Need Help Optimizing Therapy

Sleeprider wrote:Resistance settings are in both patient and clinical settings. They are intended to be set according to the mask if a respironics mask is selected, otherwise, enter 0. Here is a link to mask resistance settings: http://www.healthcare.philips.com/pwc_h ... ontrol.pdf

All full face masks are set to X1. That would probably be a safe bet for the Quatro. Pillows masks are all over the map, but feel free to draw your own conclusion.

And that's what I said in my post up near the top of this page. I've got copies of the resistance settings

Wulfman... wrote:The P/R "Resistance Settings" are only supposed to be set if using a P/R mask. The setting should be noted in the manual that came with the mask. All other masks like ResMed should have the Resistance Setting at "0" (zero).

With the ResMed "MASK" settings, you select which type of mask, regardless of manufacturer.

These are the mask settings for the previous models:

Settings - Mask
ULTRA - Ultra Mirage Nasal Mask
MIR FULL - Mirage Full Face Mask
Mirage Full Face Mask Series 2
Ultra Mirage Full Face Mask
ResMed Hospital Full Face Mask
ACTIVA - Mirage Activa Nasal Mask
SWIFT - Mirage Swift Nasal Pillows System
MIRAGE - Mirage Nasal Mask
STANDARD - Mirage Vista Nasal Mask
Modular Nasal Mask
Papillon

These are the options for the S9:

Pillows /
Full Face /
Nasal /
Nasal (Ultra)

"If your patient is using a full face mask ensure that the “Full Face” setting is selected. If your patient
is using a nasal pillows mask ensure that the “Pillows” setting is selected. If your patient is using a
nasal mask ensure that the “Nasal” setting is selected with the exception of the Ultra Mirage mask
which should use the “Nasal Ultra” setting."


Den

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I understand it is a proprietary thing with PR and they only list their masks but what would be the reasoning for their masks to work better with different settings and not with Resmed masks. I also don't think it would make much of a difference. But it bugs me and I couldn't see where PR stated all other masks were to be set at 0. And if what's good for one why not the other? The only thing I can come up with is it is business.

OkyDoky wrote:I understand it is a proprietary thing with PR and they only list their masks but what would be the reasoning for their masks to work better with different settings and not with Resmed masks. I also don't think it would make much of a difference. But it bugs me and I couldn't see where PR stated all other masks were to be set at 0. And if what's good for one why not the other? The only thing I can come up with is it is business.

And, up until the P/R System One models came out, there was no setting options with regard to ANY masks.


Den

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I tend to think pressure is pressure. Flow can increase and decrease, but pressure needs to be constant in therapy. I think I know where Wulfman is going. Then again, I only use nasal pillow masks which seem to very directly apply pressure where it is needed. It doesn't surprise me that one might need different settings when using a different type of mask, but as long as the manufacturers don't tell us or even clinicians what the resistance settings do, I guess we need to continue to our trial and error approach.

And, to focus in on the part of the setup manual regarding the options, it says:

"SYSTEM ONE resistance ( ) - This setting allows you to adjust the level of air pressure relief based on the specific Philips Respironics mask. Each Philips Respironics mask may have a “System One” resistance control setting. System One resistance compensation can be turned off by choosing the setting “0”. "

So, you can either use it or not. And it doesn't say whether you HAVE to have it on when using a P/R mask or not.
And, interestingly, it refers to "air pressure relief".


Den

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It wasn't Molette's discussion I was thinking of but it was Molette pointing in one thread to deltadave's explanation in another thread.
viewtopic.php?f=1&t=74076&st=0&sk=t&sd=a

There are no settings available for masks other than Respironics because Respironics didn't want to go to the work to do them for other brands masks. They would prefer you use Respironics masks and aren't going to do anything to promote using another brand.

If someone wants to try to compare...you need to compare the resistance rate or pressure drop (see what deltadave says in the above thread) at so and so with each mask and come up with something similar to what a Respironics masks does and use that setting choice. It's a lot of work for a bit of fluff IMHO but if someone else wants to do all that work then go right ahead. Just make sure you are doing the correct work or it is a waste of time.
Vent rate is NOT what is to be compared though. Originally that was thought what needed to be compared but resistance is not the same as vent.

I have seen in Respironics material somewhere that says "if non ResMed mask is used then set to 0" but I don't/can't find it now.
Didn't think it was necessary for me to keep since it answered my question as to what setting to use since I never use a Respironics mask. It's out there somewhere though....I didn't dream it up.

My discussion is not that we need to change the PR resistance settings, although with detective work it can be figured out and done. Mine actually is on 0 and I don't change it. With monitoring therapy and tweaking pressures the mask settings can be compensated for either way. Believe me Pugsy, I never believed you dreamed it up, you remember more than most people. I just couldn't find anything from PR that addressed any mask other than their own.

OkyDoky wrote:Believe me Pugsy, I never believed you dreamed it up, you remember more than most people. I just couldn't find anything from PR that addressed any mask other than their own.

I would have sworn it was in one of the manuals but they aren't showing it now. Maybe it was an older manual I saw and they now have changed the manual (they do that often). It's not any any of the manuals I have now..either user or provider...so beats me where I might have seen it...this was probably 3 to 4 years ago when I got my first 50 series sometime in mid 2011.
Respironics has redone their US website a lot in the past year and maybe it got lost.

I do know that I did try all the settings including off with my Swift FX (that was what I was using at the time) and I saw no difference any anything no matter where it was set. It also "felt" the same to me no matter what setting.
To my thinking...if a person wants to make sure Resistance setting needs to be "perfectly accurate" then they need to get a Respironics mask and use it. Back when I was using my first 50 series machine the only nasal pillow mask that Respironics had that was any where close to the Swift FX was the Optilife and I had already tried it back when first starting therapy and I absolutely hated it. Now they have some other masks that might not be so bad...like the GoLife (which I never tried) and the Nuance which I have tried and liked but tried it way after I did my Resistance control pressure settings.
I gave away my Nuance or I would dig it out along with my PR S1 Bipap and do more experiments just to see if I could really tell any difference...but I gave it to someone who needed it worse than me as it was probably number 4 in my overall preference list.
I am using the S9 now anyway since it has sort of spoiled me.

The only reason I spoke up here about it was because people were once again saying compare vent rates and that's not what needs to be compared. The vent rates might correlate but it would be coincidence.

Here's a link to a review:

http://www.clinicalsleep.com/resources/ ... system_one

Which states:

"For those who use a Philips Respironics CPAP mask, the new System One Resistance Control is a new feature that compensates for different resistance levels the the different masks produce to once again improve patient comfort and compliance. This technology was only noticeable if you continue to have issues with the perceptions of increased resistance while using a CPAP. Being a long time CPAP user, this was not particularly important but I can see the benefits it may provide to new CPAP users and patients who continue to struggle with this problem due to higher pressure settings. (If you use a mask from another manufacturer, this technology should be turned off) "


Den

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donewithbeingtired wrote:So its better to increase the pressure on the FFM, than try to make the nasal mask work?

Why such a disparity on pressure? I can get low single digit AHI on the nasal at 7cm, and am hitting 25 AHI sometimes on the FFM with pressure all the way up to 10cm?

I don't get it.

Many fine folks hereabouts swear that there is no therapeutic difference for a given pressure between nasal and FFM.

I suspect most strongly that for many, if not most patients, there is a physiological reason for higher AHI using the FFM. This is because the nasal mask (when properly tightened) pulls the maxillae (top of bite) inward with no effect on your air intake, while the FFM pushes the mandible toward the windpipe, and tends to close the flow. (I recognize that there are differing views here, and respect opposing opinion.)

Try this little experiment. Breath in comfortably; and, while doing so, push back on your chin (mandible). If you are like many (including me) you will notice your inhalation stopped by the occlusion of your trachea (windpipe). And so it is with the FFM as it presses back on your jawbone.

This is not to say that FFMs are bad. They just might require more pressure to overcome the occlusive force placed on the mandible. This pressure increase may or may not be without consequence. I use FFMs on the rare occasion of an extremely bad cold, but never otherwise. Mouth breathers prefer FFMs, as one would predict.

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Sleeprider wrote:I tend to think pressure is pressure. Flow can increase and decrease, but pressure needs to be constant in therapy. I think I know where Wulfman is going. .

"pressure is pressure" is a gross oversimplification... once again.

here, maybe this can help your disconnect.



pressure *VARIES* as you breath in and out due to different amounts of FLOW, and the RESISTANCE of the various parts of the circuit (humidifier, hose, and, yes, mask) affect the flow, and thus, the pressure.

you forget, or overlook, the fact that a cpap machine, even on a fixed pressure, is not a static system, it's a dynamic system, with the blower speeding up and slowing down, to attempt to maintain the desired pressure as you inhale (which would lower pressure if the blower motor was running at a fixed speed) and exhale (which would, conversely raise pressure).

you can better experience this by putting the machine up to your ear, or putting your ear to the machine, whichever you're more comfortable with, and listen to the blower speed up and slow down as you breath in and out..... even with it set to cpap mode.

the reason that resmed says 'well, just set everybody else's to zero" is that they don't care, and won't be held responsible for testing the resistance of everybody else's mask on the market and assigning them numbers.

resmed does flow compensation with their mask settings, simplifying it somewhat.... while it isn't as precise as respironics method, at least they don't say "and if you're not using one of our masks, you're on your own, go ahead and have less correct pressures".

though, on reflection, it probably won't do any more good explaining it this time, than last.

palerider wrote:pressure *VARIES* as you breath in and out due to different amounts of FLOW, and the RESISTANCE of the various parts of the circuit (humidifier, hose, and, yes, mask) affect the flow, and thus, the pressure.

Would this be why there can be a "perceived" flow difference by the user with different masks of the same type at the same pressures? I certainly thought that I could tell the difference between two nasal masks. Thus, would Phillips be trying to make an adjustment that while not critical might smooth out any perceived difference between any of their masks and more accurately deliver the prescribed pressure at the "fine lines" (allowing for the marketing play).

I notice that Resmed says select pillows for the Nano nasal mask. I have assumed this would apply to the Wisp and Eson nasal masks as well as they have similar specs. What exactly would we look for to make sure of the proper selection?

Best,

Mike

Wulfman... wrote:Here's a link to a review:

http://www.clinicalsleep.com/resources/ ... system_one

Which states:

"For those who use a Philips Respironics CPAP mask, the new System One Resistance Control is a new feature that compensates for different resistance levels the the different masks produce to once again improve patient comfort and compliance. This technology was only noticeable if you continue to have issues with the perceptions of increased resistance while using a CPAP. Being a long time CPAP user, this was not particularly important but I can see the benefits it may provide to new CPAP users and patients who continue to struggle with this problem due to higher pressure settings. (If you use a mask from another manufacturer, this technology should be turned off) "


Den

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Den,
I saw this link which is a review of the machine from an RT and apparently he came to the conclusion that it was easier to turn off than use with other masks (like a lot here). But I still haven't seen anything from the manufacture directing this, nor do I expect to because they don't want to imply that you can or can't get this benefit using masks other than theirs. So my bottom line is, if you want to do the detective work and find the resistance of your mask and find a Respironics mask where the resistance compares to yours, you could use that number. Or you could say I don't want to mess with it, set it to 0, and find some other way to compensate.

palerider wrote: here, maybe this can help your disconnect.

it probably won't do any more good explaining it this time, than last.

Great information, if you could just leave out the snarky condescending shit. I'm changing resistance for tomorrow to X1 based on the information posted by Wulfman, and the flow /pressure resistance compensation you posted. It will probably be subtle, but I'm interested...and I do get it.

Sleeprider wrote: I'm changing resistance for tomorrow to X1 based on the information posted by Wulfman, and the flow /pressure resistance compensation you posted.

For large pillows per Phillips?

Thus, is this trial and preference? I take it we can't find published specs on resistance other than the general Phillips listing and the Resmed mask type selection list for their masks?

Best,

Mike