta for this particular scenario (comfort scenario). However, more patient data or even manufacturer clarification shall tell if the EPAP/IPAP delta might not go all the way to zero---such as in the case of heavy or atypical expiratory obstruction, when EPAP would actually move up to approach IPAP.

It will never go ABOVE the 3 cm MAXIMUM, if set at 3 cm. That is a Max PS, not a minimum setting, however it is the minimum for the Max PS setting. See the rules. Also, it cannot be set above the 8 cm Max PS. Only between 3 cm and 8 cm. So it is not going outside any barriers as per the rules. Whatever the Min EPAP is, it begins at 2 cms above for the IPAP, not to break the rules and can titrate up to 8 cms differential depending on a particular Max PS setting. If it starts with 2 cm difference and the Max PS is set at 3 cm, it only allows the EPAP to titrate between 2 and 3 cm which is very little for a bilevel machine. If you set your Min EPAP to 4 and the Max PS to 3 and IPAP to 10, the rule would keep the machine to within 3 cm Max at all times. If the IPAP titrated to the 10 cm, the EPAP would be no lower than 7cm. I think you confuse the Max PS setting of 3 cm with some minimum setting. For best clarification, email Respironics if you don't understand my reasoning.

I suspect that will be the usual-case trend too. However, Respironics would not have a PS max setting of 8 cm if it were never to be algorithmically achieved.

I agree with that statement. In some scenarios it may be necessary to obtain an 8 cm differential, but that would only be in a low percentage of patients. IMO

Since PS max, IPAP max, and EPAP min do not come in to play in straight BiLevel mode, CPAP mode can be achieved is straight BiLevel mode by setting IPAP=EPAP. Or have you perchance noticed a restriction setting in provider setup mode that would preclude setting IPAP equal to EPAP?

In a bilevel mode, the EPAP=IPAP can be set to achieve a CPAP mode. But, then one defeats the purpose of purchasing a higher priced bilevel machine. I imagine some may be that ******

I'm not sure if you are just being argumentive or really don't know. I personally cannot explain it any clearer so perhaps you should contact Respironics if you are considering the purchase of the bipap auto and there are parts of it you don't understand. Besides, I'm just giving my opinion. If the CPAP works for you, I would not purchase the BiPap Auto and save some $$$. I've had a bipap for almost 4 years and have just purchased the auto and am still learning with it.

Exit a Guest, but not an original Guest.