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Help understand the different machines
#11
I am learning so much here.
I wish I could absorb it all though!

(06-22-2014, 02:11 AM)vsheline Wrote: In general, the "Auto" function in an APAP machine refers to automatic adjustment of EPAP [ IPAP? ] in order to minimize obstructive events while keeping the average EPAP [ IPAP? ]pressure low (by raising EPAP [ IPAP? ] only as much as recently shown to be needed)

I thought it was IPAP that reduced obstructive events?

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#12
(06-22-2014, 01:14 PM)jcarerra Wrote: I am learning so much here.
I wish I could absorb it all though!

(06-22-2014, 02:11 AM)vsheline Wrote: In general, the "Auto" function in an APAP machine refers to automatic adjustment of EPAP [ IPAP? ] in order to minimize obstructive events while keeping the average EPAP [ IPAP? ]pressure low (by raising EPAP [ IPAP? ] only as much as recently shown to be needed)

I thought it was IPAP that reduced obstructive events?

On a titration study, IPAP will be raised for Hypopneas, but not OAs. EPAP will be raised for OAs and Hs.

On an auto bi-level machine, the way the auto algorithm works depends on the brand of machine. The Resmed VPAP Auto will raise both IPAP and EPAP in response to OAs, Hs, snores, and flow limitations. The PR System One BiPAP Auto will raise IPAP for Hs, flow limitations, and RERAs; it will raise EPAP for OAs, OAs+Hs, and snores.

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#13
(06-22-2014, 03:05 PM)robysue Wrote: On a titration study, IPAP will be raised for Hypopneas, but not OAs. EPAP will be raised for OAs and Hs.

On an auto bi-level machine, the way the auto algorithm works depends on the brand of machine. The Resmed VPAP Auto will raise both IPAP and EPAP in response to OAs, Hs, snores, and flow limitations. The PR System One BiPAP Auto will raise IPAP for Hs, flow limitations, and RERAs; it will raise EPAP for OAs, OAs+Hs, and snores.

I have the bold ones and a few centrals and periodic breathing (my diagnosis) when in a cluster. Occasionally, the periodic breathing and hypo's infrequently occur outside clusters. Uncertain that my scored OAs may be centrals. But, with my Elite machine, none of those things are going to be raised or lowered.

What's a RERA?

The NOT raising IPAP for OAs is counterintuitive to me; my mind says you want to increase the IPAP when there is an obstruction to "blow through it."

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#14
(06-22-2014, 03:36 PM)jcarerra Wrote: What's a RERA?
From PRS1 provider manual: Event Definitions
RERA Detection: RERA (Respiratory effort-related arousal) is defined as an arousal from sleep that follows a 10 second or longer sequence of breaths that are characterized by increasing respiratory effort, but which does not meet criteria for an apnea or hypopnea. Snoring, though usually associated with this condition need not be present. The RERA algorithm monitors for a sequence of breaths that exhibit both a subtle reduction in airflow and progressive flow limitation. If this breath sequence is terminated by a sudden increase in airflow along with the absence of flow limitation, and the event does not meet the conditions for an apnea or hypopnea, a RERA is indicated.

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#15
(06-22-2014, 03:36 PM)jcarerra Wrote: What's a RERA?
A RERA is a "respiratory effort related arousal". They are the problem in a condition related to OSA called UARS (Upper airway resistance syndrom).

Quote:The NOT raising IPAP for OAs is counterintuitive to me; my mind says you want to increase the IPAP when there is an obstruction to "blow through it."
Auto PAPs do NOT raise the pressure during an apnea; they wait until the event is over to respond.

The rationale is simple: CPAPs and ordinary Bi-levels are NOT ventilators. In order to try to force an inhalation (i.e. "blow through the obstruction") the machine would have to jack up the IPAP really, really HIGH--as in by 10-12 cm of additional pressure or more. And that kind of pressure change can cause its own problems with sleep continuity.

In other words, CPAPs and APAPs work by preventing the vast majority of events from occurring in the first place.
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#16
(06-22-2014, 04:06 PM)robysue Wrote: Auto PAPs do NOT raise the pressure during an apnea; they wait until the event is over to respond.

The rationale is simple: CPAPs and ordinary Bi-levels are NOT ventilators. In order to try to force an inhalation (i.e. "blow through the obstruction") the machine would have to jack up the IPAP really, really HIGH--as in by 10-12 cm of additional pressure or more. And that kind of pressure change can cause its own problems with sleep continuity.

In other words, CPAPs and APAPs work by preventing the vast majority of events from occurring in the first place.

OK, but my musing has to do with why it is EPAP being raised vs. IPAP?


[attachment=882]And does the image look like RERA?
oops nevermind--those were called OAs so can't be RERA by definition.
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#17
(06-22-2014, 04:06 PM)robysue Wrote: Auto PAPs do NOT raise the pressure during an apnea; they wait until the event is over to respond.
From 'S9 AutoSet white paper':
Automatic algorithms respond to the presence of apneas (assumed to be obstructive) by raising delivered pressure because, although this does not treat the apnea that is detected, the pressure increase reduces the likelihood of further obstructive events occurring. If the apnea, however, is central an increase in pressure is inappropriate and may increase the chance of further central apneas.

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#18
(06-22-2014, 03:36 PM)jcarerra Wrote: What's a RERA?

Great article explaining UARS and Respiratory Effort Related Arousal (RERA) events, and why some patients continue to suffer excessive daytime sleepiness even though they are using PAP treatment and have low AHI numbers, and how bi-level treatment may be able to solve this:
http://www.apneaboard.com/forums/Thread-...light=UARS

ADDED: The link to the article is fixed now.

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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#19
(06-22-2014, 04:50 PM)vsheline Wrote: http://www.apneaboard.com/forums/Thread-...light=UARS

bad link.
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#20
(06-22-2014, 04:59 PM)diamaunt Wrote:
(06-22-2014, 04:50 PM)vsheline Wrote: http://www.apneaboard.com/forums/Thread-...light=UARS

bad link.
Flow Limitation/UARS and BiPAP - Barry Krakow MD
http://www.apneaboard.com/forums/Thread-...-and-BiPAP

Upper Airway Resistance Syndrome
http://www.apneaboard.com/forums/Thread-...e-Syndrome

Bilevel Positive Airway Pressure Worsens Central Apneas During Sleep
Karin G. Johnson, MD; Douglas C. Johnson, MD
http://www.apneaboard.com/forums/Thread-...ring-Sleep

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