PB420E APAP - I'm Officially Impressed

NightHawkeye · Post by **NightHawkeye** » Thu Jun 14, 2007 11:48 am

With an extended overseas trip coming up I finally decided to get a PB420E (which I've been eyeing for about a year). It arrived two days ago, and is one really nice machine.

Aside from being small, lightweight and quiet, it also works quite well with my Comfort Curve mask. Because the Comfort Curve comes with its own special hose, I hadn't expected that. I'd been planning to take the Swift with me on travel, and only use the Comfort Curve at home. Instead, I found that the hose which comes with the PB420E mates nicely with the Comfort Curve. It's purely coincidental, of course, but the PB hose coupling is small enough in diameter to slide snugly into the mating coupling at the base of the Comfort Curve mask. Nary a leak and it fits so snugly that there's little chance of it accidentally detaching.

The other surprise with the PB420E was in the recorded data. Although my residual AHI isn't much different than with my Respironics machines, I find that the PB420E records an extremely large number of flow limitations. I'm inclined to think that these flow limitations correlate with my prior experience of sinus congestion. Until about six or eight months ago I used to clean out my sinuses nightly, but after a year of xPAP therapy found that I slept OK without doing that.

I tried the machine both with FL1 OFF and ON, and can't tell much difference in the response between the two settings. The machine indicates that around 25% of the night I experience flow limitation cycles.

I'm wondering whether the flow limitations being recorded are an indication of UARS. I should probably do the nasal irrigation thing this evening and see if that changes anything.

I did some searching through prior PB420E posts last night, but didn't find anything directly related to my experience with flow limitations. Comments?

Regards,
Bill

Slinky · Post by **Slinky** » Thu Jun 14, 2007 12:47 pm

Okay, just go ahead and pour salt in the wounds, NighthawkEye, just 'cause on accountta you know I'm intrigued by the 420E and would like to have one but can't justify buying one at this point.

Glad you like it and that it is working well w/your favorite mask, tho, even if I am jealous!!!!

puffing billy · Post by **puffing billy** » Thu Jun 14, 2007 12:49 pm

I have a PB420e as my second/travel machine and yes it does work well.
Regarding the flow limitations, my thoughts are that the PB420e is very responsive, possibly due to the fact that the sensor tube goes down to the mask. This is probably the reason why some people (myself included) have to turn FL1 off.
My usual machine is a Respironics Auto with Cflex (the tank) and I believe that the PB420e works better, but is noisier (mine whines as you breathe in and out) and the build quality is not as good.

Billy

PS. Sorry its so subjective.

WillSucceed · Post by **WillSucceed** » Thu Jun 14, 2007 1:01 pm

There have been other threads in this forum about the noise made by various machines. I guess I'm lucky in that my 420E seems to be silent. I hear zero motor noise -all I hear is a bit of exhaust noise if I have my face too far into the pillow such that the mask exhaust is hitting the pillow or blanket.

I think the 420E is an excellent machine -I like it far better than the Respironics tank that I also own.

tangents · Post by **tangents** » Thu Jun 14, 2007 1:05 pm

I've searched on here for information about the whistle from the 420E, and it seems to be the consensus that it is the coupling between the machine and the humidifier. Some have tie-wrapped it, but I like to clean my hose so I don't want to do that. I'm considering ordering a replacement PB H2O Coupling from cpap.com for $9.95 to see if it will eliminate the whistle. I notice that at 7 cm, it's quiet, but at 10 cm it whistles. It hasn't driven me crazy yet, but it might some day.

Cheers,
Cathy

tillymarigold · Post by **tillymarigold** » Thu Jun 14, 2007 1:13 pm

Mine also whines, and it's not the coupling. The coupling can whistle if it's not on properly, but the machine can also whine. It sounds like someone using a vacuum cleaner in a different part of the house.

I love mine even with the whine but it would be perfect without it.

I suspect the machine is indeed more sensitive to FLs and that's one of the things I like about it. I have UARS and that is one of my main symptoms. (However, I believe it is not possible to have OSA and UARS at the same time.) Some people have problems with the machine for that reason, because it can be *over*-sensitive and misinterpret normal breathing for FLs. I'd leave IFL1 on unless you're getting runaway pressures.

WillSucceed · Post by **WillSucceed** » Thu Jun 14, 2007 1:14 pm

I've found an easy solution for the coupling-whistle.

Slide the humidifier tank out of the hot-plate base. GENTLY remove the silicone coupling from the CPAP/APAP machine air outlet and place it on the humidifier tank air inlet. The shorter end of the coupling (there is a spacer on the inside edge of the coupler) goes on the humidifier tank.

Make sure that the CPAP/APAP machine is properly placed on the humidifier platform and that it is properly sitting on the two little stabalizing pins at it's back edge. With your left hand holding the CPAP/APAP machine firmly in place (so that it does not dislodge from the two little pins) use your right hand to slide the humidifier tank into the humidifier hot-plate platform.

This process seems to properly mate the machine with the water tank... no more noise from the coupler.

puffing billy · Post by **puffing billy** » Thu Jun 14, 2007 1:26 pm

A tie wrap still works best.

Billy

NightHawkeye · Post by **NightHawkeye** » Thu Jun 14, 2007 6:21 pm

Slinky wrote:Okay, just go ahead and pour salt in the wounds, NighthawkEye, just 'cause on accountta you know I'm intrigued by the 420E and would like to have one but can't justify buying one at this point.

I know what ya mean, Slinky. Like I said, I waited a year before I finally decided I might as well just get my own PB420E. Ya could always justify it on the basis of your health being worth the best. I mean, how do ya know whether or not it can extend your life unless you try it? With that sort of reasoning, one can justify about anything. .

I have no idea at this point what machine I'll decide to use on a permanent basis, although the PB420E has a real advantage for traveling. I certainly haven't noticed a big difference between machines in terms of how well I sleep though.

Regards,
Bill

NightHawkeye · Post by **NightHawkeye** » Thu Jun 14, 2007 6:51 pm

puffing billy wrote:Regarding the flow limitations, my thoughts are that the PB420e is very responsive, possibly due to the fact that the sensor tube goes down to the mask. This is probably the reason why some people (myself included) have to turn FL1 off.
My usual machine is a Respironics Auto with Cflex (the tank) and I believe that the PB420e works better, but is noisier (mine whines as you breathe in and out) and the build quality is not as good.

I could easily believe that the PB420E is overly responsive to flow limitations, just like the Remstar is overly responsive to snores. However, I'd like to know what other folks see with the machine. If other folks aren't seeing large numbers of flow limitations, then I assume it must be me . . . I know I have a certain amount of congestion, but thought maybe that wasn't interfering with therapy. Perhaps it is though . . .

As for FL1, I left FL1 ON when I went to bed the first night, but my wife woke me up after about an hour complaining about noise. The only time she does that with the Remstar is when air is blowing through my mouth. I don't think I'd been breathing through my mouth though . . . I guess I need to ask her to clarify whether what she heard was air noise, or the machine whining. (If it was the machine whining at a high pitch I likely wouldn't have heard it.) Because the machine had topped out at my high setting of 10 cm, I decided then, after only an hour using it, to switch FL1 OFF. The rest of the night indicated lots of flow limitations, so I switched FL1 back ON last night and got even more flow limitations than the first night.

Tonight I think I'll just leave FL1 ON, raise the top pressure a little, and do a nasal irrigation to see whether that makes a noticeable difference.

Regards,
Bill

Snoredog · Post by **Snoredog** » Thu Jun 14, 2007 7:47 pm

not a bad little machine, mine doesn't whistle but I use a Remstar HH tank coupler instead of the PB one.

IFL1 setting: That is "command on Flow Limitation", meaning if disabled it won't respond with a pressure response when it sees a FL. Most machines would like to eliminate those FL's when they are FL as opposed to Hypopnea. When you disable that setting you are basically telling the machine to ignore those FL's and wait for them to develop into Hypopnea before triggering a response from the machine. If they go away on their own, then the machine won't have to address it as a hypopnea.

When you think about it, it may be a better way to go, when it increases pressure after seeing a hypopnea it should also eliminate any FL's that would have normally been eliminated at a lower pressure. What is a hypopnea? well it is only a 50% reduction in flow lasting >10 seconds. Not positive, but I think on that machine it only needs to see a 40% reduction in flow lasting >10 seconds before it triggers a response to a hypopnea. So theoretically, the machine still addresses FL's even with that FL1 parameter disabled.

I use the settings which increase the Normal cycles seen. When I first started on that machine it was showing around 68% Normal rest were flow limited cycles. Now I'm consistently over 95% Normal. My goal using mine is reducing the number of flow limited cycles seen. It will still trigger a response when it sees a Hypopnea+FL, those will even be scored separately.

I think I lucked out and got a really quiet one, it is quieter than my Classis was by nearly 10dB. For travel, you can't beat that little sucker.

rested gal · Post by **rested gal** » Thu Jun 14, 2007 7:57 pm

The PB 420E was my primary machine during my first year on "cpap" and did a great job for me. I loved the Silverlining software.

I have had two 420E's. No, the first one didn't conk out or anything...I gave it to a friend who needed the advanced settings it has. The first one I had made a whiny up/down sound as I breathed. The second one (bought it used from another member of the message board) was extremely quiet. None of that motor revving up and down sound at all. I still have the second one.

Bill, the easiest, fastest way to determine if you need to turn off IFL1 is give the machine its head. Put your minimum pressure wherever you want it, but set your upper pressure at 20. Look at the data the next day. If you see the pressure was running wayyy up repeatedly during the night (might not hit 20, but will go into repeated steep climb and hit some pretty high pressures) then turn off IFL1 and leave the top pressure still at 20. If you see the pressure behaving much more reasonably with IFL1 off, you've got your answer.

Well, I should say maybe your answer, as there can be other things that could run the pressure up that have nothing to do with IFL1. GERD episodes, for example.

Since you already know you might have sinus congestion issues at play during the night, it could very well be that the 420E might interpret some of your "normally" congested breathing as something that needs more pressure to correct. But of course, more pressure isn't going to correct it if that's the way you're going to breathe at night. Thus, turning off IFL1 might help. Or not. That's why I'd test it for at least one night with a LOT of ceiling up there just to see what the machine does.

People think of Puritan Bennett as manufacturers of "travel" machines since they were the first to come out with the first small, lightweight machines years before Respironics and resmed finally scaled theirs down. And they are, indeed, great for travel. But the PB machines really are excellent "every-night-at-home" treatment machines, too. I always thought of it as a workhorse in a small package.

Guest · Post by **Guest** » Thu Jun 14, 2007 8:47 pm

Well, I should say maybe your answer, as there can be other things that could run the pressure up that have nothing to do with IFL1. GERD episodes, for example.

How, RG, does an episode of GERD impact how the 420e responds, please?

WillSucceed · Post by **WillSucceed** » Thu Jun 14, 2007 8:48 pm

Oops!

rested gal · Post by **rested gal** » Thu Jun 14, 2007 8:58 pm

WillSucceed oops'ing himself wrote:How, RG, does an episode of GERD impact how the 420e responds, please?

I should have said any autopap...not just the 420E. If nightly acid baths irritate the tissue in esophagus and back of throat to the point the tissue is swollen (rigid) or cause vocal cord spasms, an autopap might do a lot of unnecessary pressure raises trying to improve the limited air flow situation.

CPAP is designed to push aside soft tissue. It's tough to push aside a brick wall.

Nov 05, 2005 subject: SUCCESS AT LAST-GERD,420E, PRILOSEC AND BENADRYL
loonlvr's saga - solved by -SWS

This was interesting too, about GERD in general being possibly related to people with OSA:
http://www.medscape.com/viewarticle/516189