I need help with settings on new Sandman Auto

[terry123]

I have purchased a new Sandman auto, the settings seem a little more complicated than my Respironics M Series. I tried to use it last night. The maximum was at 12, I woke up and hit the ramp button. Shouldn't it just go back to the Ramp pressure at that time? It didn't. What is the Command on IFL? Should it be on?
I was using 7.5 to 12 on my Respironics. Should the settings on the Sandman be the same as the Respironics. I had an old Puritan Bennett420E that ran on 4-10 without problems, but not sure the pressures are more similar to the old 420E or not.

[mindy]

Terry,

Here's a link to a previous thread in which I asked about some of this and I thought it would make more sense to point you to this one:

viewtopic.php?f=1&t=36712&p=318804#p318804

Hopefully some of the others like Ozij will chime in, too.

Mindy

[mindy]

Terry,

While you're waiting for your Sandman reader, are you looking at your basic stats on the LCD? It shows # hours sleep, AHI and whether or not it considers your leak rate to be "normal" or not. That might at least give you some idea of how your therapy is going.

If you were comfortable with 4-10 on the PB before and went up to 14 last night on the Sandman, I can think of several possibilities:

mask not sealed well (is it the same mask; how old is it?)
mouth breathing

I'm not at all sure, but if IFL is ON or enabled and you were leaking a lot, is it possible that when you hit ramp that IFL kicked in? (Ozij or RestedGal would know the answer to that one).

Mindy

[ozij]

Terry, everything I know about the Sandman comes from reading the manual I've never seen or touched the machine.

The ramp pressure on the Sandman is not what they call the "comfort pressure" - so make sure the ramp is set, and that its length of time is not zero.

If you're constantly finding the machine hovering at the maximum pressure - and haven't had that happen with the Respironics then you most probably need to have IFl1 turned off (that was IFL1=0 on the 420E - take a look at your old machine).

O.

[terry123]

I have gotten the card reader and am going to use my Sandman Auto tonight. I did turn off the IFL Command. What is the function of the IFL Command?

[mindy]

I have gotten the card reader and am going to use my Sandman Auto tonight. I did turn off the IFL Command. What is the function of the IFL Command?

Terry,

In the thread I linked with URL above, there are some descriptions of the PB parameters and the Sandman is very similar.

For the IFL command, here's the exact quote:

---Snoredog wrote:

My machine is a 420e but basically the same when it comes to function:
IFL=Inspiration Flow Limitation; meaning Inspiration breath is flow limited or flattened, with IFL enabled it will pad the inspiration breath with extra pressure to round out the inspiration breath waveform, this may be felt and resemble a "puff" or pulse of air of which I can actually feel. Just night before last I woke up with too much pressure, I pushed the Ramp button pressure settled back down but before I could get back to sleep at the end of ramp I had to keep opening my mouth to relieve the pressure, finally I fired up the laptop to check the settings as I had downloaded from machine earlier, I guess before leaving Silverlining I had enabled the IFL box. I disabled, shut down the laptop and I had no problems at all with it puffing at me while falling asleep.

I think it is a setting you need to try both ways, but having it disabled works for me, I can tell the difference if it is enabled or disabled. Enabled it seems to respond to stand-alone FL's, with it disabled they have to be associated with a Hypopnea. On a 420e they show up on the Hypopnea +FL line.

So it sounds like you need to decide if you want the pressure to increase with flow limitation (standalone) or only if it is associated with a hypopnea.

Mindy

[ozij]

The 420E does not "pad" breaths' with an extra puff when IFL1 is on.

The 420E - and one would assume the Sandman as well - counts those breaths that are flow limited. When IFL1 is on, it wll raise the pressure in response to a run of flow limitations. A run being a certain number of flow limited breaths comming one after the other. When the machine identifies a "run" it raises the pressure. And when it misindentifies many breaths as runs, it will raise the pressure over and over and over. However, for some of us, what the machine identifies as a "run" of flow limitations is actually normal breathing - so the machine never stops raising the pressure till it reaches the maximum allowed. That's when IFL1 has to be turned off.

O.

[ozij]

The 420E does not "pad" breaths' with an extra puff when IFL1 is on.

The 420E - and one would assume the Sandman as well - counts those breaths that are flow limited. When IFL1 is on, it wll raise the pressure in response to a run of flow limitations. A run being a certain number of flow limited breaths comming one after the other. When the machine identifies a "run" it raises the pressure. And when it misindentifies many breaths as runs, it will raise the pressure over and over and over. However, for some of us, what the machine identifies as a "run" of flow limitations is actually normal breathing - so the machine never stops raising the pressure till it reaches the maximum allowed. That's the kind of response that indicates IFL1 has to be turned off.

O.

[terry123]

Thanks Ozij for the explanation. I had used the Sandman about 10 days ago, but didn't have my card reader yet. I woke up with it going full blast and had the same problem with a 420E I used to have, so I thought I would try it last night with the IFL off. I don't know if I did the right thing, but with my history with the 420E, I had settings of 4-10 for over a year and thought I did fine.(I never saw any reports, only my DME saw them, so I don't know), then when I had problems with it, they replaced it with another 420E and I had problems with it going to the highest pressure and waking me up even when they increased the max to 12. So when I used a RespironicsM, I used the old settings and was having terrible headaches. Thanks to this forum, I was advised to increase the minimum as I was rebreathing CO2, which I did and it helped, but the Resp. just isn't as comfortable as my 420E, so, since they are not available any more, I got a Sandman. I set the pressure at 6-12 last night and I thought I slept pretty good, but my blood pressure was a little high when I got up - went back to normal in a short time, so I am wondering if again I need to raise the lower pressure.The pressure stayed at 6 or 7 all night last night. Also with the IFL turned off, the reports said I had about 9 Centrals along with 4 AHO's,Runs were 455 so not sure if I need to try again with it turned on. Any suggestions.

[rested gal]

ozij's description is correct. The IFL(1) trigger on the PB 420E (and presumably, the Sandman auto) responds with more pressure to a series of flow limited "runs."

As ozij said, some of us have slightly "flow limited" breathing which is normal for us. However, the 420E (and presumably, the Sandman Auto) may see breathing that's normal for us as something that needs "correcting", which it does by raising the pressure more, more, and more. If "slightly flow limited" is our normal breathing, those pressure climbs by the machine are unnecessary. That's why some of us find we need to turn off the IFL(1) trigger.

It's best to have the software to actually see what's going on. Here are pictures of my own data showing how the 420E was skyrocketing the pressure when I had IFL1 turned On... and how the pressure settled down when I turned IFL1 Off:

IFL1 On -

I would say those kinds of extreme pressure climbs would show up on the Sandman graph, too, if having IFL "On" is a problem for the person.



IFL1 Off -



As for this...I don't think this is correct at all...

with IFL enabled it will pad the inspiration breath with extra pressure to round out the inspiration breath waveform, this may be felt and resemble a "puff" or pulse of air

"

I agree with ozij. As far as I know, IFL does not "pad" each inhalation with "extra pressure" puffs or pulses.

[mindy]

Thanks much, Ozij and Laura!!!

I've noticed with my Sandman Auto with IFL turned on, I wake up some mornings with my pressure running at 15 while the average is between 9 and 10. I'm going to try it with IFL disabled and see what happens.

The Sandman Auto has IFL, not IFL1 and IFL2.

Mindy

[Thunder Road]

What is your comfort pressure set to? I would set it to 8-9. It is not just a ramp feature since the machine will hover aroundthat set pressure in the absence of any events. It is Covidien's answer to EPR/CFLEX. They claim you do not need that with the pressure sensitivity built in to the processor. I would also set the command on apnea to 11 since your max pressure is set to 12. I acheived my "sweet spot" of 0 AI with the following perameters. Pressure of 4-10 with comfort set to 6 and command set to 9. I do not use ramp latency and my humidifier is set to 5. Do not underestimate how the humidifier for this unit controls comfort. It is very presise and goes along way toward finding satisfaction with the apap. I have used the comfort select mask that you use and have found that mask to be successful along with the CG when using the Sandman. It should not take very long to tweak your machine and be on your way.My pressure hovers around 5.7 instead of the minimun set pressure of 4.This allows for very little awakening in the middle of the night as the machine aduststo any events shouldthere be a need to. FYI I just reached 1000 hrs on my Sandman and have never looked back and thought I purchased the wrong APAP. Good luck and keep us imformed.

RIP Snoredog!!!! You gave me the knowledge to reach the current perameters of my successful treatment. You are missed and the board is not the same without you. Thanks to the wily veterans that have stepped up and helped all the newbee's in his place. You are appreciated.

[terry123]

Thunder Road, Do you not have any problems with rebreathing co2 with the settings that low. With my Respironics M Series, I did. Also how do you delete the info on the card? I used the Sandman about 10 days ago and then again last night, so I would like to start over the numbers fresh.

[mindy]

Also how do you delete the info on the card? I used the Sandman about 10 days ago and then again last night, so I would like to start over the numbers fresh.

You don't need to delete info on the card. Somewhere in the manual it references over 100 sessions of data being saved. Last time I downloaded data was 12/7. I just downloaded today and got all the days from 12/7 to today. It takes care of it automatically. Also, in the software you can select a group of dates and it will show the stats for that group.

Mindy

[ozij]

Bumping this up for Terry123.
O.