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PRS1 bipap auto vrs AirCurve 10 vauto
#1
Hi All,
This is my third attempt at CPAP therapy (over the years) and I am REALLY trying to make this work. This time I have a good sleep doc and DME. Though my doc wanted me to go with a bi level machine due to past non-compliance, I thought I'd try the Air Sense 10 Autoset for Her first. This machine is definitely an improvement over the past PR models however the breathing pattern is just not right yet. My sleep study showed I only needed no more than a 6 pressure but at home my normal pressure ranges from 11-13. Sometimes I'm a very active sleeper while other times I remain like a lump in the same position all night. Likewise, my breathing tends to be somewhat erratic..sometimes long deep breaths, others short & shallow. I've turned the ramp off and the pressure on the machine was upped from 5 to 8 to start from the doctor but I still feel short of breath. And I never seem to fall into any deep sleep. I'm either awake or semi awake waiting for the 4 hours to pass. (Masks have been a problem as well but the artificial breathing pattern is the deal breaker.)
So, I'm now ready to try the bi-level and I'm to call the rep about my choice between the PRS1 60s Bipap Auto w/ bi-flex and the AirCurve 10 v auto ASAP (As I said, they're really working with me, knock on wood!) Sound was a problem with the other PR's- a very annoying whine but I understand the PR bipap is much quieter.
What's confusing is the part about the System One adjusting the EPAP and IPAP separately but the ResMed "can detect breathing cycle & deliver comfort pressures proactively". The rep tried to explain but I'm still confused. Is there a difference in the smooth transitions with one being more natural? I'm hoping to hear if someone else has had a similar experience as well as any opinions or comparisons.
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#2
Hi Winkin', something doesn't add up here, so I think we need you to provide some more detailed details. (It's often hard to get everything straight when we're changing settings and machines).

As I understand it, your titration pressure was only 6 cm H2O (which is really low) and your Autoset was set on 5 - 15. You found this made it hard to breathe so the minimum pressure was upped to 8. However the machine is running at 11 - 13, which is close to your maximum. The first thing this suggests to me is that basing your titration pressure on a single night in a lab is not really a good idea, especially if you don't actually get any sleep. It also suggests that there's no way you'd get a bilevel if you really only needed 6 cm, as the 4 cm difference between epap and ipap would leave you with an epap of 2 - and that aint' gonna do much good.

So just working through a few of the points you've raised....

If it was me, I'd rely on the Autoset to do the titration, and it's showing 11 - 13 then that's a lot more likely than 6.

At that pressure it's plausible you could need a bilevel if you have trouble exhaling against the pressure. But first, you need to adjust the exhalation pressure relief (EPR) to find a setting (3, 2, 1 or 0ff) which feels best for you. You mentioned "the artificial breathing pattern is the deal breaker". That suggests to me that you are using EPR (Resmed) or Flex (PR) and it could be that this is part of the problem.

Do you have insomnia when not using the machine, or just with it? Perhaps some melotonin or mild sleeping agent might help - discuss with your doctor.

Noise - there have posts on the forums complaining about noise from particular machines. Without having done any type of count I think the majority of complaints seem to be about the newer Resmeds. However I think it's almost a case of luck - I've had two Resmeds, one of which was very quiet and the other is quite noisy. I had a PR for a while and that was utterly silent.

Inhale / exhale transition - there is an army of advertising people employed by these comanies to come up with beautiful but ultimately meaningless phrases to describe their products. If your doc and DME are working with you, arrange to try both machines and see which suits you best.

Good luck!
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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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#3
Hello DeepBreathing and thank you for getting back to me. I'm not very technical so I know my post sounded confusing, but you nailed it!
The latest lab study did show that mild 6cm H20 was indicated. This was actually a follow up; my insurance turned down the first. According to the doctor, my events happened mainly in the later hours and were severely disrupting the REM cycle.
The new RemStar was set at 5-15, and after struggling for breath, the minimum was set at 8- better, but still a problem. Disabling the ramp helped, as did tweaking the EPR but none of those ultimately helped me to breathe "properly".
My cm H20 is pretty consistently in the 11-13 range, sometimes higher, usually not much lower. Insomnia (without it) was not a problem, however I was waking up tired, experiencing daytime sleepiness, cognitive impairment and other issues pointing to sleep deprivation. The worst part though, and reason for this final CPAP attempt is the terrifying wake ups gasping for breath and the ensuing panic. It's a d***ed if I do, d***ed if a don't situation made worse by mask problems originally thought to be the primary issue but are actually secondary.
So that's where I am now which is why the bi-level appears to be the last shot. Exhaling against the pressure followed by too short inhalations is how I would describe it. Again, even that is not all the time though. Very frustrating!
This ResMed for Her AirSense10 Autoset is the best of all previous (Respironics) machines. It still sounds like "the voiceless breather on the other end of the phone" but even that is preferable to the in and out breath-following whine of the other which truly kept me awake!
Your last sentence is what I'm hearing from the DME and one other board.. I was just curious if the PRS1 *separate* EPAP/IPAP adjustment would make any difference. The machine I get will probably be the last one so I want to know as much as I can about the two.
So far those who have responded seem to favor the Phillips Respironics. I'll be talking to the DME later today (and will shed a tear over parting with the AirSense 10 Autoset for Her)
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#4
The PR machines and the ResMed machines have different ways to detect breathing and prepare for the next one.

One detects the end of the exhale and starts the inhale. The other detects the end of the inhale and starts the exhale.

A lot of people do not like how the PR machines "forces" the user to breathe as it feels too abrupt. Others don't like ResMed because it doesn't feel like it is doing anything.

Trying out both of them is a very good idea since it will give you a chance to actually feel the difference. And use it for more than one night. You may not notice anything at first. Or you may notice it too much. Give it time.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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#5
for what its worth I can (and have) adjust my machine to do about anything and I find it vary comfortable. my only problem is I have a hole in my head and the air leaks out my mouth and I have yet to find a FFM to fit me. I will in time get a resmed and compare and the less favored will become a backup as I never want to go another night w/o pap therapy. You don't say if you are using SleepyHead and if not I must emphatically recommend you do so. you will get vastly better help that way.
I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
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#6
Thank you for the input Paula and Mark.
As it turns out, the rep was out of the office today so I have all weekend to drive myself crazy! Thinking-about
The last thing I want is to feel forced breathing though. I'll see if I can try out each machine, but my understanding is that it has to be ordered and I doubt my insurance will go along with that.
My Mac needs upgrading badly and being a computer sped I'm a bit afraid to tackle Sleepyhead.. and then you'll want me to post the results which is all Greek to me and I'll feel even more like an idiot when everyone says "nothing to it"!

P.S. MD, so sorry about the holeGoodOne
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#7
(07-17-2015, 05:42 PM)PaulaO2 Wrote: One detects the end of the exhale and starts the inhale. The other detects the end of the inhale and starts the exhale.

Is this for real? We have different interpretations of a single breath. One says a breath starts with an inhale and one says it starts with an exhale?
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