Which machine type should I go with? Depressing!

jamiswolf · Post by **jamiswolf** » Fri Nov 18, 2011 5:53 pm

Rick,
I would think that someone so hypersensitive to pressures would not want an auto machine. Just saying...
J

Pugsy · Post by **Pugsy** » Fri Nov 18, 2011 5:59 pm

red1 wrote:the S9 Vpap Auto increases & decreases both the IPAP & EPAP at the same time. SO, if the machine increased my pressure by 1 on the IPAP, it would also increase the pressure by 1 on the EPAP. IS this correct?

That's the way I understand it.

Have you seen this written by jnk one of our forum members. It may help you understand.
And yes, perhaps with your history of centrals Respironics variable pressure support might work better for you similarly to Robysue perhaps having less problems with aerophagia when EPAP can be lower. Seems logical anyway.
From this thread but it is quoted often from other thread somewhere in the archives. A good common sense explanation on how things work.viewtopic.php?f=1&t=39248&p=378447&hili ... or#p378447

jnk wrote:

I think you may misunderstand the differences between the two machines and how each machine must be set. They are both good autobilevels, but you can't set either of them up correctly by attempting to use the numbers that were used on the other brand of machine. You have to think about the numbers and translate them for how you want the other brand of machine to run.

As an illustration, think of inhale and exhale as being two dancers. On the Respironics dance floor in the Respironics world, the two dancers dance two different dances without caring what the other dancer is doing. You simply set the size of the dance floor and you tell the dancers the maximum distance they are allowed to get from each other during their separate dances (there is an automatic minimum to keep them from bumping into each other), and they each do their own thing. Sometimes they dance close to each other, and sometimes they dance far apart. That distance varies. On the other hand, on a ResMed dance floor in the ResMed world, the two dancers do the same dance and are always the exact same distance from each other, but they can still roam the full dance floor, as long as they do it together. So if you mistakenly set the fixed distance of the dancers to be the same size as the dance floor, you keep the dancers from moving at all.

In other words, for the Respironics machine, you set the maximum IPAP and minimum EPAP (the size of the dance floor), then you set the MAXIMUM pressure support, or maximum distance allowed between the two separate pressures (dancers). For the ResMed, you similarly set a maximum and minimum (the dance floor), but then you set the ACTUAL pressure support, the fixed distance (or, difference) between inhale pressure and exhale pressure for the night. On that machine, those two pressures increase and decrease TOGETHER, NOT SEPARATELY, moment to moment, during the night (since the two do the same dance together).

It seems that the person who set up your machine didn't understand that difference between the two machines and set up the ResMed as if it were a Respironics. That is incorrect. If you want the ResMed to run as an auto, make sure the pressure support number is a number LESS THAN the distance between Max IPAP and Min EPAP so the dancers have some room to move. If the machine isn't set up correctly, it is the person who set it up who has kept the machine from running as an auto. That is not a limitation of the machine; it is a limitation of the person who set it up. That person was confused. So don't blame ResMed.

As for which approach to autobilevel dancing is best, I don't know. I just know the two approaches are different and that before you set up one brand after using another brand, you had better learn something about dance floors and choreography in the other world and translate from one to the other, if you want to see a dance.

jeff, who set up his own autobilevel, but is a lousy dancer in real life if he doesn't have a guitar in his hands.

red1 · Post by **red1** » Fri Nov 18, 2011 7:32 pm

jamiswolf wrote:Rick,
I would think that someone so hypersensitive to pressures would not want an auto machine. Just saying...
J

Thank you Jamis & Pugsy for the great info on this.

There is so much to look at when going from one xpap machine to a diferent type of xpap.

I really like the Resmeds way of recording all the data. I will certainly miss this if I go to a Respironics.

If I do not go to an "AUTO" type bipap, what would be the point of having the bipap? IF its set up to a using one constant setting, would it not just be a CPAP, or is it, you can set a constant, with a much larger range between the IPAP & EPAP, unlike the 3 EPR with a Resmed S9 Elite? Then I could just adjust the IPAP without having an increase to the EPAP?

Thanks

RIck

jamiswolf · Post by **jamiswolf** » Fri Nov 18, 2011 7:45 pm

Rick,
Keeping it as simple as possible...a straight bilevel has the epap setting and the ipap setting (bilevel), but they are fixed at whatever you set them at. Not adjusting automatically...so you would have more control. My guess is that if you got an auto BiPap, you would probably just end up using it as a straight Bipap. The auto's cost more, but if it's an insurance deal that's not an issue. With the auto, you do get two or rather three machines in one....cpap, bipap or bipap auto...depending on how it's set up.

To further complicare things, even straight BiPaps still have epr or flex for comfort. Just keep reading and asking questions and it'll get more clear.
Jamis

Pugsy · Post by **Pugsy** » Fri Nov 18, 2011 7:47 pm

red1 wrote:If I do not go to an "AUTO" type bipap, what would be the point of having the bipap? IF its set up to a using one constant setting, would it not just be a CPAP, or is it, you can set a constant, with a much larger range between the IPAP & EPAP, unlike the 3 EPR with a Resmed S9 Elite? Then I could just adjust the IPAP without having an increase to the EPAP?

I am currently using a PR S1 BiPap Auto in straight bilevel mode. I don't have a problem with centrals though.
I am doing it because I like it and I actually feel better.

Nice thing about the Auto BiPap.... I can use it in Auto mode, BiLevel mode and even as a straight CPAP.
Personally as far as "feelings" while awake..I like straight BiLevel better because of the difference in how IPAP and EPAP feels when I am awake and breathing. I have a 4 cm range and after the first couple of breaths I feel like I am breathing normally just like I do during the day. Because APAP mode forces me to use a 2 cm difference in IPAP and EPAP I don't "feel" the difference and it is the difference that I like. I used to use APAP 10 / 20. Sometimes I needed 18 cm...Right now EPAP 9 and IPAP 13 is doing a great job and I don't seem to be missing those 18 cm events like I thought I might. I am guessing that 13 IPAP keeps airway open well enough to stop the tough 18 cm events from showing up.

red1 · Post by **red1** » Sun Nov 27, 2011 5:00 pm

I had my bipap titration last night. It was a bad experience, to say the least.

They used a Resperonics Straight Bipap, as opposed to a auto. It was very uncomfortable. The Ipap would switch to Epap, before I finished breathing in. I'd be 3/4 of the way through an inhale & then it felt almost like nothing. What made it so bad is it was abrupt. It did not ease into lowering the pressure while I was in Ipap. It felt like someone put their hand over my mouth while I was inhaling. Then there would be Ipap breaths that followed fine all the way through. IT kept changing. I eventually had to just breath more shallower so that I finished the Ipap, before the machine switched to Epap.

Is this a common thing with bipap machines?

Last week the company I deal with lent me a S9 Autoset set at 4 & 10. IT was quite compfortable. I could never get below 13.5 AHI with the S8 elite ii, however, with the s9 Autoset, my 51 hour average, using the ResScan software was:

Obstructive Index of 2.9
Hypopnea Index of 0.6
Central Index of 1.1
AHI Total 4.7

My normal AHI without XPAP is 109.3 (Part of that number is Centrals at 12.2 Index)

I am uncertain what to do. Especially after my experience last night.

teaseinjusito · Post by **teaseinjusito** » Sun Nov 27, 2011 5:15 pm

jamiswolf · Post by **jamiswolf** » Sun Nov 27, 2011 5:27 pm

Red1 wrote: Is this a common thing with bipap machines?

Red1,
Sorry things didn't go smoother. Unfortunately Respironics machines can sometimes be a little difficult. They use an algorithm or breathing system called the auto-trak which is supposed to compensate for leaks (as I understand it). I know Respironics users who have changed brand because of it. I currently am using such a machine and I find it's only an occasional thing that the machine tends to "rush" breaths for me. Usually adjusting mask eliminates it...but it took me a few days to figure that out. Probably a poor choice for a sleep lab machine.

So you're back to square one?

Since you had bad experiences with Respironics, if they want to give you a ResMed auto bipap with full data...grab it. Later, if you decide you have the pressures dialed in, you can use the machine on straight bipap mode. I use Respironics because that's what I started on...never used a Resmed. So I speak with limited personal experience.
Jamis

red1 · Post by **red1** » Sun Nov 27, 2011 5:54 pm

Thank you so much Jamis.

It actually interfered with my titration. IT was very difficult getting to sleep. Once I am asleep, its ok as my breathing becomes more shallower. I almost got up & left. I would think a sleeper that deep breathed, would wake up with a jolt if they got cut off in mid breath. They would have to add that machine to the list of events that wake you, in their software.

Thanks again Jamis,

Rick

red1 · Post by **red1** » Sat Dec 03, 2011 10:33 pm

After my experience with the rushed breaths of the Resperonics Bipap, during my very uncomfortable titration, I have decided to go with the Resmed Vpap Auto.

Can anyone tell me, if the Resmed Vpap Auto, rushes your breaths. Does it breath with me, or do I have to breath with it. Will it cut short my Ipap like the resperonics one does? If it does, I'll have to stay away from the bilevel machine. I need to be able to breath at my own pase, at least while I am still awake. Sadly I am unable to try a Resmed bipap auto as none of the companys in my area do not hold them in stock. They have to order them in.

I glad they used the Resperonics machine for my titration. Otherwise, I would not have known about the rushed breaths on Ipap. I know a lot of you out there, have no problem with it. Sadly, I certainly do. The bilevel is something I really need because on regular cpap, increase in pressure on the Epap causes more centrals for me & a higher AI.

I need so much to get my apnea under control. IT has ruined my life. I have become extremely depressed, exausted, irritable, & feel so lost, because nothing to date has worked for me. I try so hard. I use the cpap every night, all night. Still once I reach a certain pressure, anything beyond that increases my centrals. I am quite sure it is Epap pressure. As I said before, I tried cutting back epr from 3 to 2 & it only increased my AI & slightly decreased my HI

I see my sleep doctor in a couple weeks & have to have data & a machine in mind, when I see her.

Thanks

Rick

jamiswolf · Post by **jamiswolf** » Sun Dec 04, 2011 9:54 am

Red1 wrote: After my experience with the rushed breaths of the Resperonics Bipap, during my very uncomfortable titration, I have decided to go with the Resmed Vpap Auto.

Red1,
I don't have any real pertinent ResMed experience...other then having used an older S7 vpap. It behaved differently from my Respironics but isn't without it's quirks. Many people use Respironics without having the difficulty that you did. It was more likely related to the way your titration machine was set up. I'm not trying to change your mind in any way though.

If you fail to get any response to your last post/inquiry, I suggest you start a different thread with a more to-the-point title like "Seeking VPAP feedback" or something along those lines. Just a thought.
Jamis

Pugsy · Post by **Pugsy** » Sun Dec 04, 2011 10:28 am

Very few members here have had a chance to use both the ResMed VPAP and the Respironics BiPap to be able to offer you their thoughts on the 2 machines. What you may perceive as rushing may not be perceived by another user in the same way.

I do think that Rested Gal has had a chance to use both brands of BiLevel machines. I think she explained how she perceived the differences in another BiLevel thread. I will see if I can find it and post a link to it if I can find it.

Edit: Some of Rested Gal's comments in my own BiPap experiment thread here viewtopic/t71442/viewtopic.php?f=1&t=71 ... te#p656179

There was another one but I can't seem to find it. I will continue to look.

red1 · Post by **red1** » Sun Dec 04, 2011 3:58 pm

Jamis & Pugsy, thank you so very much for your feedback. I really appreciate it.

I somehow need to be certain the Resmed Vpap is ok, because I have to pay out of pocket for it, as I only had my CPAP machine 3 years. Insurance will not help until 5 years after original purchase. They are a lot more expensive in Canada, then they are in the US. The S9 Autoset goes for about 1650.00 in Canada. No idea yet what the Vpap goes for here, though I am sure it is double the price of the Autoset.

I will take your advice Jamis & start a new thread.

Thank you both again so very much. You both have been a great help throughout this process. It is something I won't forget.

Thank you so much.

RIck

jamiswolf · Post by **jamiswolf** » Sun Dec 04, 2011 4:17 pm

Red1,
Knowing your situation better, you might consider the used market. Something to consider. Check out the Craigslist in your area. That's a popular venue for cpap adverts.
J

Pugsy · Post by **Pugsy** » Sun Dec 04, 2011 5:27 pm

Is there any way you can rent a ResMed VPAP so you will know for sure if it suits you or not?

Which machine type should I go with? Depressing!

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Re: Which machine type should I go with? Depressing!

Re: Which machine type should I go with? Depressing!

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Re: Which machine type should I go with? Depressing!

Re: Which machine type should I go with? Depressing!