plr66 wrote:
ozij wrote:Since you do have a 420E, if it were me, I would switch to that to find out what was going on with my breathing.
I would set its "maximum pressure for command on apnea" to equal the the fixed pressure recommended by the PSG, or the maximum pressure - if you had a range recommendation. That way, it would not supply more pressure in response to apneas - even if it thinks they are obstructive; It may make the wrong identification, but you can keep it from raising the pressure. O.
Ozi, is this the same thing as setting the minimum & max pressure to the same setting using apap on the Remstar? Not sure I know how to set "maximum pressure for command on apnea" on the 420E. Will there be a way to interpret what's going on to cause these runaway episodes?
Unlike a Respironics, you can give the 420E separate limits for apnea and snores. The 420E comes with a default limitation of 10 to its maximum response to apneas - but that
can be changed if necessary. This flexibilty does not exits in either a Respironics or a Resmed. In your case - now that I know your pressures, I don't think you need to change it. You could set up the 420E to an initial pressure of 10, a minimum of 8 or 9 and a maximum of 16 - or 12, or whatever, and the machine would
not respond to apneas that happen when your pressure is higher than 10 - but it
would raise the pressure to the maximum if necessary should you snore, or have hypopneas accompanied by flow limitation.
I agree with Den's analysis -trying 10 fixed for a week may turn out to be good - and you'll know soon enough if it isn't. Granted, with your distinctly different breathing pattern in REM you
may benefit from the flexibility to having more pressure part of the time - but maybe 10 is enough to handle your REM events as well - and you don't need the lower pressure since 10 is tolerable.
Nothihg will tell us
why those runaway pressures happen. Working with the limited data we get from the machines, we're guessing - aiming at the best combination of numbers and quality of sleep and wakefulness.
The rather sudden appearance out of nowhere of the "mad machines syndrome" - two months without anything like that - make me think that CorgiGirl has a good point there too - have the machine checked. Luckily, you have a good backup machine.
Wulfman wrote:One thing you don't know is if the "pressure bumps" (regardless of whether they're the little ones or bigger increases) are not actually causing an involuntary resistance in your airway. My theory is that some of us feel the pressure increases and that causes the airway to resist more pressure.....then it interprets that as yet another reason to bump pressure.
Another point to remember is that of how the Respironics algorithm works.
I would say its the brain resisting - it stops breathing because of the info it get about how stretched the lungs are - so the airway is open, but breathing isn't taking place despite that - and that's the kind of non-breathing that will not respond to more and more and more pressure.
Taking into account the dialogue between Den you that is going on as I'm composing this, I would do the following:
Set up the 420E with max=min=10 -which will give you fixed pressure with all the enchanced reporting capacity of Silvelining.
Have the rogue behavior of the Respironics checked.
O.
O.
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.
Antoine de Saint-Exupery
Good advice is compromised by missing data
Forum member Dog Slobber Nov. 2023
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