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Wish to have zero pressure at exhaling
#11
RE: Wish to have zero pressure at exhaling
Does your machine put settings into the report? Could you post that info about these 2 charts, and no I don't think it will explain the difference.

IMHO we must determine which is accurate. It is VERY unusual to see that much of a difference. On your old machine, did you ALWAYS see significant Central events?

Why did you choose to get a new machine?
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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.
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#12
RE: Wish to have zero pressure at exhaling
Hi,
 
As I already reported, with the previous PRISMA machine (and also with a Sefam EcoStar I used for about a month) I used to have very few OBS event and about 10/h CNT hypopneas. Pressure in both machines was between 4-6. Unfortunately, I tried the Resmed only for few minute and don’t have access to it.
I’ll try 8-15 and SoftPAP mode 3 this night and see what happens.
Thanks,
Arik
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#13
RE: Wish to have zero pressure at exhaling
(01-06-2019, 03:46 PM)bonjour Wrote: Does your machine put settings into the report?  Could you post that info about these 2 charts, and no I don't think it will explain the difference.  

IMHO we must determine which is accurate.  It is VERY unusual to see that much of a difference.  On your old machine, did you ALWAYS see significant Central events?

Why did you choose to get a new machine?

Hi,

I always had between 5-15 CNT Hypopnea events per hour and very few OBS events per hour. I got a new machine due to service reasons.
Thanks,
Arik
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#14
RE: Wish to have zero pressure at exhaling
(01-06-2019, 02:29 PM)bonjour Wrote: Settings 1 and 2 of the softPAP breathing relief function are intended for patients who find exhaling against high pressure uncomfortable. The breathing relief function reduces the pressure early during the transition to expiration, allowing you to breathe out more easily. 
Setting 3 is suitable for patients who experience respiratory distress with a low pressure setting. The pressure is raised slightly during inspiration. You can select the setting for the softPAP breathing relief here or deactivate it if you do not wish to use the function anymore. 
• Setting 1: Low breathing relief 
• Setting 2: Normal breathing relief 
• Setting 3: Breathing relief with inhalation assistance 
This function is only available in CPAP and APAP mode. If it is not possible to select this function in one of these modes, it must be enabled by your physician or authorized dealer. 

Which softPAP setting are you using?  I think you have it set to Off.

By any chance do you have a copy of the Clinician Manual?  PDF format would be preferable. I would like to see it added to our collection.

Your detail views show Flow Limitation.  The way this is treated is with Pressure Support (PS) on a Bi-Level machine.  The ResMed Autoset EPR can behave like PS on a biLevel and this is one reason we really like it.  Your softPAP may give you some of the same benefits.

With CPAP we deal with the Flow Limits the same way we deal with Hypopnea and Apnea, by raising pressure.
I would set your range from 7 to 20 for a night, I don't think your max pressure will run away and this will show what your machine thinks it needs to treat your apnea.

Also your events look a bit clumpy, in clusters, which implies likely positional apnea.  We have seen this and it is easily and well treated with a loose fitting soft cervical collar to keep the chin from tucking.

There are several bi-level machines, They all have 3 basic pressure settings, Expiration Min, Inhalation Maximium, and Pressure support (PS) which is added to the expiration pressure to determine the actual inhalation pressure.  The different bi-level machines treat different conditions and are not interchangeable.  

from the user guide for your machine: BiLevel therapy device for the treatment of patients with obstructive, mixed, or complex sleep apnea, and a high and/or fluctuating pressure requirement, poor CPAP compliance The device has different pressure levels during inspiration and expiration. 

Fred

Hi Fred,

1. I used to set the softPAP to off. 
2. I have the User Manual, I wish I have the clinical manual because some of the terms used in the SW are unclear to me.
3. Can you explain what Flow Limitation is?

Thanks,Arik
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#15
RE: Wish to have zero pressure at exhaling
(01-07-2019, 11:54 AM)Arik Wrote:
(01-06-2019, 02:29 PM)bonjour Wrote: Hi Fred,

1. I used to set the softPAP to off. 
2. I have the User Manual, I wish I have the clinical manual because some of the terms used in the SW are unclear to me.
3. Can you explain what Flow Limitation is?

Thanks,Arik

Event Definition Apnea, Hypopnea, Flow Limitation[edit]
  • Apnea: 80% to 100% reduction in airflow for >= 10 seconds

  • Hypopnea: 50% to 80% reduction in airflow for >= 10 seconds

  • Flow Limitation: <50% reduction in airflow for >= 10 seconds
These events may be either Obstructive or Central in nature They represent different degrees of similar events. All of these may be disruptive. While Central Hypopneas are important in diagnosing Central/Mixed/Complex apnea they are not monitored in most Sleep Studies.

When you have questions about terms feel free to ask about them here.
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.
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#16
RE: Wish to have zero pressure at exhaling
(01-06-2019, 03:31 PM)bonjour Wrote: Unless the manufacturer changed their algorithm. . . 

Based on the Previous machine I would say you purchased the wrong machine.

Do you have access to a ResMed Autoset?  Why, so we can see a night with a machine that is different.  I, like you, am questioning the accuracy.  Based on the machine I would suggest totally different paths.  I would suspect the old machine is wrong, but that is a guess based mostly on age.

Fred

Hi Fred,

Probably they changed the algorithm. There is no way we can get any explanation on that. (I'm a retired SW engineer and familiar with the profession internals...).
I would agree that the old machine is wrong except I was feeling much better in the mornings with it   Dont-know
Thanks,
Arik
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#17
RE: Wish to have zero pressure at exhaling
(01-07-2019, 10:33 AM)Arik Wrote:
(01-06-2019, 03:46 PM)bonjour Wrote: Does your machine put settings into the report?  Could you post that info about these 2 charts, and no I don't think it will explain the difference.  

IMHO we must determine which is accurate.  It is VERY unusual to see that much of a difference.  On your old machine, did you ALWAYS see significant Central events?

Why did you choose to get a new machine?

Hi,

I always had between 5-15 CNT Hypopnea events per hour and very few OBS events per hour. I got a new machine due to service reasons.
Thanks,
Arik
By CNT do you mean Central or Count?

The treatment for Central/Complex/Mixed Apnea is significantly different than that for Obstructive Apnea.  

Central Apnea is where the brain does not signal the body to breathe.  This is treated by forcing air into the lungs with a very quick and fairly large pressure increase which is followed by a rapid drop to your "normal" exhale pressure.  This is what occurs in an ASV bi-level machine.  This is your previous chart

Obstructive Apnea is where something is "restricting" or blocking the airway.  This is treated with fairly constant pressure.  This is what CPAP and "entry" level bi-level is designed to treat.  This is your Current chart.

You acquired your new machine because of service reasons.  I'm looking for a reason for the difference between the two, and "service" reasons could be the culprit.  What type of service reasons?

With a CPAP or APAP (your machine) increasing pressure, and pressure changes tend to increase Central Apnea events so we want to lower your pressure, decrease your pressure range and minimize or turn off your softPAP (flex), pretty much the opposite of what you do for obstructive events and the opposite of my previous recommendations.

A 1 night trial on a ResMed AutoSet would do wonders for validating which machine of yours has valid numbers.

Fred
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.
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#18
RE: Wish to have zero pressure at exhaling
(01-07-2019, 12:09 PM)Arik Wrote:
(01-06-2019, 03:31 PM)bonjour Wrote: Unless the manufacturer changed their algorithm. . . 

Based on the Previous machine I would say you purchased the wrong machine.

Do you have access to a ResMed Autoset?  Why, so we can see a night with a machine that is different.  I, like you, am questioning the accuracy.  Based on the machine I would suggest totally different paths.  I would suspect the old machine is wrong, but that is a guess based mostly on age.

Fred

Hi Fred,

Probably they changed the algorithm. There is no way we can get any explanation on that. (I'm a retired SW engineer and familiar with the profession internals...).
I would agree that the old machine is wrong except I was feeling much better in the mornings with it   Dont-know
Thanks,
Arik

Then Let's work at it and get you dialed in on this machine.  Make the changes I suggested and post here after 1 night.  We need to keep a close eye on it for a while.

Fred
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.
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#19
RE: Wish to have zero pressure at exhaling
[attachment=9730 Wrote:bonjour pid='282019' dateline='1546882868'][attachment=9730][attachment=9730]
(01-07-2019, 12:09 PM)Arik Wrote:
(01-06-2019, 03:31 PM)bonjour Wrote: Unless the manufacturer changed their algorithm. . . 

Based on the Previous machine I would say you purchased the wrong machine.

Do you have access to a ResMed Autoset?  Why, so we can see a night with a machine that is different.  I, like you, am questioning the accuracy.  Based on the machine I would suggest totally different paths.  I would suspect the old machine is wrong, but that is a guess based mostly on age.

Fred

Hi Fred,

Probably they changed the algorithm. There is no way we can get any explanation on that. (I'm a retired SW engineer and familiar with the profession internals...).
I would agree that the old machine is wrong except I was feeling much better in the mornings with it   Dont-know
Thanks,
Arik

Then Let's work at it and get you dialed in on this machine.  Make the changes I suggested and post here after 1 night.  We need to keep a close eye on it for a while.

Fred

Hi Guy,

I made the changes as follows: P 6-15, softPAP stage 3. What I got i the following (see attached files):
A. Only 2 Centrals in 4 hours sleep.
B. Obstructive AIH went down to 7/h. Only 2 Apneas during the 4 hour.
C. BUT-very disturbed sleeping. A lot of unintentional "air bubbles" from my mouth (how you call it?). After 4 hours I had to remove the mask in order to stay asleep. Is it caused by a bad mask? dry mouth? or what?
I attached a 4 hours report and a 30 Min. report. I added a screen shot to let you see the color map for the pressure curves.

Let me know what you think and how to proceed.
Thanks,
Arik
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#20
RE: Wish to have zero pressure at exhaling
(01-08-2019, 04:05 PM)Arik Wrote:
(01-07-2019, 12:41 PM)bonjour Wrote: Then Let's work at it and get you dialed in on this machine.  Make the changes I suggested and post here after 1 night.  We need to keep a close eye on it for a while.

Fred

Hi Guy,

I made the changes as follows: P 6-15, softPAP stage 3. What I got i the following (see attached files):
A. Only 2 Centrals in 4 hours sleep.
B. Obstructive AIH went down to 7/h. Only 2 Apneas during the 4 hour.
C. BUT-very disturbed sleeping. A lot of unintentional "air bubbles" from my mouth (how you call it?). After 4 hours I had to remove the mask in order to stay asleep. Is it caused by a bad mask? dry mouth? or what?
I attached a 4 hours report and a 30 Min. report. I added a screen shot to let you see the color map for the pressure curves.

Let me know what you think and how to proceed.
Thanks,
Arik
If your machine produces a summary of the night please provide that too.

Your leak chart is showing "Mouth Breathing"  the flat tops of the leak chart indicate that.  Read the Mask Primer the section on Mouth Breathing. Mouth breathing frequently causes a dry mouth.

Let's bring your range to 7 -15 to try to bring down your obstructive element of your AHI.  In the USA the medical community want to see an AHI of < 5 AHI or 5 events per hour.  We like to see it lower.

Are you getting air in your stomach?



So change the settings and see if you can effect a change for the mouth breathing. 

Fred
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.
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