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[Product Review] Dreamstation Bipap Auto SV
#1
4  to 5

For the last two weeks I have been using the Dreamstation Bipap Auto SV.  

Some caveats and assumptions:

  1. I have altitude-related complex sleep apnea.  At sea level I have OSA, and the higher I go, the more it presents as mixed or complex apnea.  My experience may differ from someone with traditional central or complex apnea.  
  2. I have NO EXPERIENCE with the previous generation of ASV/Auto SV machines, so I can't compare.  
  3. This machine does NOT work with sleepyhead (but I am working on that), it DOES work with Encore Pro 2, and dreammapper. 
  4. Dreamwear headgear was awful with this machine.  My dreamwear normally has a great fit, but with the pressure support moving up and down it loses its seal very quickly and becomes an arousal liability during the night.  I switched back to p10s and they worked like a dream.   
TL;DR:  This machine is exceptional, and if you are looking only at numbers, it's not quite as effective as the Aircurve 10 ASV.  Despite that, I still found the quality of sleep to be excellent, and in some ways better than on the Aircurve 10 ASV.  Its going to be a tough decision as to which machine I ultimately will choose.    

HARDWARE:   5
From a design standpoint, this machine is identical to all other models of dreamstation, except the front face is black instead of white.  I actually find the dreamstation hardware to be aesthetically pleasing, and in many cases to be more attractive than my Resmed models.  It does have the same footprint as other dreamstation models, which is larger than the Airsense/Aircurve line, but the humidifier is detatchable, and the blower is quite small when disconnected.  In Colorado, humidity is a must as the relative humidity is so low, so I keep it attached.  

One difference I have noted from the regular dreamstation:  I can't quite figure out why, but a simple press of the off-button does not stop the blower.  Pressing the off-button stops recording data (time, AHI, etc) but keeps the blower on.  To stop the blower you must hold the off button for 2+ seconds.  

I found the humidifier to run a lot more on this machine than on my resmed's set at a comparable humidity level.  I often had to refill the tub during the night on this machine, and I have never done that with my resmed machines.  This is somewhat a positive for me, as the air in Colorado is very dry, and the more humidity the better. 

I also found the heated hose to be fairly light and less obstrusive than my resmed hoses.  I was able to roll around during the night and rarely felt the hose at all.   

SOFTWARE:  5
The dreamstation software is fairly nice to use.  They have clearly spent quite a bit of time on their UI/UX, and it shows.  On the Bipap Auto SV the software is dark, and has a grey black background.  Navigation is easy, and the placement of menu items has been well thought out.    

My understanding was that previous PR versions of this machine were available as a standard Auto SV and Auto SV advanced.  It seems they have dropped the two models, and this is the only version they offer.    Like the Aircurve 10 ASV, this machine allows for EPAPmin, EPAPmax, PSmin, PSmax, and IPAPmax (which they call pressure max).  Breath per min is set to Auto, or can be manually set by the user.  

This machine also records a ton of data.  It records:
  • Obstructive Events
  • Hypopnea
  • Clear Airway events (although I am not sure how when it is treating them)
  • Vibratory Snore
  • Periodic Breathing
  • Pressure Support data throughout the night
  • Patient triggered breaths
           ** The one thing I can't find is RERA **

ALGORITHM:  4
Like most PR machines, I found that this machine was a little slow to treat obstructive events out with the settings wide open.  When I narrowed the EPAP range, and approached my previous EPAPmin on my vAuto, I noticed that virtually all obstructive events disappeared.  

With central apneas the machine seems to do very well.  I'm not sure how, but it first determined that the event is a central event, and then increases PS to stop it.   This is where it isn't as effective as the Aircurve 10 ASV.  I still found a few centrals sneak through, and they appear in my AHI in the morning. 

I will talk more of the algorithm in a second post.  I intend to post a comparison of the algorithm of both the Aircurve 10 ASV and the Bipap Auto SV as I have used both machines for approximately 2-3 weeks each. 

On the PR machine I average 0.3 AHI - 1.2 AHI per night.   On the Resmed machine I was seeing 0.0 ahi - 0.5 ahi.  

COMFORT/QUALITY OF SLEEP:   5
This is where the PR machine excelled.  Despite the fact that it was less effective than the Aircurve 10 ASV when looking at the numbers alone, it was more comfortable (for me) to use during sleep and often resulted in longer periods of sleep, and less disruption during the night.  Despite issues with breath clipping on other PR machines, I found this machine to sync perfectly with my breath, and was on par with the Aircurve.   Having used the Aircurve 10 vauto, I have always been of the opinion that Resmed has done a much better job of syncing with patient breathing than PR machines, and I was pleasantly surprised that this seemed to be different on the Bipap Auto SV.  

I find PR version of auto-start to be flawed, slow, and generally useless.  On Resmed machines I can take 1 or 2 breaths and the machine is started.  On PR machines I often find I have to take a few heaving breaths to get the machine started, or sometimes it takes longer.  

I felt very rested after a full-night of sleep.  So much so that after the first week, I was less concerned about the difference in numbers between the Aircurve and the Bipap Auto SV. 

CONCLUSION: 
Despite being skeptical of this machine, and a resmed user in general, I found the quality of this machine from a hardware and software standpoint to be exceptional.  The algorithm isn't quite as effective or aggressive as the Aircurve 10 ASV, but the results were equally excellent.  I slept long hours, with minimal arousals, and the quality of the sleep was without equal.  Now the really hard part will be determining which one to buy!   Thinking-about
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#2
Thanks for the excellent review. My opinion of the PR SV machines was significantly influenced by several users who were experiencing high levels of apnea and hypopnea and the machines they were using seemed not to raise pressure to deal with the events. Those were all the older 60 series, and I wonder if a more aggressive SV algorithm may have been implemented in the Dreamstation series.
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#3
ill refrain on guessing whether they have updated the algorithm since I haven't used the previous. What has been fairly evident is that PR seems to want to balance comfort and aggressiveness, and given how refreshed I feel when I wake up they seem to have succeeded.

My limited experience with the Dreamstation APAP, and Auto Bipap was not similar to this. I found them slower to respond, and i was getting noticeable improvements in sleep quality with Resmed devices.

I'm working on a comparison of the two algorithms based on my usage. I think there are some pros and cons to both. I suspect given the way I have noticed these machines respond, the Aircurve would be superior in treating predominant CA.
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#4
Being able to see the mask pressure response is a very visual way of verifying the Resmed reaction to events. This is very encouraging for the Philips machines.
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