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Central Apnea question
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Peter_C Offline

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Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #41
RE: Central Apnea question
I do not know your machine.

But on a Resmed machine, you set:

MIN EPAP
MAX IPAP
Pressure Support

So if I wanted mine to act like a 'Auto-CPAP', I would do this:
MIN EPAP (when you are doing anything but inhale) to your comfortable lowest number
MAX IPAP (when inhaling only) to wide open, in my case '25'
Pressure Support to '1'. (Can't do zero on my machine)

As my machine raises both sides by the same amount a 9/10 could become a 11/12, 15/16 and so on, as it can't change the PS automagically.

*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."
05-05-2014 03:30 PM
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Sleepster Offline
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Posts: 4,994
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #42
RE: Central Apnea question
Exhalation Pressure Relief, known as EPR, C-Flex, Bi-Flex, or A-Flex, is a way of reducing the exhalation pressure by 1, 2, or 3 cm.

To reduce it further, a bi-level machine (also known as a BiPAP or VPAP) can be used to set the exhalation pressure (EPAP) lower yet.

CPAP-induced CSA is a real effect that tends to subside with time. There is evidence that this is made worse, or even caused by, bi-level therapy. This is why you hear people talk about reducing the EPR or raising the EPAP to reduce CSA.

Sleepster
Apnea Board Moderator
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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 OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
05-05-2014 06:34 PM
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vsheline Offline

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Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #43
RE: Central Apnea question
(05-05-2014 03:24 PM)WakeUpTime Wrote:  
(05-05-2014 03:05 PM)Bama Rambler Wrote:  You can make the BiPAP act like an APAP.

Thanks for that Bama. I had mistakenly initially thought EPR was referring to the exhaust pressure (EPAP in a BiPAP). I understand now that he was referring to the Philips equivalent C-Flex/B-Flex setting.

Turning off or decreasing EPR is like turning off or decreasing PS.

EPR on ResMed APAP machines and Pressure Support (PS) on all bi-level machines are both equal to the difference between EPAP and IPAP, except PS represents an increase and EPR represents a decrease.

PS on bi-level machines is added to EPAP to get IPAP.
EPR on ResMed APAP machines is subtracted from IPAP to get EPAP.

EPAP + PS = IPAP
IPAP - EPR = EPAP

EPR is pressure based, like true bilevel, except it is limited to 3 cm H2O.

Using EPR, the low EPAP pressure does not transition back to the higher IPAP pressure until inhalation actually begins. So a ResMed S9 AutoSet with EPR adjusted to "3" is similar to a ResMed S9 VPAP Auto with PS adjusted to 3, except EPR cannot be set higher than 3 on the S9 AutoSet, and PS can be set as high as 10 on the S9 VPAP Auto.

But Flex does not work quite the same way as EPR.

Although both EPR and Flex introduce some exhalation pressure relief, Flex does not last as long.

On Philips Respironics models, Flex is Flow based. During the times when there is no exhalation Flow, Flex adds no exhalation pressure relief.

Because it is usually natural for the exhalation Flow to reduce to nearly nothing well before inhalation actually begins, it is normal for Flex to end well before inhalation begins, about half way between the start of exhalation and the start of inhalation. This is different than true bilevel. EPR and PS, in contrast, last the entire period between the start of exhalation and the start of inhalation.

This is why Philips Respironics BiPAP models offer both PS and Flex, because these are different.

And this is why the ResMed VPAP Models do not offer both PS and EPR, because these are the same, except PS has a larger range.

Take care,
--- Vaughn

ADDED:

And to make a bi-level S9 VPAP Auto act like an AutoSet prescription, one would set PS the same as EPR, and would also adjust Min EPAP to match the minimum EPAP used by the AutoSet, which is the AutoSet's Min Pressure minus it's EPR.

For example, if AutoSet settings are 10 to 15 for Pressure, and EPR is 3, the equivalent settings on the VPAP Auto would be:

PS = same as EPR = 3
Min EPAP on bi-level would be AutoSet's Min Pressure minus EPR = 10 - 3 = 7
Max IPAP on bi-level would be same as AutoSet's Max Pressure = 15

To make a PRS1 BiPAP Auto act like an APAP is similar, except the PRS1 BiPAP Auto has a feature which the S9 VPAP Auto does not have.

On the BiPAP Auto the PS will very slowly vary and automatically adjust itself within a range, with the goal of best minimizing Flow Limitation and pressure. So the BiPAP Auto has a Min PS setting (fixed at 2 cm H2O on earlier models and adjustable between 0 and 8 on Series 60 model) and a Max PS setting. On the S9 VPAP Auto the PS is fixed, only manually adjustable between 0 and 10.

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.
(This post was last modified: 05-05-2014 11:42 PM by vsheline.)
05-05-2014 06:37 PM
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jbuchanan6196 Offline

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Posts: 22
Joined: Apr 2014

Machine: ResMed Autoset S9
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: ResMed
CPAP Pressure: 7
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Tennessee

Post: #44
RE: Central Apnea question
Eat-popcorn I'm just taking all this in.Cool
05-05-2014 09:34 PM
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jbuchanan6196 Offline

Preferred Members

Posts: 22
Joined: Apr 2014

Machine: ResMed Autoset S9
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: ResMed
CPAP Pressure: 7
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Tennessee

Post: #45
RE: Central Apnea question
What can you all tell me about flow limitation? I can't tell what's considered 'normal'? Seems like I heard that it wasn't measured like a normal graph so I'm not sure.
05-06-2014 10:57 AM
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