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Machine recommendation
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Amybirds Offline

Members

Posts: 12
Joined: Apr 2015

Machine: PRS1 DS760 BIPAP Auto
Mask Type: Full face mask
Mask Make & Model: ResMed AirFit F10
Humidifier: Heated tube humidifier
CPAP Pressure: 8-25
CPAP Software: Not using software

Other Comments:

Sex: Undisclosed
Location: California

Post: #11
RE: Machine recommendation
Vaughn,
Thank you for that information. I do have a copy of the report, but it seems like there are a lot more blank fields on it than filled-filled out ones...

(04-12-2015 11:27 PM)vsheline Wrote:  CPAP "was titrated" up to 13cm, right?

Correct. Typo, oops!

(04-12-2015 11:27 PM)vsheline Wrote:  Does the data portion of the report indicate what was meant by "25/10cm"? (Please note: For your husband's own personal medical records, he has a right to receive copies of the complete reports, including the data, of both the diagnostic sleep study report and the titration report.)
...
Does the titration record show that IPAP (or Max IPAP) was set to 25 cmH2O, and Pressure Support (or Max Pressure Support) was set to 10 cmH2O?
...
What was the breakdown of central apnea versus obstructive apnea, at the final titrated pressures?

Here's what I have in the report--
Cover sheet: In addition to the quotes I provided originally from the cover sheet, there is a section on the cover page that says (and forgive any mis-spellings -- I'm looking a copy of a faxed report):
"Procedure: Polysomnography was conducted. The following were monitored, Central and occipital EEG, Electrooculogram, submentals, EMG, nasal and oral airflow, thoratic wall motion, anterior tibialis, EMG and electrocardiogram. Arterial oxygen saturation was monitored with the pulse oximeter. The tracing was scored using 30 second epochs. Whenever indicated CPAP or BIPAP was titrated. Oxygen was used when desaturation existed despite CPAP or PIPAP use."
Next page:
Sleep Staging Data
Sleep Onset Latency (min): 0.0
REM Latency (min): 45.5
Latency to Stage N1: 6.0
Latency to Stage N2: 0.0
Latency to Stage N3: 14.0
Latency Wake: 349.0

# Cycle N1: 23
# Cycles N2: 35
# Cycles N3: 11
# Cycles REM: 7
# Cycles NREM: 69
# Cycles W: 4 or *... can't read it
Then there's a table with Time/Normal Values TST, TIB over Stage N1, Stage N2, Stage N3, REM, Wake.
Then there's a tracing.

Next page has 4 charts with TST, Bruxlamo, Crisis, CAP, RBD, RMD, but all have all zeros.

Next page has Cardiac Data (let me know if this would be relevant to post)
Next: Periodic Limb Movement & Snoring Data
Next: "Body Position Data" -- and I take this all with a grain of salt because there are rows for data for Supine, Left, Prone, Right and Standing, and all have zeros in all columns except for Standing which lists 395.5 minutes of Standing data... broken down as follows:
REM Duration (min): 83.0
NREM Duration (min): 292.5
# Apnea C/O/M: 0/12/0
Index Apnea C/O/M: 0/0/0
Index total Apnea: 1.9
# Hypo: 29
Index Hypo: 4.5
AHI: 6.6
RERA: 0
Index RERA: 0
RDI: 6.6
# Snore: 0

Lastly there's a page with tracings for DSAT, Position, Arousal, Apneas, PAP and REM. The tracing for PAP show:
starting lines at 20 and 8 (maybe 7?). Top line increases to 25 after a few hours, bottom line increases to 8 after an hour or so and then to 9 when the top line switches to 20 and then a little notch higher for the last hour or so.


(04-12-2015 11:27 PM)vsheline Wrote:  If the pressure is too high, or if the Pressure Support is too high, these can cause central apneas to increase. But on the other hand, the pressures were presumably needed to control the obstructive apneas and hypopneas, and, usually, central apneas which are created by CPAP therapy gradually settle down and go away during the first few weeks of therapy, as the nervous system gradually becomes accustomed to CPAP therapy.

Good to know.


(04-12-2015 11:27 PM)vsheline Wrote:  1. I suggest confirming with your doctor (or whoever provided your husband's prescription) that appropriate ranges for EPAP and IPAP would be:

Max IPAP: 25 cm H2O. (This seems to be what the sleep report is recommending, but actually this is very high, the highest possible value supported by the PRS1 BiPAP Auto. Although it is not unusual to set the Max IPAP this high, if your husband experiences a painful amount of air swallowing "aerophagia" you may need to lower the Max IPAP, at least temporarily.)

Min EPAP: 8 cm H2O. (This seems to be what the sleep report is recommending.)

Max EPAP: 15 cm H2O. The sleep report does not seem to be recommending a value for this. Some machines do not have this setting and the EPAP simply ranges as high as it needs to go, as long as EPAP + PS does not exceed Max IPAP. For machines which have a Max EPAP setting, Max EPAP is set somewhere between (Max IPAP minus Max PS) = (25-10) = 15 as an example lowest possible value, to (Max IPAP minus Min PS) = (25-4) = 21 as an example highest possible value.

2. The ResMed bi-level Auto machine can only use a fixed (manually-adjusted) value for Pressure Support, but a very nice feature of the PRS1 BiPAP Auto is that we can give PS a range, and the machine will automatically adjust itself to use only as much PS as your husband needs to avoid Flow Limitation.

I suggest confirming with your doctor (or whoever provided your husband's prescription) that an appropriate range for Pressure Support would be:

Min PS: 4
Max PS: 10

Take care,
--- Vaughn

That is excellent information. The sleep study doctor didn't actually provide a "prescription", just the report. Our Primary Care Physician wrote the prescription based on the report. However, our PCP seemed to think from the report that the settings would be IPAP 25, EPAP 8. If we need a range, I'm not sure who would be better to get the info from -- the sleep doctor with the semi-flakey report (and who moved right at the time of the study, and took 3 weeks to produce the report in the first place) or the PCP who isn't an expert on these things. Sad

At this point, I am unsure which machine would be better for us: the ResMed or the PRS1 BiPAP Auto... Based on our exeriences with the sleep study Dr (and report) and the DME's I'd like a machine that is the most DIY or self-adjusting because I don't trust the local providers to be of much support. Any advise to help us decide?

Thank you for all the info. It is very helpful.
04-13-2015 09:59 AM
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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: #12
RE: Machine recommendation
(04-13-2015 09:59 AM)Amybirds Wrote:  # Apnea C/O/M: 0/12/0
Index Apnea C/O/M: 0/0/0
Index total Apnea: 1.9

Looks like 12 apneas, all Obstructive, in a little more than 6 hrs, resulting in an overall Apnea Index of 1.9 (apneas per hour).

No central apneas and no mixed (partly central and partly obstructive) apneas.

(04-13-2015 09:59 AM)Amybirds Wrote:  # Hypo: 29
Index Hypo: 4.5
AHI: 6.6
RERA: 0
Index RERA: 0
RDI: 6.6
# Snore: 0

Looks like 29 hypopneas, in over 6 hrs, resulting in an overall Hypopnea Index of 4.5 (hypopneas per hour).

(04-13-2015 09:59 AM)Amybirds Wrote:  Lastly there's a page with tracings for DSAT, Position, Arousal, Apneas, PAP and REM. The tracing for PAP show:
starting lines at 20 and 8 (maybe 7?). Top line increases to 25 after a few hours, bottom line increases to 8 after an hour or so and then to 9 when the top line switches to 20 and then a little notch higher for the last hour or so.

So the sleep tech titrated on CPAP up to 13, then switched to BiPAP.

He then titrated EPAP lowly up to about 10, while IPAP was 20, or 25, or back to 20. Apparently 25 was no better than 20.

So, looks like ending Pressure Support was 10, because 10 equals 20 (the ending IPAP setting) minus 10 (the ending EPAP setting).

The sleep doc recommended an "Auto BiPAP" with Min EPAP of 8 (a couple below his last titrated EPAP pressure). The Auto function would automatically adjust EPAP higher whenever needed.

In AutoBiPAP mode the PRS1 BiPAP Auto has only the following settings which control the pressures:

Max IPAP
Min EPAP
Max PS
Min PS

I think the sleep doctor who evaluated the titration report recommended the following Auto bi-level settings:

Max IPAP: 25
Min EPAP: 8
Max PS: not clear, perhaps as high as 17. (I would suggest not higher than 10 as a start, even if only temporarily.)
Min PS: not clear, perhaps as high as 10. (I would suggest not higher than 6 as a start, even if only temporarily.)


(04-13-2015 09:59 AM)Amybirds Wrote:  The sleep study doctor didn't actually provide a "prescription", just the report. Our Primary Care Physician wrote the prescription based on the report. However, our PCP seemed to think from the report that the settings would be IPAP 25, EPAP 8. If we need a range, I'm not sure who would be better to get the info from -- the sleep doctor with the semi-flakey report (and who moved right at the time of the study, and took 3 weeks to produce the report in the first place) or the PCP who isn't an expert on these things. Sad

At this point, I am unsure which machine would be better for us: the ResMed or the PRS1 BiPAP Auto... Based on our experiences with the sleep study Dr (and report) and the DME's I'd like a machine that is the most DIY or self-adjusting because I don't trust the local providers to be of much support.

I suggest asking for clarification from the evaluating sleep doctor who wrote the titration report and recommended an Auto BiPAP machine, presumably operating in AutoBiPAP therapy mode, not straight BiPAP therapy mode.

(04-12-2015 11:27 PM)vsheline Wrote:  2. The ResMed bi-level Auto machine can only use a fixed (manually-adjusted) value for Pressure Support, but a very nice feature of the PRS1 BiPAP Auto is that we can give PS a range, and the machine will automatically adjust itself to use only as much PS as your husband needs to avoid Flow Limitation.

I suggest the PRS1 BiPAP Auto because of its auto-adjusting feature for Pressure Support. In my view, this feature will give you information helpful in arriving at optimal settings.

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: 04-14-2015 02:49 AM by vsheline.)
04-14-2015 02:42 AM
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Amybirds Offline

Members

Posts: 12
Joined: Apr 2015

Machine: PRS1 DS760 BIPAP Auto
Mask Type: Full face mask
Mask Make & Model: ResMed AirFit F10
Humidifier: Heated tube humidifier
CPAP Pressure: 8-25
CPAP Software: Not using software

Other Comments:

Sex: Undisclosed
Location: California

Post: #13
RE: Machine recommendation
Vaughn,
Thank you!!
These reports are so confusing for us newbies!
I'll reach out to the sleep doctor like you recommended, and see if I actually get a call back this time. It's like pulling teeth...

Your responses, and those of all the others who replied, have been very helpful and encouraging. I'm glad to have found this forum.
04-14-2015 08:59 AM
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Amybirds Offline

Members

Posts: 12
Joined: Apr 2015

Machine: PRS1 DS760 BIPAP Auto
Mask Type: Full face mask
Mask Make & Model: ResMed AirFit F10
Humidifier: Heated tube humidifier
CPAP Pressure: 8-25
CPAP Software: Not using software

Other Comments:

Sex: Undisclosed
Location: California

Post: #14
RE: Machine recommendation
Vaughn - would this match the machine you're referring to:
"New, Open Box Respironics System One DS760 BIPAP Auto w/ Heated Humidifier" (it's on Supplier #2's site)...

What would be the advantage to going with this instead of the ResMed S9 Auto? (I think what you're saying is that it will self-adjust-- does the S9 Auto not self-adjust too? or do both adjust the IPAP and only one self-adjusts the EPAP?)
(This post was last modified: 04-14-2015 09:16 AM by Amybirds.)
04-14-2015 09:07 AM
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Sleeprider Online
Wiki Editor
Advisory Members

Posts: 3,315
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #15
RE: Machine recommendation
The DS760 is the same machine I'm using and it is an Auto BiPAP. The other machines that fit the auto-bilevel definition are the Resmed S9 VPAP Auto, or Aircurve 10 VAuto. I know of a used (230 hour) S9 VPAP auto for sale at $400, but the machine you are considering has a 2-year warranty and the vendor does a good job of backing and supporting his product. I think you're on the right track. If you want to know about the used one, contact me by PM, since we don't do links here.

______________________________________________
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04-14-2015 09:21 AM
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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: #16
RE: Machine recommendation
(04-14-2015 09:07 AM)Amybirds Wrote:  Vaughn - would this match the machine you're referring to:
"New, Open Box Respironics System One DS760 BIPAP Auto w/ Heated Humidifier" (it's on Supplier #2's site)...

What would be the advantage to going with this instead of the ResMed S9 Auto? (I think what you're saying is that it will self-adjust-- does the S9 Auto not self-adjust too? or do both adjust the IPAP and only one self-adjusts the EPAP?)

The Open Box Special is a brand new unit which includes heated humidifier, with standard 2 yr warrantee.

Please note, do not purchase without first emailing or calling Supplier #2 to ask whether this price would also include the heated tube and the bigger 80 Watt power supply unit needed for the heated hose. Ask for price for system with heated tube so you will not be buying a system with the smaller 60 Watt power supply which would need to be replaced if later changing to a heated hose.

The ResMed bi-level Auto models cannot auto-adjust Pressure Support throughout the night. Trying to optimize PS would be very slow process of trying one PS setting for a week or two, and then making small change and trying the new setting for another week or two, and then continuing to make small changes every couple weeks with an overall goal of using not higher than necessary PS, but would not know whether PS was too low, causing RERA events (unlike PRS1 units, ResMed bi-level units do not try to detect RERA events).

Every few minutes the PRS1 BiPAP Auto can check by raising and lowering the Pressure Support by 1 cm H2O to see if Flow Limitation is reduced by the slightly higher PS in which case would use the higher PS until the next check, or if the slightly lower PS is just as good it would stay at lower PS until the next check. Or, if desired, PRS1 BiPAP Auto can be adjusted for fixed PS like the ResMed units would use, but this could be based on observing the Auto-adjusted PS for several days before choosing the fixed setting for PS.

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: 04-14-2015 10:24 AM by vsheline.)
04-14-2015 09:55 AM
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Amybirds Offline

Members

Posts: 12
Joined: Apr 2015

Machine: PRS1 DS760 BIPAP Auto
Mask Type: Full face mask
Mask Make & Model: ResMed AirFit F10
Humidifier: Heated tube humidifier
CPAP Pressure: 8-25
CPAP Software: Not using software

Other Comments:

Sex: Undisclosed
Location: California

Post: #17
RE: Machine recommendation
Sleeprider & vsheline, thank you for that information. I appreciate tapping into your knowledge and experience.

(04-14-2015 09:55 AM)vsheline Wrote:  The Open Box Special is a brand new unit which includes heated humidifier, with standard 2 yr warrantee.

Please note, do not purchase without first emailing or calling Supplier #2 to ask whether this price would also include the heated tube and the bigger 80 Watt power supply unit needed for the heated hose. Ask for price for system with heated tube so you will not be buying a system with the smaller 60 Watt power supply which would need to be replaced if later changing to a heated hose.

The ResMed bi-level Auto cannot auto-adjust Pressure Support throughout the night. Every few minutes the PRS1 BiPAP Auto can raise and lower the Pressure Support by 1 cm H2O to see if Flow Limitation is reduced by the slightly higher PS, or if the slightly lower PS is just as good.

Yes, I noticed the power supply issue on another site and have it in my notes to ask when they return my call (just left them a message).

I was going to go with the ResMed originally, but I'd like the auto-adjust feature on this one, so we'll see if they still have one available, and if they can get it to us asap.
Thanks!
04-14-2015 10:06 AM
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SaldusMiegas Offline

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Posts: 227
Joined: Apr 2015

Machine: ResMed AirSense 10 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: P-10, F&P Simplus
Humidifier: integrated
CPAP Pressure: Rx:14, Set:Auto 8.0-15.0
CPAP Software: ResScan SleepyHead

Other Comments: Woot! P-10 pillows plus Ruby chinstrap for side-sleeping mouth breathers

Sex: Male
Location: Virginia

Post: #18
RE: Machine recommendation
Vaughn, Amybirds,

let me try to clarify for my own understanding as well as this discussion the differences in the class of machines you all are discussing.

Auto CPAP machines (like the S9 auto) are different from Auto BiPAP machines. The Auto CPAP machines have the capability to set different inhale versus exhale pressures, but the range is limited (inhale IPAP pressure 4-20, exhale EPAP pressure 1-3) and the exhale pressure must be manually set in the clinician's menu.

Auto BiPAP machines (like the DS760, Resmed S9 VPAP Auto, or Aircurve 10 VAuto) have a higher range of pressure for both inhale and exhale, plus they can automatically adjust the exhale pressure as well as inhale pressure.

Based on the numbers Amybirds provided, the prescribed settings (IPAP=25, EPAP=8) are both beyond the capabilities of the Auto CPAP machines, and would require one of the Auto BiPAP machines such as Vaughn identified.

The S9 Auto Amybirds is considering would not meet the requirement (unless that is actually the S9 VPAP Auto).

Did I get that right?

I don't use a BiPAP so I'm testing my own understanding as well as asking the question for this discussion.

Saldus Miegas
04-14-2015 10:34 AM
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Amybirds Offline

Members

Posts: 12
Joined: Apr 2015

Machine: PRS1 DS760 BIPAP Auto
Mask Type: Full face mask
Mask Make & Model: ResMed AirFit F10
Humidifier: Heated tube humidifier
CPAP Pressure: 8-25
CPAP Software: Not using software

Other Comments:

Sex: Undisclosed
Location: California

Post: #19
RE: Machine recommendation
(04-14-2015 10:34 AM)SaldusMiegas Wrote:  The S9 Auto Amybirds is considering would not meet the requirement (unless that is actually the S9 VPAP Auto).

Crud, yes, that's what I meant -- the S9 VPAP Auto. I discovered my error too late and couldn't edit it in my post.
(This post was last modified: 04-14-2015 10:39 AM by Amybirds.)
04-14-2015 10:38 AM
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Sleeprider Online
Wiki Editor
Advisory Members

Posts: 3,315
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #20
RE: Machine recommendation
When I got my BiPAP, it came with the standard hose and humidifier. I purchased the heated hose upgrade kit from Supplier #1, and it came with the 80 watt power supply, humidifier lid and heated hose. They were running a special, so I only paid $67, but the retail is $75. Well worth it.

I think Secondwind is offering the machine without the heated hose upgrade, but don't let that stop you. It is very easy to install, and quite affordable. You'll end up with some spare parts.

______________________________________________
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04-14-2015 11:02 AM
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