Need Help Optimizing Therapy

Mac,
Each mask has resistance in it's specs. I looked at Resmed and they label theirs at Resistance with this being from the P10 manual.
Resistance Drop in pressure measured (nominal)
at 50 L/min: 0.4 cm H2O
at 100 L/min: 1.4 cm H2O

And this from Respironics OptiLife manual
Pressure Drop cm H2O (hPa)
50 slpm 100 slpm
All Sizes < 2.9 < 9.5
Just to give you an idea where you have to look and compare to be specific. You can find these manuals online. I'm probably not going to do that much work but if I get more curious I might.

Macpage wrote:

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

It's an educated guess based on all P.R. Large pillows masks being the same setting. Without the ability to measure, I have no idea if it will even be noticeable, but I've done more daring experiments.

OkyDoky wrote:Mac,
Each mask has resistance in it's specs. I looked at Resmed and they label theirs at Resistance with this being from the P10 manual.
Resistance Drop in pressure measured (nominal)
at 50 L/min: 0.4 cm H2O
at 100 L/min: 1.4 cm H2O

And this from Respironics OptiLife manual
Pressure Drop cm H2O (hPa)
50 slpm 100 slpm
All Sizes < 2.9 < 9.5
Just to give you an idea where you have to look and compare to be specific. You can find these manuals online. I'm probably not going to do that much work but if I get more curious I might.

Thanks. I see. Thus, is this the figure we need to look at when properly selecting the Resmed mask type in the machine? When Resmed puts one of their nasal masks under "pillows", we could use this figure to see if a Phillips nasal would be similar and need to be selected as pillows as well?

Best,

Mike

Macpage wrote:

OkyDoky wrote:Mac,
Each mask has resistance in it's specs. I looked at Resmed and they label theirs at Resistance with this being from the P10 manual.
Resistance Drop in pressure measured (nominal)
at 50 L/min: 0.4 cm H2O
at 100 L/min: 1.4 cm H2O

And this from Respironics OptiLife manual
Pressure Drop cm H2O (hPa)
50 slpm 100 slpm
All Sizes < 2.9 < 9.5
Just to give you an idea where you have to look and compare to be specific. You can find these manuals online. I'm probably not going to do that much work but if I get more curious I might.

Thanks. I see. Thus, is this the figure we need to look at when properly selecting the Resmed mask type in the machine? When Resmed puts one of their nasal masks under "pillows", we could use this figure to see if a Phillips nasal would be similar and need to be selected as pillows as well?

Best,

Mike

These are the comparative specs but with a Resmed machine such as yours you don't have to worry about it. Resmed made it simple with the different category choices. It's the Respironics machines that have a resistance setting but they only correlate it with their masks so if you have a Resmed mask with a Respironics machine, you could make an educated guess by comparing masks to use this setting. Or just guess, or don't bother.

OkyDoky wrote:Resmed made it simple with the different category choices.

Thanks again. Well, Resmed almost made it simple. Sometimes you have one type of their masks but they tell you to put it in the machine selection as another.

Best,

Mike

Macpage wrote:

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?

it's hard to say, perception is a fickle thing, and when you're talking subtle things, it's anybodies guess whether it's an actual or imagined difference. sometimes actual differences are missed and other times there are differences felt that don't exist... witness the many reports of wine 'experts' declaring one wine better than another, decisively, when it's actually the same wine in both bottles...

or an experiment I performed with some fig bars that came in "three flavors" fig, raspberry, and blueberry... I couldn't tell any difference in the taste, but my housemates said they could... so I set up a test, and fed them bits of different flavors... and marked down what they thought.... they were surprised, sometimes saying the same bar was definitely different flavors, or saying getting the flavors wrong,... it was conclusive, they all taste like fig, and there's not enough other flavor to matter. they're still tasty though.

Macpage wrote: 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).

well, I don't think that it has anything to do with perception, I think it, and the resmed mask selections is just taking advantage of increased computing power to model the flow dynamics of the breathing circuit in order to get more accurately delivered pressures at your face.

the old resmed ASV machines had a sensing tube that ran back from the mask to the machine so that the machine could read the pressure at the mask and compensate. with the hugely greater computing power available today, they can calculate the effects of the humidifier, hose diameter and length, and yes, the mask openings, make adjustments of the pressure at the machine to better deliver the desired pressure at your face. (at least, that's my theory until I hear something better )

Macpage wrote: 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

the resistance specs in the back of the manual. I sat down and looked up resistance of a bunch of resmed masks, made a little spreadsheet, and sorted it by resistance.... and with just a couple of exceptions, the masks fell neatly into the pillow/nasal/full face lineup, even though their vent rates varied more.

Sleeprider wrote:

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.

you're welcome not to read what I post, you presumably read it before, and then ignored it.... or something. so, whatever *shrug*

the real question is, are the people that say they like the snarky condescending shit being truthful, or are they just trying to get me in trouble with those who are offended by it?

OkyDoky wrote:Mac,
Each mask has resistance in it's specs. I looked at Resmed and they label theirs at Resistance with this being from the P10 manual.
Resistance Drop in pressure measured (nominal)
at 50 L/min: 0.4 cm H2O
at 100 L/min: 1.4 cm H2O

the annoying part of that, for those of us that occasionally like to be precise on something, is that each p10 pillow size would have a DIFFERENT resistance... *grumble* *grump*

OkyDoky wrote:

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

.

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.

I think you nailed it there. Even though they KNOW that everybody uses other masks from other manufacturers, they're unlikely to condone it.

And, to me, from that review, it sounds like the resistance settings slightly enhance the Flex settings (or exhale in general)......IF a person (or new user) needs it to further enable them to adapt to this therapy.

And, yes, I also had the illustration posted by "Dave" (in any of his various identities).


Den

.

palerider wrote:the resistance specs in the back of the manual. I sat down and looked up resistance of a bunch of resmed masks, made a little spreadsheet, and sorted it by resistance.... and with just a couple of exceptions, the masks fell neatly into the pillow/nasal/full face lineup, even though their vent rates varied more.

Thanks for the information. Very helpful as always!

It makes sense to be more of an actual pressure delivery mechanism than just a feel matter. I agree completely with you on perception. My wife and I can differ quite a bit on our perceptions.

Your take on the whole mask selection feature makes sense to me. I've always thought it to be rather logical when reading it in prior postings.

Best,

Mike

palerider wrote:the real question is, are the people that say they like the snarky condescending shit being truthful, or are they just trying to get me in trouble with those who are offended by it?

"Now that right there's funny, I don't care who you are........." (LTCG)

or

"Only YOU can prevent forest fires" ........ (STB)


Den

.

Am I correct in interpreting that this long discussion about mask pressure/resistance settings is not really that relevant to my case? BC to be honest I can't really follow it all and it seems like you are talking about some fairly fine grained optimization when I am still trying to get the coarser grained stuff dialed in?

I should focus on the results of a few nights of apap to get a more ideal pressure for the ffm?

I plan to post up more results once I get a few more. Last night wasn't that representative bc I was out late and threw alcohol into the equation which I am sure skews the data.

donewithbeingtired wrote:Am I correct in interpreting that this long discussion about mask pressure/resistance settings is not really that relevant to my case? BC to be honest I can't really follow it all and it seems like you are talking about some fairly fine grained optimization when I am still trying to get the coarser grained stuff dialed in?

I should focus on the results of a few nights of apap to get a more ideal pressure for the ffm?

I plan to post up more results once I get a few more. Last night wasn't that representative bc I was out late and threw alcohol into the equation which I am sure skews the data.

You are right on both accounts.

donewithbeingtired wrote:Am I correct in interpreting that this long discussion about mask pressure/resistance settings is not really that relevant to my case?

Yep, pretty much not horribly relevant to your case.
Just concentrate on the basics and see what's leftover after the basics are better dealt with and understood.
Leave System One Resistance control set to 0 since you are using a ResMed mask...it's not going make that big of a deal one way or the other anyway.

Captain_Midnight wrote: the FFM pushes the mandible toward the windpipe, and tends to close the flow.

Try this little experiment. Breath in comfortably; and, while doing so, push back on your chin (mandible).

I have heard this before and I have tried it before. I just tried it again sitting here. No matter how hard I push, my mandible will not budge.

Now if you came into my bedroom and pushed on my chin while I was asleep .....