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Are Auto-Adjusting Machines Smart or Dumb?
breaking this off as a separate topic, which explains why this is an excerpted from another comment i made on a different thread, but the ultimate question is just how smart or dumb auto-adjusting machines are...
"On the one hand, I'm with Duane that these machines are too "dumb" as they stand right now. Think about it: the machine doesn't know until it's too late -- until you already have had the apnea event -- that it needs to up the pressure. It's purely reactive, not proactive. But on the other hand, I think the future of auto-adjusting machines is bright -- i can see the day in the not too distant future when they displace CPAP altogether. I think that day will have arrived when the APAPs are smart enough to detect on a breath-by-breath basis what is going on with airflow, and to raise the pressure proactively to eliminate the apnea before it occurs. The machines sort of have to predict the future, and react just in time to save the patient any arousal. Or are there machines out there that already do that and I'm just not giving them enough credit?"
"On the one hand, I'm with Duane that these machines are too "dumb" as they stand right now. Think about it: the machine doesn't know until it's too late -- until you already have had the apnea event -- that it needs to up the pressure. It's purely reactive, not proactive. But on the other hand, I think the future of auto-adjusting machines is bright -- i can see the day in the not too distant future when they displace CPAP altogether. I think that day will have arrived when the APAPs are smart enough to detect on a breath-by-breath basis what is going on with airflow, and to raise the pressure proactively to eliminate the apnea before it occurs. The machines sort of have to predict the future, and react just in time to save the patient any arousal. Or are there machines out there that already do that and I'm just not giving them enough credit?"
Views: 74
Replies to This Discussion
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Permalink Reply by Daniel on
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There is no cost difference in manufacturing them because the only difference between an Auto and a fully data-capable CPAP is the software loaded into the device. The manufacturers charge retailers, both online and brick and mortar, a premium for Auto.
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Permalink Reply by RockRpsgt on
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Daniel I actually have a neighbor who claims that her father,after years of fighting with CPAP,built a pressurized box around hs bed. I am waiting to here back from her and her father on the exact data of the experiment. She calims that at one time these experiments blew a 2x4 through the bedroom wall of her house landing in the side yard. The report that I recieved that her father figured out that at a pressure equal to 3500" below sea level the apneac events disappeared. Like I said though as of this point it is all heresay. I am hoping to see the actual results soon. Sorry to highjack the post.
Daniel said:Rock Hinkle said:You could always pressurize your bedroom.
I used to wonder about this very question myself. Or its varitation - If wearing a mask is so uncomfortable, why not have the hose feed a plastic bag tied around your neck (with exhalation holes, of course)? Seems logical to me.
The answer seems to be in your ears. If your ears are getting the same pressure as your upper airway, it isn't really positive pressure at all - it's just the room pressure.
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That's pretty funny, Rock. Hard to believe it's for real, though.
Daniel
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Permalink Reply by Judy on
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j n k said:
D*mn it, jnk, you just had to go and "say out loud" what I've been worrying about - that Respironics' bi-level auto pressure support might well be the better therapy for me than my beloved Resmed VPAP Auto's pressure support. You just HAD to bring the issue up, didn't you? You have no idea how much I dislike the platform, the two cords, the heavy box on the second cord, the EncorePro software, the limited data via the LCD screen .... NOTHING to do w/the therapy, just the features I've mentioned. *sigh* I'd rather stay on my VPAP Auto in auto mode than switch despite I do have a lightly used (226 hours) Respironics pre-M Series Bi-PAP Auto w/Bi-Flex here. And I even have the software and cable reader. *sigh* I know, I know, I should at least give it a try. But I'd rather stick w/my VPAP Auto in auto mode and not have to use the Respironics except in an emergency. Which hopefully will be never.Good stuff, Daniel, as always.
If you don't mind my asking, what is your take on the differences in approach between the ResMed and the Respironics autobilevels. Does one approach seem smarter in practice than the other, such as in how ResMed keeps the pressure support the same whereas the Respironics varies it, for example? That difference seems like a significant one. (I figure the question is fairly on topic, since it is about smartness of autos). I use a ResMed autobilevel, but I am curious about the Respironics one. Any comments from you or any of the other pros or users here?
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j n k said:Good stuff, Daniel, as always.
If you don't mind my asking, what is your take on the differences in approach between the ResMed and the Respironics autobilevels. Does one approach seem smarter in practice than the other, such as in how ResMed keeps the pressure support the same whereas the Respironics varies it, for example? That difference seems like a significant one. (I figure the question is fairly on topic, since it is about smartness of autos). I use a ResMed autobilevel, but I am curious about the Respironics one. Any comments from you or any of the other pros or users here?
jeff
(Mods are welcome to kick this question to its own topic, if that would be better.)
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I'm not 100% sure, but I believe the AutoBilevels for each brand use the same or similar algorithms for each brand's AutoCPAP. I wouldn't say that one is better than the other.
Other differences I've noticed between the Respironics AutoBiPAP and the ResMed VPAPAuto25:
- I can't remeber for sure which does which, but I believe the ramp on the AutoBiPAP starts with the EPAP minimum and the IPAP at EPAP plus Pressure Support, whereas the VPAPAUTO25 starts both IPAP and EPAP at the ramp start level, gradually fanning out to the IPAP/EPAP levels. I believe this approach is probably much more comfortable for a newbie
- BIPAP Auto has BiFlex, an easy way for the patient to tweak the transitions between IPAP and EPAP. VPAP AUTO25 must be tweaked by the clinician, but it has many, many more nuances that can be tweaked. For example, the sensitivity from IPAP to EPAP, independent from the sensitivity from EPAP to IPAP, the speed of transition from EPAP to IPAP; the speed of transition to EPAP; the minimum and maximum lengths of inhale time for IPAP. This is complex stuff that you can't expect to get perfect from the get go, because unless you're in a lab environment, you can't make the adjustments based on actual sleep. You have to have the patient use it for a while, then self-report on the experience and tweak according to your interpretations of their problems.
- The VPAPAUTO25 is unbelievably quiet in comparison to the BiPAP Auto - hands down
One is not better or worse than the other - just different. I've set up about the same number of each.
Daniel
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Judy,
It's very clear that the VPAPAUTO25 is the superior device for you. Don't even think about changing...
Daniel
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I thought the only difference between the VPAPAUTO and the VPAPAUTO25 was that the 25 can be set to go as high as 25cmH2O, but otherwise, everything else is the same.
j n k said:Judy and I both have the VPAP Auto, not the Auto 25. The VPAP Auto was sort of an S8 1.5 before the true S8 IIs came out.
My understanding is that the BiPAP Auto is set by setting a range of pressure support allowing the distance between EPAP and IPAP to vary throughout the night, whereas the ResMed autobilevels have a set pressure support that never varies--the distance between EPAP and IPAP will always be the same during the night. Another way to say that is that the EPAP and IPAP range independently in the RR, whereas the IPAP and EPAP range together, in tandem, within the range set on the RM.
Daniel said:Judy,
It's very clear that the VPAPAUTO25 is the superior device for you. Don't even think about changing...
Daniel
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Thank you, Daniel. I certainly don't intend to. Not as long as I'm doing so well w/my VPAP Auto in auto mode. It does bug me tho, that this VPAP Auto has all these "comfort" options that I tend to believe could overcome and eliminate that "puff" in Spontaneous mode if I had someone familiar w/it to figure out which adjustments need to be made or to guide me.
I do tend to think tho that the Respironics, given the fluctuation allowed between EPAP and IPAP, might work better for me. There's just too many features I don't like about the Respironics having nothing to do w/the quality of therapy they can provide.
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Nyah, nyah. It ain't a gonna happen anyway, Jeff, except in case of an emergency. I happen to LIKE my Resmed VPAP Auto.
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I had a CPAP and mask for 2-3 months back in 1998 or so, maybe 1996. But the mask was impossible, cut the heck outta my nose and the local DME basically said "T.S." So I told them what they could do w/their precious CPAP and mask. And thus cut my nose off to spite my face for another 8 years. It sure is nice to sleep good again and to feel rested. Ahhhhhhh! *sigh*
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