Final part of the puzzle

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
jordie500
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Final part of the puzzle

Post by jordie500 » Wed Jul 12, 2017 7:24 pm

Please can anyone help me?

I was diagnosed earlier this year with central sleep apnea. Came as a massive shock to me but it is what it is.

I was given a philips bipap autosv advanced machine with amara view mask to use. After several leaks and adjustments (and help from this forum) I finally started feeling so much better. I became compliant because I was using it at least 4 hours per night and my AHI which started at 50 to 60 went right down to 2. The only problem I had was a very dry mouth so I mentioned it at my next appointment. Something which I now regret

The nurse recommended I use a humidifier but the machine I had been given was not able to be used if I wanted to use a humidifier. Apparently the humidifier she had in stock, fitted an older model of the machine I had been given so the solution was to swap machines. My machine was swapped to a very similar looking machine but apparently slightly older model and the humidifier fitted fine. Off I went and since that day I have had nothing but problems.

The only differences I can see are
1) I am now using a different machine (older model)
2) A humidifier was added on

I have tried removing the humidifier and it makes no difference whether it is connected or not.

Since swapping my machine I am experiencing the following:
Very very difficult to swallow both food or water.
Ear Pain
Pain after 5 minutes of use in my stomach
The machine seems to breath with me for the first 5 minutes and then the pressure gets so high that it starts blowing the mask off my face. Tightening the mask doesn't help at all.
The mask is blowing a constant high pressure when I am awake. I am awake, I am fine, I don't need the high pressure it is forcing on me.

At my appointment today the nurse said she is baffled but doesn't know what to recommend? Is she doesn't then what hope do I have.

I am no longer living. I am existing and it is wearing me down, i am so unhappy.

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Pugsy
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Re: Final part of the puzzle

Post by Pugsy » Wed Jul 12, 2017 7:32 pm

So exactly which model were you using and exactly which model are you now using?

How about getting your first machine back and getting a humidifier that will work with it?

Are you absolutely certain that all the prior settings are identical to the settings on this new "older" machine?
jordie500 wrote:philips bipap autosv advanced machine
Unfortunately the above covers about 4 model lines and while I think that the algorithms were unchanged I can't swear to it or the possibility that one model might have some features the other one doesn't have.

Oh...one other thing. Have you checked the run hours on this new "older" machine to see if it was used prior to your use.
Therapy hours can be reset to 0 but machine run hours can't. If it was used in the past then maybe it was returned because of a problem with it.

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WickedLoki
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Re: Final part of the puzzle

Post by WickedLoki » Thu Jul 13, 2017 1:14 pm

xxyzx wrote:
......
your dry mouth could have been your mouth being open
confirmed if the leak it caused ran the pressures way up on the second machine
but we need to see the data to know for sure
Leaks do not cause PAPs to increase pressure! They cause PAPs to increase flow in an attempt to maintain pressure!

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palerider
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Re: Final part of the puzzle

Post by palerider » Thu Jul 13, 2017 2:56 pm

WickedLoki wrote:
xxyzx wrote:
......
your dry mouth could have been your mouth being open
confirmed if the leak it caused ran the pressures way up on the second machine
but we need to see the data to know for sure
Leaks do not cause PAPs to increase pressure! They cause PAPs to increase flow in an attempt to maintain pressure!
you're absolutely right, and the idiot is wrong. as usual. in fact, if the leaks are bad enough, auto machines will *REDUCE* pressure in an attempt to get the mask to seal:

Image

pressure drops during the excessive leak periods, then goes back up as soon as the leak stops.

the idiot clearly doesn't understand rudimentary flow dynamics.

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robysue
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Re: Final part of the puzzle

Post by robysue » Thu Jul 13, 2017 4:20 pm

xxyzx wrote:
palerider wrote:
WickedLoki wrote:
xxyzx wrote:
......
your dry mouth could have been your mouth being open
confirmed if the leak it caused ran the pressures way up on the second machine
but we need to see the data to know for sure
Leaks do not cause PAPs to increase pressure! They cause PAPs to increase flow in an attempt to maintain pressure!
you're absolutely right, and the idiot is wrong. as usual. in fact, if the leaks are bad enough, auto machines will *REDUCE* pressure in an attempt to get the mask to seal:

Image

pressure drops during the excessive leak periods, then goes back up as soon as the leak stops.

the idiot clearly doesn't understand rudimentary flow dynamics.
========

rotflmao
i was correct

you are grasping at straws for special cases that did not happen here

i understand flow dynamics quite well
but you fail completely at logic and facts
xxyzx,

LOOK at the graph that palerider posted.

During the excessively large leaks, the machine is REDUCING the pressure. You can see that with your own eyes if you just LOOK at both the pressure curve and the leak curve at the same time. And if you read the documentation that is available, both Resmed and PR have said that the reason their xPAPs reduce the pressure in the presence of Large Leaks in an attempt to get the mask to reseal.

On the other hand, if the leaks are not too bad, the xPAP will increase airflow into the system in an effort to maintain the desired pressure. Increased airflow in the presence of a leak does NOT increase pressure, it simply makes it possible to keep the pressure at the same level it was before the leak started. As long as the excess leaks are not too bad, the xPAPs we use are designed to balance airflow with leak in order to maintain the desired pressure.

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TASmart
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Re: Final part of the puzzle

Post by TASmart » Thu Jul 13, 2017 4:26 pm

Amazing how many of you like to beat your heads against the wall.
All posts reflect my own opinion based on my experience and reading.
Your mileage may vary
Past performance is no guarantee of future results
Consult with your own physician as people very

nanwilson
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Re: Final part of the puzzle

Post by nanwilson » Thu Jul 13, 2017 4:32 pm

[quote="xxyzx

the idiot clearly doesn't understand rudimentary flow dynamics.[/quote]
========

rotflmao
i was correct

you are grasping at straws for special cases that did not happen here

i understand flow dynamics quite well
but you fail completely at logic and facts[/quote]

Xxyzx do you not know the difference from an opinion and fact????? Obviously you believe that every you state is "fact", sorry pal. Everything you have read is not fact, much of it is opinion, and your opinion gets clouded in with the item and in your mind it must be fact so you must repeat it. There are folks here that have been on cpap for many, many years and they are sometimes still learning. You believe that since you have tried to use a bipap and failed, then you MUST know everything about everything, Even Einstein and his biggest colleages in the world learned new information from time to time. Just because you have read something does not make it fact, please try and listen to those that have been here for many years, perhaps you will learn a thing or two . Everyone on this planet is still learning something new every day and will continue to do so, no-one knows everything, even though you believe that you do and must push, your "OPINIONS" on everyone. Think before you spout off, you might just learn that you are wrong from time to time, just like the rest of the world. NO ONE IN PERFECT< AND NO ONE KNOWS EVERYTHING!!!!!
Take a chill pill and sit back and learn about what you don't know, about life having to sleep with a mask and machine .
Started cpap in 2010.. still at it with great results.

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palerider
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Re: Final part of the puzzle

Post by palerider » Thu Jul 13, 2017 7:00 pm

since the moron is incapable of learning, this is to anybody else, that might be mislead by his stupidity.

Pressure is the result of resistance to flow. think of a garden hose, with water flowing freely from the end, there's little pressure, but lots of flow, because there's little pressure, it doesn't spray very far.

add some resistance, say your thumb over the end of the hose, and the flow drops dramatically, and the pressure goes up, forcing the water that's there to shoot out a much greater distance.

when there are more leaks at your mask, if the machine did nothing, the pressure would drop, just like loosening your finger on the hose.

however, the machine is programmed to *MAINTAIN* a desired pressure, and so it increases the flow, to compensate for the leak, and maintain the desired pressure.

you can put your ear up to the machine and listen to the fan speeding up and slowing down as you breath, because when you inhale, it's like a leak, and the machine has to create more flow to maintain pressure.... when you exhale, it's like there's suddenly less leak, and the machines blower slows down, so the pressure stays where it's desired.

be mislead by xmoronx at your own peril.

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palerider
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Re: Final part of the puzzle

Post by palerider » Thu Jul 13, 2017 9:11 pm

https://www.youtube.com/watch?v=AyizWUpPt28

works the same with air.

you're clearly a parts changer.

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palerider
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Re: Final part of the puzzle

Post by palerider » Thu Jul 13, 2017 9:30 pm

xxyzx wrote:
palerider wrote:https://www.youtube.com/watch?v=AyizWUpPt28

works the same with air.

you're clearly a parts changer.
=========

nonsense

i showed you the facts

you need pressure to create flow
whether air or electrons
see the thing that everybody else is realizing about you is that you have
no practical experience.
you're all 'book learnin', but you've never done anything in the real world, like say:
hook up a manometer to the end of the cpap hose, and *OBSERVE* the pressure that's presented at the end of the hose, where the mask connects.

if you had, you wouldn't make stupid comments like "the machine increases pressure in response to a leak"... because you'd have seen that the pressure remained constant until the leak overcame the flow generators ability to create more airflow, at which point the pressure would be seen to drop.

Of course, it's impossible for you to consider that reality may be different than what you believe.

to everybody else, I *have* a manometer, and I *have* conducted this experiment.

as always, believe the opposite of what xidiotx says, and you'll be pretty safe

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palerider
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Re: Final part of the puzzle

Post by palerider » Fri Jul 14, 2017 11:32 am

xxyzx wrote:tell me how you can get flow without pressure to make it happen
you cant because it is impossible no matter how many silly meters you own
and there ya go, folks, reality has no place in xmoronx's world.

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CapnLoki
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Re: Final part of the puzzle

Post by CapnLoki » Fri Jul 14, 2017 12:07 pm

xxyzx wrote: i wont consider the alternate reality of the libtards

i know that pressure causes flow

and yes you feel the pressure at the mask because the pressure is pushing the air to cause you to feel it


you cant have flow without pressure first

the only stupid comments are yours
the machine increases pressure when there are leaks came out of an xpap manual

it adds more pressure so the loss from the leak does not prevent the proper pressure from getting to the user

you are just a dumb tekkie that does not understand anything
like some army guy trained in electricity
its a hoot to hear them describe what they think is actually going on
it may work to fix things but not to design them

i dealt with way too many of them in my career
same with hackers who think they can code too

tell me how you can get flow without pressure to make it happen
you cant because it is impossible no matter how many silly meters you own
The issue is not "which came first, pressure or flow?" its "if you have a constant pressure pump and you reduce resistance which lets the flow increase, will the pressure go up or down?" By definition, if its constant pressure, it will not change!

However, since there is no such thing as a perfect constant pressure pump, what might we expect? The pressure will dip until the pump compensates by raising the flow. Whether it overshoots a bit depends on the quality of the sensors and the smarts built into the logic to anticipate. Since a cpap is designed to handle major flow changes on every breath, I would think it does a good job of handling leaks.

To use the electrical analogy, if you turn on the lights does the voltage go up or down? In my experience it goes down a bit and then recovers with little overshoot.

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CapnLoki
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Re: Final part of the puzzle

Post by CapnLoki » Fri Jul 14, 2017 2:24 pm

xxyzx wrote:
CapnLoki wrote:The issue is not "which came first, pressure or flow?" its "if you have a constant pressure pump and you reduce resistance which lets the flow increase, will the pressure go up or down?" By definition, if its constant pressure, it will not change!

However, since there is no such thing as a perfect constant pressure pump, what might we expect? The pressure will dip until the pump compensates by raising the flow. Whether it overshoots a bit depends on the quality of the sensors and the smarts built into the logic to anticipate. Since a cpap is designed to handle major flow changes on every breath, I would think it does a good job of handling leaks.

To use the electrical analogy, if you turn on the lights does the voltage go up or down? In my experience it goes down a bit and then recovers with little overshoot.
an xpap is a continuous air PRESSURE device AT THE USERS INPUT not the machines output

there is no flow without pressure
True, but the question is what happens as conditions change. What happens near the pump is largely irrelevant, the conditions at the mask are the only thing that concerns us. One can consider the hose to be part of the pump; what goes on inside is not our concern.
xxyzx wrote:when there is a leak the cpap will increase its delivered pressure to try to maintain the USER pressure at their set point
No, it increases the flow rate to compensate. The pump can be thought of as a large reservoir. If a valve is opened a bit more, the flow increases, but the pressure never changes. If the compressibility of air creates a pressure change, it would be a design goal to make that not appear at the mask end.
xxyzx wrote:to use the electric analogy correctly
when your voltage changes in your car
then the regulator changes the alternator to keep it within its working range
I deal with regulators regularly. Its job is to maintain an exact voltage, regardless of the load. It does not raise or lower the voltage, it tells the alternator to produce more or less current. Since there are voltage drops in the wire, where you measure, and the details of the regulator are adjusted to keep a constant voltage at the battery.
xxyzx wrote: or when you have a dimmer switch
then you can turn the voltage up or down to keep the light constant no matter what size bulb you use
Dimmers usually change the voltage to change the current because the resistance of the bulb is constant.
xxyzx wrote:how hard is it for you all to know that a cpaP provides PRESSURE
A cpap provides a precise pressure, regardless of breathing or leaks. It will try to avoid pressure changes. That is the primary design goal of a cpap, everything else is just minor adjustments and enhancements.

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Goofproof
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Re: Final part of the puzzle

Post by Goofproof » Fri Jul 14, 2017 3:31 pm

TASmart wrote:Amazing how many of you like to beat your heads against the wall.
To bad people couldn't get some knowledge put it down on paper, then hold it of their forehead, them beat the knowledge in. Mankind could be improved, but there
would have to be a lot of beating going on. Jim
Use data to optimize your xPAP treatment!

"The art of medicine consists in amusing the patient while nature cures the disease." Voltaire

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CapnLoki
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Re: Final part of the puzzle

Post by CapnLoki » Fri Jul 14, 2017 5:36 pm

xxyzx wrote: you are the gift taht keeps on giving
Sorry. Using the same snarky line twice in a thread shows that you're actually a middle school boy.
xxyzx wrote: the only way to increase flow is to increase pressure to cause flow

what it really does is increase pressure to allow for the lost pressure at the leak
so as to keep the mask pressure to the end user at the set point value for pressure

flow is all irrelevant as it just comes along for the ride

its called a constant postiive air PRESSURE device because it delivers pressure by starting with enough pressure to account for loss in the tube and leaks and the mask size
You should learn about "Constant Pressure Systems." There is no requirement to raise the pressure; the only requirement is to increase the flow rate to match the needs. What happens in the pump & hose is irrelevant to the user, its only at the mask that's interesting. You can claim the pressure increases at various places, but it only matters at the mask, so everything upstream is simply a "constant pressure pump."

If the size of a pipe stays constant then to increase flow implies increased pressure. However, the leak in the mask can be viewed as an increase in the pipe, which really blows away the increased pressure claim. For that matter, every breath implies a major change in the volume so this discussion has little to do with leaks.

You can claim that from a engineering viewpoint, if you measure pressure at different points it will vary dramatically with the flow rate. But from a therapeutic viewpoint, which is what we in this forum are concerned with, this is basically a Constant Pressure System, that handles changing flow rates.

For further reading, consider:
http://erj.ersjournals.com/content/17/2/259
This is a study where various respirators, including several BiPaps, are measured for how they respond to small and large leaks. You'll notice that they only talk in terms of the pressure drops at the mask, not about increased pressure at the pump. BTW, the pressure with the BiPaps dropped with leaks.

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