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Rhythmical Spikes in pressure?
#11
(07-04-2015, 10:09 AM)quiescence at last Wrote: just keep in mind - these routine blips are a sign of things being good. the pressure change is gradual and not even 2 cm. looking carefully, it is 1.5 cm.

see post http://www.apneaboard.com/forums/Thread-...#pid101641

It is important to note - the study uses a signal generator to mimic normal and then flow limited breathing. It clearly shows that the algorithm bumps up pressure periodically even when no flow limitations occur.

QAL


Agree, when looking at my graphs, they are always at 1.5 cm, and only seem to occur when nothing else is going on....like no flow limitations, no apneas. Thinking-about
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#12
(07-06-2015, 09:39 AM)Mosquitobait Wrote: Huh. I found the pressure going up and down so quickly was not helping me (I have a Respironics loaner). It got so bad that I finally changed from auto-pressure to straight pressure at 11.

Strange you would notice more abrupt pressure change of the loaner compared to the ResMed. Respironics automatic pressure adjustments are so much slower, and return to lower pressure so much sooner than ResMed.

QAL


Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
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#13
(07-06-2015, 02:21 PM)quiescence at last Wrote:
(07-06-2015, 09:39 AM)Mosquitobait Wrote: Huh. I found the pressure going up and down so quickly was not helping me (I have a Respironics loaner). It got so bad that I finally changed from auto-pressure to straight pressure at 11.

Strange you would notice more abrupt pressure change of the loaner compared to the ResMed. Respironics automatic pressure adjustments are so much slower, and return to lower pressure so much sooner than ResMed.

QAL

I'm sure that machine response is dependent on individual respiration characteristics but my experience with the AirCurve is that the rate of change of pressure is proportional to the severity of the flow limit. There are no pressure changes above the minimum setting unless a flow limit crosses a lower threshold. Therefore as long as I am breathing smoothly the PAP is level. Most of my limits are low, within the low symbol region and the pressure rise for them is much slower than the Respironics data shown in this thread and the total rise is less than 1cmH2O. When a flow limit gets into the third symbol region where the flow waveform is significantly degraded the pressure rise slope is much steeper, more so than the periodic Respironics spikes. Also the total rise is 1cm or more. At the point my breathing is this disturbed I doubt I would be further bothered by the steeper pressure adjustment.
I see this as a more straightforward way of addressing the flow problem, especially my flow problems which are not as severe as some others. I don't need a periodic pressure pulsing when I am breathing smoothly and suspect it would disrupt my sleep.
Also my experience with unnecessarily complex algorithms is that they are prone to errors and unexpected consequences.
if you can't decide then you don't have enough data.
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#14
(07-06-2015, 02:21 PM)quiescence at last Wrote:
(07-06-2015, 09:39 AM)Mosquitobait Wrote: Huh. I found the pressure going up and down so quickly was not helping me (I have a Respironics loaner). It got so bad that I finally changed from auto-pressure to straight pressure at 11.

Strange you would notice more abrupt pressure change of the loaner compared to the ResMed. Respironics automatic pressure adjustments are so much slower, and return to lower pressure so much sooner than ResMed.

QAL

I'm thinking that the return to lower pressure too fast is perhaps what was causing me to wake up - I had more events and they always followed a pressure spike. Multiples of them woke me.

I'm envious of Ailu. We have the same machine and she's already doing better. Smile I would play with mine a bit more, but since I should be getting my replacement machine this week, I'll just stick with what I got. But, I have to say, looking at my results and Ailu's chart helps me to understand how these machines work. I'm just glad things are working out great for her!
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#15
(07-06-2015, 05:41 PM)Mosquitobait Wrote: I'm thinking that the return to lower pressure too fast is perhaps what was causing me to wake up - I had more events and they always followed a pressure spike. Multiples of them woke me.

I suppose it's possible, but the pressure change from inhale to exhale is generally 1-3 cmH2O for anyone using flex or EPR, and my BiPAP has a minimum pressure change of 5 for each breath cycle. The so called pressure spike in auto is 1.5 cm over several minutes and many breaths. it's not a spike at all. It looks like this up close:

[Image: 5jUMG9X.png]
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#16
here are two examples showing the comparison between the gradual "test" bump of the respironics and the normal 1.0 cmH2O step that occurs when 2 snores, 2 FL, or one apnea are detected.

The original poster experienced (and asked about) this bump [test bump]:
[Image: hrXAgt5.png]

While you were probably served up a (more abrupt) bump like this [based on apneic issues]:
[Image: EE39DyH.png]

You were probably repulsed by many individual steps, together, such as this, changing from 5.0 to 10.0 in 12 minutes *:
[Image: 1iMryH9.png]

But, looking at this next slide indicates to me that the S8 vaulted the pressure from 4.0 to 16.0 cmH2O in about 6 minutes [2 times faster and 2 times higher] **:
[Image: JJztpGP.jpg]

At any rate, I found neither disruptive, and YMMV (your mileage may vary).

What I found was disruptive was the AFlex at any level 1, 2 or 3. Setting my AFlex off means my inhale pressure is the same as my exhale pressure. I find it comforting.

QAL

* - interestingly my RERAs were before the machine pumped up my pressure. There is no evidence that I was aroused by the big bump.

** - The Airsense 10 Autoset for Her may actually not vault the pressure up as fast. That is one of the actions I think they worked to change.

.
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
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#17
QAL, thanks for the data.
Very interesting! The overlay slide must be a joke. (I've seen it before, what is the origin?) If someone goes to sleep at level 4, the jump to 16-18 could blow their pillows out Smile I hope to not sense any of that happening. Of course when your breathing is already struggling, maybe any port in a storm will do.
Thankfully, I don't see anything even close to that in my ResMed data.
if you can't decide then you don't have enough data.
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#18
The plot I posted came from !http://www.rtmagazine.com/2009/08/auto-adjusting-positive-airway-pressure/

There were other plots included. This one was only for flow limitation. I note there is a different looking plot for how they all responded to apnea, and another for hypopnea. All units responded about the same for apnea.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
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#19
(07-07-2015, 08:20 AM)quiescence at last Wrote: The plot I posted came from !http://www.rtmagazine.com/2009/08/auto-adjusting-positive-airway-pressure/

There were other plots included. This one was only for flow limitation. I note there is a different looking plot for how they all responded to apnea, and another for hypopnea. All units responded about the same for apnea.

QAL

Thanks for the link. This is an interesting article, although historical since it was written in 2009 regarding machine testing that was done several years earlier. However, the points that it makes about the clinical interpretation of the different algorithms used by different manufacturers is in line with the current complaints I read on this forum. The sleep medicine industry (including both manufacturers and medical professionals) is still not facilitating good decision making and follow up on the part of Doctors and DME with respect to the characteristics of the various PAP machines and the needs of individual patients.
The data in the slides is surely obsolete now so proliferating it is only marginally useful to investigating today's algorithms. And when used it should be noted that the data is circa 2006. Maybe there is a current version of this information. This thread has piqued my interest and I will be on the lookout.
if you can't decide then you don't have enough data.
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