Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

Highest Periodic Breathing, Leaks and Apnea Ever!
#71
RE: Highest Periodic Breathing, Leaks and Apnea Ever!
I would have preferred getting the ResMed Air Sense 10 machine as it works wonders for my son and my brother in law ResMed Air Sensesince my doctor didn't put an order in for that machine I just figured the sleep supply company I get my supplies from did not carry that machine. I think I will pursue though as I did see a different doctor this past week at the Pulmonary/Sleep Center I go to and she is putting in an order for a different type of mask for me and to get a different pressure set on my machine.  I think when they call me about being ready for me to come in for the new mask fitting I'm going to ask if they have the Res Med Air Sense machine and if they could call my doctor to get approval to switch out that Dreamstation for the Air Sense. I am willing to try anything and everything at this point otherwise I feel like I've wasted the last 12 years of my life trying to get much needed benefits from CPAP therapy all for nothing. I don't think I will ever get used to using the soft cervical collar at night but the pillow that was suggested may be helpful. Thanks for all the feedback from everyone on here.
Post Reply Post Reply






Donate to Apnea Board  
#72
RE: Highest Periodic Breathing, Leaks and Apnea Ever!
jennie,
I assure you that we don't recommend the cervical collar lightly. Who want's to wear something more through the night. There is no argument the it is effective. That said anything that you can do to stop the involuntary chin tucking is good, let us know what works for you.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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.
Post Reply Post Reply
#73
RE: Highest Periodic Breathing, Leaks and Apnea Ever!
I am just re-reading your comments from a few weeks back and am wondering when you mentioned EPR - what exactly is that and what does it mean? Also you suggested possibly even switching to the Aircurve 10 Vauto bilevel machine. How will this differ as far as the therapy I need from a regular CPAP or APAP machine? I realize I have not put my foot down with the doctors I see and more or less demand what I want as far as what type of machine but it always seems to come down to what the insurance will pay for.  I have said it before to you all on here and to my doctors on more than one occasion that I am willing to pay out of my own pocket for the correct equipment that will best meet my needs. I guess I will put this out there again otherwise I will be forever suffering because of my unwillingness to change the habits I've been locked into for so long. I guess at times I feel intimidated when I see my doctors and am afraid to speak up on my own behalf - maybe it's an age thing or I'm just extremely nervous about being in a doctor's office at this time of Covid 19.  
Post Reply Post Reply
#74
RE: Highest Periodic Breathing, Leaks and Apnea Ever!
The ResMed AutoSet has a comfort setting called EPR. While it's a comfort setting, we oftentimes suggest EPR as a part of therapy as the EPR is a bi-levels Pressure Support in reverse and limited to up to 3 cmH20 of exhale reduction. Some will benefit from a bi-level, in the case of ResMed the best is the VAuto. It has PS settings that go beyond 3 to help with therapy and comfort. You just have to speak up for yourself and state the Respironics has NOT done its job thus far and you need to try another brand, the ResMed. You are strong enough if you believe you are. Good luck, go and do.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply






Donate to Apnea Board  
#75
RE: Highest Periodic Breathing, Leaks and Apnea Ever!
EPR, on the surface only, is listed as a comfort feature that reduces exhale pressures.  On PR machines the similar feature is Flex.  
EPR's implementation is considerably different than PR's Flex.  EPR chart patterns are identical to Pressure Support (PS) on ResMed BiLevels such as the VAuto.  It is limited to the values of 1,2,and 3 cmw.  PS allows fractional increments and can go considerably higher, easily 15+ cmw, which is way too high without other medical reasons.
We often utilize the ResMed AutoSet with EPR as a BiLevel substitute, (The actual BiLevel is a more flexible machine)
 
ResMed AutoSet Dreamstation Auto comparison
Why ResMed?
1. Faster algorithmic response to events than PR.
2. ResMed Responds to Flow Limits
   PR responds to Snores
3. Lower average pressure (PR require a higher pressure to ward off obstructive events)
4. Better to avoid Aerophagia.
5. EPR provides for better treatment of hypopneas, RERAs, Flow Limits, UARS, and snores
6. EPR acts like a BiLevel up to a limit of 3cmw (1,2, or 3cmw) and a max pressure of 20 cmw
7. EPR follows your breathing whereas Flex predicts it with a feeling of fighting to get a breath when it predicts incorrectly
8. More flexibility in treating a greater variety of Apneas and respiratory events.
9. In general provides better therapy.
I have frequently told many DreamStation users that they need to get either the ReaMed AutoSet or BiLevel to get better therapy. 

What is BiLevel?

BiLevel 101:
Pure CPAP delivers a single constant pressure.  This pressure is what splints open the airway.  APAP (AutoSet) is what we prefer to see as it can vary the pressure to suit the situation.  For now, let's forget about APAP.

Basic BiLevel delivers two fixed independent pressures, EPAP is Exhale Pressure and is what actually splints the Airway open, It is the equivalent of "Pressure" in a CPAP and does the same thing.  
IPAP or Inhale pressure is the higher of the two pressures.  Once the Obstructive Apneas are resolved with the Exhale pressure (EPAP), IPAP is used to resolve hypopneas, flow limits, RERAs, and UARS.
The difference in these pressures is called Pressure Support or PS.  PS is always added to EPAP by convention to get IPAP so IPAP = EPAP + PS
FYI if you were to set the EPAP = IPAP you would have a basic pure CPAP functionally.
The above info is derived from Titration guides.

BiLevel 102:
BiLevel models are not interchangeable.  Each is designed for a specific condition.
up rate.  On the most basic level this is fully applied everytime.
Backup rate is the frequency in breaths per minute that the BiLevel will initiate.  The basic BiLevel does not have this feature and instead just follows your breathing with a mode called Spontaneous or "S".  Timed mode or "T" initiates a 'breath' at the defined 'rate' in breaths per minute.  How effective this is varies by individual and the settings defined includine EPAP, IPAP, and PS.

The Auto CPAP such as the ResMed AirSense 10 AutoSet is typically the initial machine of choice for treatment of obstructive apnea and hypopnea

Just to clarify The VAUTO, ASV, S, and the ST are all BiLevel machines for treating different conditions, they are NOT interchangeable. They are not a choice between them to treat a single condition.

They should be chosen to treat the specific condition that the user has, Here are the various CPAP Modes and what they are designed/intended to treat

The following info is from the ResMed Sleep Lab Titration Guide
  • * CPAP (continuous positive airway pressure) Fixed pressure delivered with optional expiratory pressure relief (EPR). It Treats OSA
  • * AutoSet/APAP (automatic positive airway pressure) Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. It treats OSA
  • * AutoSet for Her/APAP Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas along with an increased sensitivity to each flow-limited breath, providing a more comfortable therapy for women. Increases sensitivity to each flow-limited breath, providing a more comfortable therapy for women (OK for men too). It Treats OSA
  • * VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA
  • * S (Spontaneous) Senses when the patient is inhaling and exhaling, and supplies appropriate pressures accordingly. Both treatment pressures are preset: inspiration (IPAP) and expiration (EPAP). It treats Non-compliant OSA and COPD
  • * ST (Spontaneous/Timed) Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  • * T (Timed) Supplies a clinician-set respiratory rate and inspiratory/expiratory time, regardless of patient effort. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  • * iVAPS (intelligent Volume-Assured Pressure Support) Maintains a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and automatically providing an intelligent backup breath. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  • * ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  • * ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  • * PAC (Pressure Assist Control, also known as Pressure Control) The inspiration time is preset in the PAC mode; there is no spontaneous/flow cycling. Inspiration can be triggered by the patient when respiratory rate is above a preset value, or delivered at a set time at the backup rate. It Treats Neuromuscular disease (NMD), pediatric patients
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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.
Post Reply Post Reply
#76
RE: New Machine, New Settings, Worse Outcomes Yet!
(09-08-2020, 08:57 AM)jennie54 Wrote: Well it seems that my needs are definitely not being met and my sleep is worse than it ever was 
Of course, because de facto you're using your machine as a leaf blower.  In presence of the massive leaks the machine isn't capable to do its beneficial work.  Second, due to the leaks, you may not rely on the data the machine delivers.
First thing to do is manage your leakage.
Mike
Post Reply Post Reply
#77
RE: Highest Periodic Breathing, Leaks and Apnea Ever!
I have contacted both my sleep doctor's office and the sleep supplier to let them know I will be turning in my Dreamstation and insist that an order is put in for the ResMed Airsense 10. In the event that my doctor will not put in the order I want to purchase the ResMed outright for myself. If this is the case I will need help and recommendations as to how to set it up as far as recommending the pressure settings etc. I am hoping to hear back from both the doctor's office and the medical supply office soon and will be back on here for help when I do. I allowed myself for way too long to be told what they think I need and there has never been a good outcome. It is way past time for me to put my foot down before my sleep apnea continues to worsen my other health problems due to not correctly addressing the therapy that will benefit me the most. Thanks.
Post Reply Post Reply






Donate to Apnea Board  
#78
RE: Highest Periodic Breathing, Leaks and Apnea Ever!
Be sure to tell them you want the AirSense 10 AutoSet, or you may end up with a "brick".
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


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.
Post Reply Post Reply
#79
RE: Highest Periodic Breathing, Leaks and Apnea Ever!
IF you can not get the Dr onboard you can purchase on line for as much as MY copay with insurance. Supplier #2 from the supplier list at the top of the site. I got a “slightly” used (about 1 moth use) and the company and machine are excellent. Of course if you have excellent insurance and
Dr onboard that would be great.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
Cervical Collar     Dealing w DME     Chart Organizing
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  Sudden onset of mouth breathing after heart attack Possum 8 188 10-20-2020, 09:55 AM
Last Post: Possum
  number of time i stop breathing kerm007 6 172 10-17-2020, 11:39 PM
Last Post: Jeff8356
  periodic leg movement sheepless 101 4,131 10-13-2020, 04:05 PM
Last Post: sheepless
  Variable Breathing WSHenry 5 670 10-05-2020, 08:18 AM
Last Post: jas102543
  Large Leaks with New Resmed Airsense 10 Autoset for Her--have questions SideSleeper 4 230 10-03-2020, 11:09 PM
Last Post: staceyburke
  [Equipment] Trying to get insurance appvl for MMA surgery, sleep doctor saying my leaks "normal" Jenk2k 18 514 10-01-2020, 11:26 AM
Last Post: Jenk2k
  New to nose breathing when using CPAP Sleepless D 4 202 09-24-2020, 01:07 PM
Last Post: DaveL


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.