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[CPAP] How do I know if my CPAP is working for me?
#21
(04-12-2014, 10:41 AM)aselvan Wrote: I am considering purchasing either PRS1 60 Auto (OR) Resmed S9 Autoset. Any advice on which one?

Hi aselvan, welcome to the forum!

Either unit would be an excellent choice.

From what I learned from the forum, the noise level varies from one machine to the next, even for the same model. Some have trialed both models and decided that the ResMed S9 was much quieter, or that the PRS1 was much quieter. Depends on the acuteness of the person's hearing and on the individual machine. That said, I think I've read more complaints about the S9 units having a slight and intermittent whistle during exhalation, than complaints about noise from the PRS1 units.

I would suggest the S9 AutoSet, because I think ResMed EPR is far more comfortable than PRS1 A-Flex. These both provide pressure relief during exhalation, but the ResMed EPR is much closer to a true bi-level machine by design, because the pressure relief lasts however long we are exhaling, versus A-Flex which (by design) returns to full pressure approximately half way through our exhalation. I found A-Flex annoying, but on the other hand I've never really tried to get used to it, and many people like it just fine.

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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#22
When I first saw the title of this thread I thought someone was trying to pull my leg. The most obvious answer to the question is: You're still here! Whistle

Years ago, at the end of my first sleep study, the doctor informed me that I needed to start using a cpap immediately or risk not getting out of bed some morning. What he actually said was: If you don't use a cpap every night you'll wake up - dead! I suspect he meant it as a joke; but, it's words I've lived by. I have used a cpap every night since the day I got my first one, in 1995. I-love-CPAP
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 OPINIONS ONLY AND NOT NECESSARILY STATEMENTS OF FACT.
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#23
(04-12-2014, 11:01 PM)vsheline Wrote: I would suggest the S9 AutoSet, because I think ResMed EPR is far more comfortable than PRS1 A-Flex. These both provide pressure relief during exhalation, but the ResMed EPR is much closer to a true bi-level machine by design, because the pressure relief lasts however long we are exhaling, versus A-Flex which (by design) returns to full pressure approximately half way through our exhalation. I found A-Flex annoying, but on the other hand I've never really tried to get used to it, and many people like it just fine.

Actually, my observations with a manometer (pressure measurement device) say that this is not completely true.

At the first part of exhale, the pressure drops to well below IPAP - Flex. Shortly thereafter (still during the exhale), the pressure then increases to IPAP - Flex. It only returns to full IPAP at the start of the next inhale.

And yes, I do find the A-Flex completely natural. But that could be because I am used to it.
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#24
(04-14-2014, 01:09 PM)RonWessels Wrote:
(04-12-2014, 11:01 PM)vsheline Wrote: I would suggest the S9 AutoSet, because I think ResMed EPR is far more comfortable than PRS1 A-Flex. These both provide pressure relief during exhalation, but the ResMed EPR is much closer to a true bi-level machine by design, because the pressure relief lasts however long we are exhaling, versus A-Flex which (by design) returns to full pressure approximately half way through our exhalation. I found A-Flex annoying, but on the other hand I've never really tried to get used to it, and many people like it just fine.

Actually, my observations with a manometer (pressure measurement device) say that this is not completely true.

At the first part of exhale, the pressure drops to well below IPAP - Flex. Shortly thereafter (still during the exhale), the pressure then increases to IPAP - Flex. It only returns to full IPAP at the start of the next inhale.

And yes, I do find the A-Flex completely natural. But that could be because I am used to it.

Thank you all for the feedback. I purchased PRS1 60 and used it last night with auto setup with 11-15 as auto range (my sleep study recommended is 13). I feel that I had a very comfortable and good sleep last night... I am planning to check data tonight to see what the machine thought how I slept. I immediately felt the pressure relief during exhalation which is awesome. Noise level is definitely more (especially the change in noise during alternating inhale/exhale) than my Fisher&Paykel icon but I am sure I will get used to it.

Once again thanks for all your feedback.


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#25
(04-16-2014, 08:00 AM)aselvan Wrote:
(04-14-2014, 01:09 PM)RonWessels Wrote:
(04-12-2014, 11:01 PM)vsheline Wrote: I would suggest the S9 AutoSet, because I think ResMed EPR is far more comfortable than PRS1 A-Flex. These both provide pressure relief during exhalation, but the ResMed EPR is much closer to a true bi-level machine by design, because the pressure relief lasts however long we are exhaling, versus A-Flex which (by design) returns to full pressure approximately half way through our exhalation. I found A-Flex annoying, but on the other hand I've never really tried to get used to it, and many people like it just fine.

Actually, my observations with a manometer (pressure measurement device) say that this is not completely true.

At the first part of exhale, the pressure drops to well below IPAP - Flex. Shortly thereafter (still during the exhale), the pressure then increases to IPAP - Flex. It only returns to full IPAP at the start of the next inhale.

And yes, I do find the A-Flex completely natural. But that could be because I am used to it.

Thank you all for the feedback. I purchased PRS1 60 and used it last night with auto setup with 11-15 as auto range (my sleep study recommended is 13). I feel that I had a very comfortable and good sleep last night... I am planning to check data tonight to see what the machine thought how I slept. I immediately felt the pressure relief during exhalation which is awesome. Noise level is definitely more (especially the change in noise during alternating inhale/exhale) than my Fisher&Paykel icon but I am sure I will get used to it.

Once again thanks for all your feedback.

That's great news. It is wonderful to hear someone sounding so good.
Keep up the good work.
Sleep Tight...
Gabby
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#26
As it happens, my sleep study also recommended a pressure setting of 13.

One thing you might want to consider is eventually raising the upper pressure limit from 15 to 20. Setting the lower pressure limit can have a significant effect on your treatment: setting it too high means that you are getting more pressure than you need, and setting it too low means that you can experience an extended period with sub-optimal pressures.

Setting the upper pressure limit is somewhat different. Setting the upper pressure limit too low means that the machine is unable to provide the pressure that it thinks you need, resulting in sub-optimal treatment. This may be a good idea when initially starting out to get used to the pressures, since sub-optimal is better than none. However, setting the upper pressure limit too high has no negative consequences whatsoever. If the machine does not feel that you need the pressure that high, it won't even attempt to get there. But if something happens that makes the machine feel that a higher pressure is (temporarily) needed (eg. rolling on your back), not limiting the upper pressure means that it can provide as much treatment as it thinks you need.
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#27
(04-14-2014, 01:09 PM)RonWessels Wrote:
(04-12-2014, 11:01 PM)vsheline Wrote: I would suggest the S9 AutoSet, because I think ResMed EPR is far more comfortable than PRS1 A-Flex. These both provide pressure relief during exhalation, but the ResMed EPR is much closer to a true bi-level machine by design, because the pressure relief lasts however long we are exhaling, versus A-Flex which (by design) returns to full pressure approximately half way through our exhalation. I found A-Flex annoying, but on the other hand I've never really tried to get used to it, and many people like it just fine.

Actually, my observations with a manometer (pressure measurement device) say that this is not completely true.

At the first part of exhale, the pressure drops to well below IPAP - Flex. Shortly thereafter (still during the exhale), the pressure then increases to IPAP - Flex. It only returns to full IPAP at the start of the next inhale.

And yes, I do find the A-Flex completely natural. But that could be because I am used to it.

Hi Ron,

Here is a link to Respironics web site which discusses A-flex operation, but I think the figure may actually show bilevel Bi-flex, not A-flex.

http://aflex.respironics.com

If (as I think) the plots show Bi-flex (because the ending EPAP pressure is different than the IPAP pressure), then only the first small fraction of an exhalation gets full flex pressure relief, and flex tapers off and typically ends shortly after half way through the exhalation period. (Notice that the plots show the affect of flex settings of 1 versus 2 versus 3, and in all cases the affect of flex ends shortly after half way through a typical exhalation period, and the ending EPAP pressure is not affected by the flex setting.)

By the way, because Respironics flex is based on the rate of airflow during exhalation, and since the Flow typically returns to zero shortly after half way through the exhalation period, if we (artificially) extend the time we are actively breathing out
(trying to see if the pressure relief will end before exhalation stops) we will be distorting the usual behavior of flex.

Normally there would be a significant pause between the end of actively exhaling and the beginning of inhaling. I think ResMed EPR continues to provide full pressure relief during this pause in the Flow, and I think PRS1 flex provides no pressure relief during this pause.

I think PRS1 ends its flex pressure relief before inhalation actually begins because the start of inhalation is the easiest time for an obstructive apnea to begin, and I think Respironics wants to guard against flex causing apneas to start which would have been prevented by early return to normal pressure.

If using ResMed EPR on a fixed-pressure CPAP machine, because EPR does not return to full normal pressure before inhalation starts, and because a fixed-pressure machine will not auto adjust its pressure higher when there are signs of Flow Limitation, I think using EPR on a fixed-pressure CPAP machine will tend to increase the likelihood of obstructive events (at least in some patients) unless the IPAP pressure is increased a little to compensate.

In any case, I'm glad flex is working well for you.

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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#28
No, that plot is exactly what I am seeing on the manometer. If we define IPAP as the "pressure setting" and EPAP as IPAP minus the A-Flex setting, the pressure initially drops well below EPAP at the beginning of exhalation, eventually climbing up to EPAP during the exhalation, and staying at EPAP until the start of the next inhalation.
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#29
(04-24-2014, 12:29 PM)RonWessels Wrote: No, that plot is exactly what I am seeing on the manometer. If we define IPAP as the "pressure setting" and EPAP as IPAP minus the A-Flex setting, the pressure initially drops well below EPAP at the beginning of exhalation, eventually climbing up to EPAP during the exhalation, and staying at EPAP until the start of the next inhalation.

Hi Ron,

Maybe you can you perform an experiment for us? Consciously add a 2 second pause between the end of exhalation and the start of inhalation: inhale, exhale, pause; inhale, exhale, pause; repeat. This way you would definitely not be skipping the normal pause after exhalation, and I think the 2 second pause would likely be long enough for your manometer to settle to an accurate value.

On the plot at the Respironics link I posted, unless the plot shown is actually that of a bi-level machine it does not make sense that -- no matter what the flex setting is -- the End EPAP is always lower than IPAP.

Thanks.
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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