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brooksea

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The dino model of BiPap my husband has is an ST (Spontaneously Timed). He would like a newer model, as they are smaller and portable.

Was wondering if the ST model is necessary for a PALS. The ST is there in case the patient does not breathe. Would this be the case for a PALS, since the diaphragm's muscles weaken and FVC is measured on a regular basis? I would think if FVC is so low it would be time for a vent. Perhaps I don't understand the whole picture.

Maybe a stupid question, but wondering what other PALS are using as far as BiPap equipment...
 

Al

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I have a Syncrony ST. It's about as big as a shoebox but a bit taller. To the best of my knowledge the S/T is the best for us because if we fail to take a breath it will push one in after a set time. With decreased resp. function I am told this is important.
AL.
 

fiddleplayer51

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CJ,
We were first set up with a ResMed VPAP III, but have had so much trouble with the company we got it through that I requested that our ALS clinic rewrite the order and start all over with another company in our town. (I wrote all about it in my thread "Major BiPAP Woes" in case you didn't see it).
I read posts on this forum to find out what others were using and Al mentioned the Synchrony s/t by Respironics. I googled Respironics and read about the Synchrony line and it specifically mentions that ALS and neuromuscular patients may benefit from the Synchrony BiPAP line. The other Respironics BiPAP models didn't mention using with ALS and NMD patients. I am therefore specifying that we be issued a Respironics Synchrony s/t from the new company.
About s or s/t (spontaneous or spontaneous/timed) here's a quote from that article by Margie Petrakis RN that I gave a link to in the Caregiver forum in answer to the thread "possible start of bipap...have questions":

"The primary muscle of respiration is the diaphragm, a large muscle situated under the lungs. When the diaphragm contracts during inspiration, it moves downward and opens up the lungs, causing air to flow into the lungs. When the diaphragm relaxes, it moves upwards and pushes air, now containing carbon dioxide, back out of the lungs. If the diaphragm becomes weakened in ALS, it impairs the ability to take a deep breath. Other muscles involved in breathing are termed the “accessory muscles of respiration” and include the neck, chest, abdominal and back muscles...When the diaphragm is weak, these muscles end up doing some of the work of breathing to help keep oxygen and carbon dioxide levels normal... During deep sleep, the accessory muscles “turn off” and the only muscle working is the diaphragm...

The term “BiPAP”, is derived from “bi” meaning two (as in inhalation and exhalation) and PAP meaning positive airway pressure (positive pressure means air is pushed into the lungs). We prefer the term non-invasive positive pressure ventilation (NPPV) for this type of device since BiPAP is actually only the name of the original bi-level machine. There are other machines now available that do the same thing. NPPV designates two levels of positive pressure in the airways of the lungs. The machine applies a maximal amount of pressure directly into the airways when it senses that the patient is beginning inspiration (IPAP – inspiratory positive airway pressure). A second, smaller amount of pressure is exerted on expiration (EPAP- expiratory positive airway pressure). This lower amount holds the airways open and keeps the level of oxygen elevated to normal. When NPPV is set up on ALS patients, a “backup” breathing rate is usually set as well. If the breathing rate falls below a set level, the machine can automatically give additional breaths."

The part in red about a backup breathing rate being set as well means that the BiPAP machine must have not only the capability of giving spontaneous breaths, but also the capability of giving timed breaths. Therefore, the s/t would seem to be essential for ALS patients as the diaphragm weakens since during deep sleep the accessory muscles aren't working.
Hope this helps.
Jane
 

patricia1

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Just Curious

Hey guys
What are your settings on your Bi Pap I am at 10.5

Thanks Pat
 

fiddleplayer51

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Pat,
Ours is at 10/5 also.
Jane
 

joelc

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I started out with the ST model but it is older technology and did not work well for me, so they gave me a Harmony model, it is still a Respironics product. It is newer technology and can be setup very nicely to give you breaths if you forget to take one - it is a wonderful unit.
Actually the ResMed VPaP is an even better product, but since you have had trouble with the supplier you might be wise to stay with the Harmony. I also have a battery for my Harmony which allows me to take it anywhere.
 

Al

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My IPAP is 18 and EPAP is 8. Rate is 18 BPM.
AL.
 

brooksea

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Thank you all for this very valuable information.

Jane, thanks for the detailed explanation. I get it now! Spontaneous AND Timed!

I've been reading so much about equipment that I can't keep it all straight, even though I try to make files for it all!

Thanks y'all for clearing up my confusion! Sometimes I'm dumb as dirt!:shock:
 

fiddleplayer51

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You're welcome, CJ. I'm like you, I've read about equipment so much that I can't keep it straight either and am always wondering where the hay I read something. Then I have to go looking for it again!

Joel,
I was curious as to why you feel the ResMed VPAP is even better? So s/t is an older concept? How does your BiPAP give breaths?
We've still not really communicated with the new company and I want to have all my ducks in a row before real dialogue with them starts. Thanks for any input and thanks for mentioning the Harmony. I'll go read about it now.
Good luck all!
Jane
 

patricia1

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Do you use the humifier with your Bi pap or without I use without but cant use it more than 4 hours

Pat 1
 

joelc

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The Harmony unit has more settings so you can set it to give you a breath (forced breath) if you don't take one on your own. You can set the time, I have mine set for five seconds. What that means is if I don't call for a breath after five seconds it will give me one.
The VPaP is even more sensitive and triggers to give you a breath much easier than other units. It also has more control over this than other units.
Hope this helps answer your question.
If not let me know.

PS - I always use the humidifier, and have it set to last about 12 hours before running out of water.
 

cajuntexusa

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Charlie has a BIPAP and his settings are IPAP 12, EPAP 5, Backup Rate 12. His lung capacity is 53%.

It has a heated humidifier.

He is still trying to get used to it and uses it about 5 hours each night.

Take care,
 

fiddleplayer51

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Thanks Joel. That does help. I'm still planning on asking the new company for a Respironics Synchrony s/t based on the fact that it specifically mentions being of benefit to ALS and NMD patients, but hope we're not disappointed in its performance compared to the ResMed VPAP III my PALS is still using until the switchover to the new company happens. I did read about the Harmony also.
We've still never gotten the humidifier and my husband's mouth gets so dry during the night.
All the best,
Jane
 

joelc

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Jane, you have to get a humidifier, it really helps. I really recommend the Respironics Harmony over the ST. It is much closer in performance to the VPAP and is the new generation unit replacing the ST. Please don't discount it too quickly, it really does work better than the ST. (From my experience)

God Bless,
Joel
 
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