Help Interpret Silverlining Report - PB420E

[Brian000]

I've been on xpap for about 7 years now. While it's definitely been an improvement, I haven't had the really great responses some others have.

I finally ordered the Silverling software for my 420E. Here's what I show for last night -- an 8 1/2 hour session.

Settings are currently low of 11 and high of 17. My prescribed pressure is 11 cm. The max pressure for command on apnea is 16.5.

Within a half hour of starting up the pressure climbed up to 17 and pretty much bounced between 16 and 17 for the entire night (except for one point when I got up). Leaks hover right around 0.8 l/s for most of the night (green scale) with "leaks max" (pink scale) rising from 1 to 1.7 l/s throughout the night.

I had 1 apnea, 3 Central Apneas, and 4 Hypo Apneas.

While I feel like I slept through the night (didn't lie awake for extended periods of time) I am tired today.

Any thoughts? Should I run this thing at 20?

An unrelated question. Can somebody please explain the difference under settings of "Command on Flow Limitation Run (IFL1)" and "Command on Flow Limitation with an amplitude decrease (IFL2)". Both are currently enabled on my machine.

Many thanks.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): 420E

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): 420E

[ozij]

Hi Brian,
You don't say when your prescription is from - and pressure needs do change for some people.

However, a rather large number of people have discovered that the 420E has this habit of jumping to the to of the range, and hovering there when left on its default setting. That's entirely related to the command on flow limitation, as a matter of fact.

A flow limitation is a change in the shape for your breath, from nice round sinusoid to something else. With Command on inspiratory flow limitation runs (IFL1) set to on, the machine just responds whenever it thinks there's a run of flow limitation (a bunch coming together) - and for some of us, it thinks wrong.

If I had your Rx, and the machine behaved like that, I would set it up as follows:

Minimum pressure = 9
Initial pressure = 11
Maximum pressure = 13
Maximum pressure for command on apnea 13
Command on Flow Limitation Run = disabled.


By setting up the initial to the prescribed pressure, you let the machine see how your breathe on the Rxed pressure. If it then figures out you're OK with lower, it will drop the pressure gladly, but bring it up to 11 quickly - where it will pause to see if that's enough. If not, it will continue further up. Conversely, when the pressure is higher than 11, it will drop the pressure rather quickly to your Rxed, and will pause to see if its OK to go further down - and it will.

That will give a lower average pressure, with differential response when you're above or below the preferred pressure.

You can leave the max. wide open if you prefer. I prefer limiting the max. in the beginning. Snores will drive the pressure to the maximum pressure - regardless if the limitation set by "maximum pressure for command on apnea".

My machine runs at min 6 to max 9, initial =7 IFL1=off, maximum pressure for command on apnea= 8,

The result is an average pressure of 6.31, 70% of my time spent at 6, 26% at 7, and 4% at 8. The amount of time it touches 9 is less than 1%.

O.

[Brian000]

Oz,

Thanks for the info -- this helps. I'll certainly try disabling those functions. Would you disable both IFL1 and IFL2?

I did two sleep studies back in '02 and my Rx is from then.

Thanks especially for explaining the initial setting -- I've always wondered if it made any difference where that was set when is APAP mode.

What is interesting is I never knew about the Command on Flow settings -- unless I'm mistaken it would appear that the only way to access them is via the software: it can't be done via the 420E's therapy mode.

[Snoredog]

I've been on xpap for about 7 years now. While it's definitely been an improvement, I haven't had the really great responses some others have.

I finally ordered the Silverling software for my 420E. Here's what I show for last night -- an 8 1/2 hour session.

Settings are currently low of 11 and high of 17. My prescribed pressure is 11 cm. The max pressure for command on apnea is 16.5.

Within a half hour of starting up the pressure climbed up to 17 and pretty much bounced between 16 and 17 for the entire night (except for one point when I got up). Leaks hover right around 0.8 l/s for most of the night (green scale) with "leaks max" (pink scale) rising from 1 to 1.7 l/s throughout the night.

I had 1 apnea, 3 Central Apneas, and 4 Hypo Apneas.

While I feel like I slept through the night (didn't lie awake for extended periods of time) I am tired today.

Any thoughts? Should I run this thing at 20?

An unrelated question. Can somebody please explain the difference under settings of "Command on Flow Limitation Run (IFL1)" and "Command on Flow Limitation with an amplitude decrease (IFL2)". Both are currently enabled on my machine.

Many thanks.

depends on what you are trying to fix, but if the pressure is running up and centrals are showing up it could be from a too aggressive machine response. Find out from the detailed report what is driving up the pressure it is probably either FL or snore. I would also note at what pressure the centrals are appearing, if they appear regularly at a given pressure you are exceeding your threshold and need to lower the command on apnea setting. I would also lower it from current 16.5 to under the pressure where those CA's appear.

I would also uncheck or disable the IFL1 check box.

[Brian000]

More info from last night:

Flow Limitations - Runs: 518. Index/h - 62.3
Flow Limited Cycle - 39%

[ozij]

Do not disable IFL2 - leave it checked.

IFL1 can en / dis abled from the machine - software isn't mandatory for this one.

Most of us with that large a number of flow limited cycles have to turn IFL1 off.


O.

[Brian000]

Okay, Thanks for the clarification Oz. I'll give it a go.