PB 420E Therapy Manual

[Brian000]

Folks,

Just moved from a plain jane REMstar Plus CPAP (almost 4 years old) to a new PB 420E APAP. I had the opportunity to trial APAP for a couple months and it's working much better for me, but still not perfect.

Since I got the PB through my insurance and a DME I don't have the full instructions on how to adjust settings and get into the therapy mode. Would anybody be kind enough to email or send them otherwise to me? I don't really understand what the central apnea setting is or what it does (my range is 4cm-14cm, with a start-up titration of 11cm. The central apnea setting is 5 below my high setting; so, it's set at 9cm).

You can contact me directly at bwr000@gmail.com

Many thanks in advance.

Brian.

[ozij]

I have a 420E with the software to read it , Silverlining 3.6, and have never seen a "central apnea setting".
Where did you run into that?

O.

[Guest]

Maybe they confused "command on apnea" for "central apnea" setting?

[ozij]

Yes, that's what I've been thinking too --
Here's -SWS explaining the 420E indices, and especailly command on apnea in the second paragraph.

-SWS on 420E settings.

<snip>

That third adjustable parameter is really best thought of as an AutoPAP pressure-response "safety limit" or "safety cap" to help in the avoidance of pressure induced central apneas (which can easily escalate in some patients, manifesting in a condition referred to as "runaway" central apneas). This "command on apnea" setting is defaulted at 10 cm on the 420e. That 10 cm default limt has very sound statistical basis across the apneic patient population with respect to air pressures at which central apneas are known to manifest in significant numbers. There are only two scenarios that I can think of in which a therapist would need to adjust this "command on apnea" parameter: 1) significant occurences of pressure-induced central apneas at or below 10 cm (in which case the patient might ultimately require a BiLevel machine specifically designed to "treat" central apneas), or 2) a patient requiring more than 10 cm pressure to reactively (not proactively) clear his/her obstructive apneas and that patient shows absolutely no signs of inducing "runaway centrals" at those higher "apnea responsive" pressures.

And also, further down on this same thread:

Command on Apnea: an adjustable parameter to limit just how high the AutoPAP is allowed to go (pressure-wise) in response to any apnea. However, it does not limit how high the AutoPAP is allowed to go in response to all other obstructive sleep event types. This is a safeguard to prevent accidentally causing central apneas with too much air pressure. The reason this pressure safety limit exists for apneas and not other obstructive types such as snore or flow limitation: the 420e cannot always safely distinguish a central apnea from an obstructive apnea (even with "cardiac oscillation detection techniques" that others here have talked about). This command-on-apnea parameter comes factory set at 10 cm since that pressure value is known to be statistically "best" for most people. However, some patients might still have central apneas with this setting. Their central apneas may or may not be because this 10 cm is not a low enough "protection limit" for them. For these patients the command-on-apnea setting should be cautiously and experimentally lowered to see if the central apneas go away and if the obstructions are still being treated adequately. These patients may actually need a BiLevel that is better suited to treat central apneas rather than simply trying to avoid causing too many central apneas with high pressures.

The other reason to change that 10 cm default setting would be patients that have "heavier" than usual obstructions. The 420e will try to prevent as many apneas as possible with a "smart" delivery of air pressure. The 420e will not limit itself to 10 cm as it prevents any sleep events, apneas included. However, as hard as it trys, the 420e must also "respond" to apneas. That responsive scenario is what the "command on apnea" parameter is trying to limit (pressure-wise). So this second reason to change the "command on apnea" 10 cm limit has to do with patients that not only need plenty of "responsive" pressure treatment (versus "proactive" pressure treatment)----but the fact that these unusual patients also need more that 10 cm pressure to clear their obstructive apneas. For these patients, the command-on-apnea would be experimentally raised. The therapist would hope to see that they have fewer obstructive apneas, but not at the expense of pressure-inducing central apneas at those higher pressure.

-SWS posts on any subject you want to understand better - in this case the 420E - are a must read, with the following, typical, caveat taken into account:
(Further down on the same thread)

Must "dequalify" myself real quick, Wader. I'm just a patient (with a completely unrelated background in design and development) making heads or tails out of "sleep therapy" as everyone here is. I dread the thought of anyone reading anything written on a message board by me or anyone else as gospel. We are literally the blind leading the blind here----and it is utterly amazing that so often the information we get here is better than that which we get from the medical establishment. I would really like everyone to take anything that I ever write about as potentially accurate information that is, none the less, also potentially wrong.

O.

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[Brian000]

Many thanks to all of you who replied with help. The DME who ordered the this unit for me usually only deals with REMstar, and didn't know much about PB. They really didn't want to get it for me; but, my doc was very helpful in specifying this unit in my RX -- she knows I'm a pretty educated patient and had researched what I wanted. (For me, the size was important because I travel long distances by motorcycle a lot -- every cubic inch of baggage saved is HUGE ).

I think the "command on apnea" is what was perplexing the DME. I'll get it figured out now that I've got a manual.

Again, thanks and cheers to all!!!

Brian.