Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

pressure plateau
RE: pressure plateau
a few per hour is what I had Fred and now, it's alot more, sir. You really think stop breathing for 10 seconds or more isn't an issue?

I think it is.... it's me not breathing possibly during REM sleep.... and that's critical to me, considering I've been that way for many years. Sorry if you think I'm splitting hairs here....
Post Reply Post Reply






Donate to Apnea Board  
RE: pressure plateau
We try to work with members to keep perspective on their events, We see a lot of people here, and we do our best to provide helpful analysis and advise where we can. Our work is voluntary, and your attitude in responding to bonjour is not welcome or appreciated.  You can take or leave our suggestion, but you are treading on thin ice if you think for a moment we will tolerate the inference of your post, that we don't care enough.  

You have a low CAI of about 2/hour that will not be considered by any clinician or insurance for treatment, and that's a fact we all have to deal with in trying to guide you to making good therapy decisions and working with your doctor.  Frankly nearly all of your problems would disappear if you would get a Resmed and ditch the Philips.  That is the fastest and easiest solution to solving your problem, which is mostly hypopnea. I think resolving the hypopnea with EPR and having better sync with a machine than the Philips can provide, would go a long way. This algorithm and Flex just doesn't play nice with some people. That said, I assume for not, the Philips is what we have to work with, and I don't see a central issue that is likely to be viewed as qualifying for ASV. Anyway, you have an upcoming titration, so maybe that will reveal something useful.

[Image: attachment.php?aid=23044]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply
RE: pressure plateau
(05-20-2020, 08:24 PM)Sleeprider Wrote: We try to work with members to keep perspective on their events, We see a lot of people here, and we do our best to provide helpful analysis and advise where we can. Our work is voluntary, and your attitude in responding to bonjour is not welcome or appreciated.  You can take or leave our suggestion, but you are treading on thin ice if you think for a moment we will tolerate the inference of your post, that we don't care enough.  

You have a low CAI of about 2/hour that will not be considered by any clinician or insurance for treatment, and that's a fact we all have to deal with in trying to guide you to making good therapy decisions and working with your doctor.  Frankly nearly all of your problems would disappear if you would get a Resmed and ditch the Philips.  That is the fastest and easiest solution to solving your problem, which is mostly hypopnea. I think resolving the hypopnea with EPR and having better sync with a machine than the Philips can provide, would go a long way. This algorithm and Flex just doesn't play nice with some people.  That said, I assume for not, the Philips is what we have to work with, and I don't see a central issue that is likely to be viewed as qualifying for ASV.

[Image: attachment.php?aid=23044]



Quote: Frankly nearly all of your problems would disappear if you would get a Resmed and ditch the Philips. 

you comment is post number #5
Quote:SleepriderThese charts are much more useful. We can see you probably need a higher minimum pressure, and I want to be sure you are using a lower AFlex setting of 1 or 2 in an attempt to reduce CA. You seem to have mixed or complex apnea with a pretty significant central apnea component, and there is some clustering of obstructive events.  I think a minimum pressure of 8.5 is appropriate, and Flex at 1.


this post is post #7
Quote:Unlike Resmed EPR, the Philips Flex setting has a lot more to do with timing than actual pressure relief. Flex reduces pressure ahead of expiration and continues to about midway through, then moves back to CPAP pressure ahead of inspiration. Philips C-Flex, A-Flex and Bi-Flex are all forms of "Proportional Positive Airway Pressure" where the amount of pressure relief is proportional to the patient expiratory flow. https://patents.google.com/patent/US8789527B2/en? This means that the amount of pressure relief is up to 2-cm H2O but varies in proportion to flow, so for any individual or breath, we can't accurately predict the amount of flow relief nor its duration.

Flex is way too complicated and doesn't work well for everyone, including you. It can in some cases cause a lot more problems, and a setting of 3 can cause more sync problems than lower settings. Pressure relief in general can make CA events more numerous. My suggestion is that you turn your Flex setting down. This has worked for a lot of people, however, your results are potentially bad enough that a different therapy is needed to manage CA. By contrast, Resmed EPR is very straight forward and identical to their bilevel pressure support delivery. The pressure reduction follows respiration and is 1 to 3 cm according to the settings, rather than best-guess proportional to flow. It is a lot easier to identify whether a problem is related to pressure support than to isolate the problems of Flex.

this post is post # 12

Quote:There is definitely a different vibe here. I was a member there since 2008 and eventually drifted away from the conflicts, and arguments. There are some very good, knowledgeable people over there and if you can deal with the chaos I guess it's okay. We assume most people come here for help and havn't heard of the things we tell them, even if we have repeated it countless times. At the end of the day we find it a lot more rewarding to see positive results and than to try to criticize or shame someone for not knowing, or getting it wrong on the internet. We often disagree, but the difference is, we don't need a personal insult to defend our position. I mostly hang out here.


Helping you are but telling me to work with a piece of equipment and then redact well....what should I think? I am not trying to come off cocky, it's just frustrating to try and keep up with I see as contradiction.


I'm trying to be transparent here..... be upfront right off and I won't be confused. I am willing to be humble about this.

I think the second sleep study will tell me better... my apologies if I offened. I have been so consumed about it that I haven't been focused with things lately. Concentration, is a big thing and my memory. That's why I've been pounding so hard to get the right therapy. I lost it, which I don't normally do, since I've been here. I asked Fred to be more clear... and I guess I got impatient.
Post Reply Post Reply
RE: pressure plateau
Well I'm consistent in pointing to the Philips as the problem. We are 16 pages in at 156 posts, and progress is definitely hard to come by, so we have focused on alternative machines. While an ASV would certainly eliminate the events, I'd be open to seeing if bilevel actually increases CA or resolves hypopnea. The truth is, we don't know, and we can always hoe your upcomig titration may help clear some things up.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply






Donate to Apnea Board  
RE: pressure plateau
(05-13-2020, 07:43 AM)SarcasticDave94 Wrote: I forgot to address the FL you were asking about, as pertaining to being a left panel statistic vs a graph. I think that's the way Respironics displays the FL. ResMed displays FL as a graph as I recall.

Changing from CPAP to APAP should be helpful. If Sleeprider suggested it, I'd go with it. He's better at seeing things that form that suggestion that I sometimes miss. I'd go with his suggestion over my own.

To me, an APAP introduces adjustable pressure. This can be good for several reasons. Pressure needs can change even in an overnight segment of time. You may need 6 to start, but 3 hours later 8,9,10 may be better. You can't just wake up and edit the pressure, so have a machine that can do the adjustments. These settings are not suggestions only discussion examples.

EPR on the ResMed would give a limited of up to 3 PS BPAP. This can be helpful to some. However, I am a bit concerned about the dominant event count of CA for you. In cases like this, pressure swings can make this worse, so it needs to be monitored closely.

I don't know what level of machine is best for you, but I do believe a ResMed in any flavor will serve you better than Respironics.

PS bonjour touched on an aspect, I suggest noting all comfort and complaint issues, present it to doc and say a ResMed up to VAuto would help tremendously. Myself, I would not accept this therapy you're showing on OSCAR past yesterday.



Quote:EPR on the ResMed would give a limited of up to 3 PS BPAP. This can be helpful to some. However, I am a bit concerned about the dominant event count of CA for you. In cases like this, pressure swings can make this worse, so it needs to be monitored closely


Dave,  the 3 BPAP Pressure Support.... could you elaborate? And other please chime in. Thanks
Post Reply Post Reply
RE: pressure plateau
(05-20-2020, 09:02 PM)Sleeprider Wrote: Well I'm consistent in pointing to the Philips as the problem. We are 16 pages in at 156 posts, and progress is definitely hard to come by, so we have focused on alternative machines.  While an ASV would certainly eliminate the events, I'd be open to seeing if bilevel actually increases CA or resolves hypopnea.  The truth is, we don't know, and we can always hoe  your upcomig titration may help clear some things up.

Quote:Well I'm consistent in pointing to the Philips as the problem.

This is true......and considering my machine is MSRP 500 beans, I would say for a couple barritos you can have dis macheen man !
Post Reply Post Reply
RE: pressure plateau
ResMed uses EPR for pressure relief. Pressures are decreased up to 3cm during exhale and quickly increased back to prescribed pressure when inhale is detected.

Is definately better than...

A-Flex, available on Auto CPAP machines only, lowers the pressure on exhale and gradually increases the pressure during inhale.

It seems more than just a comfort option....please Fred explain...

A ResMed, with it's distinct and consistent EPR would allow for a lower average pressure thus lessening your aerophagia. It would also allow for a better treatment for hypopneas, flow limits, RERAs, snoring and UARS. Actually your argument is that you cannot tolerate your PR machine and that you need a BiLevel/ BiPap to help with your aerophagia via it's pressure support (flex and even EPR are only 'COMFORT' settings). If you are successful then get a ResMed VAuto which is the best machine as long as you don't need an ASV.

EPR follows your breathing whereas Flex predicts it with a feeling of fighting to get a breath when it predicts incorrectly.
Post Reply Post Reply






Donate to Apnea Board  
RE: pressure plateau
It exactly the same as the Aircurve bilevel pressure support, but limited to 1, 2 or 3 cm and no Ti or trigger or cycle controls. We have used EPR to treat and significantly improve hypopnea, flow limits and other issues. Some people need the Aircurve, but at least we can see how an Airsense works by viewing mask pressure and respiratory flow in adjacent charts. The Philips CPAP works fine for some people, but where it doesn't provide good therapy, it is extremely frustrating to deal with its limitations compared to the Resmed.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply
RE: pressure plateau
(05-20-2020, 10:10 PM)Sleeprider Wrote: It exactly the same as the Aircurve bilevel pressure support, but limited to 1, 2 or 3 cm and no Ti or trigger or cycle controls.  We have used EPR to treat and significantly improve hypopnea, flow limits and other issues. Some people need the Aircurve, but at least we can see how an Airsense works by viewing mask pressure and respiratory flow in adjacent charts.   The Philips CPAP works fine for some people, but where it doesn't provide good therapy, it is extremely frustrating to deal with its limitations compared to the Resmed.

Quote: extremely frustrating

So I guess you might know how I feel.  Oh-jeez I think I would be embarrassed to market a PR machine, or do they really know what they market?

EPR follows and Flex predicts.... and come to think of it.... ASV,

Targets the patient’s minute ventilation,
continually learning the patient’s
breathing pattern and instantly
responding to any changes

and other ventilators that follow rather than predict.
Post Reply Post Reply
RE: pressure plateau
Okay, you asked for it:
The end users of CPAP equipment with a few exceptions like the members of this forum, are completely in the dark about what differentiates the brands and models of positive air pressure machines. Philips hides all of this information from the end consumer or patient to a much greater degree than Resmed who also directs most useful technical information to medical providers. That's why it is so much more work to figure out how things like "Flex" or the auto CPAP algorithm work, while we can see how EPR and the Autoset algorithm responds.

All marketing and promotions from Philips are directed to their authorized distribution network of DMEs, Online sellers, sleep clinics, insurance companies and physicians. There have been particular incentives to be an "exclusive distributor" which means competing brands are not even available. The promotions all tout the technical superiority of the products and how they help to serve patients while making the suppliers and doctors jobs easier and increasing profit margins. Philips is very active in providing incentives, training, and has provided many sleep clinics with free test machines so that titrations are based on the Philips lineup and proprietary terms like "BiPAP". All of this is perfectly acceptable because among the entire sleep distribution chain and sleep medicine, the differences between brands of machines is perceived as negligible, and the lowest price and biggest profit return becomes the controlling interest. We are actually fortunate we are not overwhelmed by the numerous new Chinese CPAP entries that can be purchased very cheaply, because insurance will reimburse suppliers for those machines at the same rate as Philips or Resmed.

If an incentive exists for prescribing or dispensing a particular brand, and it actually costs less, than a competing brand, what do you think happens when end-users have absolutely no knowledge to make a choice? Very few people actually have a clue what they are getting when they are dispensed a machine, and as a result the end-user is left out of the promotions and usually not given a choice. Recently Philips and Resmed have done some direct marketing to consumers, mainly for travel machines where a choice is actually involved. Noe of this will change until enough people take the time to educate themselves on the choices and self-advocate for the best choice. That is what we do here, and our membership is a tiny speck in the PAP marketplace, or if you prefer, a fly in the ointment of the CPAP mafia.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  Is expiratory pressure relief similar to BiPAP on lower pressure settings? drmaestro 11 571 05-18-2020, 01:35 PM
Last Post: bonjour
  [Pressure] Difference between EPAP set pressure and operational pressure brugerard 8 670 01-02-2020, 10:03 PM
Last Post: brugerard
Question 90% Pressure meaning & Setting Correct Pressure for Auto-CPAP dk2011 2 1,521 12-28-2018, 05:37 PM
Last Post: bonjour
  Pressure vs Mask Pressure paulag1955 8 2,185 08-21-2018, 09:31 AM
Last Post: Sleeprider
  Isn't Resmed's Expiratory Pressure Relief really Inspiratory Pressure Support?? Reznik 116 8,685 11-27-2017, 07:28 PM
Last Post: Reznik
  With a face mask pressure is about 8.5. With a nasal pillow pressure was 20 at one po brojohn1611 10 2,390 11-04-2017, 03:05 AM
Last Post: James2017
  Autoset 90 percentile pressure vs. Titration study pressure CDNHoser 12 2,076 10-19-2017, 09:02 PM
Last Post: Sleepster


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.