How Come? Auto Bipap seems to be fighting me.

Guest · Post by **Guest** » Mon May 22, 2006 7:25 am

NightHawkeye wrote:As for the comment about cooler heads prevailing, Guest, I certainly hope so. It does seem to me though that the only emotional arguments being put forth here have been made anonymously.

dsm wrote:Yet again we have a courageous poster slipping a hood over their head to post a distortion ...

wading thru the muck wrote:It's those that obscure their identity to make a comment for which the motivation should be questioned.

Larry, Curly and Moe have spoken.

If you think its working to deflect our attention away from the content of the post by concentrating on the anon poster, think again.

Guest · Post by **Guest** » Mon May 22, 2006 7:30 am

NightHawkeye wrote:You'll have to trust me on this, since I am one of the 50% of new users who has discovered this "limitation" when starting my therapy.

NightHawk, what is your source for this statistic? You are one of the 50% of new users of the Respironics BiPAP Auto who have discovered this limitation?

wading thru the muck! · Post by **wading thru the muck!** » Mon May 22, 2006 7:56 am

Anonymous wrote:
NightHawkeye wrote:As for the comment about cooler heads prevailing, Guest, I certainly hope so. It does seem to me though that the only emotional arguments being put forth here have been made anonymously.

dsm wrote:Yet again we have a courageous poster slipping a hood over their head to post a distortion ...

wading thru the muck wrote:It's those that obscure their identity to make a comment for which the motivation should be questioned.
Larry, Curly and Moe have spoken.

If you think its working to deflect our attention away from the content of the post by concentrating on the anon poster, think again.

"Guest" if you are so confident in the value of your comments why do you not stand behind them by identifying yourself?

-SWS · Post by **-SWS** » Mon May 22, 2006 8:39 am

DSM-Guest wrote:SWS,

Welcome to the discussion. Your input is without doubt a great boost to the usefulness of the topic.

On the issue of terminology in describing 'situations', I tried to address this with some suggestions in the Cpap Users Group thread.

Let me paint a hypothetical...

On the one hand we can have a user who purchases a machine and seeks to use it. The user has heard good comments about this machine from people here on cpaptalk.

However, the user finds that with their mixed brands of mask, humidifier & machine, they are not getting what they expect from the way the machine works, in fact they begin to think that the good reports on the machine just don't match their observations...

At this point we can deduce the following ...

- User appears to have a problem (user certainly thinks so)
- The machine could be faulty
- The user could be faulty
- The use could be faulty
- So the 'perceived problem' can be from a number of possibilities
--o User not using the machine as it was designed
--o User has a unique combination of mask, hose, h/h, machine & breathing
--o and the machine was never tested with this particular combination before
--o Manufacturer's algorithms may be incompatible with the combination
--o Machine may be a defective unit

Lets say that the user in this case decides the machine must be defective & it is just bad luck. The user then obtains another new one of these machines & finds the same pattern. If the user already knows that a couple of other brands of machines do work well allowing that all else remains equal, , then the user may well begin to look at the 1st brand of machine and say, it may be 'deficient' or have some 'limitations' compared to the other brands in the similar configuration.

The conclusions that the user can come to include
--o Brand x has a limitation when working with this combination
--o Brands y & z work as expected
--o People should be made aware of this

The user goes onto a discussion forum & states they think they have found a problem with brand x but rather than find an interactive discussion on what might be possible causes of the perceived 'issue', 'problem', 'defect', 'situation' (chose your own term), the user merely gets told by some other posters that they never experienced this machine problem, but more to the point, get asked to not be making apparently disparaging remarks about brand x.

The user still has a 'problem' but is being asked not to talk about it as being a problem. The user may then wonder just what is going on.

How does one broach the subject of possible problems without talking about them.

It is a given, and perfectly reasonable that the user be advised to engage in trials & tests to see if all parties can better understand if in fact it is a design issue or a usage issue.

So in this discussion I am now asking how does a user even get to talk about the possibilities if the topic is sidelined or squashed before it gets started ?

Saying there can never be a problem makes no sense at all.
Saying that manufacturers never make mistakes is not viable
Saying that the user must prove the problem before discussing it is a catch-22 (an in my opinion is what is being argued by some people in this thread).

However, I do agree that we could adopt a code of discussion that defines 'issues', 'problems', defects', etc: - it seems to me that a common language for talking about such issues may help.

DSM

DSM, I think it would suffice to document all problems. If your committee somehow managed to document which problems were most common to the rest of us, so much the better in my opinion. Just be aware that many of those problems truly are limitations of today's technology. I'll underscore the crux of today's technical limitations one more time for the non-technical readers who are following:

1) Patient airflow signals are highly complex composite signals that
are comprised of many contributing factors

2) Those highly complex composite signals, unfortunately, manifest with great diversity across the human population

3) The SDB events themselves can never be directly measured via the patient airflow signal

4) Rather, each SDB event type must be indirectly derived on a probability basis from that airflow signal

5) Because airflow signals are so complex and diverse across the human population (even more so across the SDB patient population) there are no 100% probability airflow signals.

6) The lack of "100% probability" airflow signals across the SDB patient population is precisely why any given algorithm cannot achieve a 100% compatibility or efficacy rate across the patient population.

So simply being aware of the fact that many of the problems you document have to do with technical limitations versus "bugs" will probably go a long way toward interfacing with manufacturers. I think your point about finding some middle ground terminology is perfect, since your committee will not be able to discern the exact nature of each technical shortcoming you bring to the manufacturers. For better or worse, you will be at the mercy of the manufacturers regarding disclosure of each technical limitation. I think if you are to have any degree of success interfacing with the manufacturers, your approach will be key. This is an extremely delicate issue to them since their hands are tied regarding each technical shortcoming that has to do with the limitations of today's technology.

Tread lightly, my committee friends, and put your wonderful forte to work on behalf of all of us. Good luck and again, thanks!

NightHawkeye · Post by **NightHawkeye** » Mon May 22, 2006 8:43 am

Guest wrote:Larry, Curly and Moe have spoken.

I doubt that emotional personal attacks carry much sway here. If you believe there is substance behind your feelings you might try a persuasive argument instead. Folks on this forum consistently respond to detailed and thoughtful posts.

Regards,
Bill

Snoozin' Bluezzz · Post by **Snoozin' Bluezzz** » Mon May 22, 2006 9:17 am

NightHawkeye wrote:
Guest wrote:Larry, Curly and Moe have spoken.
I doubt that emotional personal attacks carry much sway here. If you believe there is substance behind your feelings you might try a persuasive argument instead. Folks on this forum consistently respond to detailed and thoughtful posts.

Regards,
Bill

Guest is a "descender" not an "ascender" meaning he (or she) sinks to whatever level he perceives the discourse to have acheived rather than taking the high road. This particular guest has probably never ever heard of, let alone been on, the high road. I sometimes wonder if this Guest's intent is specifically to disrupt discourse and to start a flame war? We will never know, will we. He certainly does not seem to like Bill or DSM, nor they him (or her). Oh Well.

So back to the topic at hand, huh?

I am very grateful to SWS for his contribution on this topic. His clarity about the complexity of signal analysis and the difficulty of interpreting that analysis in a consistent and effective manner does contribute to the flaw/flub question significantly.

If Bill and DSM are statistical anomalies then they are pretty much screwed in getting any real relief on this issue. If they are not (how to determine this?) then they are entitled to be heard and the possibility of relief.

David

Guest · Post by **Guest** » Mon May 22, 2006 9:27 am

wading thru the muck wrote:"Guest" if you are so confident in the value of your comments why do you not stand behind them by identifying yourself?

I stand behind them 100%. Registration is not required here at cpaptalk and no one is required to identify themselves. Guest posting is allowed. But you already knew that, having posted as "Guest" yourself on numerous occasions over the past 19 months. Perfectly legal.

NightHawkeye wrote:I doubt that emotional personal attacks carry much sway here.

Are you referring to the lighthearted jib-jab offered by our well respected anon friend?

Now back to the subject.

NightHawkeye wrote:You'll have to trust me on this, since I am one of the 50% of new users who has discovered this "limitation" when starting my therapy.

NightHawk, what is your source for this statistic? You are one of the 50% of new users of the Respironics BiPAP Auto who have discovered this limitation?

wading thru the muck! · Post by **wading thru the muck!** » Mon May 22, 2006 9:34 am

Anonymous wrote:
wading thru the muck wrote:"Guest" if you are so confident in the value of your comments why do you not stand behind them by identifying yourself?
I stand behind them 100%.

Your definition of 100% seems more like about 60% to me.

Guest · Post by **Guest** » Mon May 22, 2006 11:21 am

-SWS wrote:So simply being aware of the fact that many of the problems you document have to do with technical limitations versus "bugs" will probably go a long way toward interfacing with manufacturers. I think your point about finding some middle ground terminology is perfect, since your committee will not be able to discern the exact nature of each technical shortcoming you bring to the manufacturers. For better or worse, you will be at the mercy of the manufacturers regarding disclosure of each technical limitation. I think if you are to have any degree of success interfacing with the manufacturers, your approach will be key. This is an extremely delicate issue to them since their hands are tied regarding each technical shortcoming that has to do with the limitations of today's technology.

That makes sense--rather than implying these problems are the result of flawed machines, approach the manufacturers from the point of view that you understand many of these problems are the result of limitations of today's technology. It would show the manufacturers you know what you're talking about and they'd be more likely to respond when not put on the defensive.
If they understand you are not demanding solutions but rather, desiring to understand the limitations, they might actually entertain your questions.

NightHawkeye · Post by **NightHawkeye** » Mon May 22, 2006 1:05 pm

Guest wrote: NightHawk, what is your source for this statistic? You are one of the 50% of new users of the Respironics BiPAP Auto who have discovered this limitation?

Well, since you have again simultaneously displayed both your ignorance of this thread, and the fact that your intent is not to foster discussion, but merely to disrupt it, I will answer your question this time. Rather than simply refer you back to the post I made a few days ago, where I stated precisely where this number came from (but which apparently you missed), I will provide you an exact link to make your life easier.

Apparently, you haven't been following this thread very well at all. I was actually surprised at the time when you let that one go unchallenged. Oh well, some days are like that . . .

viewtopic.php?p=79433&highlight=#79433

Regards,
Bill

Guest · Post by **Guest** » Mon May 22, 2006 2:30 pm

NightHawkeye wrote:By my count that makes two folks who actually live with the BiPAP-auto who have encountered this problem, and two folks who haven't. That's 50% of the BiPAP-auto users I know about who have encountered the problem. Statistically speaking, even though the sample size is small, the percentage of 50% is very significant. Threshold numbers that I know of for problem indications are usually well under the 1% range.

You think this is "statistically significant"? I wasn't going to be so rude as to say you were ignorant, but since you have accused me of displaying my ignorance, I think it's only fair to point out you've just displayed your own.

I'd be curious to know, of the total number of BiPAP-auto users in the world (not the 4 you know of personally, but the actual total number), how many have encountered the problem. That figure would be statistically significant.

NightHawkeye wrote:the fact that your intent is not to foster discussion, but merely to disrupt it

Are you the arbiter of my intent?

As long as you brought it up, because I may disagree with what is written and speak up to say so, does not mean it is my intent to disrupt discussion. It is my intention to see the discussion is based on fact. When it is not, it is my intention to point out the discussion is based on conjecture. When it is not fact or conjecture, but blatant misinformation, it is my intention to point that out as well. I think this is an obligation we all have on the forum and view it as our responsibility to our fellow hoseheads. Checks and balances.

dsm · Post by **dsm** » Tue May 23, 2006 1:09 am

Anonymous wrote:
-SWS wrote:So simply being aware of the fact that many of the problems you document have to do with technical limitations versus "bugs" will probably go a long way toward interfacing with manufacturers. I think your point about finding some middle ground terminology is perfect, since your committee will not be able to discern the exact nature of each technical shortcoming you bring to the manufacturers. For better or worse, you will be at the mercy of the manufacturers regarding disclosure of each technical limitation. I think if you are to have any degree of success interfacing with the manufacturers, your approach will be key. This is an extremely delicate issue to them since their hands are tied regarding each technical shortcoming that has to do with the limitations of today's technology.

That makes sense--rather than implying these problems are the result of flawed machines, approach the manufacturers from the point of view that you understand many of these problems are the result of limitations of today's technology. It would show the manufacturers you know what you're talking about and they'd be more likely to respond when not put on the defensive.
If they understand you are not demanding solutions but rather, desiring to understand the limitations, they might actually entertain your questions.

Good points,
I myself have no problem at all with taking the view that what might be deemed a problem to me is called a limitation by the manufacturer. The main issue is to establish a language we can all talk in common so we can at least get to explore the 'limitations' users may find and can identify them.

Because of the variety of masks and machines and tube lengths (My PB330 has 12" tube to the HC150, a 6' tube to my mask & the Resmed UM F/F mask has its own 12" tube - 8 foot total (but not the same config I tested the Bipap S/T with)), it is to be expected that there will be challenges for users.

It is an accepted fact (published) that several brands of early AUTO would not work with particular masks. This was accepted as a limitation and in several cases stated clearly by the manufacturer.

One example I am well aware of is that the early Sullivan Autoset T would not work with the Puritan Bennett mask. Resmed came out and said so. They also said they expected that some other masks would not work with that pioneering machine including their own UM F/F mask. In fact a modification was subsequently made to the Sullivan Autoset T where a separate pressure sensing line was run outside the air hose, to the mask and this mod allowed use of a F/F mask.

Following on the above point. I would not have any problem whatsoever if Respironics were to issue a statement that my model Bipap S/T had difficulties with ResMed's UM F/F mask. If I know what the limitations are, I have the choice to buy or not buy.

Resmed back when highlighting the problem with the Breeze (due to 'air resistance' created by the small diameter of the Breeze tube) stated that they just weren't able to test their machines against every mask & every setting. A fair comment.

(I recently tried a temp mod to my Bipap S/T (running a separate pressure sensing line to the mask) to see what would happen. It actually was very funny. If I stopped breathing the mask (no matter what type) would go into a frenzy of pulsing - like a living throbbing thing attached to my face - reminded me of the movie Alien when one of the spacemen had an embryonic alien creature stuck over his face only the masks were more animated

Half the frustration for me, that came out in this particular thread was a strong perception that any talk of problems would get derailed before it got the least traction. A common language in describing these situations should go a long way to resolving this perception and issue (it is certainly was a perception and issue I had).

Cheers

DSM

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, bipap, hose, Puritan Bennett, auto

dllfo · Post by **dllfo** » Tue May 23, 2006 10:54 am

I'm back.

In my original posting I asked if any of you felt like the Auto Bipap was fighting you. It is a week later and I have logged an average of approximately 8 hours sleep per night. Lots of dreams. Hopefully that is REM sleep.

Do I still feel the machine "fights me"?? Yes, but the machine and I are learning to live with each other and I am much better off for having it. I
am in "synch" with it about 99% of the time and when I do "bump up against
it" I understand why and adjust my breathing.

Thanks for your help, it keeps a lot of us from getting discouraged during the early stages of using our equipment.

This thread seems to have generated some interesting discussions and some not so positive responses.

I can't speak for the others, but any entity that consistently logs in as a guest and refers to respected members as the three stooges has tainted their credibility for me. And when you are asked to register, you state that it is not required and you are correct. But common courtesy would indicate you should do so. IF your intention is to add to the positive flow on the subject, then register. If your intention is to antagonize and irritate people, continue as you are. I, for one, have not read anything from you that is contributory or positive to the thread. Many forums do NOT allow "guests" to post. They can read, but if they want to post, they have to register and THAT is an excellent rule. What you are doing in this forum validates that rule. Actually you may have contributed something positive and I missed it because after your discourse about the 3 stooges, I skipped your comments...as most of us will do. Please do yourself, and us a favor and register.

As to the others...thank you so much for helping, your comments are not
only encouragint to me, but have helped me convince my wife to finish her
sleep apnea test. Hopefully we will both be getting a good nights sleep by
next week.

Guest · Post by **Guest** » Tue May 23, 2006 9:33 pm

Shemp!

Take it easy, as wading thru the muck pointed out its lighthearted jib-jab.

dllfo wrote:Please do yourself, and us a favor and register.

You're new to the forum so you've missed out on the many great discussions we've had here over the past 21 months on the topic of allowing guests to post. Some people like to register and some don't. Its up to each individual.

As for your decision to skip comments someone has written because they upset you, that is exactly what you should do. Don't let them bother you and don't waste your time or energy on them.

dllfo wrote:I am in "synch" with it about 99% of the time and when I do "bump up against it" I understand why and adjust my breathing.

You've reached a major milestone. And quickly too. It takes many people a lot longer than 3 weeks to adjust to xpap therapy and to average 8 hours of sleep a night, so it seems you're reaping the benefits of the Respironics Auto Bipap to the fullest degree. A great machine and a great success story.

dllfo · Post by **dllfo** » Tue May 23, 2006 11:50 pm

Your comments are positive and contribute to the discussion. The last few I
saw from guests were negative, argumentative and in general tended to move the thread off the subject.

If you don't mind being lumped in with those people, go for it. Personally,
I HATE registering for sites I may only use once or twice. But for a forum, I
consider it a matter of courtesy. If DSM does a post, I want to read it. If I
see a guest making the last post, I don't bother. It may be YOU or some
one ....not as interesting.

Thanks for the comments about adapting to the new life style. With the
Heated Humidifier it is easy. The mask was bad for me due to my severe
asthma and lung problems. I was removing the mask all night long due to
a mucus discharge. The nose mask is wonderful. Much easier than my other experience with pressure breathing in the Air Force. As for getting my timing together with the machine, I admit, I am almost desparate to make this work.

My sleeping is a thousand per cent better and my entire life is better. It really is. The wife is so impressed she is doing her test tomorrow night.
Maybe we can both improve our lives and live a better, more healthy life.

For all the bashing of Apria, they still get a pat on the back from me for jumping thru hoops to get me a machine when I really needed it.
While they aren't perfect, and some of their policies frustrate me, I would
still give them a B+ overall. If they send me my clinician's manual , I will
Very pleased with them. And that puts ME in the minority. Very few people
like them or their service.

My next task is to find a back up unit that does everything I need. I have
the respironics auto bipap. But I figure I can find a unit that will handle my
needs without spending a fortune. Any suggestions?

How Come? Auto Bipap seems to be fighting me.

Re: Flip: Flop or Flub???

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