Need help with the settings on Airsense 10 Autoset for her

palerider wrote:

Wulfman... wrote:And, after looking at your report, your Flow Limitations are what is driving your pressures up......for no "good" reason.

you are making statements driven by your bias that you cannot prove.

the machines attack snoring and flow limitations *for a reason*. because it's a proven indication that there is danger of the airway closing, plus, flow limitations and snoring are in and of themselves potentially harmful due to the extra work that they put the respiratory system to, and the extra pressures put on the heart as a result.

This is exactly the same point I have failed to deliver. It seems like even my personal experience (I have "normal" untreated AHI of 4.9) is not relevant and won't convince Wulfman that is not black and white, that there are shades of grey, too.

And you're both missing MY point.......in that "chasing" flow limitations with pressure increases can elicit more flow limitations by the human subconscious reflex reaction to the pressure increases. If "MORE" pressure will subdue the flow limitations and there are virtually no apneas that they are preceding, then using a higher fixed pressure MAY help (depending on the person). If more pressure does NOT subdue the flow limitations, then there are other issues which need to be addressed in some other way......or, ignored (depending on the effects to the person).


Den

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Wulfman... wrote:pressure increases can elicit more flow limitations by the human subconscious reflex reaction to the pressure increases.

this is the first I've heard of pressure increases causing some kind of subconscious reflex action that causes flow limitation increases.

please elucidate, cite sources, reference material, etc.

palerider wrote:

Wulfman... wrote:pressure increases can elicit more flow limitations by the human subconscious reflex reaction to the pressure increases.

this is the first I've heard of pressure increases causing some kind of subconscious reflex action that causes flow increases.

please elucidate, cite sources, reference material, etc.

Why do you think the Puritan Bennett auto machines had the IFL switches in their setup configurations?

viewtopic.php?f=1&t=36217&st=0&sk=t&sd= ... limitation


Den

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So... here's my image from last night. Not sure why I had such a high leak rate. I'll try to make sure I have the mask on right tonight. At least those snores are better. I'm a champion snorer- even the dogs don't want to sleep in the room with me!

Wulfman... wrote: ( Although if someone had been through an in-lab sleep study, it's highly unlikely that they'd have been prescribed a range. From what I've seen, "ranges" are PRESCRIBED for people who the doctors don't seem to have a clue and it's like saying "I don't know, try this." )

I hate to jump into a discussion without an introduction post (I'll get to that) but I do have some input here. I had an at-home sleep study. Based on the results, my doctor wanted me to do an in-lab titration because my SPO2 never returned to 100% overnight after the first apnea event. She feels I may be a good candidate for a bi-level machine depending on what the titration determines. Insurance denied it. She personally called them for a "peer to peer" review, and they still refused. The rep she spoke with basically said he had attended a seminar a couple of weeks back and that an in-lab titration is not necessary any more due to the advancements in auto machines. They said I have to try the auto machine for 6 weeks, and if I'm still not getting the desired results, then they'll allow an in-lab titration study. So it isn't necessarily the doctor that is lacking the clue, her hands are tied by the insurance company unless I want to pay out of pocket for the lab.

My insurance also requires an appointment after 30 days (but before 90) after starting XPAP therapy as part of their compliance requirements. Therefore my plan is to run with Auto 5-15, then meet with my doc for the 31 day appointment. She'll look at the numbers and make any necessary adjustments to my prescription. If another couple of weeks on the new settings isn't putting me where I need to be, then she'll re-submit for the lab and hopefully they'll approve it.

It is a pretty sad state of affairs that we've allowed insurance companies to override our doctors on what the best course of action is.

PollyCT wrote:So... here's my image from last night. Not sure why I had such a high leak rate. I'll try to make sure I have the mask on right tonight. At least those snores are better. I'm a champion snorer- even the dogs don't want to sleep in the room with me!

snores? what snores?? those aren't better, according to the chart, they're GONE!

looks like you're doing good. you can right click the leak chart and turn on a dotted line at 24lpm, which is where you need to keep the leaks under. as long as they're under that (and they were for some 98% of the night) and the leaks aren't bothering you, don't worry too much about them.

as to the way the thread has degenerated into bickering, just ignore that, it tends to happen to all threads around here... there's often some useful info that turns up in the back and forth though

Wulfman... wrote:

palerider wrote:

Wulfman... wrote:pressure increases can elicit more flow limitations by the human subconscious reflex reaction to the pressure increases.

this is the first I've heard of pressure increases causing some kind of subconscious reflex action that causes flow limitation increases.

please elucidate, cite sources, reference material, etc.

Why do you think the Puritan Bennett auto machines had the IFL switches in their setup configurations?

viewtopic.php?f=1&t=36217&st=0&sk=t&sd= ... limitation

so your best answer is to drag out some nearly totally unrelated thing from 7 years ago, on completely unrelated equipment, from a time that's multiple generations back to say "see! it's all crap"??

REALLY??

but, to take a stab at your question, I'd *GUESS that PB came up with some new, cutting edge thing, pushing the boundaries of current(then) tech, and said "well, maybe we should make it optional since we haven't figured out all the ins and outs".

now, a *rational* individual, which I typically believe you are, would say "hmm, how much has the computer industry changed since 200(whenever those were introduced, before , well, let's see, they're much more powerful, the amount of computing power that one can cram into a box the size of a cpap has increased hugely, the "smarts" they can cram into a little box has changed greatly, and just maybe some advancement in the controlling and measuring of pressures has happened, and maybe even there's more information available about respiratory issues since then", so maybe, just maybe, the several generations newer machine doesn't do things the same way the pb420e did... but, no, it's easier to say that "the first version wasn't perfect, they're all crap".

you didn't answer with any backing of your claim that "pressure increases can elicit more flow limitations by the human subconscious reflex reaction to the pressure increases."

palerider wrote:you didn't answer with any backing of your claim that "pressure increases can elicit more flow limitations by the human subconscious reflex reaction to the pressure increases."

I WAS going to be done with this thread, but......

It's "common sense"!!! All you have to do is look at many of the posted reports on the forum and see it. Even Polly's last report.......the flow limitations INCREASE when the pressure increases in response to some of them. Her pressures were much lower before it started responding to the flow limitations. Think about it.....LOGICALLY and RATIONALLY. If you're asleep (or even awake) and something blows a shot of air into your nose or face, you would have a somewhat startled reaction and (if asleep), the reflex reaction COULD be enough to cause the machine to interpret it (the breathing anomaly) as another flow limitation......and the cycle continues. Polly's flow limitation numbers are miniscule but are enough to escalate the pressure output. Is it "sleep disturbing"? Only SHE will be able to determine that over a period of time. If she starts reporting that she's not feeling rested, then that's what I would start looking at.......because the apneas and hypopneas are pretty non-existent.

And, as far as that OLD technology you're trying to put down.......
The PB machines may have had a leg up on the FOT technology and use.....

As we discussed before.....

viewtopic/t103086/What-does-the-cpap-ma ... ntral.html

And finally, ResMed has caught up. Sort of a "Back to the Future" scenario?

http://www.resmed.com/int/products/s9_s ... nc=dealers

"CSA detection

Central Sleep Apnea (CSA) detection is now available in both the S9 AutoSet and S9 Elite. It uses the Forced Oscillation Technique (FOT) to determine whether the airway is open or closed during an apnea. Small oscillations in pressure are added to the current device pressure. The CSA algorithm uses the resulting flow and pressures to measure whether the airway is open or closed."



NOW I'M DONE!

Den

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Wulfman... wrote:It's "common sense"!!! All you have to do is look at many of the posted reports on the forum and see it. Even Polly's last report.......the flow limitations INCREASE when the pressure increases in response to some of them. Her pressures were much lower before it started responding to the flow limitations.

her flow limitations increase as she gets deeper into sleep, not as the pressure goes up. the whole POINT of auto pap technology is that peoples needs can, and do, change during the night. of course, her pressures were much lower before they were increased.

Wulfman... wrote: Think about it.....LOGICALLY and RATIONALLY. If you're asleep (or even awake) and something blows a shot of air into your nose or face, you would have a somewhat startled reaction and (if asleep), the reflex reaction COULD be enough to cause the machine to interpret it (the breathing anomaly) as another flow limitation......

except, nothing is "blowing a shot of air into your nose or face". there's no blast of air, the pressure increases over the span of minutes, not instantly.

it's pretty easy to look at a breath on the flow chart and see the characteristic flow limitation curves, a startled breath, as you suggest, would not look the same, and would not be interpreted the same. for that matter, a single flow limited breath would not cause the pressure to increase.

you'd know this if you'd ever spent time looking at reports, scanning the individual breaths, looking at the flow, the scored flow limitation curves and the pressure responses.

Wulfman... wrote:Polly's flow limitation numbers are miniscule but are enough to escalate the pressure output. Is it "sleep disturbing"? Only SHE will be able to determine that over a period of time. If she starts reporting that she's not feeling rested, then that's what I would start looking at.......because the apneas and hypopneas are pretty non-existent.

1) her flow limitations, on the chart, are anything but minuscule, they're moderate at times, and the machine responds to that. as SAG said in the thread you linked: "But the point remains, if IFL1 is "doing something", then it is "seeing something""

2) you've NO EVIDENCE, whatsoever that her apneas and hypopneas would still be pretty non-existent if the auto algorithm were not doing it's job as it is.

Wulfman... wrote:And, as far as that OLD technology you're trying to put down.......
The PB machines may have had a leg up on the FOT technology and use.....

I'm not "trying to put down" the old technology, I'm saying that the technology has come a long way since then.

I also fail to see where FOT has anything at all to do with this conversation.

Wulfman... wrote:the flow limitations INCREASE when the pressure increases in response to some of them. Her pressures were much lower before it started responding to the flow limitations. Think about it.....LOGICALLY and RATIONALLY.

This looks wrong both logically and rationally to me. Flow limitation increases as negative pressure from lungs goes up on an inhalation effort, but machine's positive pressure helps counter the effect.

PollyCT wrote:

Wulfman... wrote: For what it's worth.......
I'm close to 67 and retired six years ago after working with computers for over 40 years. Virtually all aspects of mainframes, minis and micros, including administration. Did some programming, too...COBOL, Basic, DBase/Foxbase, etc.

You definitely have me beat - I only go back to Basic in 1978!

Point taken!

I learned FORTRAN IV 1974. Used punched cards.

I'm new to CPAP and using a loaner Resmed 9. I love technical gadgets too, and I want to get the same machine you have. It looks much nicer than the black one.

tan wrote:

Wulfman... wrote:the flow limitations INCREASE when the pressure increases in response to some of them. Her pressures were much lower before it started responding to the flow limitations. Think about it.....LOGICALLY and RATIONALLY.

This looks wrong both logically and rationally to me. Flow limitation increases as negative pressure from lungs goes up on an inhalation effort, but machine's positive pressure helps counter the effect.

Think about these 3 concepts, and let them soak in until at least tomorrow:

• While spontaneously breathing, it is easy to understand the concept of flow limitation. Breathing is a negative pressure system, and when it gets too negative, sleep continuity may be disturbed. However, once someone is on xPAP, and pressures are maintained close to therapeutic level, does "the lung" (airway) ever see negative pressure again?
• The flow sensor is inside the machine. Is the flow of xPAP machines fixed or variable?

Morbius wrote:

tan wrote:

Wulfman... wrote:the flow limitations INCREASE when the pressure increases in response to some of them. Her pressures were much lower before it started responding to the flow limitations. Think about it.....LOGICALLY and RATIONALLY.

This looks wrong both logically and rationally to me. Flow limitation increases as negative pressure from lungs goes up on an inhalation effort, but machine's positive pressure helps counter the effect.

Think about these 3 concepts, and let them soak in until at least tomorrow:

• While spontaneously breathing, it is easy to understand the concept of flow limitation. Breathing is a negative pressure system, and when it gets too negative, sleep continuity may be disturbed. However, once someone is on xPAP, and pressures are maintained close to therapeutic level, does "the lung" (airway) ever see negative pressure again?

If obstruction occurs, even at therepeutic level, then why not?

As a very new user, I want to thank everyone who contributed to this thread! I got a lot out of it! Thank you!