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[Equipment] Disconcerting pressure pulses between breaths on Dreamstation Pro
I have just changed my machine from a reliable REMStar to the Dreamstation Pro - a change forced upon me by my provider - and I have had severe problems using it. Right from the start it has generated pulses of pressure between breaths as though it is trying to force me to breathe in again before I'm ready - and that just made it impossible for me to sleep. I have seen a couple of other people on the forum have mentioned this characteristic (problem?) so I thought it might be useful if I posted my solution.

None of the 'User settings' made any difference to the pulses, so my provider changed the Flex setting from C-Flex Plus to standard C-Flex. That helped a little, but the pulses were still there, this time accompanied by a rapid 'chuffing'. The provider then turned off Flex completely which got rid of the chuffing and the lower frequency pulses of pressure, but the lack of pressure relief made the machine too uncomfortable to use.

Fortunately, I found this site and the admins kindly sent me a copy of the Clinician's / Provider's Manual, which has allowed me to experiment with the settings. Surprisingly, the solution I found was to change the Therapy>Mode setting from C-Check to CPAP. This, apparently, stops the machine from automatically adjusting the therapy pressure every 30 hours, but for some reason it also stops it generating the unwanted and disconcerting pressure pulses (even when I am using C-Flex). I really can't fathom out why it would do that, but it does.

Can anyone throw any light on why the pressure pulses occur and why this C-Check/CPAP switch might affect them? Could it be a software bug? My machine is operating with firmware version 1.0.6.

I'm just glad that I have found a way around the problem, because the pulses and lack of C-Flex otherwise rendered the machine unusable for me. It's just a pity that I have had to tinker with settings that I am not supposed to even know about. It would be nice if these providers trusted their patients (customers) to take responsibility for their own health and disclosed all the product information up front. Thank goodness for this forum.

Anyway, I hope the above might help others who find this pulsing behaviour troublesome.
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What pressure settings did you have when on Auto ?

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Thanks for your reply kwhenrykerr. I've not had the machine on Auto mode. This model doesn't support it. But the therapy pressure (referred to as 'cmH2O' on the device's screen) is set to 10, which is the same as I had been using for years on my old REMStar.

I believe the C-Check mode, in which I had experienced the pressure pulsing, is different from Auto, in that it adjusts the pressure by no more than +/-1 cmH2O once every 30 hours; and even then the maximum cumulative variation is limited to 3 cmH2O either side of the programmed pressure.

I wondered whether the pulsing might have been something to do with correcting periodic breathing, as it occurred mainly when I had left several seconds between consecutive breaths. I can understand why this might have shown up with C-Flex or C-Flex+ enabled, but why would it happen only when C-Check is enabled as well? That doesn't seem logical to me - but maybe my understanding of this feature is flawed.

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A CPAP machine can't and won't correct your breathing. You need a different sort of machine to achieve that. It sounds like it is sending pressure pulses to determine if your not breathing is a closed or open airway event. Increasing pressure is not done to respond to an open airway event. C-Check might be doing this as part of its data collection.

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Yes, that makes sense, chill. But why would it do that in C-Check mode and not in CPAP mode? Presumably it would mean that, in CPAP mode and/or when Flex is off (i.e when there are no pulses), the machine can't distinguish between closed- and open-airway events. Unfortunately, the manuals don't say.
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Hi Johnbrooking,
WELCOME! to the forum.! Good luck to you with your CPAP therapy, hang in there for more responses to your post.
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The pressure spikes are how the machine tests whether the machine is set to the correct pressure (and to test whether the airway is open like chill said). I know that that's how auto mode works on a Philips Respironics machine, and I wouldn't be surprised if C-Check mode uses pressure spikes for the same purpose. Switching to fixed-pressure CPAP mode is the best solution, but then you are left with the problem of figuring out whether the pressure is set correctly. You should download Sleepyhead using the link at the top of the webpage to see how well your new machine is working for you, and if a pressure adjustment is needed.
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Thanks for your suggestion big_dave. I had planned to use just the AHI figures to work out whether I should adjust the pressure, but I guess the software will provide a more comprehensive picture. Just going to download it now.
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SleepyHead software reports pressure pulses at the same time that I am aware of them, so this, together with the advice members have kindly given here, seems to point to the pulses being generated as part of the machine's attempt to distinguish obstructive events from clear-airway events.

Unfortunately, when I said before that switching from C-Check mode to CPAP mode stopped the pulses I was wrong. Obviously I hadn't let the machine run long enough on the latter setting, because it has now become apparent that this mode also generates the troublesome pulses. I had a terrible time trying to get to sleep last night because of them. For some reason I produced a high number of clear airway events (and suffered a corresponding high number of pressure pulses) while trying to get to sleep, but afterwards, I only had one obstructive event and two clear-airway events in the whole 6 hours of sleep.

The Dreamstation is far more sophisticated than my old REMStar M series machine, but the downside is that it generates all of these unwanted (and very disturbing) pressure pulses which stop me from getting off to sleep. In my case (and I appreciate it's not the same for everybody), the ability to distinguish between obstructive and clear-airway events is of limited diagnostic benefit and of absolutely no theraputic benefit. In fact, this feature is of some detriment because it renders the machine almost unusable for me.

I am pretty cheesed off with my provider for forcing this change upon me. I asked to be switched back to the old REMStar M but was told bluntly "that's not happening". I only suffer from mild sleep apnoea, with no discernable daytime tiredness, and now I wish I had never gone to the doctors with my throat / rhinitis symptoms because now I'm cursed with having to use this awful pulsing machine (which actually impairs my sleep and does make me tired) - or buy a non-pulsing model privately.

Unfortunately, the old REMStar M series machines are now discontinued, so I wondered whether anybody can suggest a good alternative. All I want is a fixed pressure setting with some (albeit minimal) EPR - but most importantly NO pressure pulses. And all I need it to record is the total therapy hours and/or the number of "compliant" (>4h) sessions.

I would be really grateful if anyone can give me some model recommendations.

Thanks in advance, John.
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PS Does anyone know whether the System One REMStar 60 Pro generates the pressure pulses and whether it records any data other than usage time? (As far as I can make out, it seems to be the model most similar to my old REMStar M series machine.)
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