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[Equipment] Which machine?
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Sach_nyc Offline

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Posts: 10
Joined: Dec 2012

Machine: Philips Remstar Auto
Mask Type: Nasal mask
Mask Make & Model: Fisher and Paykel, FlexiFit 407
Humidifier: None
CPAP Pressure: 7.5-11
CPAP Software: Not using software

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Sex: Male
Location:

Post: #1
Which machine?
I would like to know which kind of machine (cpap auto, bipap auto, auto sv etc) will immediately increase the pressure if airway is fully obstructed and patient has stopped breathing. I have seen that cpap and bipap takes many minutes to increase the pressure and they will simply will not increase the pressure if patient airway is totally collapsed and has stopped breathing altogether. I have heard AutoSV machine can do that as they control pressure breath by breath. Is that so? Does anybody has experience with such machines?

A simple test for that machine will be to obstruct the flow by hand and see pressure increases to maximum level permitted. Also, please include brand and model of machine which you recommend.

Thanks
Sal
06-20-2013 01:13 PM
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jdireton Offline

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Posts: 149
Joined: Feb 2012

Machine: Resmed S9 Elite
Mask Type: Nasal mask
Mask Make & Model: Resmed Mirage FX
Humidifier: Resmed H5i
CPAP Pressure: 12
CPAP Software: ResScan

Other Comments: ClimateLine Hose

Sex: Male
Location: Florida

Post: #2
RE: Which machine?
Sal,

Your question really requires the answer of a doctor. Without the specifics of the respiratory condition, it would be irresponsible to even guess at an answer for you.

If you can provide us some more information on the exact problem you are facing, we can help steer you in a direction. We are not medical professionals. I think we still abide by the dictate of "Do not harm."
06-20-2013 01:36 PM
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RonWessels Offline

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Posts: 465
Joined: Jun 2013

Machine: REMstar Auto AFlex DS560TS
Mask Type: Nasal mask
Mask Make & Model: ComfortGel Blue
Humidifier: REMstar Heated Tube DS6T
CPAP Pressure: 11 - 20
CPAP Software: SleepyHead

Other Comments: CMS50F Pulse Oximeter

Sex: Male
Location: Ontario, Canada

Post: #3
RE: Which machine?
A fixed-pressure CPAP machine will typically be capable of varying the pressure on a per-breath basis to provide pressure relief on exhale. Respironics calls this CFlex, Resmed calls this EPR.

These machines also (for recent models) tend to provide a "puff" of air during a detected apnea event to distinguish between an obstructed apnea event (airway blocked) and a central apnea event (airway open). This puff is not designed to force open an obstruction in a blocked airway.

A bilevel PAP machine is similar to a fixed-pressure CPAP machine, except that it supports a greater difference between inhale and exhale pressures. CFlex/EPR is limited to 3 cmH2O. These machine also typically have a higher pressure capability. Fixed-pressure CPAP machines tend to max out at 20 cmH2O pressure.

An auto-adjusting PAP machine will slowly (ie. over spans of minutes) adjust the delivered pressure so that it is the minimum value required to (mostly) eliminate apnea events. Body position during sleep, alcohol consumption, and lots of other things can affect the ideal pressure setting, and these machines tend to compensate for these effects.

There are also auto-servo machines that treat central sleep apnea by providing timed bursts of extra pressure, either periodically, or as a timed failsafe if the user stops breathing on their own. If you are asking about these types of machines, as jdireton has already mentioned, you should really be talking to your sleep doctor to make sure you are getting the right treatment at the right settings.
06-20-2013 05:39 PM
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Sach_nyc Offline

Members

Posts: 10
Joined: Dec 2012

Machine: Philips Remstar Auto
Mask Type: Nasal mask
Mask Make & Model: Fisher and Paykel, FlexiFit 407
Humidifier: None
CPAP Pressure: 7.5-11
CPAP Software: Not using software

Other Comments:

Sex: Male
Location:

Post: #4
RE: Which machine?
Thanks. Answers are very useful. I think talking to a doctor is better. In my cpap machine, sometimes pressure does not increase immediately and i cannot sleep as I feel obstructed. This happens when I am very tired or not feeling well.
So, obviously I think a machine which immediately increases pressure to open obstruction is better. Auto SV seems like does this but yes, good idea to talk to doctor.
06-21-2013 12:13 PM
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vsheline Offline

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #5
RE: Which machine?
(06-20-2013 01:13 PM)Sach_nyc Wrote:  I would like to know which kind of machine (cpap auto, bipap auto, auto sv etc) will immediately increase the pressure if airway is fully obstructed and patient has stopped breathing. I have seen that cpap and bipap takes many minutes to increase the pressure and they will simply will not increase the pressure if patient airway is totally collapsed and has stopped breathing altogether. I have heard AutoSV machine can do that as they control pressure breath by breath. Is that so? Does anybody has experience with such machines?

A simple test for that machine will be to obstruct the flow by hand and see pressure increases to maximum level permitted. Also, please include brand and model of machine which you recommend.

(06-21-2013 12:13 PM)Sach_nyc Wrote:  In my cpap machine, sometimes pressure does not increase immediately and i cannot sleep as I feel obstructed. This happens when I am very tired or not feeling well.
So, obviously I think a machine which immediately increases pressure to open obstruction is better. Auto SV seems like does this but yes, good idea to talk to doctor.

Hi Sal,

To answer your original question, only an ASV machine such as ResMed S9 VPAP Adapt (new model 36037 is more capable than previous model 36007) or Philips Respironics System One BiPAP autoSV Advanced (now Model DS960TS includes humidifier with Heated Tube) will immediately increase the pressure if patient has stopped breathing (for whatever reason, whether or not the airway is obstructed).

Keep in mind that the phrase "will immediately increase the pressure" really means this: the pressure will alternate higher and lower, to cause inhalation and exhalation, so there will be no interruption of the patient's usual breathing rate.

The amount of pressure increase (the amount that the inhale pressure is higher than the exhale pressure) is called the amount of Pressure Support.

On my machine, if I consciously will myself to relax and not breathe but I keep my throat open, the machine will keep me ventilated, will keep air entering and exiting my lungs (as long as the machines's pressure settings allow the machine to increase the Pressure Support to 10 or higher, which will be high enough for the machine to do for me all the work of breathing).

Pressure support is the name used for the difference between the inhale pressure versus the exhale pressure. ASV machines automatically adjust the Pressure Support to keep us ventilated. For example, if recently I had been taking an average of 15 breaths per minute and my breathing suddenly pauses, the machine will work to keep me taking 15 breaths per minute by increasing the pressure for a second or two to cause inhalation, and then will lower the pressure for a few seconds to cause exhalation, and it will repeat the cycle to produce 15 breaths per minute (or at whatever bpm rate I had been recently breathing).

On my machine, if I close my throat (for example, to swallow some saliva) this will completely block the airway for a couple seconds, and the pressure will immediately (within a second or less) increase the pressure to try to get me to breathe (up to its maximum setting or until I finish swallowing and start to breathe again).

Does not matter whether the throat is closed (obstructive event) or open (central event), the machine immediately responds.

Here is a link to the Philips Respironics System One Comparison Guide:
http://www.healthcare.philips.com/asset....-guide.pdf

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 06-22-2013 07:25 AM by vsheline.)
06-22-2013 07:21 AM
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OMyMyOHellYes Offline

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Posts: 913
Joined: Mar 2013

Machine: Respironics 560 Auto
Mask Type: Nasal mask
Mask Make & Model: Resmed Mirage FX
Humidifier: Respironics System One (no heated hose)
CPAP Pressure: 08.0-15.0 cm/H2O
CPAP Software: EncoreBasic

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Sex: Male
Location: Texas

Post: #6
RE: Which machine?
Different machines (auto adjusting ones) are programmed differently to address the same problems. Anecdotally I have understood that the ResMed products tend to ramp up faster than the Respironics, which IIRC takes a longer time to do the same things. Again, this is only my understanding and as I have not recently stayed at a Holiday Inn Express, is provided for your entertainment only.

OMyMyOHellYes
06-22-2013 09:17 PM
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archangle Offline
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Posts: 3,159
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 16-20
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments: Happy PAPper

Sex: Undisclosed
Location: USA

Post: #7
RE: Which machine?
(06-21-2013 12:13 PM)Sach_nyc Wrote:  Thanks. Answers are very useful. I think talking to a doctor is better. In my cpap machine, sometimes pressure does not increase immediately and i cannot sleep as I feel obstructed. This happens when I am very tired or not feeling well.
So, obviously I think a machine which immediately increases pressure to open obstruction is better. Auto SV seems like does this but yes, good idea to talk to doctor.

Sounds like your minimum pressure is too low.

Just increase your minimum pressure to the point where you don't have this problem falling asleep. No reason to suffer from apnea while your APAP figures out you need more pressure.

Quite a few APAP users find they don't sleep well if the minimum pressure is too low. Some doctors have too much faith in the "auto" part. It works better if you make a good choice for minimum pressure.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
06-23-2013 05:07 PM
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Sach_nyc Offline

Members

Posts: 10
Joined: Dec 2012

Machine: Philips Remstar Auto
Mask Type: Nasal mask
Mask Make & Model: Fisher and Paykel, FlexiFit 407
Humidifier: None
CPAP Pressure: 7.5-11
CPAP Software: Not using software

Other Comments:

Sex: Male
Location:

Post: #8
RE: Which machine?
Thanks Vaughn for details on AutoSv. It really is what I thought about it. Also, thanks for suggestions from OMyMyOHellYes and archangle.

PS: I somehow missed notifications of reply on this thread but I am back (and with a new question Smile on different thread)
07-12-2013 01:42 PM
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spdklls99 Offline

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Posts: 71
Joined: Jun 2013

Machine: Respironics System One BIPAP Auto SV Advanced DS950
Mask Type: Full face mask
Mask Make & Model: comfortgel full
Humidifier: PR S1 Heated
CPAP Pressure: epap 10-15,psmin 3, bpm Auto
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Eastern TN

Post: #9
RE: Which machine?
I was titrated and prescribed a bipap for complex apnea...for 3 years i used it and felt like i was run over by a truck every day..When I complained to Dr and asked if an Autosv would be my next step because my research indicated it was...HE SAID NO! an autosv is not what you need...you need a Trilogy Ventilator.....imagine my dismay when I googled it and saw that this was a $15,000 ventilator designed specifically for people with moderate to severe respiratory diseases??????? I have no respiratory diseases..at all!!!

So I dumped Mr.quack sleep DR. and purchased myself an Autosv advanced......3 weeks using the machine later and I can say I am now a Happy Papper....what I love about the Autosv is its ability to SENSE what pressure it deems necessary for each and every breath you take...some nights my pressures run higher most of the night...some nights they are all lower..,.,.rgardless my AHI stays super low every night...the machine takes all the guessing out of it and does all the work...so it works for me...maybe it will you too

I don't believe anything I hear and only half of what I see
07-12-2013 10:05 PM
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Sach_nyc Offline

Members

Posts: 10
Joined: Dec 2012

Machine: Philips Remstar Auto
Mask Type: Nasal mask
Mask Make & Model: Fisher and Paykel, FlexiFit 407
Humidifier: None
CPAP Pressure: 7.5-11
CPAP Software: Not using software

Other Comments:

Sex: Male
Location:

Post: #10
RE: Which machine?
spdklls99 - Nice. Did you need new prescription to purchase AutoSv advanced?
07-13-2013 12:26 PM
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