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bi-level ST and the AVAPS machines
#1
I think I read a post here that mentioned a post or maybe a wiki article with information about the types of machines available. I am interested in finding out about/reading about PAP machines that can act as non-invasive ventilators----they are the bi-level ST and the AVAPS machines (I read this in a post that robysue posted). Can someone tell me where to look for this information on this forum?

Thanks.
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#2
Hi me50 - I'm not sure where it is on the forum, though I did see a very detailed post by Robysue a week or two back. The Resmed site has a lot of information about their non-invasive ventilators, though it's a matter of separating the technical information from the sales pitch.

http://www.resmed.com/au/products/ventil...clinicians
DeepBreathing
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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.
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#3
me50,

The bi-level ST machines and the ASV machines are both much, much more expensive than either a CPAP/APAP or a simple bi-level machine. And they are typically harder to get used to sleeping with because of the substantial pressure changes needed to "trigger" the inhalations. The way the machine triggers an inhalation is to sharply and significantly increase the IPAP while leaving the EPAP along. On bi-level ST and ASV machines, the PS= IPAP - EPAP can rather suddenly increase from a modest 3-4 cm of pressure to a substantial 10-15 cm of pressure (or more). And that huge change in pressure between IPAP and EPAP continues to happen as long as the machine is detecting a need to trigger inhalations ....

Bi-level ST and ASV machines are typically prescribed to patients with serious problems with CAs that persist after several weeks to several months of PAPing. In other words, they are typically prescribed when the problem is either Central Sleep Apnea or Complex Sleep Apnea. Most insurance companies will require the patient to first try (and "fail at") CPAP, APAP, and regular bi-level before they will authorize a switch to a bi-level ST or an ASV machine.

The reason is simple: True Central Sleep Apnea is actually pretty rare. And while 10% of new PAPers develop some issues with central apneas after starting CPAP therapy, many of those people with pressure emergent CAs actually wind up doing fine on a CPAP, APAP, or a plain bi-level after their body fully adjusts to the machine. In other words, once the patient is sleeping with the machine for several weeks, the problem with CAs resolves itself and the needed pressure is no longer inducing CAs in enough numbers to be clinically important. Hence the phrase Complex Sleep Anpea is used to diagnose those PAPers with OSA whose problem with emergent central apneas does not go away simply by giving the body enough time to learn how to sleep with the PAP machine blowing air down the upper airway all night.

That said, why are you looking for info on bi-level ST and ASV machines??? And what kind of info do you want to know?
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#4
I wanted to know more about it because when I was at the DME yesterday, she said something about the ST and also told me that I would not want a bipap auto because it would cause too much air in my stomach. I told her that with a bipap it would not cause as much air to be in the stomach as it is with an auto where the pressure would be the same on inhale and exhale if you don't have the EPR on. She also said that nobody should use the EPR higher than 1. When I had my last titration study, I was on a bipap and the tech told me that the machine he used would adjust the pressure breath by breath. I was just trying to understand about the machines you spoke of in another post. I had not heard of the ST before but had heard of the ASV and don't think I need one of those FYI.
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#5
I used to have horrible aerowhatever (air in stomach) with every pressure change my doc made. But with my Autoset, I've not had any at all. And I've gone from a CPAP setting of 12 to an APAP setting of 12-18 with 95% being 17. So I don't think APAP would cause more air. I think it would cause less air as it is changing as the needs change vs the constant pressure whether you need it or not.

The person who told you about the EPR was weird. But you probably already know that.

If you are paying out of pocket, a BPAP is going to cost you a small fortune. If you are going to try and get your insurance to pay for it, good luck. Unless you are failing compliance with the CPAP and unless you have a lung condition preventing you from breathing out against an EPR setting of 3, they aren't going to pay for it. And, really, why would you want one?
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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.




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#6
I don't want an ST or ASV unless my doc says I have to have it and I doubt that is the case and as far as BIPAP goes, that is my doctor's call because I am having trouble with APAP. I will see what he says once he looks at my last titration that I had 2 weeks ago.

EDIT: As far as the EPR issue goes, I betcha you remember the stories about Apria. There you have it
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#7
A bi-level machine (Resmed VPAP, auto) will do what you are looking for, except it will not 'start a breath for you' - you need an ASV machine to get that function.

My 'VPAP Auto 25' - think "S8" version - can do; CPAP, Manual Bi-Level (All settings locked in), and Auto Bi-Level (set min EPAP, MAX IPAP, and PS - and the machine auto-changes within the ranges set).

EPAP is the pressure when not inhaling.
IPAP is the pressure when inhaling
PS is 'pressure support' which is the difference between EPAP and IPAP.

On my machine, PS is a locked number, manually set by the user. So if EPAP is raised, so is IPAP.

Then there are settings like 'trigger' and 'cycle' that basically changes how fast the machine changes from one type to the other - I like the 'trigger' on high, so IPAP comes in fast, and 'cycle' to be on MED, so the change to EPAP comes in a bit slower - hope that makes sense.

So for instance, right now my min EPAP is at '7', and PS is at '8', and max IPAP is at 25. And my pressure graph bounces around 15-17 during the night.

The newer model "S9" can act on more issues, and detect 'centrals' (which mine can't see).

That's bout all I know myself. I do like my machine, but it's looking like I will need to move to an ASV machine (we're thinking). My machine was the cutting edge - the best of the best - when I got it.
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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#8
Peter_C does BIPAP change pressure with every breath if it needs to? I ask because a tech told me that the BIPAP they used in my titration did that. I don't mean start an inhale.
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#9
Yes - a full breath cycle - which is both an inhale and an exhale is "ONE". Plus, it will watch the pattern of your breathing - both how often, and how deep/shallow it is - and will do stuff if it doesn't like any changes that happen.

A lot of the stuff I read is frankly beyond me... But the short version is a current model bi-level will do everything *except* breathe for you - for that you need an ASV machine.

The different brands both say they are the best, shrug, they each do things slightly differently, but have basically the same features.

Remember, my use and knowledge is on a older model machine, the rest I have only read about.
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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#10
(12-21-2013, 09:02 PM)me50 Wrote: does BIPAP change pressure with every breath if it needs to? I ask because a tech told me that the BIPAP they used in my titration did that. I don't mean start an inhale.

I think the tech was probably trying to say the bi-level machine changes its pressure with every breath (meaning between EPAP and IPAP).

On an S9 Elite or S9 AutoSet, EPR does the same thing but the difference between EPAP and IPAP can only be 3 using EPR. On the S9 AutoSet the EPAP will automatically adjust to prevent obstructive events.

On bilevel machines the difference between EPAP and IPAP, which is called Pressure Support (PS), can be set as high as perhaps 10 cm H2O, if desired.

On standard bi-level, like the S9 VPAP S, the EPAP and PS are fixed values unless manually changed.

On an Auto bi-level, like the S8 VPAP Auto 25 or S9 VPAP Auto, the EPAP will automatically adjust to prevent obstructive events, and PS is fixed until manually changed.

On a bilevel ST, like the S9 VPAP ST, if we don't start a breath on our own the machine will automatically start transitioning between EPAP and IPAP at a normal breathing rate but the EPAP is fixed and the PS is fixed.
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.
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