auto cpap for 10+ apnea

Is there an APAP that has algorithms that are capable of chasing apneas that require pressure setting at or above a setting of 10? I have an S8 autoset II that can not (I have been informed) chase apneas requiring high pressure. Is there another manufacture whose machine is capable of this?

try this post

viewtopic/t46132/viewtopic.php?f=1&t=29 ... hm#p250258

There was another thread but I can't pinpoint it just yet. Maybe someone else will remember. It dealt with the +10 explanation. Obviously the machine increases pressure above 10 and up to 20, so I too would appreciate some clarity on this. At one time I thought I would remember the discussion, but I'm drawing a blank now.
Kathy

Kathy, how about the short version until someone finds one of those A10 threads?

The auto machines (ResMed or Respironics which seem to be most common) have different algorithms to address apnea events. Each machine WILL respond to an apnea and go above 10 cm event IF the event meets the requirements of an obstructive event by the machines definition. The events above 10 cm of pressure must have some of the normally seen event precursors like snores or flow limitations, then the pressure will raise.

If the event doesn't have any of the normal apnea indicators then the machines won't try to fix them. If it does not sense that the event is obstructive but instead thinks it might be something else, then it won't go there.

So to say that ResMed auto machines won't respond to events at pressures above 10 cm is not a complete (notice I didn't say it was incorrect) statement.
It needs to be expanded or explained differently. We need to qualify that statement by stating that it won't go above 10 cm unless certain criteria are met that proves to the machine that the events are obstructive in nature.
Seems like people read part of the ResMed algorithm but don't read or remember the rest of the story.

If the events are central then they won't have the normally seen obstructive indicators. It might appear to be sudden episode of no breathing with no snores, no flow limitations so the machine says "whoa, this doesn't look like what I am suppose to chase after so I will sit here a while and see what happens"... "I am not supposed to chase centrals"...

My over simplified way of thinking of how to explain why not all events get chased after with any machine really.

rbtgjns wrote:Is there an APAP that has algorithms that are capable of chasing apneas that require pressure setting at or above a setting of 10? I have an S8 autoset II that can not (I have been informed) chase apneas requiring high pressure. Is there another manufacture whose machine is capable of this?

Hi rbtgjns

The Sandman Auto has a setting for Command on IFL, with a maximum pressure for apnea. I think it is supposed to do what you want, and others will hopefully correct me if I am wrong. Also see -

https://www.cpap.com/cpap-machine/covid ... nformation

I still have to test out this feature when I have finished my basic pressure testing, so I do not know how well it works.

cheers

Mars

Thanks Pugsy for some clarification. Helped me formulate some questions. #1 Are very many obstructive apneas abrupt without prior indicators - I mean, is this a non issue? #2 Is there a point at which the the ResMed Auto does kick in and respond even if not initially? #3 How do other machines respond differently?

Guess if I was having any centrals I'd be appreciative of a machine not worsening the situation by increasing the pressure. Otherwise, unless #1 is significant, seems the discussed algorithm wouldn't be an issue for most.

Kathy

kteague wrote:Helped me formulate some questions. #1 Are very many obstructive apneas abrupt without prior indicators - I mean, is this a non issue? #2 Is there a point at which the the ResMed Auto does kick in and respond even if not initially? #3 How do other machines respond differently?

Guess if I was having any centrals I'd be appreciative of a machine not worsening the situation by increasing the pressure. Otherwise, unless #1 is significant, seems the discussed algorithm wouldn't be an issue for most.

I am not qualified to answer your questions in depth since I really don't understand the minute details of the different algorithms. My machines (Respironics auto AFlex and CFlex) seems to raise just a bit in pressure when it sees something it doesn't quite understand and holds that raise (I think 3 cm) for 15 (might be 30) minutes. I have seen it on the software reports in response to a handful of NR (non responsive events) that it flags. Then if no response still then it backs down. I have always used either machine in auto mode. I had no history of centrals in either of my sleep studies though. I have no way of knowing if those NR are centrals or not. In 5 months I can count the number of NR on one hand. I have seen the pressure line seem to raise the 3 cm and seemingly stay there for the 15 minutes on several occasions though. I just don't remember all the details of what the Respironics algorithm does.

Seems like the machines have to have some sort of line drawn where they don't respond on the off chance that the event without the normal obstructive indicators might be a central. I don't know if ResMed auto machines will eventually respond to this "unknown" entity but from what I read, it seems like it simply doesn't want to go there. It waits till things return to normal and starts its job again. Sort of like that weird event never happened.

I prefer to think of the machine as a screening tool and realize that it simply cannot do "everything" and score everything in a manner that is as detailed as a PSG study. I do believe that they are set to err (if that is what happens when they have to sit for a while) that they err on the side of caution. Sometimes I think that we as patients want the machines to do more than they are designed to do in telling us "exactly" what is going on.

Do centrals always happen without any of the normally seen obstructive indicators? Beats me. I would suspect that the definition of a central would lead me to think that they don't have any indicators though. A central is when we stop breathing but the airway is open so there shouldn't be anything there to limit the flow or cause a snore....

Remember it is possible to have a "central" randomly even for normal non OSA patients. I can hold my breath with the airway open while awake. I have read that this will sometimes happen when we wake in the night (and not remember it). So unless I had a history of a significant number of known central events then I wouldn't worry too much about the algorithms.

We have had a few people on the forum that there was a good chance that they were having a good number of centrals because their AHI numbers remained high despite pressure increases and the auto units simply wouldn't travel above 10 cm trying to chase those events. It is a very small percentage and seems like they do end up with different machines designed to help those people having centrals either predominately or mixed.

So my meandering thoughts will have to do until someone can go into a better detailed answer to your questions.
I can comprehend the generalities well enough but have not mastered many of the specifics yet....

What about Intellipap and it's ability to handle apnea? Is it similar to ResMed or Respironics in it's abilities. Devilbiss site doesn't seem to provide any information on how their machine works or how their algorithm addresses apnea events. I had thought all machines were the same in how they operated and respond to sleep apnea.

I happened to have NR last night at the very end of my night. Below is the graph showing the pressure raise (and a truck load of events) and the subsequent flat line pressure response. It appears to be longer than 15 minutes, probably would have been 30 minutes. There is no way of knowing if this was a central or not (now if I had the latest Respironics machine and the software, maybe I could tell) but I really don't worry so much about it. Seems like most of my nights are like the first 6 hours and this last hour is not the norm for me. I do have pressure raises above 10 cm and I am assuming that I have the corresponding obstructive event indicators. If my nights were all like the last hour then I would start wondering what the heck was going on.... I was awake off and on that last hour. Stressor from ailing dog so I won't give that last hour more than a passing glance.

What about Intellipap and it's ability to handle apnea? Is it similar to ResMed or Respironics in it's abilities. Devilbiss site doesn't seem to provide any information on how their machine works or how their algorithm addresses apnea events. I had thought all machines were the same in how they operated and respond to sleep apnea.

IT DOES. I can tell you from experience. Occasionally, when sleeping on my back (my sleep studies have shown strong POSITIONAL Apnea--when I am on my back primarily), I have had it jump to 10 or 11 with no problem. It will respond quite well, in my experience. My high "peaks" are short duration and rare, but when they do come, the machine catches it with no problem.

rbtjns wrote:Is there an APAP that has algorithms that are capable of chasing apneas that require pressure setting at or above a setting of 10? I have an S8 autoset II that can not (I have been informed) chase apneas requiring high pressure

ResMed based its response on the justified assumption that for most patients, it has can identify precursors of obstruction, and by raising pressure in response to those, it will preempt total obstructions. The precursors, for Resmed machines, are flow limitations and snores. It has quite sophisticated ways of responding to them, varying its response based on its analysis to the the properties of those precursors. Resmed maintains those ways of responding to flow limitations and snores at any pressure.
http://www.resmed.com/au/clinicians/com ... nc=dealers

When you run an auto in auto mode, the aim is not to "chase apneas". The aim is to avoid as many apneas as possible at the lowest possible pressure .

kteague wrote:Thanks Pugsy for some clarification. Helped me formulate some questions. #1 Are very many obstructive apneas abrupt without prior indicators - I mean, is this a non issue? #2 Is there a point at which the the ResMed Auto does kick in and respond even if not initially? #3 How do other machines respond differently?

Those were indeed great explanations, Pugsy.
Some people - a minority - do have total obstructions appearing out of the blue so to speak, even if their pressure is high - higher that 10. It not a non-issure, but its a small group. For that small group, the ResMed alorithm will not work - they will have to set the machine's minimum where it will avoid apneas. Many of us do that anyway. A ResMed will not raise pressure in response to an apnea that appears above 10. However, it will raise pressure as high as 20 if it encounters flow limitations and snores.

I am presently trying an Autoset. I stop snoring when my pressure is 6 or so. When I set the Autoset at a minimum of 7, maximum of 10 - it will hang at 10 simply because of my flow limitations. I had a single apnea last night, many hypopneas -- to which the ResMed does not respond - but enough flow limitations to keep the pressure at 10. It will actually go higher if I let it. I would not have been able to use the Autoset at all if it were not for its EPR that gives me lower exhale pressure.

All automatic machines have to find ways of not raising pressure in response to open airway apneas. ResMed decided to draw a line in a the sand at 10. Respironics prefers the "oops, I goofed I better backtrack" technique (you can see the pressure drop immediately after Pugsy's NR); and Sandman lets you decide where to draw the line -- it can be below 10, it can be above 10 -- based on what you need.

Section1 wrote:What about Intellipap and it's ability to handle apnea? Is it similar to ResMed or Respironics in it's abilities. Devilbiss site doesn't seem to provide any information on how their machine works or how their algorithm addresses apnea events. I had thought all machines were the same in how they operated and respond to sleep apnea.

DeVilbiss take a very simple approach: The machine has one standard pressure change to anything defined as either an apnea or a hypopnea -- it couldn't care less how you define it - the definition is changeable - you can tailor it to whatever you doc or insurance company want to define as an apnea or hypopnea . They also decided that any flow drop between 95% and a 100% is a central apnea to which they won't respond.

The only way of knowing which algorithm will work for you is by trying it.

O.

I'm not sure why you feel the "need" to have to use an APAP in a range of pressures. Far too many people get "Auto envy" when they see others using them. Fact is, they don't provide the best therapy for EVERYBODY......only a very small minority.

If you're contemplating getting another machine, what you need to do is do some comparisons......like this:

https://www.cpap.com/cpap-compare-chart ... sting-CPAP

You need to decide what features you need (like exhale relief), and work at this from a process of elimination.

In my opinion, the "M Series Auto w/A-Flex" still has the most flexibility, features and availability of software. And, it will (normally) pursue apneas above the pressure of 10 cm.


Den