BiPAP Cures Aerophagia

Anonymous wrote:This doesn't mean there is a design flaw in the machine.

Using more precise language, then it more correctly should be called a limitation of the algorithm. In my own case, I believe the limitations of the algorithm qualify as being substantial when using the machine results in hyperventilation and runaway pressure increases.

As another reality check, one might recall the Ford Mustang, and Pinto which carried around bombs below the trunk space. These cars worked just fine for most of their owners. Only some of whom ended up burned to a crisp because of the design flaw.

Just because a design flaw hasn't personally affected you doesn't make it any less of a flaw.

Regards,
Bill

dsm wrote:If I thought it would be of any use I would produce a video clip of the Bipap S/T in operation with the CMS pressure guage connected as well. But I am not sure that it would be enough evidence for you - would it ? - if yes I'll do it - it just seems to me that you are implying that based on your experience, what I am observing and is quite predictable (now on 2 Bipaps) is probably not happening ?.

Nope, not implying that at all, darlin'. I don't doubt that what you described happened for you. I don't doubt that it's quite predictable and repeatable for you. All I was saying is that for me, several different bi-level machines did not do the kind of flippin' you describe.

I think it's great that people share on the message boards the personal experiences they have with equipment, be it machine, mask, whatever. Bad experiences as well as good ones.

What I do have a little trouble with is seeing personal difficulties (yours, mine, anyone's) with a machine, a mask, or combo thereof, turn into this kind of generalization, even moreso if the person speaks of being an engineer and running "experiments":
"the Respironics Bipaps have a flaw related to the type of mask being used"

dsm wrote:I guess what I am also saying is that there is little doubt in my mind that the Respironics Bipaps have a flaw related to the type of mask being used.

Just because you, the BiPAP, and a full face mask don't gee and haw well together doesn't necessarily equate to this: "the Respironics Bipaps have a flaw related to the type of mask being used."

That reads to me like a statement of fact, when it's really a personal opinion based on your experience with the Respironics BiPAP and a certain mask. I don't doubt your account of how it was for you, or that some other people might have the same thing happen. I simply added my two cents about my more favorable experience with the BiPAPs.

If we're going to venture opinions....and why not?....we all do... ... then I'd guess that the vast majority of people all over the world who happen to be using a Respironics BiPAP Pro or Pro 2 machine AND a full face mask do not experience premature "flipping" from IPAP to EPAP. Doesn't mean it doesn't happen to you and to some others. But I betcha' it doesn't happen for most who are using that machine, regardless of mask.

While we're both indulging in guessing, I'd also guess that a rather high number of people who use the Respironics BiPAP are also using a full face mask to control mouth air leaks at the higher pressures that often lead to a bi-level Rx in the first place. I'd think if there were a widespread problem of premature "flipping" associated specifically with the Respironics BiPAP and full face mask usage, that problem would have been noted and addressed long before now. The BiPAP and full face masks have both been out there for a number of years.

Not saying the combo doesn't work for you, dsm, and for some others. Just saying that doesn't mean one can say there's an algorithmic flaw in general in the BiPAP, with or without a specific mask involved.

Some types or brands of machines naturally suit some people better than other machines do. That doesn't mean a machine you have a problem with while you wear a particular mask has an inherent flaw that is going to cause the same problem in the BiPAP-using, Full Face mask-wearing apneic population in general...imho.

RG, if I may interject yet again, here . . .

I won't begin to speak for DSM, but I will attempt to explain a little of the engineering mindset which often leads people to think us engineers are being extremely negative about something when in fact we are not.

1) Engineers like to solve problems.
2) Every design can be improved. (How many hundred year old appliances do you use?)
3) Even good designs have flaws. (It doesn't mean they don't work.)
4) Most design flaws are small flaws. Nevertheless, those tend to be the most important ones to work on in order to make improvements and to advance the state-of-the-art.

Now, as I've said before, I think what happened with the Respironics algorithms is that in accomplishing all the things that they did, some of the basic algorithmic functions became a little less stable than they had been previously, hence the IPAP/EPAP flipping, hyperventilation, and runaway pressure I've personally experienced. I would think that an engineer at Respironics responsible for the performance of the algorithm would be grateful for the feedback (although management might not be ).

Given that our sample size here is not very large, the fact that two of us here have had problems with the Respironics algorithms suggests to me that these issues are not insignificant. (In my recent poll only a handful of people responded about having a BiPAP.) But then, neither does it mean that the Respironics algorithm is fatally flawed, unusable, or worse than the algorithms used by other manufacturers.

I do think, given that two of us here in this small community have experienced these problems, that it is certainly fair game to point out to others here that these issues exist for some of us.

Regards,
Bill

rested gal wrote:

dsm wrote:
<snip>
darlin'.
<snip>

She loves me

RG,

All else aside. If a machine has problems I am more than willing to do what I can to help solve them. As an engineer I don't take that responsibility lightly.

When someone keeps posting that something has no problems when my own repeatable experience shows that there may be one, I will warn people. But will gather as much info and evidence as I can.

I have invested a lot of my own money in this gear and I have the buyer's rights to expect a normal functioning of the machine. I have repeatedly stated how I am buying extra monitoring gear to help pinpoint the issue (that I wish I hadn't found) - I would far rather be using the machine and getting the benefits of it rather than spending time trying to analyse its weaknesses and leaving it in the hall cupboard.

RG, you seem have an agenda in promoting Respironics and defending any besmirching of their algorithms ?. I am a user who believes in being pro-active about resolving problems. Not all that many people are going to have machine diagnostic backgrounds & the disciple to analyse performance and draw conclusions.

Do you know anyone who we could contact to discuss the issues we are finding ? - despite your concerns you must be able to see that we are activists willing to do what we can to help rather than just knocking a product for knocking's sake!.

Thanks

DSM

NightHawkeye wrote:I will attempt to explain a little of the engineering mindset

---

1) Engineers like to solve problems.

So do I.

NightHawkeye wrote:2) Every design can be improved.

For the most part, I agree.

However, sometimes what one person might think would be a design improvement could make the design not work as well for the many it already suited perfectly.

Ideally, any design improvement would make something better for the few it didn't suit while not ruining it for the many it already suited. I can imagine some designs that might never lend themselves to being "improved" to the point that they'd suit everyone equally well.

NightHawkeye wrote:3) Even good designs have flaws. (It doesn't mean they don't work.)

That can be very true in many cases. It can also be true that what a few people call a "flaw" in a design is simply an incompatibility of that person with that design. Goes back again to what's "improvement"? Improvement for how many people? And in the real world...at what cost?

NightHawkeye wrote:4) Most design flaws are small flaws. Nevertheless, those tend to be the most important ones to work on in order to make improvements and to advance the state-of-the-art.

Setting aside the question of whether the dsm/BiPAP/FF mask thingy even qualifies as a small "design flaw" at all vs a simple incompatibility of a particular person with a particular machine/mask, I agree in part with what you are saying in this point 4. Improvement to large design flaws would be a leeeetle more important in my mind. But yes, any flaws -- the small ones, too -- should be worked on to make advancements.

rested gal wrote:What I do have a little trouble with is seeing personal difficulties (yours, mine, anyone's) with a machine, a mask, or combo thereof, turn into this kind of generalization, even moreso if the person speaks of being an engineer and running "experiments":
"the Respironics Bipaps have a flaw related to the type of mask being used"

dsm wrote:I guess what I am also saying is that there is little doubt in my mind that the Respironics Bipaps have a flaw related to the type of mask being used.

Just because you, the BiPAP, and a full face mask don't gee and haw well together doesn't necessarily equate to this: "the Respironics Bipaps have a flaw related to the type of mask being used."

That reads to me like a statement of fact, when it's really a personal opinion based on your experience with the Respironics BiPAP and a certain mask. I don't doubt your account of how it was for you, or that some other people might have the same thing happen. I simply added my two cents about my more favorable experience with the BiPAPs.

If we're going to venture opinions....and why not?....we all do... ... then I'd guess that the vast majority of people all over the world who happen to be using a Respironics BiPAP Pro or Pro 2 machine AND a full face mask do not experience premature "flipping" from IPAP to EPAP. Doesn't mean it doesn't happen to you and to some others. But I betcha' it doesn't happen for most who are using that machine, regardless of mask.

While we're both indulging in guessing, I'd also guess that a rather high number of people who use the Respironics BiPAP are also using a full face mask to control mouth air leaks at the higher pressures that often lead to a bi-level Rx in the first place. I'd think if there were a widespread problem of premature "flipping" associated specifically with the Respironics BiPAP and full face mask usage, that problem would have been noted and addressed long before now. The BiPAP and full face masks have both been out there for a number of years.

Not saying the combo doesn't work for you, dsm, and for some others. Just saying that doesn't mean one can say there's an algorithmic flaw in general in the BiPAP, with or without a specific mask involved.

Some types or brands of machines naturally suit some people better than other machines do. That doesn't mean a machine you have a problem with while you wear a particular mask has an inherent flaw that is going to cause the same problem in the BiPAP-using, Full Face mask-wearing apneic population in general...imho.

Thanks rested gal. As always, you are the calm voice of reason.

It's just like with masks. What works splendidly for you, may fail dismally for me. This doesn't mean the mask design is flawed. It would be the height of irresponsibility for me to say it was, and even more irresponsible (not to mention, egotistical) to issue warnings about it's use because I came to the conclusion that since it didn't work for me, it must be flawed.

Sharing our personal experiences is wonderful. But we need to emphasize that's all they are. Our personal experiences. Everyone benefits when we bear that in mind and post responsibly.

Anonymous wrote:

rested gal wrote:

dsm wrote:
<snip>
darlin'.
<snip>

She loves me

Yup, I wuv ya, dsm....especially when you do endearing little things like accidentally guesting yourself.

If a machine has problems I am more than willing to do what I can to help solve them.

Big "If". I think there's a big question as to whether the machine has "problems" or whether it's something as simple as your particular type of sleep disordered breathing is not compatible with that machine when you wear your FF mask. I don't see it as necessarily being a design flaw in the machine. It's always been a simple fact that not every machine is going to suit every person. It would be easier if any/every type/brand of machine did. But some just don't suit a few people. I don't see why you keep thinking that has to mean there's a flaw, rather than a simple incompatibility. Same as the way some masks suit some people and not others.

When someone keeps posting that something has no problems when my own repeatable experience shows that there may be one, I will warn people. But will gather as much info and evidence as I can.

Don't remember ever saying "something (I guess you mean the Respironics BiPAP machine) has no problems". I said that two Respironics BiPAPs did not give me the flipping problem you described they gave you. That's all. Please don't take that as any more than what it is. My doing exactly what you're doing -- posting personal experiences with the machines. I'd no more say that the flipping didn't happen to you than you'd say the smooth treatment I described getting with them didn't happen to me. LOL!!

RG, you seem have an agenda in promoting Respironics and defending any besmirching of their algorithms ?.

My goodness! Not at all. Perhaps you've missed the fact that the Puritan Bennett 420E autopap is the machine I've been using since last summer. And maybe you missed my comment in a poll over a year ago when I said I thought ResMed machines were probably the best quality (just my opinion.)

I really can't imagine why my saying that I had not experienced "flipping" with a couple of BiPAP machines manufactured by Respironics would lead you to think I'm "promoting" or "defending" anything. Just relating my personal experiences with some machines. Same thing you are doing.

I am a user who believes in being pro-active about resolving problems.

Me, too. I think that's a good thing.

Not all that many people are going to have machine diagnostic backgrounds & the disciple to analyse performance and draw conclusions.

Correcting the typo to "discipline", I couldn't agree more. I think you're absolutely right about that.

Do you know anyone who we could contact to discuss the issues we are finding ?

I don't know anyone at Respironics. I've never contacted any cpap manufacturer about anything.

you must be able to see that we are activists willing to do what we can to help rather than just knocking a product for knocking's sake!.

Honey, (see, I did it again!! ) I can assure you that I've never once thought you were knocking a product or a manufacturer just for the heck of it. I've always thought you were absolutely sincere in what you wrote, and I've always thought you intend to be helpful. I've never thought you had an agenda. I don't either, by the way.

Gee RG,

Will you marry me

I can take care of the mechanical side of things & you can look after the myriad ways of solving mask problems plus keep up your amazing access to links & data.

We could take the xPAP world by storm

DSM

LOL!!! You nut!

Ya got multiple machines, multiple masks. And now you want multiple wives!! Where does it all end?!!

Hey, I may stay up half the night, but I really can't stay awake ALL night to take notes! You've already got a better wife than I could ever be!

g'nite.

Aww, that's so sweet to see that you guys have kissed and made up. . . .

Anyway, back to business . . .

I opted to leave the BiPAP set to 10/6 last night and didn't have nearly the out-of-sync problem last night as before, so I kinda think I'm adjusting to the machine (or maybe the machine's adjusting to me).

I did, however, this morning have the worst aerophagia that I've had probably since I began using the BiPAP-auto again. It appears that the aerophagia isn't reducing with time. Also, the 10/6 pressure combination just isn't as comfortable as the 9/6 was, and my sleep time for the past few days has been enough less that I'm starting to feel the lack of sleep.

So, I think I'll revert to 9/6 for a few days since I slept so well with that before, and see how that goes before continuing on with the 10/7 pressure combination. Wish me luck.

Regards,
Bill (not being masochistic, just trying to get those occasional nasty residual apneas reduced)

Rested Gal Quote "If I had to start from scratch and get just one machine, I'd get the Respironics BiPAP Auto with Bi-Flex...the machine NightHawkeye and a few others on this board have. Would be nice to have the best of both worlds working at once - bi-level for wonderfully precise exhalation relief and auto for varying the pressure as needed. If a person wanted to, the machine could even be used as a straight CPAP by setting IPAP/EPAP to the same single pressure. Quite versatile" Unquote

Rested Gal,

I didn't realize you would consider getting the Respironics BiPAP Ato over and above the Remstar Auto as your machine of choice.

So after all of your experiences, (and knowledge) you would get at BiPAP machine?

I have NOT ordered my machine yet (was going to order the Remstar Auto) but now I'm waivering... may I should spend the BIG bucks and see if I can get the BiPAP. Unfortunately, it's TWICE the cost of the Remstar Auto, and I'm paying out of pocket. I don't want to spend it though just to be spending it. BTW, my prescribed pressure is just "10 cm".

But, as many have said, it's my health... and maybe I'd be better off spending more now than realizing I actually "NEED" the BiPAP later ?

Tim

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap, CPAP, auto

pratzert wrote: . . . I'm waivering... may I should spend the BIG bucks and see if I can get the BiPAP. Unfortunately, it's TWICE the cost of the Remstar Auto, and I'm paying out of pocket. I don't want to spend it though just to be spending it. BTW, my prescribed pressure is just "10 cm".

But, as many have said, it's my health... and maybe I'd be better off spending more now than realizing I actually "NEED" the BiPAP later ?

Tim, this is the joy of taking charge of your own health. You make the decisions, not the doc or DME.

On the positive side, here are the main reasons people go to BiPAP (that I've read about):
- respiratory problems
- high CPAP pressures
- central apneas
- aerophagia
- comfort

And on the negative side:
- cost
- complexity of adjustment
- machine's algorithm may not fit your breathing pattern well

Of course, some of these apply to APAP also. In honesty, there's a risk either way. In my case, I weighed the risk against what insurance would pay and opted initially for the BiPAP-auto, but when I had problems I then got the Remstar-auto. Now, I'm back with the BiPAP and it definitely works better for me than the auto, but the auto makes a good back-up machine for me, and I'm happy with the way things seem to be working out.

Good luck with your decision, Tim. It sounds like you haven't started therapy yet, so don't wait too long to decide.

Regards,
Bill

Some thoughts from a non-techie.

To those of you testing the BiPap S/T (which is the machine I use), the Provider Manual, in section 2-6 states that there is a safety mechanism set to limit the time spent at IPAP during spontaneous breathing. The time limit is 3.0 seconds. Once that limit is reached the unit automatically cycles to EPAP. Would that be the cause of some of the flipping?

There is a lot more in this section about the algorithms, especially in relation to the Digital Auto-Trak Sensitivity feature. I am most definitely not an engineer, and this stuff is over my head.

Another note in that section is "Because no preset sensitivity threshold can assure patient and machine synchrony with changing breathing efforts and circuit leaks, the Synchrony continuously tracks patient breathing patterns and automatically adjusts sensitivity thresholds to ensure optimum sensitivity as breathing patterns change or as circuit leaks change." There are 3 algorithms involved in that alone

Good luck to you all who are trying to work this out. It does sound like a tough one. I haven't often noticed problems myself. I'm a shallow breather. It's only happened a couple of times when I was taking a long, drawn-out breath that I've felt like I've been cut off.

Bella,

I have the S/T set to 3.0 secs.

The situation that I have is that if I use a nasal pillow mask, the machine performs normally.

If I use a Resmed Ultra Mirage F/F mask, 2 things will happen
1) If I breathe through my mouth ( large airflow, short duration) it works ok
2) If I nose breathe (slow long airflow, long duration) the flipping problem happens

So the givens are ...
The Ultra Mirage, is one of the most popular & widely used F/F masks
The Ultra Mirage has a particularly high fixed-leak rate (45 lpm at 15cms)
The nasal pillows mask (such as Swift) have a low fixed-leak rate (IIRC 27 lpm at 15cms)
My nose is unique & has its own airflow patterns (I normally have some stuffiness & thus difficulty nose breathing)
My mouth can take in a lot of air fast into my lungs
My nose tends to take a small airflow over a long period

Both the above masks work 100% ok for me with PB330 Bilevel & Healthdyne Bilevel.

I have a Bipap Pro 2 + a Bipap S/T and another Bipap Pro 2 on the way.
At the moment both the Bipap Pro 2 and the Bipap S/T exhibit this flipping problem. When the 2nd Pro 2 arrives, it will be my confirmation.

This 2nd Pro 2 was sold to me by a Doctor who had prescribed it to a patient who unfortunately passed away & didn't use it so it is as new. Because the wife of the owner lost the power pack I got it from the doctor at a good price (unlike the S/T which was new & cost big). Naturally I have 2 power packs for this model already.

I have also purchased a volume meter - a device that measures volume of airflow & provides a printout over time of airflow measured in lpm.


What I plan to do is this ...

1) Measure the fixed-leak rates of a set of test masks I want to use
2) Measure my airflow when breathing through these masks & note the IPAP/EPAP switching. Also I will probably use a pressure meter so I can note cms as the tests are done. Probably will do the tests with & without the cms meter.


What am I looking for ...
a) The airflow volumes occurring when an IPAP/EPAP flip occurs
b) how long into the breathing cycle the flip occurs (thus far, with the f/f mask & nose breathing, they happen very soon into the breathout cycle)

If the data is clear cut I will put it together & try to get a contact at Respironics who can discuss the issues with me. If I can't achieve that I will think of some other approach.

Cheers

DSM

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, bipap, mirage, nasal pillow, swift, Power, Nasal Pillows

NightHawkeye wrote:Wonder when I'm gonna quit "guest" 'ing myself.

NightHawkeye,

Just set automatic log-in each computer that you use to peruse the forum. Then you won't get guested....

Moogy .