Need high exhale pressure

[farsidejg]

Hi,

I currently have an older RemStar plus CPAP machine that works amazingly well. It has 14k hours and will eventually need to be replaced. I've tried several newer machines including the Dreamstation, Airsense 10 and Aircurve 10 S and I cannot use any of those machines. I sleep at 17.5 and need a machine that does not back off on exhale. If the pressure reduces on exhale, my throat collapses and I wake gasping for air. I've disabled all comfort features on all of the new machines I've tried. On the Aircurve 10 bipap, I set the exhale pressure to the same as inhale (17.5). Unlike my current Remstar which holds the same pressure on inhale and exhale, all of my new machines seem to back off on exhale.

Has anyone encountered this issue. Are there any other machines or ways to hold the same pressure continuously?

Thanks!

[GrumpyHere]

Run the AirCurve/AirSense in CPAP mode with EPR off.

[Dog Slobber]

Straight CPAP with no pressure relief (EPR, *flex,....) is same accross all makes and models of machines. There is no algorithm being applied to adjust/change pressures.

Assuming the ResMeds you tried since were properly configured as CPAP (fixed pressure) with no EPR or PS, then they were not backing off upon exhale.

The only difference and I doubt you were caple of noticing was ResMed's are not capable of .5 cm increments. Therefore your pressure would have been at either 17.4 or 17.6.

I suggest you:

• Configure an AirSense as CPAP, 17.6 cm, turn off EPR
• Stick an SD Card in it, download OSCAR and post a graph
• Post the graph for comment

This should demonstrate that your device is configured properly and not applying any exhale pressure relief, and if you are experiencing events.

Why do you believe that the ResMeds are applying pressure relief?
How do you know the cause of your collapse?

[farsidejg]

Hi, thank you for your response. I've tried the config settings you mentioned in the past with no luck. I might not be describing what's happening accurately. When my throat closes and I stop breathing it's almost like the Aircurve (and other machines) stop pushing air. It' waits for me to start inhaling to push air. It's like the machine stalls. Very different from my RemstarPlus that holds my throat open all the time and almost forces air into my lungs. I tried raising the pressure thinking that would help with no luck. I've gone as high as 19 on both inhale/exhale and the same thing happens. Again, thank you for the help!

[ChicagoGranny]

It' waits for me to start inhaling to push air. It's like the machine stalls.

As previously advised, that is not what the machines do.

You are describing what you think you are feeling when you are awake. It's likely your "mind is tricking" you.

Have you slept overnight with any of the machines and checked your AHI the next day?

[tyrinryan]

What I think (and as a newbe, I am always thankful of a better explanation) is that:
On a regular CPAP/APAP, the motor slows down the paddlewheel inside the machine when you start to exhale
this is controlled by a sensor in front of the motor---

when you exhale you create more pressure and the motor has to ease off to keep the throat pressure continuously constant
I don't think there is any algorithym, it is probably just a one-on-one reduction.

in any case, it is not impossible that the OP can actually sense the Resmed machine "slowing down" on exhale

But I think the OP's question is whether you can get to a place where the motor does not back off or does not back as much on exhalation by using a different machine or by setting up in some fashion, one of the the higher level machines??

Maybe the old Remstar is busted? Perhaps Farsidejg could purchase one of the kill-a-watt type of monitors and test the power reduction (AC) on the old Remstar when exhaling to see if the motor is slowing down.

[ChicagoGranny]

But I think the OP's question is whether you can get to a place where the motor does not back off or does not back as much on exhalation by using a different machine or by setting up in some fashion, one of the the higher level machines??

If that is true, then he wants a machine that pumps a higher pressure on exhale as compared to the pressure on inhale. That's not the way his old RemStar Plus CPAP machine works. That machine maintains the same pressure on exhale and inhale.

[farsidejg]

The last two posts are really helpful. the comment "On a regular CPAP/APAP, the motor slows down the paddlewheel inside the machine when you start to exhale
this is controlled by a sensor in front of the motor---"

Is there a machine that allows higher pressure on exhale? My current remstar plus has operated the same way since I bought it new over 10 years ago. It's possible the sensor in front of the motor is not working because there is no backoff at all on exhale.

[tyrinryan]

Right: remstar plus just has one pressure for inhale and exhale!!!

Its motor does not slow down on exhale. simple product.

Are there other machines with this mode?? Any machine perhaps not discontinued?? Any resmed machines like the S8 perhaps or its predecessor??

[palerider]

Its motor does not slow down on exhale. simple product.

Yes, it does.

If it didn't, then your pressure would drop when you inhale (and your throat would close) and your pressure would raise on exhale.

You can prove this to yourself, buy yourself an oxygen adapter, like this: https://www.cpap.com/productpage/oxygen ... nt-adapter, put it in line with your hose, then attach a thin hose to the adapter, put some water in that hose and make a U shape, (with the water hanging down, of course, so it doesn't run out), then turn on the machine, you'll see the water deflect in the tube, the difference between the high and low water levels is the pressure, in centimeters of water.

Then breathe, and watch the water.

https://www.youtube.com/watch?v=gsI6wOeqRlI

[GrumpyHere]

I've gone as high as 19 on both inhale/exhale and the same thing happens.

If you're configuring inhale and exhale pressure then you're not running in the CPAP mode. You're using bi-level (VAuto/AutoSet) mode.

Use CPAP mode in the clinical menu. With EPR off, there's only one pressure setting. So your mind won't be expecting two different pressure.

[ChicagoGranny]

Right: remstar plus just has one pressure for inhale and exhale!!!

Its motor does not slow down on exhale.

Do you realize these two sentences are contradictory? It's impossible for both to be true.

[Dog Slobber]

You are describing the behavior of the machine based on how you feel it is behaving. That's not an accurate way of determining behaviour. You're also describing settings you've made that suggest you're not setting the machine as you're stating you should. Finally, you're asking for a feature that your REMStar doesn't have, nor any other machine, higher pressure upon exhale than inhale.

You have a solution to determine the behaviour and configuration of both your REMStar and Replacement machine. This way you and us can make sure both are configured operating correctly.

OSCAR supports both REMStar and AirSense/AirCurve 10s. Stick an SD Card in your REMStar screenshots that show your configuration, pressure, mask pressure and any events. Then do the same thing with your replacement machine.

This was suggested to you, in one of the first responses.

[farsidejg]

I'm not doing a good job of describing the behavior. The Remstar does not support an SD card - it has an older credit card style memory card - so getting data is hard without the appropriate reader. At @palerider's suggestion, I ordered a manometer to test both, I'll be curious to see the difference. I'm also downloading Oscar to see the behavior of the Airsense. Both my old and new machines are in CPAP mode with all comfort features disabled. Thanks for the help, it is greatly appreciated.

[Pugsy]

The Remstar does not support an SD card - it has an older credit card style memory card - so getting data is hard without the appropriate reader.

The Remstar Plus model machine doesn't write any detailed data to the Smart Card either so even if you had one and the reader and the appropriate Respironics software (Encore Pro) that is compatible with that machine you wouldn't have anything but setting information to look at....same as what you can see in your settings menu on the machine itself. None of the "Plus" models ever recorded efficacy data.

Look around on the ResMed machines you have and in cpap mode and look to see if you have something called "Easy Breathe" that can be turned on or off....if you have it...try turning it off and see what happens. I don't know that it will resolve your issues but it's a remote possibility that is worth trying ....if you can. No promises...if I remember correctly Easy Breathe can be turned off on some machines in some mode but I don't remember the exact details.