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choosing auto bilevel machine
#1
New doc ordered auto bilevel machine. Hubby is failed cpap user that cannot handle exhale pressure and his lungs got badly overinflated with S9 autoset. Trying to decide which machine is best for him ResMed or Respironics. His sleep study was on a Respironics and he felt a couple of quick puffs of air before he was finished exhaling. It seems the machine was testing to see if he was ready for inhale pressure. Does that make sense?

Hubby is a deep breather with a long exhale. Does either the ResMed VPap or the Respironic Bpap machines wait until you are done exhaling before raising the pressure for inhalation? Or do they force air in before you are ready?

Is the jump from exhale pressure to inhale pressure abrupt or is it gradual on either machine?

Thanks
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#2
All I know is Resmed, so I can't say which brand is better, etc... But I *CAN* tell you that you can adjust on the Resmed how weak or strong the inhale must be before the machine switches over, and you can adjust how abrupt the change is too. Have no clue is the other maker offers that or not. I was on a VPAP Auto 25 for many years, and they just switched me back to CPAP for some silly reason.
*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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#3
(08-29-2014, 07:04 AM)MastiffMom Wrote: New doc ordered auto bilevel machine. Hubby is failed cpap user that cannot handle exhale pressure and his lungs got badly overinflated with S9 autoset. Trying to decide which machine is best for him ResMed or Respironics. His sleep study was on a Respironics and he felt a couple of quick puffs of air before he was finished exhaling. It seems the machine was testing to see if he was ready for inhale pressure. Does that make sense?

Hubby is a deep breather with a long exhale. Does either the ResMed VPap or the Respironic Bpap machines wait until you are done exhaling before raising the pressure for inhalation? Or do they force air in before you are ready?

Is the jump from exhale pressure to inhale pressure abrupt or is it gradual on either machine?

Thanks

I am not familiar with the Respironics machines but as far as the Resmed machines are concerned, I can comment. First, I do not believe that the autoset has any adjustment for inhale or exhale time. The VPAP models (like VPAP Auto or VPAP S) are bilevel machines that can be adjusted for individual breathing patterns. First, they provide an adjustable window within which the machine waits to sense your exhale before it responds, which would allow it to be adjusted to your hubby's deep breathing. These machines also have adjustable sensitivity for sensing inhale and exhale. They also have adjustable rise time which adjusts the speed of change from exhale to inhale pressure.

I imagine that the PR machines have the same type of adjustability in their bilevel machines. They may or may not be called by the same names.

Best Regards,

PaytonA
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#4
(08-29-2014, 11:38 AM)PaytonA Wrote: I imagine that the PR machines have the same type of adjustability in their bilevel machines. They may or may not be called by the same names.

Hi MastiffMom,

I suggest you request by email (see the Important Threads section at top of the forum) the two Clinician setup manuals (one for the ResMed S9 VPAP Auto and one for the Philips Respironics System One BiPAP Auto Series 60) and compare the therapy settings which are available on each machine. (Very sorry, but I think you are going to need to become quite familiar with what these two machines can do.)

In some ways the PRS1 BiPAP Auto with heated tubing (which includes RERA detection and automatically-adjusting Pressure Support) is more advanced than the S9 VPAP Auto, but I don't know which machine may be better for your husband.

Regarding your husband, from info you shared in your previous thread (that after ending treatment on an S9 AutoSet with Max Pressure set to 20 "It took about 9 days before his lungs went back to normal" in http://www.apneaboard.com/forums/Thread-...6#pid80116) I am concerned that he may have developed pneumothorax from the Max Pressure being too high. Pneumothorax is potentially dangerous: http://en.wikipedia.org/wiki/Pneumothorax

I think the key thing regarding your husband's therapy would be to aggressively limit the Max Pressure (or Max IPAP) setting to something as low as possible but still hopefully high enough to prevent most of his obstructive events. After you find that the problems seen after his titration (inability to take in a full breath) do not return, perhaps the max pressure setting can be raised, to better avoid obstructive events.

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.
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#5
(08-29-2014, 07:04 AM)MastiffMom Wrote: New doc ordered auto bilevel machine. Hubby is failed cpap user that cannot handle exhale pressure and his lungs got badly overinflated with S9 autoset. Trying to decide which machine is best for him ResMed or Respironics. His sleep study was on a Respironics and he felt a couple of quick puffs of air before he was finished exhaling. It seems the machine was testing to see if he was ready for inhale pressure. Does that make sense?

I was a failed CPAP user myself, with exhalation problems, etc., etc., etc. My full sympathies go to him. Been there, done that.

Last year, I got a PRS1 Auto BiPAP 760 at home for 3 weeks - and I failed no more! Among other things, the 760 established that the initial sleep lab titration was too high (but I could have told them that after a week...) But it took a complete failure to adapt to CPAP to get it fixed.

I'm currently sleeping pretty happily with a PRS1 660 BiPAP. This xPAP does not do auto-adjustment of pressure like the 760, but the numbers indicate I didn't appear to need that level of adjustment, minute to minute, hour to hour or day to day.

My personal experience is that the more capable Respironics machines are plenty "good enough". I really have no complaints other than it won't clean itself and the mask and hose automatically. Smile

Other folks who have the similar, more capable ResMed machines like them at least as well. They're both of the highest quality.

It may come down to personal preferences and comfort between the two families of machines - if your husband could trial each of them for a week each, you and your physician would have some real evidence of which might work best for him. Getting things working is the key right now. It's possible he'd have no strong preference between the two types, though there are differences certainly.

I'd second vsheline's advice about limiting the max IPAP - either of the machine types can move around within the range of what they're told to do, and they need to have that range set correctly.

Good luck, keep us posted on how things are going!
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#6
Thanks for all the replies.



Quote:I suggest you request by email (see the Important Threads section at top of the forum) the two Clinician setup manuals (one for the ResMed S9 VPAP Auto and one for the Philips Respironics System One BiPAP Auto Series 60) and compare the therapy settings which are available on each machine. (Very sorry, but I think you are going to need to become quite familiar with what these two machines can do.)

Good idea. I have the ResMed S9 Autoset CPAP manual and will request the Respironics as well. I did confirm with the DME provider that we have 30 days to exhange the machine if we don't like it.

Quote:Regarding your husband, from info you shared in your previous thread (that after ending treatment on an S9 AutoSet with Max Pressure set to 20 "It took about 9 days before his lungs went back to normal" in http://www.apneaboard.com/forums/Thread-...6#pid80116) I am concerned that he may have developed pneumothorax from the Max Pressure being too high. Pneumothorax is potentially dangerous: http://en.wikipedia.org/wiki/Pneumothorax

Thanks for the info. That sounds exactly like what happened. The doc we went to listened to his lungs but that was all. Doc said if it was a "punctured lung" the pain would be excruiating, which it wasn't ... the shortness of breath and being unable to exhale properly was the worst part. He felt he was starved for oxygen.

Quote:I think the key thing regarding your husband's therapy would be to aggressively limit the Max Pressure (or Max IPAP) setting to something as low as possible but still hopefully high enough to prevent most of his obstructive events. After you find that the problems seen after his titration (inability to take in a full breath) do not return, perhaps the max pressure setting can be raised, to better avoid obstructive events.

We so agree and I just wish the medical providers would get it! The machine is coming with max pressure at 25. Hubby and I will discuss whether to even try that one night or whether to max it out at 11, which was the last pressure the APAP was set to before we changed doctors. I have both Sleepyhead and ResScan so I will be watching closely. When he had overnight study, she had pressures as high as IPAP at 15 and EPAP at 13 and his lungs felt it the next day, nowhere near like before but they didn't feel normal. He had mostly hypopneas even with the max pressure at 15 and she never could get him to stop snoring. Like hubby says if the machine helps him get even 1 breath out of 3 to start with, it is still better than 0 out of 3 until his lungs can get used to the machine and we can increase the pressures. After the last experience we are both very nervous about a max pressure of 25. We want to approach this in baby steps so that we are successful because in his situation, failure is not an option. Unless the snoring is causing a problem for him, I don't care in the least about the noise. Heck, part of the time I can't tell if it is the hubby snorning or the dog.

(08-31-2014, 02:30 PM)APAAW Wrote: I really have no complaints other than it won't clean itself and the mask and hose automatically. Smile

LOL ... and if it only did housework!



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#7
It's probably roughly a tossup for PRS1 vs. S9. Each one has some pros and cons.

The S9 CPAP/APAP machines seem to be somehow "gentler" on the pressure switching in a way that's hard to define exactly. I'm not sure how this correlates to the bilevel machines.

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.
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