Which Machine? (seeking successful treatment)

[robysue]

The PRS1 machine seems to be "rough" with its pressure regulation. I'm not 100% sure why, but I tend to feel puffs and pressure changes even when I'm not having apneas.

You may have been noticing the "hunt-and-peck" part of the PR Auto algorithm. Unlike the S9, the System One periodically raises the pressure to see if there are improvements in the shape of the wave flow; if there is, a new baseline pressure is set, if not the pressure is then lowered back down to the current baseline. And there are people out there who say that these hunt-and-peck pressure increases can bother them.

I feel the mask "pumping" up and down on my face as I inhale and exhale. Even if I have flex turned off. It's not a "pressure pulse" for detecting centrals, it's something to do with the way it tries to regulate pressure.

Not sure what you mean here. But then I use very low pressures.

The S9 machine seems much smoother in terms of pressure, both in terms of regular usage and when it uses FOT pulses to detect centrals.

I've almost never felt either type of pressure pulse.

Back when I was using an S9, the FOTs drove me bananas because they tickled my the back of my throat.

When I was switched from the S9 to the System One, I actually was worried that the pressure pulses and the hunt-and-peck algorithm would bother me as much or more than the S9's EPR, the rapid pressure increases when the Auto algorithm for raising pressure kicked in, and the FOTs. But breathing seemed so much more natural on the BiPAP. And that allowed me to start getting some sounder sleep.

Don't get me wrong: The S9 is a fine machine. And I think for many people the S9 is much more comfortable. But i also think that for most people, the differences between the two machines are so small that it doesn't really matter, and for a few people the System One is more comfortable.

[sparkles]

It's a bit of a dilemma, although it sounds like in cpap mode, these pulses/puffs/whatevers don't occur and so would be moot. I slept okay with the S8(?) but didn't feel well with it. So the first step is to try to find a sleep dr who has some idea of what's going on. I could always try the S9 for a few months via insurance, and then decide which way is best to go. The dr search is not something I'm looking forward to...

[Pugsy]

it sounds like in cpap mode, these pulses/puffs/whatevers don't occur and so would be moot.

No...not correct. The pressure pulses in the Respironics machines are the machines way of determining if the perceived cessation of breathing is central or obstructive. They happen in cpap mode and apap mode.
The S9 has the FOTs and they happen in cpap mode or apap mode also.

Now the Respironics also has the little test pressure spikes that it regularly does in apap mode to test the airway and those little pressure increases only happen in apap mode but they aren't something that just hits you in the face with an abrupt 2 cm increase. It is a gradual increase.
This feature is different from the features that are used to help the machine decide if the cessation of breathing is central or obstructive in nature.

Pressure pulses are tiny puffs and most people aren't going to sense them because most of the time they are going to occur while asleep because they are only used when the machine is having trouble distinguishing between central and obstructive.
They don't happen with every flagged event...just the ones where a little help is needed in figuring out what to call the event if it ends up being long enough to earn a flag of some sort.

Here is an example of a pressure pulse... The red arrow that I have drawn is pointing to it. Just a little red box for the pulse.
If you notice the preceding flagged hyponea didn't get a pressure pulse because the machine figured out what to call that event without the pressure pulse. Also notice that the pressure pulse didn't end up getting called anything with that little reduction in flow. Most likely because it didn't last long enough or the reduction didn't quite meet the % of flow reduction needed to meet criteria


And here is an example of the pressure test probes. They look at bit spikey on the big picture but in reality the change takes several minutes and is not much of a change.
Here is a picture of the overall big picture of the first test probe from my last night report...and I put an arrow pointing to it
and below it is the zoomed in picture showing how long that change took to come and go
This test pressure probe is a function in apap mode only of the Respironics machine. If this tiny of a pressure change is disturbing then you don't need to be using apap mode.



And finally this is a zoomed in shot of the S9 FOT. It's the tiny fuzzy thing that I have circled and you have to zoom way in on each breath to barely see it.

[joshuamommie]

the DME might surprise you, i didn't do any research before i went to get my machine, and with me walking in completly clueless, they actually gave me an s9 Autoset... it's the default machine they give everyone! And the carry the whole line of ResMed masks! I really got lucky that's for sure...

[joshuamommie]

i should mention that i didn't need a bi level machine, i am on straight cpap but that's still what i got...

[SleepDisturbed]

I am a newbie, only on apap for about 5 months, so ignore me if you want. (Happens all the time! ) All the top line machines are roughly equivalent. Just pick one.

Your experience and therapy effectiveness will more heavily influenced by your "interface". Spend your time/energy/money on that more than subtle nuances of treatment algorithms!

[sparkles]

Your experience and therapy effectiveness will more heavily influenced by your "interface".

What do you mean by interface?

[sparkles]

Back when I was using an S9, the FOTs drove me bananas because they tickled my the back of my throat.

When I was switched from the S9 to the System One, I actually was worried that the pressure pulses and the hunt-and-peck algorithm would bother me as much or more than the S9's EPR, the rapid pressure increases when the Auto algorithm for raising pressure kicked in, and the FOTs. But breathing seemed so much more natural on the BiPAP. And that allowed me to start getting some sounder sleep.

Don't get me wrong: The S9 is a fine machine. And I think for many people the S9 is much more comfortable. But i also think that for most people, the differences between the two machines are so small that it doesn't really matter, and for a few people the System One is more comfortable.

I'm just curious, were you noticing the disrupting FOTs only while awake, or did they wake you up when asleep?

Also, wondering, what were the reasons your dr moved you to a bipap? I've seen those mentioned, and know they are more expensive, so presumably they do more complicated things...? Sounds like whatever the reasons, it turned out to be beneficial for you.

[robysue]

Back when I was using an S9, the FOTs drove me bananas because they tickled my the back of my throat.

I'm just curious, were you noticing the disrupting FOTs only while awake, or did they wake you up when asleep?

Back when I was a newbie so many things were disrupting my sleep and feeding the CPAP-induced insomnia monster that I really can't answer this question. It's a chicken and egg question: If I was awake, the FOTs and the EPR and a whole bunch of other things would key me up and make me crazy. Once I got to sleep, I'd never sleep for very long before something would wake me up. But with so many things "bugging" me, it was hard to put a finger on what triggered any particular wake---unless the wake was triggered by aerophagia.

Also, wondering, what were the reasons your dr moved you to a bipap? I've seen those mentioned, and know they are more expensive, so presumably they do more complicated things...? Sounds like whatever the reasons, it turned out to be beneficial for you.

The doc moved me to the BiPAP to see if it would help the serious problems I was having with aerophagia, even after my pressure settings were reduced. The move to the BiPAP took the edge off the aerophagia and then after another pressure adjustment and switch to a narrow Auto BiPAP range, the aerophagia issues were finally resolved. I'm not totally free of aerophagia, but it is a very rare night that I wake up with any pain from aerophagia, whereas with the S9 Auto I was waking up with serious pain (as in it felt like I'd swallowed a basketball) on 50% or more of the nights and I was never free from the aerophagia on even the least painful nights.

[sparkles]

Thank you for taking the time to explain that. And I'm very happy for you that you were able to find relief and effective treatment.