BiPap...VPAP....heated hose..Experiments

[Pugsy]

Time for the straight CPAP report. 12 cm with EPR of 3. A less than stellar night. Got the hours on the machine but lots of wake ups during the night and in the wee hours of the morning..killer headache. Wish now I had thought to turn the machine off and on to check the time (no clock in bedroom) but I didn't. Still have a residual difficult headache after being up 2 hours. This is the typical headache I used to get pretty much every day pre cpap but are relatively rare now. Most morning headaches now are minor and go away quickly.. I do have a bad neck so I don't know how much I can blame on neck and how much on the OSA. I don't have an oximeter to evaluate O2 levels. Since this is rare and the one time I did do an overnight pulse ox with DME oximeter it was unremarkable (of course Murphy's law would have it I didn't have a killer headache when I had the pulse ox) I haven't seen the need for pulse ox purchase.

I had a few clusters last night and while the overall Obstructive index isn't horrible...there are some clusters and in the past it has been these clusters which seem to govern headaches and how I feel in general. For me to have an Obstructive index near 3 this is quite an increase. Remember I ignore any Central index because I don't know if they are real centrals or not and even if they are real they aren't in a number to worry about.

It was difficult to come up with a straight CPAP pressure and allow for the reduction that EPR gives. I always want to use the least amount of pressure that will give me optimal results. I suspect that straight 12 without EPR would have given me better results but I wanted to compare EPR relief to bilevel relief.

So 12cm with 3 EPR is not quite like BiLevel with same settings, it is close. It took perhaps a minute for me to get "in tune" with the rhythm of EPR and on bilevel it takes me maybe 2 breaths. Obviously I can use either comfortably but I prefer BiLevel at least while awake. Small thing I know and the "while awake" thing isn't a deal breaker I just feel if I am going to have to do this mask thing every night I might as well be as comfortable as I can.

Only sounds I noticed with these settings are a very minor inhale sound but a perceptible "wheezing" sound on exhale. Not hugely loud and not enough to impact sleeping though. I have no idea what is causing the exhale sound. I do not get this exhale sound on Bilevel with either machine nor on APAP with the PR S1 APAP. I did not think to try it with EPR off until just now when I mentioned it. It really is a non issue for me but I could see that it might be for someone super sensitive to sounds.

I feel less than stellar today. Not bad but not good either. Probably like a so so day on APAP. Will see how the day goes as I have several errands to run today. Not nearly as good as I feel on bilevel with same number of hours of sleep..but with the headache and the higher OAI...hard to tell who is the complicating factor.

So tonight I will do straight cpap again with EPR of 3 again (I do notice a difference and I do like 3 ) but will increase pressure to 13.5 and see if a little higher average does a better job. I suspect last night's clusters were REM stage related since by history I am worse in REM and those clusters sure seem to come in a REM cycle pattern. I saw this often when I was first tweaking my pressures when I first started therapy.

Here is last night's report for those interested.

[jamiswolf]

Good Morning Pugsy,
Sorry you had a bad night. I suspect that it would take you awhile to get used to the machine and it's settings and whether it's worth that hassle...just for the sake of information, well I don't know. I doubt that I'd persist if I didn't have to.

I've noticed that I can actually hear the motor whine in the S7 vpap I have. Could that be the exhale sound you're hearing.

Well knowledge sometimes comes at a cost so hang in there...
J

[Pugsy]

I suspect that it would take you awhile to get used to the machine and it's settings and whether it's worth that hassle...just for the sake of information, well I don't know. I doubt that I'd persist if I didn't have to.

My husband said the same thing.
Having never used cpap, I know that the body really needs time to adjust. Could also have simply been an off night. I don't mind one more night with a little bump in pressure. I am kinda curious and trying new stuff satisfies that curiosity itch. I know that in reality I need more time on cpap to really give it a chance and I can always do that on my PR S1 should I feel inclined. My time with the ResMed machine is limited so just trying to do as many experiments as I can just to get a feel for how the S9 does things is my main goal right now.

If I really wanted to be a martyr I could try cpap at my titrated pressure of 8 cm...OUCH. I don't like pain that much. While I might feel less than stellar today...8 cm cpap would put be directly in the toilet. Been there, done that and it pretty much like sleeping without machine at all in terms of how I felt. Even feeling less than stellar today, I know that I still feel a whole lot better than I did pre cpap.

So newbies reading this and getting the itch to change things. I don't normally change things so much and so quickly because one night doesn't always give us a true picture of what is going on. Some of my changes are also based on my past history and other experiments that lead me in a certain direction. It is always best to make single changes (keep your variables to a minimum) and give the change some time to see if results are consistent.

Newbies unless your therapy seems to be horribly off...give things some time to settle in and you get comfortable with experimenting and expectations before you go off dial a wingin things. Just because you can change things doesn't always mean you should.

[Pugsy]

Another straight CPAP report. Last night I increased the pressure from 12 to 13.6 cm and kept EPR of 3. It is hugely easier to breathe with those numbers than 10.6cm with no relief. Not that 10 is impossibly hard because one does adjust to it fairly easily. I am speaking just from a comfort aspect. Like Rested Gal, I feel it is the "difference" that affords the perceived comfort. I figure I don't get any extra stars for not using any comfort features and it actually may help in some small way. Doesn't matter why. I like it and I am going to do what I like the best.

Now that I am getting used to EPR rhythm, it is quite nice. Don't know what I was thinking of night before last when I used 12 cm with 3 EPR...When on APAP if I dropped the minimum from 10 to 9.5 I got those same clusters so that is obviously my threshold. I don't understand why Straight bilevel of EPAP 9 and IPAP of 13 doesn't give me the clusters...perhaps the IPAP is maintaining the airway patency just a little better overall. Perhaps it is the quicker response with bilevel than EPR. Beats me but you can see last night's report below. New settings did a bang up job. Short night but that is probably because today I am having the EGD done and I just woke up early.

I slept very well last night. No real wake ups that I can remember. I knew the data would be good this morning when I woke up and was just laying in bed thinking if I wanted to get up yet.

So for me..night before last with the clusters and despite the "okay" AHI of near 3.. I had frequent wakeups during the night, possible from the events and woke with killer headache. Felt yucky. For me it seems the deal breaker is the clusters. When I have AHI nights of 3 (obstructives only) with clusters...I feel much less than optimal. When I have AHI nights with AHI of 3 (obstructives only) that are spaced out randomly.. I feel quite decent. I have noted all along that the presence of any clusters seemed to be a factor in how I felt upon waking the next day. This is something I noticed when using the APAP also.

Last night, well, I actually feel these good numbers despite the short hours. Doesn't get much better than this folks. One single solitary Obstructive apnea lasting 13 seconds. I looked at the flow graph. It looks quite real as does the lone central. Very minimal headache this morning likely from my neck, rainy here and neck always hurts more with the rain. Far from being a "killer" headache

[Java Time]

I have been using a PR S1 APAP since April at same settings AFlex of 2. I don't use ramp. No problem exhaling at 10 cm.

Brenda,

Have you ever posted anywhere how you decided on a PRS1 AFlex of 2? Since you like the reduced exhalation, I would think you would use the max setting of 3.

Just curious as I have the same setup and I have never tried anything but AFlex 3, so far. Still trying to get other things fine-tuned before I start messing with AFlex. I am curious though on how you "discovered" your preferred 2 setting.

[Pugsy]

Have you ever posted anywhere how you decided on a PRS1 AFlex of 2? Since you like the reduced exhalation, I would think you would use the max setting of 3.

Way back when I got my first M Series APAP with A Flex I sat down and simply tried all the Flex settings.
3 may be max in number but it doesn't equal much more (if any) of a reduction in exhale than 1 does. Respironics Flex exhale feature is flow based and not pressure based (like the ResMed machines). It modifies its response based on my own breath flow.

I tried 3...tried 2 tried 1....3 made me feel like the machine was wanting me to breathe too fast. So it didn't fit my breathing rhythm.
Setting of 1 seemed just a tad slow.. Setting of 2 was perfect way back on the M series machine and I simply kept it when I got the PR S1 APAP last spring.

Flex settings do not drop the exhale pressure significantly at all.. Certainly nothing like BiLevel machines will do.

So a setting of 3 in any Flex isn't necessarily "more" relief...just different relief. I always tell people to try all the settings to see which one feels the best and to heck with what the number of the setting is.

http://aflex.respironics.com/

[rested gal]

Flex settings do not drop the exhale pressure significantly at all.. Certainly nothing like BiLevel machines will do.

Right. On both counts.

a setting of 3 in any Flex isn't necessarily "more" relief...just different relief. I always tell people to try all the settings to see which one feels the best and to heck with what the number of the setting is.

Good advice. Any given level of C-Flex or C-Flex+, or AFlex, BiFlex can feel quite different to different people. And keeping any of them turned off suits some best.

I've always gotten along fine with "the most" drop any of those can give. But some find a middle or low setting feels smoother for them. My normal breathing out is rather light, so flex isn't going to drop much for me, no matter what.

As you said Pugsy, the various forms of Philips Respironics "flex" are almost entirely dependent on the force of a person's exhalation, as to how much drop in pressure the person will feel when breathing out...regardless of the "1, 2, 3" level settings. A person who normally breathes out rather forcefully (almost like a hard "sigh") will probably feel as much (maybe more) drop at C-Flex 1, than I do (with my light breathing out) at C-Flex 3.

[Java Time]

Thank you Rested Gal and Pugsy,

Sorry to side-track the Original Post, but your various experiments made me curious on what you had tried for "relief" on your current AFlex machine.

Very helpful information, sounds like I was confused on what the AFlex was for. The AFlex graphs and info on PR's website were a little confusing and I didn't quite "get" what the machine was doing at the various settings. Putting my hand over the mask exhaust, it "feels" like it is changing pressure during the inhale and exhale. I thought the numbers indicated "more relief" rather than a different "pacing" of breath.
I see what you mean now, that AFlex is not really the same as BiPAP pressure relief.

I had a bit of a "hyperventilating" sense when I first started on the machine. I've heard others say the same thing. I'm wondering now if that would have been decreased at a "slower" AFlex setting of 1 or 2.

I'm now used to the 3 setting. but now that I get what the settings do I'l try them for a couple of nights and see if I can tell a difference.

Like Rested Gal, once I am close to sleep I think I am a "light breather", so I may not notice a lot, but interesting to try.

Thanks for sharing your grand experiment here with us and feeding the curiosity of us other CPAPers!

[Pugsy]

Sorry to side-track the Original Post, but your various experiments made me curious on what you had tried for "relief" on your current AFlex machine.

Not a problem at all. Hurts nothing to discuss other experiments.
You are new and may not have seen what happened when I experimented with turning AFlex off after using it for well over 2 years. Here is my experiment results with it. Big bomb. Just in case you or someone else hasn't read it and may want to.
viewtopic.php?f=1&t=67883&p=631376&hili ... mb#p631376

The above experiment turning AFlex off was done prior to my getting my paws on the bilevel machines that I am experimenting with now.

What can I say...I like to experiment with new or different stuff. Once I got things dialed in long ago the therapy got boring. Gives me something to do to occupy my mind and satisfy the curiosity itch.

[Pugsy]

Report on sound level differences between the PR S1 BiPap Auto and the ResMed S9 VPAP Auto.
Both in auto mode.. Both with same settings EPAP 9 IPAP 13.

Had my husband listen while I used both machines for a short time this afternoon.
I don't hear either machine at all. Nothing from the machines at all.
I hear only my inhale breath (sort of in my head noise) my husband doesn't hear it. I notice the inhale noise just a tiny bit more on the BiPap. He says he hears a very, very faint hum of machine sound with both machines. ResMed is maybe a tiny bit more quiet. He says not enough difference to worry about. He reported to me that he got up around 3 AM for bathroom break and when he came to bed things were so quiet he had to reach over to feel the air venting to know for sure the machine was on. I was using the VPAP last night. He says this has happened before last night many times...even way back when I was using the APAP. I have actually been poked in the ribs in the past with him waking me up to tell me to put the mask back on and use the machine....when it had been on and he simply couldn't tell because things were that quiet.

He says sometimes he can hear a bit of breathing sounds, unsure if inhale or exhale and only when I am right next to him. I think some of this is mask vent noise. He seems to think that the machines have very minimal noise and sometimes he just hears my inhale and exhale when I am close to him.

Neither my husband nor myself have any hearing issues so it isn't like we need hearing aids and didn't wear them.

As with anything..YMMV and if someone is sensitive to certain tones or pitches then perceived noise might seem louder for that type of person.

For me...they are pretty much equal in the noise department. I have no complaints about noise with either machine. For me not enough difference to be any issue at all. The decibel differences listed with each machine's specs are very small, for me I simply cannot really tell any difference in such a small amount. Husband says very, very minor difference in sound level. Both are extremely quiet and easily one doesn't even know either is even on.

So that is my noise report.

[Pugsy]

Here is my last night's report. 9 Centrals and 1 measly Hyponea...in approx 8 hours of sleep.
Restless night last night. More back pain than usual. It rained here and that always messes with my arthritis. I know for a fact that I had several awakenings last night turning over in bed. I have no doubt that those Centrals are probably related to either turning over in bed or sleep onset related to awakening. The last hour on the machine...I was pretty much awake for most of it. Just wasn't quite ready to get up. One little time with a bit of leak...likely the nasal pillow moved slightly. Not hugely prolonged and I won't worry about it.

Some nights I have centrals score like this or worse and some nights zero. I just shrug my shoulders and don't worry about them.

[Pugsy]

I had not updated this thread for a while so I thought I would do an update and close it out unless someone sees it and has a question.

The Hybernite 2300 heated hose has worked perfectly. I now can use the high humidifier settings that my body prefers and with winter here...colder bedroom temps which I prefer....and zero issues with rain out or ice cube nose. I see now that our forum host cpap.com now carries this same heated hose so for anyone wondering...I highly endorse it.

I have been back on my PR S1 BiPap since after Christmas. The ResMed S9 VPAP had to go back home.
I continue to feel so much more energized during the day since I started the BiPap. I still don't know why it allows me to feel so much better...less sleepy during the day. I thought at first it was that extra hour of sleep I get with it but I have had some short nights with the BiPap for reasons unrelated to sleep apnea and I still feel better on those days too...even with 5 or 6 hours of sleep.

The scientific side of my brain is really curious about why I feel better on BiPap than APAP but I have no clear cut answer. None of the usual things really pertain to me. I don't use exceptionally high pressures...I don't have aerophagia issues...meds and/or pain hasn't really changed. So I don't know.
I am thankful that I stumbled onto the first BiPap that went to my friend or I would still be missing out on feeling the good numbers that I have pretty much always had on the APAP since tweaking my pressures shortly after starting xpap therapy. Great numbers and much better than pre cpap but still not quite "there" on APAP. On the BiPap I got to "there".

My plan is to sometime in the future get a S9 VPAP Auto to have for a back up or heck just change out with the PR S1 BiPap from time to time just for fun. I really do like both machines pretty much equally.
The one huge plus for the VPAP is the fixed pressure support available in Auto mode. I can set it for 4 and I can't do that with the BiPap. I do well with a fixed PS and don't seem to need the variable that is available in the BiPap Auto. I know it is a really small thing...to have that 4 cm difference while I am awake and I know that I get superb therapy with either and I am not awake all that long but I just like that one little thing. It is not a deal breaker though. Just one little feature that is extra sweet for me.

Oh...for fun..remember I talked about my machine scoring my little Pug dog's snores? I thought I would include a report that shows them in their full glory. Encore Pro shows them more dramatically than SleepyHead. Pro is set for unintentional leak only.

[DoriC]

Inquiring minds, So what happened after 4hrs, did she just get up and leave the bed or just stop snoring?

[Pugsy]

Inquiring minds, So what happened after 4hrs, did she just get up and leave the bed or just stop snoring?

Cat probably made Sarge move away from my head. Poor little guy is terrified of the cats. This morning I woke up and had 2 cats on one side of me and another on the other side and poor Sarge was down at the foot of the bed...eyes all bugged out shaking like a leaf. Afraid to come up by "Mom". He is such a funny little dog.

[Pugsy]

Well....last night was ugly on paper... report below. I removed the barrel cozy to see if it would help with the leaks...which it did. Unsure if this would have just been an ugly night anyway. Sometimes crap happens and we just don't know why. Woke up with minor headache (which could also be from my neck as it has been giving me fits lately with the cold damp weather) and I can see some clusters on my report.
Last night probably would have been a good night to have had the machine set in Auto Mode. It is obvious I needed more pressure. I suspect if I had been using APAP...this would have been one of those nights that I saw 16 or 18 cm maximum pressure. Since using the BiPap in straight bilevel mode this type of night has been rare. Rare enough that I don't want to give up the comfort that the 4 cm pressure support that straight bilevel gives me and go to auto mode.

I seriously doubt it is related to the Bella Loops or the fact that I removed the barrel cozy last night to see if the leaks would be better (which they are) but I also adjusted the straps so who knows what the real reason for the improved leaks might have been.

I actually feel quite decent today. No better or worse than 2 nights ago when I had only 1 event in each category. Unless this report repeats itself many times....I won't be doing anything but shrugging my shoulders because this isn't a typical report and I will toss it into the "fluke" bin until if/when I see more like them on a consistent basis.

Last night's report.


report from 2 nights ago.