Dreamstation Puff vs Resmed No-Puff?

[Carleton]

Hi Everyone!

I am new to the PAP world and have sure appreciated reading threads on this forum!!

I did a sleep test and then a 3-week trial of a Dreamstation last month, and whenever I stopped breathing it would "puff" me a few times before increasing pressure. I really liked this as it would stimulate me to breathe at the lower pressure.

Dreamstations not being available, I bought an Airsense 10 last week, but so far it doesn't give me those "puffs." Just gently steadily increasing pressures.

Does anyone else have experience with this? Or is there anyway to make the Airsense puff? :p

A very small bit of background: The sleep clinician told me I only have obstructive apnea, but my sleep test was not at all like how I normally sleep. I didn't find having a clinician a helpful experience, so I've been trying to learn about all this myself. I generally have none of the symptoms of obstructive apnea, and all the signs I can see and experience are pointing toward central apnea.

I had a look and couldn't see this topic discussed before, so hopefully I didn't miss it! Thank you in advance for your experience!

Carleton
Alberta, Canada

[ChicagoGranny]

a Dreamstation last month, and whenever I stopped breathing it would "puff" me a few times before increasing pressure. I really liked this as it would stimulate me to breathe at the lower pressure.

Were you awake when this was happening? CPAP machines are designed for sleeping.

[Dog Slobber]

The Philips' "puff" you're describing is not designed to stimulate you to breathe again.

Resmed's use a technique called Forced Oscillation Technique (FOT) to determine if an Apnea is or Obstructive or Central.

Philips sends a 2-centimeter, 2-second pressure pulse to differentiate between Obstructive or Central apneas. This is probably what you are feeling and describing as a puff.

As much as you may think this puff is stimulating your to breathe, I doubt it. What's more likely is one or more of the following:

• You are awake and therefore feel the "puff"
• The "puff" or apnea is what's awakening you, and the awakening is the real stimulus to breathe
• You are crediting your resumption of breathing with this "puff"

Why would anyone want to be awakened with a puff?

But no, ResMed's don't "Puff" you back into breathing. They prevent most apneas by responding faster and open the airway without awakening you.

[ChicagoGranny]

I've been trying to learn about all this myself.

This video comparing the ResMed and Respironics algorithms might help - https://www.youtube.com/watch?v=lzCCgNLya_g

[palerider]

I've been trying to learn about all this myself.

This video comparing the ResMed and Respironics algorithms might help - https://www.youtube.com/watch?v=lzCCgNLya_g

And here's how FOT works: https://www.youtube.com/watch?v=4GW97Xk06N8

[zonker]

I've been trying to learn about all this myself.

This video comparing the ResMed and Respironics algorithms might help - https://www.youtube.com/watch?v=lzCCgNLya_g

thank you for this!

[zonker]

I've been trying to learn about all this myself.

This video comparing the ResMed and Respironics algorithms might help - https://www.youtube.com/watch?v=lzCCgNLya_g

And here's how FOT works: https://www.youtube.com/watch?v=4GW97Xk06N8

and thank you for this, as well!

thread up to this point is saved so i can grab it in the future.

[Carleton]

Thank you guys for all the great feedback!!

You guessed right, I've spent a few hours awake with both machines to get a feel for how they worked before trying to sleep with them. Sometimes I just stop breathing when awake, or take extremely shallow breaths, and the Philips 2 cm puff gave me the cue to breathe, but maybe that wouldn't do the job when I'm sleeping. The puffs never woke me up that I know of...Mask discomfort (nasal & full-face) and eating air have won that award hands down. I just got an f30i that has resolved the discomfort though.

Those videos are awesome. Thank you!!

I just found the function on my RedMed that differentiates apneas...It says 90% of my apneas are Central. Which also explains why ResMed pressure almost never changes, and generally hasn't been taking me above 7 cm pressure.

The good news is I'm only having ~10 AHI now. Down from 22 AHI on my bungled sleep test (I am hoping to schedule another one).

Assuming I do have primarily Central apnea, can CPAP ever be an effective treatment, or will I likely need a bi-level or ASV?


-Carleton

[Julie]

I think you're not yet in a place to decide if your events are all central or otherwise, and you'd have a much better chance of finding out by downloading Oscar and following instructions re how to post results in this thread for advice.

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

[Pugsy]

Assuming I do have primarily Central apnea, can CPAP ever be an effective treatment, or will I likely need a bi-level or ASV?

Sometimes...not often...using cpap is enough to deal with central apneas but you have been on cpap a long time and still having centrals....I don't think you will be so lucky. It's not totally impossible for just regular cpap/apap to fix central apnea but it sure isn't common.

You can make the ResMed machine work like a bilevel and experiment though...just max out EPR at 3 and the machine functions like a bilevel. Limited bilevel but 2 distinct pressures which is what bilevel is.

Now all that said. If you are awake for prolonged periods of time with mask and machine on then you might be seeing some false positive flagging and those centrals might just be awake breathing pauses in breathing and not real asleep centrals.
If you aren't asleep...they don't count. Go here and watch the videos and learn to distinguish awake/arousal flow rate flagged events from asleep flagged events.
http://freecpapadvice.com/sleepyhead-free-software

Posting the OSCAR info again...I think Julie's links might be broken.
OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

Before worrying about ASV ( which is just a special bilevel that can deal with both obstructive apneas and central apneas) let's see what is going on for sure.
viewtopic/t158560/How-to-post-images-for-review.html
It is possible that you have complex sleep apnea and that's where a person has both a problem with obstructive apneas and central apneas.
BUT it's too soon to be directly going down that road based solely on LCD provided data.

Need to see a detailed report first and we need it to be a night where you know you didn't spend much time awake with mask and machine on.

[palerider]

Assuming I do have primarily Central apnea, can CPAP ever be an effective treatment, or will I likely need a bi-level or ASV?


-Carleton

An ASV IS a type of bi-level machine, there are many different types of bilevels designed to treat different problems. ASV is just one of them.

[Carleton]

Thank you guys!!

So appreciate the links! I will review everything tonight.

I downloaded Oscar last week, but as I've only had the Airsense for a few days I was waiting to get a bit of data first. I put an SD card in as soon as I got it.

I don't have any access to data from my trial of the sleep clinic's Dreamstation, but it was a pretty rough ride anyway you slice it. But I will get started with Oscar right away with what I've got!

Gotta share...Last night was amazing!! I've been guilty of experimenting with the machine settings nightly to try to tolerate the therapy, so hopefully that won't bother Oscar. Last night I set the AutoPap to Min 5 / Max 7, with EPR of 2. I woke up feeling clear and energetic (a new experience for me). I slept 8 hours with 5 Events Per Hour. The LCD labelled the events pretty much all Central again. I don't remember ever waking up, although I generally would never wake up at night anyway until starting CPAP. So it was a huge win to finally have a pleasant experience with the machine/mask and wake up refreshed.

Thank you for such a detailed reply Pugsy! Might give that EPR of 3 a try tonight. Poor man's bilevel. Will get some data here shortly.


-Carleton

[Pugsy]

In your experiments you might want to try turning EPR off or at least to ramp only and see if that happens to change the number of central apneas flagged.
There is a very small percentage of cpap users who find that bilevel (which EPR creates) pressures actually can trigger central apneas.

[Carleton]

Thanks Pugsy!

And a huge thank you to whoever made/maintains OSCAR, and to all you folks who provide your time on this forum! This access to data and support really is amazing!! I'll attach my last night's data, and can screenshot anything other data or detail you'd like to see.

I had tried no EPR for awhile based on some videos I watched from the lanky lefty. But not at low pressure. Tonight I'll try no EPR again with the same pressure settings as last night and let you know what happens!

I see on OSCAR that the machine spiked me up to 7 cm throughout the night. I will try to alter one variable per night, so tomorrow night I may try increasing max pressure to 8 cm. I just don't want to eat air again, and that starts happening somewhere between 8-10 cm for me.

As a heads up, the last 45 minutes of my sleep didn't make it onto this daily graph. So I probably need to change my time/date settings on the machine, or go to bed earlier. Those 45 minutes looked nice and had an AHI of 1.18



-Carleton

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[Carleton]

And here is a quick close-up graph of the time I slept last night. Setting were Min 5 / Max 7 / EPR Off.

I didn't include the whole range, as I went to bed at 2 a.m., but only fell asleep ~4 a.m., and woke up ~6 a.m.

At 6 I was uncomfortable breathing against the 7cm without EPR, but I kept trying for 15 minutes. Then hit the buton to knock me back down to 5cm, which I tried for another 20 minutes. It was more comfortable, but I still couldn't fall back asleep, so I took the mask off and went to sleep naturally right away.

Looking forward to getting back on the horse tonight, and currently planning to set the machine to Min 5 / Max 8 / EPR 2.

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