CPAP vs Auto Setting

palerider wrote:

Wulfman... wrote: Response to Apneas and Hypopneas: Ptherapy
While in Ptherapy mode, if 2 apneas/hypopneas are detected within 3 minutes, the algorithm increases pressure by 1 cmH2O.
Re-initiate Ptherapy for 5 minutes.

Response to Apneas and Hypopneas: Poptimum
In Popt search mode, if 2 apneas/hypopneas are detected within 3 minutes, the algorithm increases pressure by 1 cmH2O.
Re-initiate Ptherapy for 5 minutes.

good to see even the older machines respond to (after the fact) apneas and hypops.

Wulfman... wrote: Elevated Leak Levels
The REMstar Auto system responds to the "large leak" by dropping the pressure 1 cmH20 every two minutes until the "large leak" condition is cleared.
As the pressure is dropped, the "expected leak" also drops.

I'd seen robysue posting that machines lowered pressure in response to excess leaks (the opposite of so many people's "the pressure ran away because I was having leaks!" claims) but I hadn't seen it documented as such, even in the last generation too

thanks!

That old persistent "wives' tale" of runaway pressure because of leaks was one of the things I experimented with during a nap in about 2008......along with some "holding my breath" apnea detection experiments.
I found out that the APAP will (for the most part) try to hold its present "pressure" through the large or other leaks. It increases air flow to try to compensate, but will not "run away". Under sleeping conditions, what probably happened was that with the loss of the mask seal the events were probably more prone to happen and THAT'S what increased the pressure. The machine was still able to detect the events and increased pressure, but it wasn't the leaks that caused it.

Edit: With regard to my experiments, I probably didn't hold the mask away from my face long enough to have the machine drop pressure. I was just doing it for lesser periods to see if it actually increased.

And, as far as the "response" issue, it has to detect TWO events in THREE minutes.
For a person with mostly "frank" events, that's hardly a meaningful response.


Den

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Wulfman... wrote: And, as far as the "response" issue, it has to detect TWO events in THREE minutes.
For a person with mostly "frank" events, that's hardly a meaningful response..

for someone that advocates NON self adjusting pressures, it seems kinda funny that you also want auto's to respond aggressively with pressure changes, or you say it's not meaningful...

palerider wrote:

Wulfman... wrote: And, as far as the "response" issue, it has to detect TWO events in THREE minutes.
For a person with mostly "frank" events, that's hardly a meaningful response..

for someone that advocates NON self adjusting pressures, it seems kinda funny that you also want auto's to respond aggressively with pressure changes, or you say it's not meaningful...

And, THAT'S WHY!!!
For example, this year, I went from May 10th to July 14th without a single apnea. Even when I do have apneas, I rarely have more than one in any given night......and can go weeks or months between having any at all. I don't "need" a bunch of pressure changes disturbing my sleep for no good reason. Respironics machines are famous for their little pressure probes (even if there's nothing going on). Anymore, I may only have a couple of hypopneas or snores per night, too.


Den

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Wulfman... wrote: Respironics machines are famous for their little pressure probes (even if there's nothing going on).

yeah, I'm not a fan of the "well, it looks fine, let'd dick with it" respironics method... though I'm sure it works for some people.

What a helpful set of replies... I am looking into sourcing the analytics HW/SW, it seems the equipment I have provides good therapy, and if I can access the data there isn't a clear benefit to upgrading.

Pugsy: If I am unable to obtain the hw/sw myself I will pm you about your offer to send you the sd card, very generous of you

FDW: very helpful info, I am going to price the options including getting a current machine that will work with my iMac.

One last question: I added my equipment under my user profile, and indicated to display it as text, BUT nothing shows on my post. I read the FAQs, but can't figure out why. Thoughts?

I understand your reasoning Den....but if I were to follow your lead I would have to use 18 cm cpap all night and I am sorry but I just don't want to do that. If it wasn't for my REM events on steroids I could use 8 cm all night on cpap and have the most boring reports in the whole world.

Yeah, I can kill every chance of an obstructive apnea or hyponea popping up and have some wonderful AHI 0.0 reports but that means a lot more pressure all night long and it isn't worth it to me.
Sometimes we make compromises and I will take an occasional frank apnea (if it happens) over 18 cm cpap all night long any day of the week.

And BTW...when I was on APAP with the 10 to 20 range ...and seeing 18 cm for brief periods of time (and 0 excess leak) I was getting a lot of below 1.0 AHI reports and I slept just fine through all those big pressure changes. Not everyone is bothered by little or even big pressure changes. Look at what people on ASV get used to. Now THOSE are some pressure changes.

Midnight Son wrote:What a helpful set of replies... I am looking into sourcing the analytics HW/SW, it seems the equipment I have provides good therapy, and if I can access the data there isn't a clear benefit to upgrading.

Pugsy: If I am unable to obtain the hw/sw myself I will pm you about your offer to send you the sd card, very generous of you

FDW: very helpful info, I am going to price the options including getting a current machine that will work with my iMac.

One last question: I added my equipment under my user profile, and indicated to display it as text, BUT nothing shows on my post. I read the FAQs, but can't figure out why. Thoughts?

When you added it, did you click on "Submit"?
You may also have to add it in the comments section like I have mine. Since CPAP.COM doesn't sell those machines anymore, they aren't selectable as equipment options.

You also might want to purchase a few more "smart cards" if you're going to be sending them back and forth to Pugsy.

And, yes, these older machines do provide EXCELLENT therapy.


Den

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Midnight Son wrote:I added my equipment under my user profile, and indicated to display it as text, BUT nothing shows on my post. I read the FAQs, but can't figure out why. Thoughts?

Links to old discontinued equipment are now broken. For a long time they worked but no longer.
If you want you can just manually type it briefly in the comments section of the equipment profile like I have my S9 machine noted.

And yes....just send me a private message if you want me to run some reports for you but give me time to make sure that the DT3500 I previously mentioned from a forum member (going to see if she will loan it) is still available and time for her to get it to me.

Pugsy wrote:I understand your reasoning Den....but if I were to follow your lead I would have to use 18 cm cpap all night and I am sorry but I just don't want to do that. If it wasn't for my REM events on steroids I could use 8 cm all night on cpap and have the most boring reports in the whole world.

Yeah, I can kill every chance of an obstructive apnea or hyponea popping up and have some wonderful AHI 0.0 reports but that means a lot more pressure all night long and it isn't worth it to me.
Sometimes we make compromises and I will take an occasional frank apnea (if it happens) over 18 cm cpap all night long any day of the week.

And BTW...when I was on APAP with the 10 to 20 range ...and seeing 18 cm for brief periods of time (and 0 excess leak) I was getting a lot of below 1.0 AHI reports and I slept just fine through all those big pressure changes. Not everyone is bothered by little or even big pressure changes. Look at what people on ASV get used to. Now THOSE are some pressure changes.

Most of the people who catch my eye regarding their therapy and pressure settings are the ones who have been on therapy for a period of time and aren't seeing any improvement in "how they feel". They're still tired or worse.....and about to quit.
Over the years, I have seen MANY people benefit from switching from ranges of pressures to straight pressures. It's an option I suggest. If they don't want to, that's their business......it's THEIR therapy.

You'll probably notice that I have NEVER gotten into a discussion regarding ASV therapy or settings.....and RARELY in Bi-Level therapy in general.

Edit: And, anybody needing a pressure of 18 cm. needs to be on bi-level therapy anyway.


Den

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With Dens help I was able to better determine my machines capabilities for data collection. I have a PR Remstar System One Auto A-Flex (Model 550P) which has a SD card (not the older smart card). As I am a Mac user exclusively, I believe Sleepyhead will work since it I have a full data model (450 or higher).

I plan to download the Mac version of Sleepyhead, and see if I can read the SD card data for analysis. If anyone can confirm my understanding (or correct it if wrong) it is appreciated.

I was successfully able to download Sleepyhead MAC OSX 9.6 to my iMac, and to import the SD Card from my machine! For the first time I have actual data on what is occurring as I am receiving treatment. Thank you again for all of your guidance!

I had one minor user error, I inserted the SD Card into the reader (slot) on my iMac, but did not first make the SD card read only (by moving the tab setting on the side of the card). It appears OSX has written an index file, so I have yet to try to use it again in my machine. Hopefully I can remedy this if it causes a problem.

Next: I need to read the posts about interpreting the Sleepyhead analysis results. With the machine in straight CPAP @10 cm last nights summary was:

AHIGraph showing running AHI for the past hour 0.69
RemStar Auto with A-FlexPhilips Respironics System One 550P P026067827945
PAP Mode: CPAP
Pressure: 10cmH2O
Date Sleep Wake Hours
10/15/14 23:30 08:15 08:39:45
Hypopnea 0.58
Obstructive Apnea 0.12
Respiratory Effort Related Arousal 4.50 *** This is notably higher than the previous 30 days (Due to increased pressure?).
Vibratory Snore 1.15
Periodic Breathing 0.6

As a comparison, the previous night I had it set in Auto mode (min 9.0cm)

AHIGraph showing running AHI for the past hour 1.01
RemStar Auto with A-FlexPhilips Respironics System One 550P P026067827945
PAP Mode: APAP
Pressure: 9.0-20.0cmH2O
Date Sleep Wake Hours
10/15/14 00:18 14:57 10:56:11
Hypopnea 0.73
Obstructive Apnea 0.27
Flow Limitation 0.46
Respiratory Effort Related Arousal 2.38
Vibratory Snore 0.82
Periodic Breathing 0.65

With time I hope to better understand this data. I also replaced my mask with a new one last night and it isn't properly adjusted yet.

the respironics (yours) don't care about the crap that osx writes on the card, so you're good there.

charts are better than text.

ahi for the full night is more important than for the last hour.

f12 will take screenshots for you from the sleephead screen, upload them to a image site, (I prefer imgur.com) and then post the bbcode link that imgur gives you here.