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New BiPap machine
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Sleeprider Offline
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Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
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Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

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Sex: Male
Location: Where they make Respironics

Post: #11
RE: New BiPap machine
(04-29-2015 07:41 AM)Mark Douglas Wrote:  Bilevel cpap is touted to increase compliance. If that be the case why wouldn't every cpap user want one? This concept is what prompted me to acquire such a machine out of the gate. If I find it causes complications due to markedly improved respiration it can be dumbed down until my body adjusts.

I will be looking forward to following in your wake.

Edited cause I slept really poorly and can't think yet this AM.

I have both the PRS1 760 BiPAP and a 560 Auto. I have done a lot of experimenting with the BiPAP and I'll be honest with you. I get significantly lower AHI and RERA with less pressure variance. I have been working with a pressure support of 5.0 for about a month and have had AHI ranging from less than 1.0 to over 3.0. Last night I used the auto again, and was right back to 0.6. Go figure. Thinking-about

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04-29-2015 08:40 AM
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iSnore Offline

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Posts: 148
Joined: Apr 2015

Machine: Phillips-Respironics DS560TS REMstar Auto
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: Phillips-Respironics DS6T Heated Tube
CPAP Pressure: 9-13 A-Flex 2
CPAP Software: SleepyHead EncoreBasic

Other Comments: SYSTEM ONE resistance set to X1 for P10

Sex: Male
Location:

Post: #12
RE: New BiPap machine
Perhaps I'm dense, but could you clarify a couple of things for me?

(04-29-2015 08:40 AM)Sleeprider Wrote:  I get significantly lower AHI and RERA with less pressure variance.

With the 760 or the 560?

(04-29-2015 08:40 AM)Sleeprider Wrote:  Last night I used the auto again, and was right back to 0.6.

Again, right back to 0.6 with the 760 set for auto pressure support or the 560?

Sorry if this is obvious and I'm just not getting it.
04-29-2015 10:32 AM
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Sleeprider Offline
Wiki Editor
Advisory Members

Posts: 3,381
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: #13
RE: New BiPap machine
I used the 560 last night and had a great night. While I've been trying to work with higher pressure support, statistically it is not my best treatment, however it is very comfortable and good enough. My best BiPAP prescription is EPAP min 10 cm, PS 2-4 (auto), IPAP max 18. That is both comfortable and works well.

On the 560, I generally run 11-14 auto A-Flex 1 and is close to results on BiPAP.

It is interesting to run the BiPAP with a lot of pressure support, and I can actually feel the machine kick in on a hypopnea or CA and add pressure for the inhale. Nevertheless, I consistently have higher AHI when I use that pressure support.

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04-29-2015 04:48 PM
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iSnore Offline

Preferred Members-2

Posts: 148
Joined: Apr 2015

Machine: Phillips-Respironics DS560TS REMstar Auto
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: Phillips-Respironics DS6T Heated Tube
CPAP Pressure: 9-13 A-Flex 2
CPAP Software: SleepyHead EncoreBasic

Other Comments: SYSTEM ONE resistance set to X1 for P10

Sex: Male
Location:

Post: #14
RE: New BiPap machine
Thank you, sir!
04-29-2015 05:41 PM
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Sleeprider Offline
Wiki Editor
Advisory Members

Posts: 3,381
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: New BiPap machine
I think it's interesting that I can get better rest with the BiPAP in spite of higher AHI, and I think it comes down to a higher RERA being the difference, and the fact the apneas I have on BiPAP are mainly CA events that really are not of long enough duration to wake me.

The other take-away is that, there are so many different ways to get good treatment with a BiPAP unit. It takes a while to try the alternatives and see what works best.

Compare last night on the 550 with great AHI but not so great RERA:

Periodic Breathing 0.00%
Large Leak 0.00%
Clear Airway 0.30
Obstructive 0.00
Hypopnea 0.20
Flow Limitation 0.90
RERA 2.11
Vibratory Snore 0.60
Pressure Pulse 0.90

Typical 760 with Pressure Support of 5 to 8 and EPAP at 8.0

Periodic Breathing 0.00%
Large Leak 0.00%
Clear Airway 1.34
Obstructive 0.56
Hypopnea 0.33
Flow Limitation 0.33
RERA 0.33
Vibratory Snore 0.67

And BiPAP with IPAP 10.5 and PS of 2.5-4.5


Periodic Breathing 0.00%
Large Leak 0.00%
Clear Airway 0.97
Obstructive 0.00
Hypopnea 0.54
Flow Limitation 0.11
RERA 0.32
Vibratory Snore 0.00

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04-30-2015 05:07 PM
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iSnore Offline

Preferred Members-2

Posts: 148
Joined: Apr 2015

Machine: Phillips-Respironics DS560TS REMstar Auto
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: Phillips-Respironics DS6T Heated Tube
CPAP Pressure: 9-13 A-Flex 2
CPAP Software: SleepyHead EncoreBasic

Other Comments: SYSTEM ONE resistance set to X1 for P10

Sex: Male
Location:

Post: #16
RE: New BiPap machine
Thanks! Now I understand better what you posted above. Depending on how my sleep study goes on the 18th, I'm going to wind up with one or the other of these two machines.
04-30-2015 05:28 PM
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vsheline Offline

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Posts: 1,908
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: #17
RE: New BiPap machine
(04-29-2015 04:48 PM)Sleeprider Wrote:  I used the 560 last night and had a great night. While I've been trying to work with higher pressure support, statistically it is not my best treatment, however it is very comfortable and good enough. My best BiPAP prescription is EPAP min 10 cm, PS 2-4 (auto), IPAP max 18. That is both comfortable and works well.

On the 560, I generally run 11-14 auto A-Flex 1 and is close to results on BiPAP.

It is interesting to run the BiPAP with a lot of pressure support, and I can actually feel the machine kick in on a hypopnea or CA and add pressure for the inhale. Nevertheless, I consistently have higher AHI when I use that pressure support.

Hi Sleeprider,

Actually, neither of your machines will treat Central Apneas. Both will put out a Philips Respironics System One "pressure pulse" near the start of an apnea in order to determine whether it is central or obstructive, and if the apnea is central the machine will not change its pressure settings.

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.
05-04-2015 09:30 AM
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vsheline Offline

Advisory Members

Posts: 1,908
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: #18
RE: New BiPap machine
(04-30-2015 05:07 PM)Sleeprider Wrote:  I think it's interesting that I can get better rest with the BiPAP in spite of higher AHI, and I think it comes down to a higher RERA being the difference, and the fact the apneas I have on BiPAP are mainly CA events that really are not of long enough duration to wake me.

The other take-away is that, there are so many different ways to get good treatment with a BiPAP unit. It takes a while to try the alternatives and see what works best.

Compare last night on the 550 with great AHI but not so great RERA:

Periodic Breathing 0.00%
Large Leak 0.00%
Clear Airway 0.30
Obstructive 0.00
Hypopnea 0.20
Flow Limitation 0.90
RERA 2.11
Vibratory Snore 0.60
Pressure Pulse 0.90

Typical 760 with Pressure Support of 5 to 8 and EPAP at 8.0

Periodic Breathing 0.00%
Large Leak 0.00%
Clear Airway 1.34
Obstructive 0.56
Hypopnea 0.33
Flow Limitation 0.33
RERA 0.33
Vibratory Snore 0.67

And BiPAP with IPAP 10.5 and PS of 2.5-4.5


Periodic Breathing 0.00%
Large Leak 0.00%
Clear Airway 0.97
Obstructive 0.00
Hypopnea 0.54
Flow Limitation 0.11
RERA 0.32
Vibratory Snore 0.00

Hi Sleeprider,

Your case shows why RDI is a better measure of sleep quality than AHI.

The Respiratory Disturbance Index (RDI) is the sum of the Apnea plus Hypopnea Index (AHI) plus the Respiration Effort-Related Arousal (RERA) index.

Your RDI is about the same whether you use the Auto machine or the BiPAP Auto machine, but, as you have pointed, with BiPAP Auto your AHI is mostly CAs which happen to be short and apparently are not causing arousals and are not as disturbing to your sleep as RERAs are.

RERA events are actual arousals caused by partial obstruction of the airway and the needing to exert excessive effort, but the excessive effort had been successful enough in maintaining airflow that the reduction in airflow was too little for the event to be classified as an Hypopnea.

The higher the amount of PS, the higher the number of CAs you get, but the fewer RERA.

On the Auto machine, A-Flex settings of 1, 2 or 3 all add 2 cmH2O of pressure relief during exhalation, plus at least a small amount of additional pressure relief based on the rate of airflow. A setting of three adds the most pressure relief while we are actively exhaling. But a setting of 3 also reduces the IPAP pressure too early at the end of inhalation, while we are still trying to finish the last bit of our inhalation, as the rate of inhaling air is slowing down.

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: 05-04-2015 10:16 AM by vsheline.)
05-04-2015 09:53 AM
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Sleeprider Offline
Wiki Editor
Advisory Members

Posts: 3,381
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: #19
RE: New BiPap machine
Thanks Vsheline for responding to this. I was away for a weekend motorcycle rally and had not looked in on the forum. Appreciate your insights. My treatment is just fine with either machine, but it is an interesting paradox that with the BiPAP I have somewhat higher AHI consisting of mostly CA that isn't treatable with pressuree, but low RERA, while the APAP produces consistently low AHI but higher RERA. I guess I can take my choice. Smile

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05-04-2015 02:55 PM
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Sleepster Offline
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Posts: 4,995
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #20
RE: New BiPap machine
(04-29-2015 01:52 AM)brianwood619 Wrote:  Max Ipap: 25.0
Min Epap: 8.0
PS: 9.0

Assuming no ramp, you start out with an EPAP (exhale pressure) of 8.0. To get the IPAP (inhaling pressure) we add the PS of 9.0 to get 17.0. As you breathe the machine will raise and lower both the IPAP and the EPAP, but always keep them apart by 9.0. The highest your IPAP can go is 25.0, so at that time you'd have an EPAP of 16.0.

So IPAP ranges from 17.0 to 25.0.
EPAP ranges from 8.0 to 16.0.
PS is always fixed at 9.0, so IPAP minus EPAP is always 9.0.

PRS1 BiPAP's allow the PS to vary and they also have Bi-Flex which lowers the EPAP even further and changes the shape of the inspiratory portion of the pressure graph.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
05-04-2015 08:30 PM
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