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Sleep study and the algorithm of the machinery
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goodonya Offline

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Posts: 79
Joined: Dec 2013

Machine: S9 Vpap Adapt
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: yes shut off with water in it
CPAP Pressure: Mode ASVAuto
CPAP Software: Not using software

Other Comments: No longer know the new sleep study instead of a break out of percentage OSA and CSA simply says OSA

Sex: Male
Location:

Post: #1
Sleep study and the algorithm of the machinery
Hi, After my initial exhausted pass out at the beginning of my new and 2nd sleep study(the first in April, 2010), I woke up. I went off to sleep again and woke up again. The sleep clinic breathing machinery was doing an all too familiar thing. It was determinedly pushing air back at me before my exhalation was finished. Hmmm. Phillips Respironics?? The clinic lady comes running in exasperated. One person alone handling two sleepers makes time of the essence. She calms me down and we try again. Same thing. This time there was a hurried conversation. I was determined to find out is this Phillips Respironics equipment? Yes it is. We discussed how to get me to sleep. I did my best to hold my exhale to the same as my inhale. I could sense the machine trying to shove the air. I could also sense her at the controls keeping it in check till I finally went off to sleep.

If the possibility should arise again that I ever have insurance again or a large chunk of extra money for another sleep study I will do my best to determine 3 things.

I. That the Clinic has adequate staffing.
2. That the Clinic has Resmed breathing technology.
3. That the Clinic is not in Alaska but in a large technologically advanced city like Seattle or Portland, Or.

This is just my opinion. Some people I am certain are served well by the PR and the community here. I did not come into this situation all critical and angry and mostly I am not. Frustrated yes. Definitely frustrated. It falls in a zone of things that I struggle with, I am not a techie, graphs and pressures and the ins and outs of breathing mechanics are not my thing. I just want to get enough sleep to function at the level I spent most of my life at. I have not achieved that yet.
I do want to say how much I appreciate this forum. It has been a real and genuine help.

My questions are this: Does Resmed supply breathing technology and machinery to Sleep Clinics?
Is it possible for me to find out with genuine accuracy that a Clinic has Resmed before I go to them?
Is it also possible for me to find out if they have enough coverage in staffing that someone is always at the controls?
----------------------------------
I did interview the lady at the last sleep study as we set up. I am impressed by her decades of experience as a respiratory therapist and sleep technician and nurse as well as having a compassionate and professional demeanor.
(This post was last modified: 06-02-2014 01:42 PM by goodonya.)
06-02-2014 01:40 PM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #2
RE: Sleep study and the algorithm of the machinery
I don,t know about Alsaka or anywhere else but my 1st sleep study was done in the main hospital, they use resmed equipment and gave me F&P mask. 2nd sleep study done at local sleep center, brought my own mask and they use Respironcis equipments, when asked the doc about the equipment, he said it was supplied by the company
I think manufactures are in the business of promoting their own equipments especially masks, what better place to that than at the sleep center ... where people most likely to go and buy the mask they have been tested on
06-02-2014 02:19 PM
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robysue Online
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Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #3
RE: Sleep study and the algorithm of the machinery
(06-02-2014 01:40 PM)goodonya Wrote:  Hi, After my initial exhausted pass out at the beginning of my new and 2nd sleep study(the first in April, 2010), I woke up. I went off to sleep again and woke up again. The sleep clinic breathing machinery was doing an all too familiar thing. It was determinedly pushing air back at me before my exhalation was finished. Hmmm. Phillips Respironics??
My guess is that Flex was turned on. And if Flex had been turned OFF you would NOT have had that sensation of the machine pushing air at you before you're done exhaling.

For what it's worth: I noticed the same damn thing on Resmed's EPR system back when I was a newbie. The PR BiPAP with Flex turned OFF does NOT do that however. It waits until I'm inhaling to increase the pressure back to IPAP. (With Bi-Flex turned ON, however, there's a small "extra" reduction in pressure beyond EPAP and a pesky "increase in pressure" (back to EPAP) during the exhale that makes me feel like the machine is rushing me to inhale.

So if you can't find a sleep lab with Resmed equipment, then tell the tech to turn the Flex completely OFF.

And if you're currently stuck trying to make a Respironics machine work in your own bedroom, check the Flex setting and turn it OFF.

Quote:My questions are this: Does Resmed supply breathing technology and machinery to Sleep Clinics?
Yes. My first titration was on Resmed equipment. The tech did NOT have EPR turned on and I woke up with a bad stomach ache several times in the night. I was too naive to know enough to complain and ask that the pressure be turned back down to something my tummy could tolerate. I wound up over titrated with a script that got me off to an absolute horrendous beginning to PAP therapy.

Quote:Is it possible for me to find out with genuine accuracy that a Clinic has Resmed before I go to them?
You can ask. However at least one of the sleep labs that I've had studies at had Resmed equipment in some rooms and PR equipment in other rooms and it was luck of the draw which room you got.

Quote:Is it also possible for me to find out if they have enough coverage in staffing that someone is always at the controls?
Ask when you are calling about setting up an appointment. However keep in mind that it could be the lab was short staffed because someone called in sick at the last minute.

That said: 2 patients per tech is about standard from what I recall.
06-02-2014 02:19 PM
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goodonya Offline

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Posts: 79
Joined: Dec 2013

Machine: S9 Vpap Adapt
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: yes shut off with water in it
CPAP Pressure: Mode ASVAuto
CPAP Software: Not using software

Other Comments: No longer know the new sleep study instead of a break out of percentage OSA and CSA simply says OSA

Sex: Male
Location:

Post: #4
RE: Sleep study and the algorithm of the machinery
Thanks Roby Sue. I see you started your journey with this stuff about the same time and sounds like a similar start.
Thanks to Zonk as well.

You both do a lot of good volunteering on here. I am just going to have to stay on this stuff and learn. I still have the PR Autoserve. I will have to see where the flex setting is. It was a daunting machine to me with a lot of buttons.
The new one I have the S9 auto vpap seems a little more accessible. It comes down to figuring out how to really run these machines and understand how it all works.
06-02-2014 02:47 PM
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robysue Online
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Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #5
RE: Sleep study and the algorithm of the machinery
(06-02-2014 02:47 PM)goodonya Wrote:  I still have the PR Autoserve. I will have to see where the flex setting is. It was a daunting machine to me with a lot of buttons.
Please clarify:

There is no such thing as a PR Autoserve (at least in the states). Your signature indicates that CSA is a problem So that means your machine is a PR System One BiPAP AutoSV (Auto Servo Ventilator) machine. Is that correct?

I didn't catch the CSA in your signature before. But a couple more ideas have occurred to me:

1) Do check the Flex setting. You may be in the minority of patients who do better with Flex turned OFF. (I'm like that.) But techs uniformly set these things up with Flex turned on because the technical stuff coming from PR says that "Flex improves patient comfort", which it does for most, but not all, patients. (Likewise, the titration guidelines PR has for its titration equipment direct the tech to start the test with Flex set to 2, the medium setting. But how many people know to complain if they're feeling like the machine is making their breathing feel funky because it increases the pressure before they're done inhaling?)

2) You may also be noticing problems with the ASV algorithm itself. That's the algorithm that is used to treat the central apnea: When your breathing becomes sufficiently irregular (in the machine's opinion), it starts triggering inhalations. And the way it does this is by cycling between EPAP and IPAP, with the IPAP being allowed to increase quite dramatically while EPAP is held fixed. Now there are two main criteria the machine's ASV algorithm uses to measure breathing instability: The tidal volume (as compared to a moving "target tidal volume" based on the last several minutes of normal breathing) and the respiratory rate (as compared to the "backup breaths per minute rate" as part of T mode). If you are breathing slower than the "back up rate" setting, then the ASV algorithm is going to kick in and increase the pressure to IPAP before you are done exhaling. So that might also be part of your problem.

3) Is your S9 actually a Resmed S9 VPAP AdaptSV (the Resmed ASV machine) or is it really a Resmed S9 VPAP Auto? It makes a difference. The VPAP AdaptSV is designed to treat central sleep apnea, but the S9 VPAP Auto is just a plain old bi-level machine that is not designed to handle central sleep apnea. So if your S9 really is a VPAP Auto, it may be "a little more accessible", but it may not do as good of a job treating your CSA since the S9 VPAP Auto cannot trigger inhalations.

4) If your S9 actually is a Resmed S9 VPAP AdaptSV, you may find breathing with it easier than with the PR BiPAP AutoSV. The VPAP AdaptSV has additional settings that control how and when the machine changes from EPAP to IPAP as well as from IPAP to EPAP. One of those settings allows you to adjust the sensitivity of the machine for detecting the beginning of the inhalation and another setting controls how fast the transition from EPAP to IPAP actually is. Those settings may wind up being crucial for your comfort.

Best of luck
06-02-2014 04:00 PM
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PaulaO2 Offline
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Machine: S9 Autoset
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Mask Make & Model: F&P Simplus
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Post: #6
RE: Sleep study and the algorithm of the machinery
Let's see if I remember how this goes.

One algorhythm senses when the inhale is about to end and drops the exhale.

One senses when the exhale is about to end and increases for the inhale.

Some people cannot tolerate one but love the other.

PaulaO2
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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.
06-02-2014 05:38 PM
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WakeUpTime Offline

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Posts: 156
Joined: Jan 2014

Machine: PR System One BiPAP S60 Auto 760
Mask Type: Nasal pillows
Mask Make & Model: P10 pillows
Humidifier: PR S1 w Heated Tube+Hose
CPAP Pressure: Auto / Inhale 11-12.5 / Exh 9
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Post: #7
RE: Sleep study and the algorithm of the machinery
(06-02-2014 02:19 PM)robysue Wrote:  2 patients per tech is about standard from what I recall.

My sleep center uses one lab tech per 6 patients. Hearing that 2 is more typical is really making me wonder now about the quality of my titration overnight. After 4-5 months, I'm still struggling to keep an AHI under 8-10!

Sleep Apnea has given me a terrible memory. Please forgive me if I've repeated myself.
06-02-2014 07:10 PM
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archangle Offline
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Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
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CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments: Happy PAPper

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Location: USA

Post: #8
Sleep study and the algorithm of the machinery
Even without Flex turned on, the PRS1 seems to sort of pump the mask pressure up and down. My guess is that it's a question of how it tries to maintain constant pressure at the mask. It has to adjust the blower to keep the pressure the same as you change from inhale to exhale. My S9 feels much more constant and less "puffy", even with EPR turned on.

Note that I'm not talking about the CA detection pressure pulse/FOT pulses. Those happen after you have an apnea for a few seconds. This is right when I switch from inhale to exhale or vice versa.

It never bothered me that much, but it is noticeable.

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.
06-04-2014 08:51 PM
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Sleepster Offline
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Machine: ResMed AirCurve10 VAuto
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CPAP Software: ResScan SleepyHead

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Location: Houston, Texas

Post: #9
RE: Sleep study and the algorithm of the machinery
(06-02-2014 07:10 PM)WakeUpTime Wrote:  My sleep center uses one lab tech per 6 patients. Hearing that 2 is more typical is really making me wonder now about the quality of my titration overnight. After 4-5 months, I'm still struggling to keep an AHI under 8-10!

That's not caused by the titration, all they do is try to find the optimal pressure. Once you get home you can tweak that.

Is your AHI dominated by obstructive apneas and hypopneas? If so, you may need to raise the pressure. In this case the titration didn't set a high enough pressure for you.

If your AHI is instead dominated by central apneas you may need to discuss the situation with your doctor and see about getting a more advanced CPAP machine designed specifically to treat central apnea.

Do you know if you were diagnosed with central apnea?

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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.
06-04-2014 09:10 PM
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Sleepster Offline
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Machine: ResMed AirCurve10 VAuto
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Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #10
RE: Sleep study and the algorithm of the machinery
(06-02-2014 01:40 PM)goodonya Wrote:  The sleep clinic breathing machinery was doing an all too familiar thing. It was determinedly pushing air back at me before my exhalation was finished.

All CPAP machines are going to force air in the positive direction (towards the patient) at all times, during both inhale and exhale.

When people can't tolerate exhaling against the pressure the usual remedy is a bilevel CPAP machine.

It makes no difference which brand of machine you have, apart from small differences, they all do basically the same thing. It may be that the small difference between the way one brand transitions from exhale to inhale pressure is significant for you. On the other hand, it may be that with a bit of time you'll adapt and this issue will no longer bother you.

Sleepster
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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.
06-04-2014 09:15 PM
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