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+0.5 blast of air
#1
I use a Respironics System One, set to a pressure of 6 in CPAP mode, no ramp. I use nasal pillows. This CPAP infuriates me so much, I have stopped using it out of frustration.

Here's what's going on. I will be drifting off to sleep, at which time the machine delivers a sudden +0.5 pressure blast of air straight into my nasal pillows and down my throat, which startles me awake. I finally calm down and relax enough to fall asleep, and just as I'm drifting off, wham!, another +0.5 pressure puff of air is shoved down my throat, startling me awake again. By this time, it's tougher to fall asleep, but eventually I calm down enough to fall asleep. And boom! Another blast of air down my gullet startles me awake again. After three of these startling events, I am just about in tears and wide awake.

Hate is a strong word, but I hate my Respironics System One CPAP for doing this. I also understand that there are other CPAP machines that do not have this aggravating +0.5 pressure puff "feature" in their control software and I am shopping around for another machine that does not have this software feature.

I have tried an older REMStar Pro Series M CPAP, which does not have this feature in the software, but the machine is too noisy at a pressure setting of 6.

I am posting to this forum, soliciting your recommendations for CPAPs that do not have this feature in their software. Please, good forum folks, what machines operate silently and do not have this +0.5 sudden pressure blast feature in the software?

Thank you!
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#2
(11-07-2016, 02:03 PM)Jimboiii Wrote: I am posting to this forum, soliciting your recommendations for CPAPs that do not have this feature in their software. Please, good forum folks, what machines operate silently and do not have this +0.5 sudden pressure blast feature in the software?

Thank you!

Might I suggest that you download SleepyHead software and see if this pressure pulse is in response to an apnea or hypopnea and if the pressure spike is displayed as a pressure spike. If the pulse is in response to an event, perhaps your pressures need adjusting. Or, alternatively, if the spike is not shown, it may indicate a machine malfunction.

Might I also suggest that you speak to your DME provider or, more specifically, their respiratory technician to resolve the issue.

Discontinuing therapy is generally a bad idea as a cure for frustration. Best of luck resolving the issue.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#3
Not sure if you are using an Auto Cpap in Cpap mode or if your machine is a straight pressure cpap.

The Phillips Respironics machines use a Pressure Pulse to determine if an Apnea is obstructive or central. These are very short and you shouldn't be noticing them.

If it's an obstructive Apnea (meaning that your upper airway is collapsing, and breathing is interrupted for 10 seconds or more), then the machine will attempt to raise the pressure to overcome the Apnea event.

If the event is Central ( the airway is open, and your brain is not telling you to breath), the machine will not raise pressure.

Now with that said, if you are using a straight pressure cpap machine, I doubt you are feeling pressure pulses, because the machine cannot react or raise pressure in response to an Apnea event if not set to auto.

I suspect that you may have a CFlex setting enabled, and that is what you are feeling. Check your settings and turn off any Flex settings and see if that helps.

You should download the SleepyHead software, as that would show you if those are pressure pulses.

What has your AHI reading been? Without software, how do you know what is going on? I suspect you may need a higher pressure than 6cm, and your arousals may not be from pressure pulses, but from a collapsing airway.


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#4
SRLevine, Thank you for your input. Of course this pressure pulse is a response to conditions detected by the software. I did discuss it with my respiratory therapist, who shrugged and said, "It's the control software and there's nothing you can do about it." I was issued the wrong machine because not all CPAPs are programmed to behave in this fashion. Can you or anyone on this forum help me identify which CPAPs do not behave in this fashion and which ones do?

Thanks again,
jim
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#5
Thanks OpalRose, Exactly. I am discussing Phillips Respironics machines' Pressure Pulse to determine if an Apnea is obstructive or central. Whether or not I'm "not supposed to feel it," I very much do feel it, and it feels like a puff of air slammed into my nasal pillows and windpipe when I am on the threshold of sleep and it startles me awake.

Not every CPAP is programmed to use a puff of pressure to determine the nature of an apnea event. Can you or anyone on this forum help me identify which CPAPs are not programmed in this fashion and which ones are?

Thanks again,
jim
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#6
The Resmed machines use a force oscillation technique to determine clear or obstructive apnea. This is a much lower amplitude, higher frequency pressure fluctuation. Most of us are unaware of the pressure pulse or FOT, but there are some sensitive individuals. The older machines did not do any of this as they didn't differentiate types of apnea. You can find a number of machines that do not have this behavior, but the trade-off is they don't provide detailed efficacy data. The basic CPAP models by Philips and Resmed do not have pressure pulse or FOT, as well as the new Resmed AirSTART models. All are considered a downgrade from your current auto cpap.
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#7
More information on this pressure pulse: Let's say I have to get up for a "bio break." I leave the nasal pillows and headgear on my head and disconnect at the connecting hose, leaving the main hose blowing at full pressure, unobstructed. And I can hear the pressure pulse. It cycles three or four times when my CPAP is blowing at full, unobstructed pressure.

But this information is not relevant to my request. I just want to know which CPAPs do not use a pressure pulse for any reason, produce a constant pressure, and run silently.

Thanks!
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#8
(11-07-2016, 04:32 PM)OpalRose Wrote: If it's an obstructive Apnea (meaning that your upper airway is collapsing, and breathing is interrupted for 10 seconds or more), then the machine will attempt to raise the pressure to overcome the Apnea event.

If the event is Central ( the airway is open, and your brain is not telling you to breath), the machine will not raise pressure.

Now with that said, if you are using a straight pressure cpap machine, I doubt you are feeling pressure pulses, because the machine cannot react or raise pressure in response to an Apnea event if not set to auto.
The PR machines use the PP (that 0.5 pressure pulse) to differentiate between CAs and OAs. And that's true regardless of whether the machine is running in fixed CPAP mode or APAP mode. The PR System One ELITE and DreamStation ELITE fixed CPAPs also use the PP to distinguish between CAs and OAs.

Even though a PR machine running in fixed pressure mode cannot "respond" to an OA, it's still important for the machine to properly distinguish between OAs and CAs. So the PP are there even in the fixed pressure machines that record full efficacy data.


Quote:I suspect that you may have a CFlex setting enabled, and that is what you are feeling. Check your settings and turn off any Flex settings and see if that helps.
Some people CAN feel CFlex kicking in. But CFLex happens on EVERY single exhalation. The OP is talking about something different.

I suspect that the OP happens to have a few perfectly normal sleep transitional CAs just as s/he is dropping off to sleep. The PR S1 needs to figure out whether to score a CA or an OA, and hence it delivers the PP. Which wakes the OP back up.

To the OP: You may find the Resmed FOT algorithm for distinguishing between OAs and CAs less disturbing. Or it could be that the FOT algorithm may be more bothersome. Still, it's worth seeing if the DME might be willing to let you try a Resmed machine for a few days.
Questions about SleepyHead?
See my Guide to SleepyHead
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#9
(11-07-2016, 06:03 PM)Jimboiii Wrote: But this information is not relevant to my request. I just want to know which CPAPs do not use a pressure pulse for any reason, produce a constant pressure, and run silently.
If you are willing to give up all efficacy data, then any quiet brick will do what you want.

If you want efficacy data, you might find the FOT algorithm of the Resmed machines less disturbing. But the FOT uses small oscillations in pressure to distinguish between CAs and OAs. Some people find them annoying and some people don't. For what it's worth, I was bothered by the FOTs, but the PP on a PR machine are much less problematic. But that's just me and a lot of people find the PR PP worse than the Resmed FOTs.

You might also look into the F&P machines and the DeVilbass machines: If I recall correctly their Auto algorithms do not try to distinguish between CAs and OAs, but they do track total number of events
Questions about SleepyHead?
See my Guide to SleepyHead
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#10
(11-07-2016, 05:55 PM)Sleeprider Wrote: The Resmed machines use a force oscillation technique to determine clear or obstructive apnea. This is a much lower amplitude, higher frequency pressure fluctuation. Most of us are unaware of the pressure pulse or FOT, but there are some sensitive individuals. The older machines did not do any of this as they didn't differentiate types of apnea. You can find a number of machines that do not have this behavior, but the trade-off is they don't provide detailed efficacy data. The basic CPAP models by Philips and Resmed do not have pressure pulse or FOT, as well as the new Resmed AirSTART models. All are considered a downgrade from your current auto cpap.

Thank you, Sleeprider! Finally some information! Quite honestly, I do not care if the machine is a downgrade, as long as it doesn't exhibit this aggravating behavior! As I said in my original post, I tried the RemstarPro Series M downgrade which does not have this pressure pulse, and I liked that, but the machine was noisy at a pressure setting of 6, which is unacceptable. Can you please provide the names of the basic CPAP models by Philips and Resmed that do not have pressure pulse or FOT, and I'll take it from there.

Thanks again,
-jim
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