Help with resmed autoset II / spirit II

[Guso]

Hi.

Before starting: The point of this thread is to learn how a resmed spirit II (autoset II in the usa?) can be set so absolutely no pressure relief or the like takes place,
just basic dumb autocpap. Because I feel the first titration was distorted by it AND I'M HAVING MY SECOND TITRATION SOON.

More elaborated explanation:
Even after buying the new machine and numerous experiments , I still feel tired. So I have visited the sleep clinic again.
The doctor said my pressure should be correct, however since I recently had a minor surgery she though it was necessary to do a new titration.

When we did the first titration, the machine (spirit II) felt marvelous, I was truly breathing effortlessly. Then after three machines none have felt anything like that.
(basic respironics cpap, respironics autocpap with aflex, resmed vpap adapt sv). The doctors keep telling me this effect was because the machine was automatic and changed the pressure during the night according to my breathing. However I tried a respironics autocpap it just feels similar to basic cpap,just slowly changing.
I tried the c-flex, the a-flex and the vpap asv "asv mode", they are a bit more comfortable but it still doesn't feel like it. THEY ALL FEEL LIKE THEY LAG AFTER MY BREATHING.

I know the spirit II has EPR, easybreathe and what they call LOW INERTIA motors. Perhaps this low inertia enables low lag. I don't know.
The doctors don't seem to know or understand their own machine.

I have read the user manual of the spirit II, and the clinician's manual of the autoset II (same machine?).
They doesn't seem to mention easy breathe or how to turn it off, they just mention EPR.

However I recently read (in another thread) that when EPR is turned off, easybreathe remains.

viewtopic.php?f=1&t=31770&st=0&sk=t&sd=a&start=15

bigk:
There was even a thread here where sopmeone said how good the EPR was on their S8II - but eventually they realised that they didn't even have the EPR activated! The Easy Breathe Technology by itself is that good.

So I want to ask the titration doctor to turn off any expiratory relief so the titration is not distorted by it.
Since I anticipate that she will have no clue about what I'm talking about, I ask you for help.
Thank you.

EDIT: I changed the title of the thread.

[Guso]

I changed the title, maybe now...

[avi123]

I could comment on these if you translate the two summaries and add dates for all:

[sleepnationtv]

This video will show you how to go into the clinical menu and turn the EPR to off.

http://www.cpaplibrary.com/machines.html

Its the S8 II series video.

Dane

[avi123]

Guso, About the shark fin- tail did you mean this from

posting.php?mode=quote&f=1&p=272033

[quote="dsm"]Re Easy Breathe vs EPR.

The two are similar concepts. It is the waveform that is different.

My understanding of the difference is that Easy Breathe has a 'shark-fin' wave form whereas the EPR didn't. But this is just an educated guess. I have never seen any data describing the EPR waveform but I know from using it it isn't a square waveform nor does it feel like or linear slope waveform. EPR seems to have some curve in it (this is noticable in the way the pressure varies when you breath out when compared to a bilevel that is known to have a liner sloped waveform (the linear slope in them is usually adjusted by the risetime setting)).

What I do believe was done in the series II machines was that they introduced a new blower that is a smaller version of the blower developed for the Vpap AdaptSV machine. The blower is quieter and can change speed much quicker thus can be better controlled to shape breathing response.
The improvements are stated in the use of 'a dual impeller' blower.

What dual impeller means is that rather than have a motor with one blower fan at one end of the motor shaft and a counter weight at the other end, they replace the counterweight with another identical fan & because the motors are high acceleration DC brushless motors they can adjust pressure in millisecs and do it quietly as the two fans balance each other and the load on the motor.

To paint a word picture, picture the air input as being sucked into a tube starting at the back of the machine. In the middle the input air input is split into 2 smaller tubes with one smaller tube directed to one end of the motor where it has a blower fan & the other smaller tube directed to the other end of the motor with its identical blower fan then the output from both fans is redirected back to a single hose that exits as the pressure out nozzle.

The design is actually simpler that described above but the principle is identical, split input air to two fans & rejoin at output nozzle - fan is harmonically balanced & with the high performance motor there is no lost energy as there was when one end had just a counterweight. In this design all the motor energy goes into shifting air & none into changing the speed of a counterweight.

The smaller faster accelerating motor then allows for more sophisticated control of the airflow & thus can do fancy tight-pattern waveforms like a shark-fin one which better emulates human breathing than the previous typical waveforms (square linear or sloped linear). Also it allowed them to add this new wave-form EPR to Auto mode.

DSM

#2: Hmmm, on reflection, easy-breathe may be different to EPR but the difference is only going to be an effect based on wave shaping and the settings are how strong the wave shaping is.

The idea may be simpler than EPR but it may not be fair to call it EPR. I guess the acid test is can EPR be turned on at the same time as easy-breathe & does each have its own setting, or can you only have one or the other in which case the arguments is one may be a modification of the other.

Does anyone with one know if both can be activated at the same time ? - can both be run at the same time in Auto mode ?

[Guso]

Well translating the summaries has nothing to do with turning all pressure reliefs off in the resmed autoset II/spirit II, however here it is (your review is welcomed):

FIRST STUDY: (to check if I had sleep apnea or not)

basal nocturnal polisomnography:
motive: osa suspicion

sleep time: 5:13 hours out of 6:24 hours of monitoring (efficiency 81%)

sleep latency: 2,5 minutes
sleep structure: rise in superficial sleep, descent of slow wave sleep and rem (I 11%, II 66%, III & IV:11% REM 11%)
REM latency is 118 minutes.
moderate fragmentation of the sleep structure with 68 minutes of awaken state
frecuent microawakenings (13 per hour of sleep).

snoring is present. apneas and hipopneas detected (mostly obstructive).
apnea hipopnea index equal to 28 per hour of sleep. This events occur mostly in the rem phase, in supine position. (rem ahi=47, supine ahi=35).
awaken sao2 equal to 94%, minimum sao2 equal to 81%, stays lower than 90% for the 40% of the time registered.
no significant heartrate variations detected.
periodic movement of leg detected correlated to breathing events.

conclusion:
ahi=28
rem ahi=47
ahi supine= 35

notable oximetric repercution and important fragmentation of sleep structure.
cpap therapy is recommended after a titration.



SECOND STUDY (titration)

polisomnographic study, (cpap titration)
motive: moderate osa ahi=28
sleep efficiency 88%
5:39 hours of sleep out of 6:22 hours of monitoring
SaO2 are maintained above 92% during the entire time the prescribed pressure was being administered.
no significant variations of heartrate shown in the ECG
prescribed pressure: 8 cmh2o
heated humidifier recommended and the use of a ramp.