(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.
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
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