Newbie With Extenuating Circumstances - Opinions Needed!

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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dreamzone
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Re: Newbie With Extenuating Circumstances - Opinions Needed!

Post by dreamzone » Wed Jan 28, 2015 6:59 pm

Janknitz – I think you have better RTs in your Sleep Lab than we do. Ours teach group classes in preparing for CPAP testing, and group classes in using your loaner. All test results are sent to the Pulmonologist for proper titration. RTs do mask fittings, but refer ALL technical questions to the Pulmonologist. I thought I’d never get to meet him, but my ENT/Vestibular doc presented my case to him, and the Pulmonologist called me at home and asked me to come in and meet with him. Very nice man, and willing to try anything to help me. Can’t speak to the issue of “sensitivity” settings on the machine… it was the vendor’s RT who told me that.

ChicagoGranny – Good question on what is causing the low nighttime O2 sats. Could be my Traumatic Brain Injury from last summer. I think this is going to take a lot of collaboration on the part of the Pulmonologist, the Neurologist, and the ENT/Vestibular Specialist. The good news is they are all located in the same hospital, and have access to all my records.

adin67 – Two years a newbie! The pressure on my machine has been reset to a maximum of 16 instead of 20. I am not getting the pressure imbalance in my middle ears when using a full face mask. (It happened with a small nasal mask, the design of which possibly deflected air pressure directly to my Eustachian tubes.)

OkyDoky – I’m pretty sure I got the machine details right... I went by not only what was printed on it, but also by what was typed up in my contract. I looked on the bottom of the machine like you suggested, and the REF was 560P, not that I know what that means…

palerider – I’m one of “those” patients…. I make providers repeat things, I write them down in my notebook, and I don’t accept vague or non-answers. I’m never rude or obnoxious, I always thank them for their help, but I do hold my providers accountable for the information they give me. I will be asking the vendor’s RT about this “sensitivity” setting he supposedly re-set. (However, whatever he did, it worked. I can now use my machine all night in comfort, which is a huge difference from where I was when I walked in his door!)

Thank you, everyone who responded. I know I’m one of THOSE cases ….. and it’s going to take time and energy to figure out all the details.

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Machine: PR System One REMStar 60 Series Auto CPAP Machine
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: REF 560P, but Humidifier does NOT have a heated tube; ALSO: Invacare Perfecto Oxygen Concentrator, for nighttime supplemental O2 @2 liters with APAP

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palerider
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Re: Newbie With Extenuating Circumstances - Opinions Needed!

Post by palerider » Wed Jan 28, 2015 8:19 pm

dreamzone wrote: OkyDoky – I’m pretty sure I got the machine details right... I went by not only what was printed on it, but also by what was typed up in my contract. I looked on the bottom of the machine like you suggested, and the REF was 560P, not that I know what that means… .
what 560 means is that you've selected the wrong machine for your listing, you need:
PR System One REMStar 60 Series Auto CPAP Machine

as well as the humidifer with the 60 series in it.

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Re: Newbie With Extenuating Circumstances - Opinions Needed!

Post by Drowsy Dancer » Wed Jan 28, 2015 10:52 pm

Is it possible that the change in "sensitivity setting" might have been changing the A-Flex/C-Flex+/C-Flex settings? Either turning them down from 3 to lower or even turning them off?

Or--changing the settings from fairly wide open APAP to either straight CPAP or a narrower APAP range might in some strange parallel universe be described as reducing the "sensitivity" of the machine.

That's all I got.

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Pugsy
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Re: Newbie With Extenuating Circumstances - Opinions Needed!

Post by Pugsy » Wed Jan 28, 2015 11:08 pm

Drowsy Dancer wrote:Is it possible that the change in "sensitivity setting" might have been changing the A-Flex/C-Flex+/C-Flex settings? Either turning them down from 3 to lower or even turning them off?
This might explain the "sensitivity" thing since the various flex settings seems to affect the breathing rhythm. The higher settings might be perceived as trying to force a person to breathe faster than they want to. For someone with a slow respiration rate and a setting of 3 on a Flex setting might make it feel like the machine is making a person hyperventilate. I found that out myself with AFlex of 3 and I don't have a slow respiration rate. The setting of 2 was much more comfortable and matched my breathing rate.
It's the only option/setting on this machine that I can think of that would give the results mentioned.

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Re: Newbie With Extenuating Circumstances - Opinions Needed!

Post by poppi2 » Wed Jan 28, 2015 11:39 pm

Pugsy wrote:This might explain the "sensitivity" thing since ...
There is a God!

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dreamzone
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Re: Newbie With Extenuating Circumstances - Opinions Needed!

Post by dreamzone » Thu Jan 29, 2015 12:53 am

what 560 means is that you've selected the wrong machine for your listing, you need:
PR System One REMStar 60 Series Auto CPAP Machine as well as the humidifer with the 60 series in it.
palerider – I got thrown by the A-Flex in the title… I think I’ve got it correct now. As for the Humidifier, the only “60” series humidifier listed in the pull-down menu shows a heated hose, which I don’t have. I did add that to my siggie line, to give more information. How did I do?

_________________
Machine: PR System One REMStar 60 Series Auto CPAP Machine
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: REF 560P, but Humidifier does NOT have a heated tube; ALSO: Invacare Perfecto Oxygen Concentrator, for nighttime supplemental O2 @2 liters with APAP

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dreamzone
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Re: Newbie With Extenuating Circumstances - Opinions Needed!

Post by dreamzone » Thu Jan 29, 2015 1:04 am

by Drowsy Dancer on Wed Jan 28, 2015 9:52 pm
Is it possible that the change in "sensitivity setting" might have been changing the A-Flex/C-Flex+/C-Flex settings? Either turning them down from 3 to lower or even turning them off?
Or--changing the settings from fairly wide open APAP to either straight CPAP or a narrower APAP range might in some strange parallel universe be described as reducing the "sensitivity" of the machine.
That's all I got.
Drowsy Dancer – thanks for thinking outside the box. I’ll take anything at this point!

~ ~ ~
by Pugsy on Wed Jan 28, 2015 10:08 pm

Drowsy Dancer wrote:
Is it possible that the change in "sensitivity setting" might have been changing the A-Flex/C-Flex+/C-Flex settings? Either turning them down from 3 to lower or even turning them off?


This might explain the "sensitivity" thing since the various flex settings seems to affect the breathing rhythm. The higher settings might be perceived as trying to force a person to breathe faster than they want to. For someone with a slow respiration rate and a setting of 3 on a Flex setting might make it feel like the machine is making a person hyperventilate. I found that out myself with AFlex of 3 and I don't have a slow respiration rate. The setting of 2 was much more comfortable and matched my breathing rate.
It's the only option/setting on this machine that I can think of that would give the results mentioned.
Pugsy – THANK YOU! That’s exactly what I was feeling… the machine was trying to make me hyperventilate! But it's all good now......

~ ~ ~
There is a God!
poppi2 – Amen to that!!!

~ ~ ~

Oh, BTW, do y'all prefer to have a poster's prior quote included in my replies? And would you like separate answers or just put them all on the same page? Trying to be a good newbie here....

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Machine: PR System One REMStar 60 Series Auto CPAP Machine
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: REF 560P, but Humidifier does NOT have a heated tube; ALSO: Invacare Perfecto Oxygen Concentrator, for nighttime supplemental O2 @2 liters with APAP

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Re: Newbie With Extenuating Circumstances - Opinions Needed!

Post by Pugsy » Thu Jan 29, 2015 1:08 am

dreamzone wrote:palerider – I got thrown by the A-Flex in the title… I think I’ve got it correct now. As for the Humidifier, the only “60” series humidifier listed in the pull-down menu shows a heated hose, which I don’t have. I did add that to my siggie line, to give more information. How did I do?
You did good.
It's a bit confusing about the heated hose humidifier to those without the heated hose but that's the only choice you have.
Doesn't matter really. We all know the heated hose is an option and not everyone gets on. The menu choices are tied to what cpap.com sells and I think they sell that humidifier so that it already comes with the heated hose up front and why the wording includes it. Not a big deal that you don't have one for purposes of equipment choices.
I wouldn't be without my heated hose....can't believe that I went years without one. Stone age it was.
All the APAP capable machines have A Flex available so it is still part of a 560 machine even if it isn't mentioned in the menu choice.
Oh, BTW, do y'all prefer to have a poster's prior quote included in my replies? And would you like separate answers or just put them all on the same page? Trying to be a good newbie here....
Either way works well for me as I have no preference one way or the other. I will often address several peoples comments separately but in one post/comment using quotes to delineate the responses. Kinda depends if I am in keep it short and sweet mode or "let's write a novel" mode. The novels I try to keep separate.

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palerider
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Re: Newbie With Extenuating Circumstances - Opinions Needed!

Post by palerider » Thu Jan 29, 2015 9:15 am

dreamzone wrote:
what 560 means is that you've selected the wrong machine for your listing, you need:
PR System One REMStar 60 Series Auto CPAP Machine as well as the humidifer with the 60 series in it.
palerider – I got thrown by the A-Flex in the title… I think I’ve got it correct now. As for the Humidifier, the only “60” series humidifier listed in the pull-down menu shows a heated hose, which I don’t have. I did add that to my siggie line, to give more information. How did I do?
you did fine, the names in the equipment list are .... pretty crap.

what the humidifier line SHOULD say is "blah blah blah with heated hose OPTION" but it doesn't

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Re: Newbie With Extenuating Circumstances - Opinions Needed!

Post by Sleeprider » Thu Jan 29, 2015 9:19 am

There is a link to the latest Sleepyhead version in my signature below this post. In Windows, most have the best luck with 32 bit version.

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Re: Newbie With Extenuating Circumstances - Opinions Needed!

Post by palerider » Thu Jan 29, 2015 9:31 am

Sleeprider wrote:There is a link to the latest Sleepyhead version in my signature below this post. In Windows, most have the best luck with 32 bit version.
or the 64 bit version if they download the dll.

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Re: Newbie With Extenuating Circumstances - Opinions Needed!

Post by OkyDoky » Thu Jan 29, 2015 9:37 am

Sleeprider wrote: In Windows, most have the best luck with 32 bit version.
Was there a discussion about this? My 64bit computer runs 64bit Sleepyhead just fine once loaded. Just have to be sure you have a 64bit computer for it and the 32bit will run on both.
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Re: Newbie With Extenuating Circumstances - Opinions Needed!

Post by McSleepy » Thu Jan 29, 2015 10:00 am

The specifics of operation of a CPAP machine can make a world of difference in one's treatment, but more so with bi-level-CPAP than with constant-CPAP machines. For instance, at one time I tried a Respironics PR S1 (the older model, I hear the new one has additional functionality) and it did not work for me, at all. In fact, even with my current ResMed S9, if I were to put it in Auto mode, it would cause me to not be able to use it. There is one specific setting that is, for some unexplainable reason, not available in Auto mode, and that is the rise time. By default it is too slow for me: about 300ms. What that means is that as soon as an attempt to inhale is detected (and there is a setting for that, too), the pressure would change from the EPAP level to the IPAP level in 300ms. I set it to "Min", which should be around 50ms (when in Spontaneous mode), and that means the pressure would go up fast enough to allow me to inhale a lot more air than if it were to take a third of the cycle just to get up to my required pressure level. On this machine (I don't know about the current PR S1 models) there is such thing as sensitivity setting and is available for both exhalation (cycle) and inhalation (trigger). I have set the former to very low and the latter to very high, or I would experience shallow breathing. That setting can be used to control how deep you breathe, and, affects directly (and can be controlled together with the settings I'll discuss next) the rate of your breathing. Now, Ms. dreamzone, I don't know if you meant to say that you normally breathe fast and shallow and like to be breathing that way, or that is something the machine caused you to do, or, one way or the other, is something you'd like to keep or avoid, but either way, there are machines with specific settings that can control those attributes of sleep. On my ResMed there are also settings for the duration of the inhalation and exhalation (Ti Min, Ti Max), and I use those to control my breathing rate - the default maximum is too short for me and I always extend the minimum to prevent me from yielding to exhaling before my lungs have had a chance to extract enough oxygen from the inhaled air.

Of course, each person is different and you should find what works best for you. Sleep doctors/DME will always try to see if the cheaper solution (constant CPAP) would work for you, but for many patients that has no chance of working. I was lucky, back in the early days of CPAP, to have a sleep doctor who didn't know much about it (in retrospect) but knew enough to prescribe a bi-level only a week after hearing I couldn't use my constant CPAP machine. Nowadays it is so much easier: there is more knowledge and resources, and there is a lot of data coming from the machines. One thing I'll advise, since you're seeing a pulmonologist, is to have a functional pulmonary test. First, to rule out any inherent respiratory problems, but also to see what your breathing needs are. For example, it turns out I have a very large vital volume (nearly 7 liters) and that explains why I need to hurry up to get all the air I need to fill my lungs. This might get them started but, in the end, you will probably need a machine that has the ability to adjust to multiple factors involved in your breathing.

Just some food for thought.

McSleepy

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dreamzone
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Re: Newbie With Extenuating Circumstances - Opinions Needed!

Post by dreamzone » Thu Jan 29, 2015 11:40 pm

McSleepy - thank you for your careful reading of my post, and your very articulate explanation.

Years ago, I went through a pain management program, where we learned slow, deep, abdominal breathing, with the idea of bringing as much oxygenated blood to O2-starved tissues and organs. Then, over the years, my breathing just got slower and slower, and - unfortunately - more shallow.

My normal breathing rate is six breaths per minute, and at times is even slower than that. Breathing that slowly does not give me "air hunger'; in fact, I rarely take a huge deep breath when I'm in slow breath mode. Perhaps I can learn to breathe correctly again....

Of course, when I'm hoofing it up the stairs because I'm late for a doctor's appt at the hospital, you can believe I'm panting like a German Shepherd.

But in the quiet times (reading, etc.) I just don't feel the need to breathe.... I know, weird. I am also seven months post-Traumatic Brain Injury, so who knows if that is affecting anything.

I am awaiting the results of my recent Pulmonary Function test, and am trying to stop procrastinating about going to get my Arterial Blood Gas test.

Thank you again for your very good explanation of what you experienced, and what helped you!!!

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Additional Comments: REF 560P, but Humidifier does NOT have a heated tube; ALSO: Invacare Perfecto Oxygen Concentrator, for nighttime supplemental O2 @2 liters with APAP

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Re: Newbie With Extenuating Circumstances - Opinions Needed!

Post by McSleepy » Fri Jan 30, 2015 12:53 pm

You are very welcome, I hope my information ends up benefitting you. In particular, I think you could make the necessary adjustments to your breathing patters if you were to get a machine with the requisite adjustability. I know my bi-level S8 and S9 wanted to speed up my breathing, so if that's hat you wanted to do, it should be able to help you. It could also be adjusted to accommodate to your current breathing patterns, if that is not causing you trouble. One way or another, you should be able to get a machine (and tune it) to provide suitable treatment while being comfortable for you. I wish you quick and complete recovery from your injury and years of healthy breathing!

McSleepy

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Previous machine: ResMed S9 VPAP Auto 25 BiLevel. Mask: Breeze with dilator pillows. Software: ResScan ver. 5.1
ResMed AirCurve 10 VAuto; Puritan-Bennett Breeze nasal pillow mask; healthy, active, middle-aged man; tall, athletic build; stomach sleeper; on CPAP since 2003; lives @ 5000 ft; surgically-corrected deviated septum and turbinates; regular nasal washes