Regarding the PR System One Algorithm?

[beadedbiker]

I went to pick up my loaner PR System One APAP today.

Something the RT said irked me. She said the PR responds to events on a 4 minute cycle? Surely that has to be wrong, because it sure doesn't sound like it would be effective if you had to struggle to breathe for 4 mins, before the machine responded. Does anyone know what she is talking about?


Eva

[blakepro]

no. No clue at all what they are talking about.

The PR1 is pretty pro active when it comes to sensing problems and adjusting your pressure appropriately.

I have not tried an S9, but I have tried an S8 and I like the PR1 algotrithm better than the S8 one.

but 4 minutes?!? Where do they get this stuff?

[Janknitz]

I'm not sure what she means--I THINK that the PR S1 ramps up in very small increments and it may take up to 4 minutes to get to "full power" when you have an apnea or Hypopnea so to speak. The purpose behind that may be that you don't need as much of an increase as other machine's cycles might give you. But I'm just guessing.

Give it a try, and try to keep an open mind--I know this machine is not what you want. But it DOES work! I went from 77 AHI to less than 1 the very first night with the PR S1, and my highest AHI ever on that machine has been 0.9. It can and does prevent AHI's just as well as any other machine.

PR S1 and the S9 may be different, but that doesn't mean that the PR S1 is flawed--it's just different. It would not be prescribed if it didn't work.

[wil]

For more information than you probably want, look here:

http://sleepapnea.respironics.com/techn ... rithm.aspx

This is how I interpret this...

When there are no events occurring, every so often (Probably the "four minutes" she was referring to) the machine will inch up the pressure slightly. If no improvement is detected it will drop back to the previous level. If there is improvement, the machine will stay at that pressure. A few minutes later, it will repeat the process. After a different time lapse it will begin bringing down the pressure and sensing whether it needs to bump it back up in the same manner.

This is an AUTO-TITRATING algorithm, which is different from an event detection/reaction situation. Event detection is described here:

http://sleepapnea.respironics.com/techn ... logic.aspx

As you can see, these are different technologies to treat different situations. Used together I have found the System One algorithms to be very good at early event detection (almost prevention) as well as maintaining a titration that is good for whatever position I'm in or whatever difficulties I may be having.

Give it a shot...

[Janknitz]

So, how'd it go the first night with the S1???

[wil]

Oh, and by the way, I swear that I am not now, nor have I ever been, an employee or in any other way associated with Phillips/Respironics. I do not work in the industry in any way... Everything I said above is from what I've been able to gather from reading everything I can get my hands on and asking anyone who might know.

Seriously, I'd also like to know how it's going. I've been very pleased with mine. It's not as flashy as the S9, and not as pretty, but I really think the core technology is as good as...

[Ms.Snuffleupagus]

I went to see my DME this week to replace my H4i humidifier of my S8 because the metal plating of the humidifier was bubbling up and bits were flaking off. It was still under guarantee, so I had no problems replacing it.
We got into a discussion about the PR1 and she said it was much much sturdier than the S9's. She said you could drop it and there would be no damage. And she also said the Respironic machines seem to last forever.

[beadedbiker]

So, how'd it go the first night with the S1???

Not bad. Not the blissful close eyes, wake up 8 hours later, feeling like a new woman suddenly wanting to clean my house experience I'd been hoping for though

I woke up a bunch of times, but I think that was mostly the mask/hose irritating me. I'm not terribly happy with the humidity control. I kept turning it up because the air felt so dry in the end I had the thing cranked to all the way to 5. It used no water. My nose feels like it was breathing sandpaper all night. It was working because there was condensation on the water box in the humidifier, but I was worried that this would happen as we keep the bedroom so cold at night and I had feared the unit would either waterboard me or sacrifice humidity to prevent rainout. It chose the latter. Which quite honestly makes me want the S9 even more. Rainout would be an easier work around.

I went by the DME and got the card downloaded, because the software my oh so knowledgeable RT gave me was not the right kind at all, and my AHI, was down to 0.4 so I'd call that a success, and my bodymedia armband shows that unlike before, when I fell asleep, I was soundly asleep, and I got a sleep efficiency of around 80%, which for me is very good. Hopefully when I get used to the mask/hose issues and quit napping during the day, I'll get that above 90% where it should be.

[Dog Tired]

I have both an S9 and PR1. I use the S9 as my primary machine. I also had an S8 as my first machine.

I know that A-flex and EPR are highly subjective things. It took me several nights to get used to the S9. For me, the A-flex felt more natural.

However, I adore the silence of the S9. I do not like the treatment I received from S8 - it just wasn't comfortable for me.

Never had a rainout problem on either machine and found the humidifiers on both to work just fine for me.

I felt I received good treatment from both machines. However, my AHI numbers are lower on the S9 - are they scored differently, or is the S9 just better? I don't know the answer to that.

[Janknitz]

Not bad. Not the blissful close eyes, wake up 8 hours later, feeling like a new woman suddenly wanting to clean my house experience I'd been hoping for though. I woke up a bunch of times, but I think that was mostly the mask/hose irritating me.

Gosh, you are so knowledgeable about the machines I know I kind of forgot that these were your first nights on CPAP. Eva, it sounds like you did AWESOME

There are a lucky few who wake up the first morning feeling like a new person and taking to CPAP like a duck to water (let's call them "duckies"), but most of us are NOT duckies. Most of us struggle mightily just to get through the night for a very long time. Elena has a great expression for this, "the ring of fire" --an apt description if you ask me.

You slept well, all things considering, and had a very low AHI--that is wonderful. The mask and hose ARE the primary irritation for most of us--while it sounds like those were issues, they were not enough to keep you awake. That's way better than most of us do on the first few nights.

I'm not terribly happy with the humidity control. I kept turning it up because the air felt so dry in the end I had the thing cranked to all the way to 5. It used no water. My nose feels like it was breathing sandpaper all night. It was working because there was condensation on the water box in the humidifier, but I was worried that this would happen as we keep the bedroom so cold at night and I had feared the unit would either waterboard me or sacrifice humidity to prevent rainout. It chose the latter. Which quite honestly makes me want the S9 even more. Rainout would be an easier work around.

First, you need to understand that your nose is not used to this assault of air coming in, so some discomfort happens in the beginning, no matter what machine and humidity setting you have.

Some people love all the warm, moist air they can get, others (like me) get more congested with that. The PR S1 does have a manual override in the clinician's menu that will allow you to run the humidifier in the classic heated mode instead of the passover mode that is the standard default. I don't know the details about turning it on (it was explained to me here: viewtopic/t51687/viewtopic.php?f=1&t=51 ... ne#p472275 but I have not personally tried it).

You may want to try some simple things to make your nose more comfortable--nasal mist or nasal rinse (i.e. a neti pot), ayr gel, and drinking plenty of fluid during the day help.

I hope that you get the S9 you want, but if you must live with the PR S1, the world will not end--promise

[wil]

First of all, Thanks to Janknitz on the classic humidifier setting. I constantly wake up with a dry mouth because I can't keep it closed when asleep, and I'm hoping a little extra humidification might help that.

I'm not terribly happy with the humidity control. I kept turning it up because the air felt so dry in the end I had the thing cranked to all the way to 5. It used no water. My nose feels like it was breathing sandpaper all night. It was working because there was condensation on the water box in the humidifier, but I was worried that this would happen as we keep the bedroom so cold at night and I had feared the unit would either waterboard me or sacrifice humidity to prevent rainout.

For what it's worth, the Non-Classic (standard) setting refers to the System One's 'relative humidity' control. It reads the humidity of the room air and compensates to bring the humidity up to the level you set. If your room is particularly humid, the S1 will not use much water from the water box.

It really does sound like you're getting there. I've been on xPap for almost 3 months now, and it has changed my life. It starts slowly, though. Now that I've gotten my sleep under control, I've managed to quit smoking (1 month!), my blood pressure has returned to normal, and I've started eating right and working out. I need to drop about 40 lbs, would like to drop 70 and get back to my high school weight! It takes some time to "pay the sleep debt" and really start to feel much better, but it does come. Being oxygen deprived for a third of your life just doesn't do!

I've only been using nasal pillows (actually, the Liberty pseudo-hybrid) for about 3 weeks, and my nostrils took a beating at first too. This also gets better with time. I don't even notice anymore.

We got into a discussion about the PR1 and she said it was much much sturdier than the S9's. She said you could drop it and there would be no damage. And she also said the Respironic machines seem to last forever.

I, too, recently had a conversation with someone about this. It seems Respironics was completely unreliable and not well built until Phillips bought them out. Phillips is a highly reputable company that makes a myriad of electronic devices for home, industrial, and medical purposes. They build excellent equipment.

[Janknitz]

Now that I've gotten my sleep under control, I've managed to quit smoking (1 month!), my blood pressure has returned to normal, and I've started eating right and working out.

WAY TO GO, WIL!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Keep up the good work, especially staying off those coffin nails!

[Guest]

I have both an S9 and PR1. (...) my AHI numbers are lower on the S9 - are they scored differently, or is the S9 just better? I don't know the answer to that.

I like your question which I find very fundamental, but unanswered, when trying to evaluate the error margin in those AHI numbers and decide which to order between S9 and PR1.
Paraphrasing your question I'm asking:
1. Which is more sensitive (S9 or PR1) in detecting events?
2. During a titration study performed using S9 or PR1 how does their AHI score compare to an independent RDI score by the sleep lab equipment during the same titration study?
3. Which is better (S9 or PR1) in preventing events?
4. What is the numeric difference in the average AHI score at the same pressure settings in your case between S9 and PR1?

In the quest for answers I found the following data so far:
- I spoke to a person in the AWAKE support group who said his sleep lab allowed him to be titrated using his autopap and the scores were: lab RDI=25, autopap AHI = 5.
I do expect a margin of error, but this difference is too big for my taste. Shouldn't such calibration titration study be mandatory for any xpap?
Unfortunately my sleep lab refuses to conduct a titration study using my xpap instead of theirs, because, I quote, "such change in the lab configuration would impact the score too much".
- During my own titration sleep study my RDI when on lab's respiratory support was 18.5 (diagnostic RDI=85), but my S8 or VPAP III never showed AHI higher than 7.
- My wife scored RDI=6.9 (no apneas, hipopneas only) during her diagnostic sleep study, but her S8 shows AI = 1, HI = 6 (AHI=7) at the pressure of 7 ccm.

5. What is the error margin of the AHI scores reported by S9 and PR1?

[elena88]

good first night!

I think by the second week, with any luck, youll be able to appreciate the PR system one w/ a flex's humidity and warmth..

I titrated on a resmed model in week one, and had the same experience you are talking about.. it was the sahara!

the second week, they gave me the system one, and by then I had adjusted enough to ENJOY the comfort, warmth and humidity
of that machine.. I loved it! however, you have to find your sweet spot on the settings.. too little, and you dont get the benefit,
too much can cause congestion in some people, it did me..

I dont care about rain outs, swamps, stormy hoses.. heck, use my nose as a storm drain, I dont care as long as I can have
that mmmmmmmmmm warm, moist, air... makes me feel like a baby lamb in the thick of the straw in a warm barn on a winter night..