question about PR System One REMstar BiPAP Auto with Bi-Flex

christinepi wrote:I was on the Resmed 9 for 4 months without success due to horrible aerophagia at any pressure above 7. I was titrated at 9-13. So I'm not getting the benefits of the machine. I was switched to PR System One REMstar BiPAP Auto with Bi-Flex, and now I'm praying this will work better (Robysue's story giving me hope here). I'll get the machine sometime in the next 10 days. Is there anything in particular (being completely unfamiliar with it) I should know and pay attention to to give me an easy and low struggle transition (settings, what to look for in its graphs, whatever else)?

robysue wrote:

christinepi wrote:I was on the Resmed 9 for 4 months without success due to horrible aerophagia at any pressure above 7. I was titrated at 9-13. So I'm not getting the benefits of the machine. I was switched to PR System One REMstar BiPAP Auto with Bi-Flex, and now I'm praying this will work better (Robysue's story giving me hope here). I'll get the machine sometime in the next 10 days. Is there anything in particular (being completely unfamiliar with it) I should know and pay attention to to give me an easy and low struggle transition (settings, what to look for in its graphs, whatever else)?

I have to say that I had much less trouble adjusting to the PR than I thought I would. That's not to say there aren't some significant differences, but rather they turned out to be less problematic than I thought.

The MOST IMPORTANT THING is to make sure you get a NEWER version of the PR S1 BiPAP Auto. The new ones have the back lit LCD, version 2.** for the firmware, a provision to accommodate either a 15mm or 22mm hose, and are rumored to be quieter than the older PR S1's were. The slimline hose on the S9 is a 15mm hose. And being able to use that smaller hose was important to me. I got my BiPAP right as the newer S1's were first starting to be released and was lucky to get one of the newer ones. My guess is that with a special order you'll be less likely to get an older one. But it wouldn't hurt to ask now rather than later.

Brilliant advice--I had the feeling there would be SOMETHING to watch out for!

You will need to either buy Encore Viewer or obtain Encore Pro. Buying EV gives an easier installation process since EV doesn't seem to care about MySequelServer (?). Eventually my husband was able to install Encore Pro on one of our older desktops, but I bought Encore Viewer in the meantime. We also installed Encore Viewer on a used netbook that I keep in the bedroom because there's no good way to get overnight data off the PR S1---at least not compared to the Resmed S9. So I pop the card out every morning, download to the netbook by the bed while I get up and go to the bathroom and pour myself a cup of coffee. And get the computer and look at the data over breakfast. If there are clusters of events or really bad snoring or something else oddball or unusual, I'll download the data later in the day to the desktop with Encore Pro installed.

Get the clinician's manual. Wish I could tell you where, but I lucked out: The DME gave me both manuals for the BiPAP by mistake. Even if you have no intention of changing pressure settings without direction from your sleep doctor, you'll still need that clinician's manual to be able to change the time of the ramp setting (the initial pressure setting is controlled from the patient set up menu). And you may need the clinician's menu to switch back and forth between "Rise Time" and "BiFlex" settings.

OK.

There's a neat feature that lets you test (at pressure) in real time the differences between BiFlex at 1, 2, or 3 and sets the Flex to whatever setting you leave it at when you turn the machine off. Likewise, if you choose Rise Time instead of Flex, there's a way to test the Rise Time at 1, 2, and 3 at full pressure and in real time. I personally found I strongly preferred Rise Time to BiFlex. Try both before settling for one.

I'll definitely try that.

And do you know what your IPAP/EPAP settings will be? Or will you be running in Auto mode? In that case, do you know what the min EPAP and max IPAP and PS will be set to? The algorithm for increasing/decreasing pressure in Auto mode does have some differences from the S9 AutoSet's algorithm. In my limited range, they both seem to increase pressure pretty rapidly in response to OAs and snoring and flow limitations. The PR S1 seems to be faster in reducing pressure back down to minimum levels, but that's just a very unscientific first impression.

My doctor gave me IPAP max 14, EPAP min 7, PS of 4--she eye balled it because I wasn't titrated for BiPAP, and titration for APAP was 9-13, EPR 3.

And I sympathize with the aerophagia issue. Mine was unbearable at 9cm (rock hard stomach unbearable). And not very comfortable with the S9 Autoset running at 4--8cm because it spent most of it's time at pressures between 7 and 8 cm. Having the lower EPAP seems to help quite a bit. Although aerophagia is still on on-again off-again issue at 8/6, it's tolerable and when 50% or more of my night has EPAP at 4--5cm the aerophagia is not an issue at all. (And that's been true most nights since I started BiPAP Auto a couple of weeks ago.)

I am PRAYING this is going to work. I also have insomnia and menopause in addition, but to at least get the OSA under control would be so wonderful.

Tomorrow night when I have time, I'll try to post links to the threads where I got some really useful information about the data Encore Viewer and Encore Pro actually provide to the user.

Thanks so much!

Best of luck,
robysue