First, the rules:
* The device
Just some clarification for others who might not realize this point: those rules are specific to how the set-up parameters will behave while in provider set-up mode. Those rules do not explain how the algorithm determines delivery pressures based on those set up parameters.
...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?
Not necessarily. As you may know AutoPAP delivers varying pressures throughout the night with equivalent EPAP and IPAP pressures. The traditional AutoPAP algorithm relies very heavily on preventing apneas and hypopneas via the detection of snores and flow limitations. Unfortunately some patients present these predictive precursors atypically with respect to predictive patterns the algorithm attempts to discern. When this happens the autopap algorithm is reduced to spending less than ideal amounts of time being predictive and more than ideal amounts of time being reactive. Those are the patients who must narrow their autopap pressure range: they typically need a higher minimum pressure to preemptively address those SDB events the algorithm cannot. Many patients seem to do quite well with the full range, or a more comfortable range of say 6 cm or 7 cm minimum pressure, all the way up to the machine's top end. I happen to fare better with a 5 cm or 6 cm spread. Others need straight CPAP, and yet others prefer a wide open range.
I suspect the Autotitrating BiLevel will have the same issues for some patients: a shortcoming by the way of preventing some apneas and hypopneas---thereby spending too much time behind the eight ball, so to speak, and simply reacting or responding to too many apneas and hypopneas versus preventing.
I think that was another poster. I happen to suspect there is a PS Min and that it is maintained or hard-coded internal to the algorithm. I suspect the algorithm likely orchestrated the resultant PS such that it will reduce all the way to zero under certain circumstances. "PS resultant" will be the IPAP/EPAP delta limited by PS Max's provider setting and PS min's internal setting within the algorithm. That delta I am referring to PS resultant will fluctuate: collapse and expand on an as-needed bases. There are two "PS resultant" collapse scenarios: 1) IPAP may approach EPAP for the sake of comfort, or 2) EPAP may approach IPAP for the sake of heavy or atypical obstructions that must be cleared during expiration. I can't think of any other scenarios, which is not to say they don't exist.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 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
This is a key question in my mind. At 8 cm the respiratory drive itself significant support compared to a 3 cm or even 4 cm spread. Why and when would this algorithm run a patient at "PS resultant" of 8 cm? This is a very interesting subtopic regarding a very new and interesting xPAP algorithm.
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 ******
The ramifications of being able to run this machine in CPAP mode would likely be of more relevance to health care institutions. They would tend to benefit more from a multi-purpose than the individual home user. However, some home users may discover after losing weight that they actually fare better on lower fixed pressure than bilevel. Other patient/doctor pairs may not be certain which xPAP platform will provide the best treatment for a patient. In this latter (albeit somewhat unusual) case, a multipurpose xPAP machine kind of makes sense.
I truly hope others will continue to share their experiences, knowledge, and thoughts about this innovative machine. We're all at the beginning of the learning curve on this one!
