Respironics System One harsh blower startup

[xsara]

Hi all,
a quick question; I've just moved from an S9 Autoset to a System One BiPAP Auto (DS760).

One thing that I notice is that when turning the blower on, the machine doesn't ramp the pressure up over a second or so, but rather just turns the blower straight on in a means that is quite harsh on the airway!

Is there any way to tweak this? I like the fact that the S9 take a second or two to come up to speed, whereas the DS760 is like firing a canon down the throat.

I'm sure more questions will come as I begin to tweak my therapy on this new machine.

Cheers!

[Pugsy]

Yes, there is a way to tame the initial start up...tell me what your current settings are and are you using the ramp feature and if you are..at what settings?
Also...are you using BiFlex and if so at what setting?

[xsara]

Hi Pugsy,
I'm very much in the early stages of self-titration, trying to acclimatise to a higher pressure as my airway collapsibility is when I hit REM sleep (UARS).

Right this moment I'm working on the following:

Min EPAP - 14.5
Max IPAP - 25.0
Min PS - 1.5
Max PS - 8.0
Bi-Flex Disabled
Ramp - 5
Ramp - 0:45

I seem to find it more comfortable to have Bi-Flex/EPR disabled, as it tends to increase my awareness of breathing patterns.
I suppose I could start the machine in ramp mode prior to placing the mask on, this might be the best workaround?

Look forward to hearing from you

[Pugsy]

EPAP of 14.5 and IPAP max to whatever with PS of 1.5 minimum...means when you start the machine you are getting 14.5 EPAP and IPAP of 16 ( EPAP plus min PS is what you start with)...big jump for sure when compared to how the S9 settings work.

Ramp - 5

I think this means that it should start at 5...
and the 45 means it takes 45 minutes to get to 14.5...which is probably too long and you might want to decrease that a bit.

BUT even though it is set to start at 5 you have to push the ramp button on the outside of the machine by the knob to start ramp...it isn't built into the settings like the S9 is. On Respironics machines we have manually push the ramp button to use ramp.
You can watch the LCD screen to make sure ramp is working or not.

Have you tried the ramp button?

BiFlex...personal choice as to what feels best for you and if off feels best then that's fine. I mentioned it because some people are totally unaware of its option and haven't even tried the various settings...since you have tried them and didn't care for it...we won't try it.

[palerider]

Yes, there is a way to tame the initial start up..

I think the OP is talking about the difference in the resmed soft start where it builds pressure over a few seconds, vs the respironics hard start where it just starts at whatever the set pressure is with no build up.

I'm not aware of any way to tame that, other than ramp, which isn't the same nice buildup.

[Pugsy]

I think the OP is talking about the difference in the resmed soft start where it builds pressure over a few seconds, vs the respironics hard start where it just starts at whatever the set pressure is with no build up.

I'm not aware of any way to tame that, other than ramp, which isn't the same nice buildup.

You may be correct but I am hoping that OP simply hasn't been utilizing the ramp feature at all because it doesn't engage automatically like the S9 ramp feature does. It's requires that last little punch on the ramp button itself on the Respironics machines.
Using ramp with 5 EPAP and 7.5 IPAP may not be as soft as the S9 gentle start but it will be a helluva lot softer than 14.5 and 15 is.

[xsara]

You're right palerider, it's the 'softstart' feature that I evidently desire! I have indeed tried using the ramp feature. It does make it more comfortable than being hit with an initial 16.5cmH2o! I might just have to put up with this. It is a different sensation from the S9, but one I suppose I'll (need to) learn to adapt to.

I've got my pressure quite high, as anything lower and I always wake up between 60-90 minutes consistently, I believe as my body falls in to REM. Having essentially a 0.0 RDI up until this point in the night according to the machine, I don't believe that my airway actually requires an xPAP splint (or perhaps 4.0 is simply enough at this point) during the lighter stages of sleep. I wake with no events evident in sleepyhead to trigger the full awakening that I experience. I'll note that in my PSG, my RDI moved from 2.0 in NREM to 17.0 in REM.

I am yet to actually successfully sleep past the 60-90 minute threshold (3 years of AutoCPAP with every possible combo of settings), having just purchased the BiPAP to see if I have better success at the high pressure than straight CPAP.

I've also got a very restricted upper airway behind the tongue base and soft palate (~2mm), although with very little fatty tissue, so I would hypothesise that a high pressure is required to splint this open. If I relax what I believe to my tongue base, I can easily fully close my airway. When awake, it seems that I need a pressure of 17 to prevent this closure when relaxing.

Cheers!

[Pugsy]

Ahh...so sorry...I was hoping that you weren't missing the "soft start" of the S9...I know what you mean. I have both a 760 and a S9...but I went from Respironics for 3 plus years to my first S9 so I hadn't had a choice to get spoiled by the Soft Start thing.

As far as I know the ramp feature is about the best we can do on the 760...unless you can sweet talk your supplier out of a ResMed VPAP...and there's an even new model than the S9 now for the VPAPs. AirCurve 10 VPAP Auto I think it is that is comparable to the 760 you have.

[palerider]

You're right palerider, it's the 'softstart' feature that I evidently desire! I have indeed tried using the ramp feature. It does make it more comfortable than being hit with an initial 16.5cmH2o! I might just have to put up with this. It is a different sensation from the S9, but one I suppose I'll (need to) learn to adapt to.

alternatively, maybe you can take it back and complain enough that you can get an s9 vpap adap or a ac10 vauto machine

[xsara]

Aha! Both good suggestions, however this machine was 'second winded' (a bargain for the price with only 155 hours!), so I think I'll just have to man up and take what it gives me!

Cheers!

[Pugsy]

Ahh...a bargain deal. Understood.
Give it some time and eventually you will get more or less used to it and it won't be quite so annoying. May never totally go away but it will lessen a bit in the annoyance factor over time.
I can't think of any other way to soften things but if I do I will let you know.

[xsara]

+ thanks