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Help with Respironics PR System One REMstar Auto with A-flex
#1
A question about Phillips REMstar Auto A-Flex. I have had three machines over the years. My original unit is from the late 90's and is huge but still works. I have another older REMstar that is set in CPAP mode to level 10. My new REMstar is a never used but paid for unit originally prescribed to my late mother. The A-Flex drives me insane and actually wakes me up with all the pulses. I set it to CPAP mode as below but it still pulses. The only thing I can think of is I am not using a mask but Nasal Pillows held by an oral appliance from NoMask. Any Ideas how to squelch the pulses. It's hard to fall asleep. Otherwise I like the SystemOne Humidification which automatically adjust temp and humidity based on room temperature.

I set the unit :
Mode CPAP
CPAP pres 10
Flex type none
SYSTEM ONE resistance 0
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#2
Xeroid, I moved your post to here in the Main Forum where it will get better responses than in the Review Forum.
PaulaO2
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#3
Hi exroid96, First, WELCOME! to the forum.! I'm not sure but I would think you could turn that feature completely off but hang in there and someone will be able to help you. Best of luck to you on this nagging problem.
trish6hundred
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#4
What do you mean by "pulses?" When do you feel them? With each breath, or just once in a great while?

The PRS1 does do pressure pulses, but only while you're having an apnea.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#5
(09-19-2012, 05:57 PM)xeroid966 Wrote: . . .The A-Flex drives me insane and actually wakes me up with all the pulses. . . .

I'm guessing that the "pulses" you refer to are from the exhalation pressure-relief activities of the machine. Which I suppose could be irritating to someone who is used to a constant pressure.

I haven't tried this, but it looks like that in Provider Mode it is possible to set Flex Mode to "none."

(Note that the word "pulses" could lead one to think you are talking about the probing pulses the machine sends out when it detects suspected apnea events.)
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#6
(06-20-2014, 10:21 PM)ericxob Wrote: I haven't tried this, but it looks like that in Provider Mode it is possible to set Flex Mode to "none."

It's also possible to do this from the user menu. If not, then you can go into the provider menu and set it so that you can adjust it from the user menu. Or do as you say and turn it off that way.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.
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#7
(06-20-2014, 10:34 PM)Sleepster Wrote:
(06-20-2014, 10:21 PM)ericxob Wrote: I haven't tried this, but it looks like that in Provider Mode it is possible to set Flex Mode to "none."

It's also possible to do this from the user menu. If not, then you can go into the provider menu and set it so that you can adjust it from the user menu. Or do as you say and turn it off that way.

if a/cflex is set in the provider menu, you can't turn it off from the user menu, you can only change the level 1-3, the resmed machines allow the user to select off-3, but the prs1 doesn't allow that much user control.
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#8
(09-19-2012, 05:57 PM)xeroid966 Wrote: REMstar is a never used but paid for unit originally prescribed to my late mother. The A-Flex drives me insane and actually wakes me up with all the pulses. I set it to CPAP mode as below but it still pulses.
There are three possible causes for the "pulses" you are feeling, and you've already eliminated two of them.

Possible causes of pulsing on a System One Auto PAP:

1) In Auto mode, the PR System One has a "Search" algorithm that tests whether or not the breathing improves with a bit more pressure. As the main part of this algorithm the machine periodically increases the pressure by about 2 cm in a 4 minute span testing to see if there are any improvements in the shape of the wave flow. If no improvements are found, the machine then lowers the pressure back down to its original level in about 2 minutes. I don't think this is what you were feeling when you were running in Auto mode because this increase in pressure does not usually feel like a "pulse." So I don't think this was the culprit when you were using the machine in Auto mode. And you've switched to CPAP mode, so this is definitely NOT what you are continuing to notice.

2) A-Flex or C-Flex. You said that A-Flex was driving you nuts. (The BiPAP version drives me nuts; but hubby likes A-Flex) Flex drops the pressure at the beginning of each inhalation and then it starts to increase the pressure back up in the second half of the exhalation, and finishes raising the pressure all the way back up once the inhalation is detected. Since the pressure is changing with each and every breath (and by a variable amount), this can be perceived as a "pulsating" sensation. But you say you've turned A-Flex off. You also said that you switched to CPAP mode. So it's worth making sure that C-Flex+ is indeed turned off. Still I'm pretty sure you really have turned all forms of Flex off. And if Flex is off, this is not what you are feeling.

3) Pressure Pulses (PP). The central apnea detection algorithm uses short bursts of pressure (i.e. PPs) to test the patency of the upper airway. These are very short lived "bursts" of extra pressure. The machine analyzes what happens to the back pressure and uses that information to decide whether an apnea is an obstructive apnea or a central apnea. The machine also uses PPs to try to figure out whether there's a live human being attached to the other end of the hose when its having a hard time detecting the breathing. This typically happens if the leaks are really high, but it can happen under other circumstances as well. My guess is that you're noticing the PPs. And unfortunately, the PPs can't be turned off---they're a critical part of the efficacy data scoring algorithm.

That said, if the problem is PPs, you shouldn't be feeling them on most breaths. And there is a way to figure out whether it's the PPs that are really causing problems: You could down load SleepyHead and import your data. PPs show up as little green boxes on the wave flow data in SleepyHead. If you see a whole bunch of them, then you have some additional evidence that it's the PPs that might be driving you batty.

Most people who notice the PP when they first start using a PR System One tend to become less sensitive to them with time. So you could try to give yourself a bit more time to adjust to them. Or, of course, you could go back to one of your older, but tried-and-true machines.




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#9
robysue,
this was really helpful info. thank for typing this all out.
S
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#10
(09-20-2012, 03:16 AM)archangle Wrote: What do you mean by "pulses?" When do you feel them? With each breath, or just once in a great while?

The PRS1 does do pressure pulses, but only while you're having an apnea.
From S9 AutoSet white paper:

The enhanced AutoSet algorithm applies FOT only when an apnea is detected and turns it off once normal breathing has resumed.
.
.
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The 1 cm H2O amplitude pulses are able to be perceived by a patient if they are awake but are not large enough to arouse them from sleep.
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