Pressure increased seems to be reversing too soon

This is my pressure from the night of 10/30/2016. It would seem to me that the pressure comes down too soon, as it frequently has to go right back up again.

Does anybody know if there's any way to make the pressure decrease more gradual?

Those little spikey things? Those are the machine doing it's test pressure probing and despite it looking like it is rapid it isn't. Zoom in real close to the flow rate and watch the pressure line...it goes up slow and comes down slow.

Only way to get rid of those spikes...limit the range and go to fixed pressure. They are a normal function of apap mode. Nothing you can do about them.

Read up on Respironics pressure probes.

Pugsy wrote:Only way to get rid of those spikes...limit the range and go to fixed pressure.

Get a ResMed machine?

Duck wrote:Get a ResMed machine?

Yeah, that will work to. ResMed APAPs don't do the pressure probes.

Since OP asked about settings on his Respironics to do away with the probes I didn't go there.

I have owned both brands.
I never had a problem with the probes but then I slept right through pressure changes a lot more than those pressure probes which are really only 1.5 cm increases. They look bad on the graphs but 1.5 cm is all they are...and they look like they are a LOT more rapid than they really are.

Pugsy wrote:Those little spikey things? Those are the machine doing it's test pressure probing and despite it looking like it is rapid it isn't. Zoom in real close to the flow rate and watch the pressure line...it goes up slow and comes down slow.

Only way to get rid of those spikes...limit the range and go to fixed pressure. They are a normal function of apap mode. Nothing you can do about them.

Read up on Respironics pressure probes.

So you're telling me that the pressure increase from 12:20 to 1:00 was "real," the rest were just probes.

If they are probes, I would have expected them to be more regular.

Yes. That little plateau increase with the probes on top of it is a real pressure increase and all the rest or test pressure probes.
As for regular vs irregular...the machine decides if it needs or wants them or not. I have had nights with little to none pressure probes and I have had nights with nothing but pressure probes. They aren't on any pre-programed schedule or anything like that.

I have never seen any documentation on the pressure probes that gives any hint as to what makes the machine decide to do them.
I just know that the machine does them if and when it wants and we have no control and they only go up 1.5 cm.

Duck wrote:

Pugsy wrote:Only way to get rid of those spikes...limit the range and go to fixed pressure.

Get a ResMed machine?

it would be so much less costly to adjust the pressure
say up to 14.5 to start with
track your ahi and how you feel

Guest wrote:it would be so much less costly to adjust the pressure
say up to 14.5 to start with
track your ahi and how you feel

It may or may not totally remove the pressure probes...I doubt that they would all go away.
From my past experience increasing the minimum pressure past what might be technically needed all the time doesn't prevent them. Might reduce them though. I have seen them on reports where the minimum was 17 and the machine never raised it beyond the probes and there were still a lot of probes.
Would be worth trying though and wouldn't cost any money.

Pugsy wrote:

Guest wrote:it would be so much less costly to adjust the pressure
say up to 14.5 to start with
track your ahi and how you feel

It may or may not totally remove the pressure probes...I doubt that they would all go away.
From my past experience increasing the minimum pressure past what might be technically needed all the time doesn't prevent them. Might reduce them though. I have seen them on reports where the minimum was 17 and the machine never raised it beyond the probes and there were still a lot of probes..

the only way pressure probes go away is if you set it to cpap mode, or set the min pressure to 20.

the respirs do the pressure probes when they feel that you're sleeping very well, apparently, that makes them uneasy and they start getting restless... you can see it in the flow, when the flow is very nice and even, pressure probes, but when the flow is uneven, like sleep is more restless.... it quits doing probes.... which I always thought was stupid. if things are great, it 'allegedly' sees if a pressure increase would help, but if sleep is disturbed, which to me is the time to try and make things better... it does nothing.

palerider wrote:if things are great, it 'allegedly' sees if a pressure increase would help

It's looking for very subtle "flow limitations" that respond well to a minor pressure increase. The subtle "flow limitations" are below the criteria for being scored as a "real" FL and the machine is being very proactive in testing whether a pressure increase is warranted before any scorable events (FLs, RERAs, snores, OAs, Hs) can occur.

, but if sleep is disturbed, which to me is the time to try and make things better... it does nothing.

Sleep can be "disturbed" for a number of reasons, including restlessness and sleep-wake-junk breathing. If you're half awake because you're tossing and turning for some reason that does NOT have to do with OSA, a pressure increase can make it worse.

In addition, if the airway is "sort of stable", but not fully stable, the pressure increase can create more problems than it solves.

Not everyone is disturbed by the pressure probes when the breathing is stable, and some of us are very disturbed when the machine starts increasing pressure when we're already halfway aroused.

Back when I was using the S9 AutoSet (a long, long time ago) I never felt rested when I woke up. Part of it was my awful adjustment. But in retrospect I suspect that the AutoSet's very aggressive response to any slightest detected "problem" in my breathing was triggering more arousals and more unstable breathing rather than allowing me to sleep soundly.

The pressure probes on my PR BiPAP have never been the same problem that the S9's rapid pressure increases in response to snoring and flow limitations were.

robysue wrote:The pressure probes on my PR BiPAP have never been the same problem that the S9's rapid pressure increases in response to snoring and flow limitations were.

Your experience and mine (which is pretty much I do well with either brand) is why I say that sometimes one machine's way of going about doing it's job works better for some people than others and some people it wouldn't matter.
I spent years on a Respironics machine before I ever even saw a ResMed machines.
There's actually a couple of minor things that I like one machine over an other and a couple of minor things that I dislike too. None are deal makers or breakers in therapy department or in the sleep quality department.

What's unfortunate is the people who might actually do better with one machine than another brand (for whatever reason) rarely get a chance to at least try the other brand(s). Most DMEs won't let a person try the different brands or models. You get whatever brand they are pushing at the moment because they got a better price on their wholesale contract and they aren't real keen on buying something else for a person just to try out.
It all goes back to the bottom line dollar instead of finding out what a patient really might do best with.
Let's face it...the patient's success with therapy is below the profit margin on the "to do" list.

In my case in the 7 plus years I have been on cpap therapy I have seen my DME go from pushing ResMeds, to Respironics and now back to ResMed. He was honest with me though about the switching...totally related to the wholesale price contract.
They don't do trial runs with multiple brands either...they will order a different brand though...I will give them credit there and not pitch a fit about it. When I first saw them they had the ResMeds and I was really wanting Respironics (back then it as data collection and the Respironics offered data the ResMeds didn't) and he told me if that was what I wanted then he would be happy to order it for me.
As it turned out I found a brand new exactly what I wanted machine on craigslist and it ended up costing a little less than my total out of pocket would have been if I had used my insurance.
I still use that DME though for masks, etc. When I told him I found a good deal privately that save me a little money he very generously said "that's wonderful...if you have any questions or problems with it we will try to help".
So while they aren't a perfect DME...they are better than a lot of them out there.

The DMEs that actually let people try different brands...my hat is off to them for putting the patient at the top of the "to do" list. There's a few of them out there.

Pugsy wrote:

robysue wrote:The pressure probes on my PR BiPAP have never been the same problem that the S9's rapid pressure increases in response to snoring and flow limitations were.

Your experience and mine (which is pretty much I do well with either brand) is why I say that sometimes one machine's way of going about doing it's job works better for some people than others and some people it wouldn't matter.

I agree with you completely.

I think for most people the brand of machine is not that important. But for some people it does make a difference---mostly in terms of comfort, but I also think for a few people, one or the other brand provides better, more effective therapy in terms of treating the OSA. But most people never have a chance to try both a ResMed and a PR machine.

I also think that it's extremely important for the long term members to not bash one brand or other of PAP machine. It's possible to discuss the differences between the Resmed AutoSet algorithm and the PR Auto algorithm without dissing the machine you don't happen to use.

Unfortunately, PaleRider's repeated negative comments about the Search part of the PR Auto algorithm sometimes do cross into bashing Philips Respironics Auto machines. It wouldn't bother so much if he were simply saying something along the lines of The pressure probes (increases) have woken me up and I can't stand them. But he tends to make statements that make it sound like anybody who is "stuck" with a PR machine has a second rate machine and those pressure probes in the Search algorithm are evidence of the fact that the PR machines are second rate. Newbies with PR machines don't need that kind of machine-bashing from forum members.

The fact is that Resmed and PR have a few fundamental differences in their design philosophy when it comes to designing the Auto algorithm. Both are effective---if they weren't they would not have won FDA approval. For most people, I think the comfort issues and the efficacy of therapy issues are pretty much a wash between the two machines. For a smaller subset, the brand of machine matters---sometimes just a bit and sometimes a whole lot. And it is a shame that DMEs and docs don't consider suggesting swapping the machine out for the other brand when a newbie is having problems and the issue is NOT the mask or leaks.

I spent years on a Respironics machine before I ever even saw a ResMed machines.
There's actually a couple of minor things that I like one machine over an other and a couple of minor things that I dislike too. None are deal makers or breakers in therapy department or in the sleep quality department.

In principle I agree with you. I have to say "in principal" because I've never actually used a PR AutoCPAP or a Resmed Auto VPAP. Given the problems I had when I was starting out on the Resmed S9 AutoSet, I'm not sure I would have done better, worse, or about the same on a PR System One Auto at the time. EPR's beginning the increase in pressure right before the beginning of my exhalations* was a huge issue, and I can infer that Aflex would have made that problem a lot worse for me. But there was also some evidence that the S9's rapid, aggressive increasing of pressure in the presence of minor flow limitations and possible snoring increased my overall restlessness as well as my aerophagia, and I may well have done better with the PR S1's less aggressive algorithm (in terms of responding to "events" together with the more gentle pressure probes to determine that a bit more pressure was needed even though my breathing was "stable".

I also can't definitively say for sure that I would do worse on a Resmed VPAP than I do on the PR BiPAPs. But I don't know for sure. All I know is that the pressure probes don't bother me at all, the variable PS helps with keeping the aerophagia under control, and the fact that if you turn BiFlex off, there is absolutely NO increase in pressure until the inhalation starts fixed the problem of "the machine is trying to make me inhale." Would I do better on the VPAP's algorithm for transitioning between EPAP and IPAP than I did on the AutoSet's EPR algorigthm? Maybe, maybe not. Would I do better on the VPAP's Auto algorithm as a whole? Maybe, maybe not, but since the EPAP gets increased everytime the IPAP needs to be increased, I doubt that I would feel as good on a Resmed VPAP.

What's unfortunate is the people who might actually do better with one machine than another brand (for whatever reason) rarely get a chance to at least try the other brand(s). Most DMEs won't let a person try the different brands or models. You get whatever brand they are pushing at the moment because they got a better price on their wholesale contract and they aren't real keen on buying something else for a person just to try out.

Even if you have a DME (like mine) that stocks and sells about the same number of both Resmed and PR machines (and will sell you an in stock F&P Icon if you really want it), there's no chance to actually try both machines out, particularly in your own bed at night for a week or two. And then make an informed decision.

They gave me lots of information about the S9 AutoSet, the PR S1 Auto, and the Icon Auto at the time I had to pick out my machine, but there was no chance to for me to actually breathe with any one of the machines before I had to choose amongst them.

My guess is that it would be prohibitively expensive from a typical DME's bottom line to allow everyone to try both machines at home for a week. But it shouldn't be so difficult for a newbie in trouble to swap one brand for another. And yet it is. My DME had no trouble swapping the S9 out for the BiPAP, but that was because my script changed and the S9 AutoSet could not be set to satisfy the new script.

robysue wrote:

palerider wrote:if things are great, it 'allegedly' sees if a pressure increase would help

It's looking for very subtle "flow limitations" that respond well to a minor pressure increase. The subtle "flow limitations" are below the criteria for being scored as a "real" FL and the machine is being very proactive in testing whether a pressure increase is warranted before any scorable events (FLs, RERAs, snores, OAs, Hs) can occur.

, but if sleep is disturbed, which to me is the time to try and make things better... it does nothing.

Sleep can be "disturbed" for a number of reasons, including restlessness and sleep-wake-junk breathing. If you're half awake because you're tossing and turning for some reason that does NOT have to do with OSA, a pressure increase can make it worse.

In addition, if the airway is "sort of stable", but not fully stable, the pressure increase can create more problems than it solves.

I'm aware of that theory, but I maintain, based on looking at a LOT of traces of peoples sleep, that it makes no sense in practical use. when it's doing the pressure probes, that's when sleep is the most calm, peaceful, and good, no FLs flagged, no hyops, no apneas, and a smooth flow rhythm. but let the flow rhythm get uneven, or start having some FLs , snores, apneas, hypos get flagged, and it *stops trying to 'make things better', the exact time when it makes *sense* to see if a pressure increase would make things better, or worse.

if you're a parent, and you look in on your child, and they're sleeping peacefully, quietly, no obvious distress, that isn't the time you mop their forehead, fluff up their pillows, re-arrange their covers, take their temperature, rub their back... no... you let 'em sleep.

now if they are twitching, moaning, thrashing, or showing other signs of distress, that's when you do something, right? that makes sense, does it not?

robysue wrote:But for some people it does make a difference---mostly in terms of comfort,

I highlighted comfort (not to disagree with you but to emphasize my feelings and climb up on the soapbox for a bit) because I think that comfort is a HUGE part of successful therapy and sometimes surpasses AHI IMHO. It's not going to do much good to get a nice low AHI if you can't or won't use the machine because of comfort issues or your sleep is total crap because some sort of comfort issue. I know you understand my feelings about this because of your own issues with aerophagia.

I get a little irked when people tend to dismiss with "it's only a comfort feature" almost like comfort doesn't matter.
Humidity is "only a comfort feature and isn't really part of real therapy"...well, it's a pretty darned important part of my therapy because if I didn't have it I sure as heck wouldn't use the machine. To me it's just as important as the pressure settings.

To me comfort equals a better chance of good sleep and good sleep is the name of the game in my play book.
Anything, anyhow and anyway is fair game in the quest for good sleep and if that involves using every "comfort" feature in the book then so be it.
It really gets on my nerves when people talk like using a comfort feature is a crutch or a sign of "needing to grow up or suck it up" or weakness.

Okay...climbing back down off my soapbox and back to your regularly scheduled viewing.

robysue wrote:[\Unfortunately, PaleRider's repeated negative comments about the Search part of the PR Auto algorithm sometimes do cross into bashing Philips Respironics Auto machines. It wouldn't bother so much if he were simply saying something along the lines of The pressure probes (increases) have woken me up and I can't stand them. But he tends to make statements that make it sound like anybody who is "stuck" with a PR machine has a second rate machine and those pressure probes in the Search algorithm are evidence of the fact that the PR machines are second rate. Newbies with PR machines don't need that kind of machine-bashing from forum members.

newbies should be afforded the knowledge that the different machines behave quite differently, and to pretend that they're both just as effective is as much a disservice as you perceive "bashing" to be. I don't believe anybody is bothered by the pressure probes, they're gradual, and happen over the space of several minutes, as pugsy mentioned, what I do believe, based on studying many peoples data, is that they are wholly ineffective at doing anything useful.

robysue wrote:The fact is that Resmed and PR have a few fundamental differences in their design philosophy when it comes to designing the Auto algorithm. Both are effective---if they weren't they would not have won FDA approval.

unfortunately, that is not a correct statement. FDA approval does not mean that something is "effective" it means that the potential benefits outweigh the potential risks.
Provent is FDA approved, and is almost universally believed to be a scam among the more knowledgeable people here and on other forums. likewise Theravent, (which is much the same). there are doubtless other ineffective gadgets, pills, and other things that have been "fda approved", yet aren't effective. or, in this case, "as effective".

robysue wrote:For most people, I think the comfort issues and the efficacy of therapy issues are pretty much a wash between the two machines. For a smaller subset, the brand of machine matters---sometimes just a bit and sometimes a whole lot. And it is a shame that DMEs and docs don't consider suggesting swapping the machine out for the other brand when a newbie is having problems and the issue is NOT the mask or leaks.

agreed. but I have seen numerous people who have bad sleep, a significant number of hypopnea events, some apnea events, all night long, resulting in "barely treated" (according to medical 'standards' (<5) ahi) and they're usually using a respironics machine, which is not doing any pressure increases. Pugsy commented on one a couple of days ago about the machine 'sitting there twiddling it's thumbs".

robysue wrote:EPR's beginning the increase in pressure right before the beginning of my exhalations* was a huge issue,

I don't know what you were experiencing, but it wasn't and effect of EPR. EPR increases pressure at the beginning of inhalation, it ramps pressure up to the set pressure, and stays there until exhalation begins, at which point it drops pressure by however many CM it is set to, and it sits there until the start of the next breath. you can clearly see this on a mask pressure trace from a resmed machine. unfortunately, a high rate trace of actual measured pressure is not available on the respironics machines, so you can't look to see what the pressure is actually doing.

robysue wrote:But there was also some evidence that the S9's rapid, aggressive increasing of pressure in the presence of minor flow limitations and possible snoring increased my overall restlessness as well as my aerophagia, and I may well have done better with the PR S1's less aggressive algorithm (in terms of responding to "events" together with the more gentle pressure probes to determine that a bit more pressure was needed even though my breathing was "stable".

it is important to point out that "rapid and aggressive increasing in pressure" happens over a period of many minutes, just as the aggressive looking pressure probes from the respironics machines happen over a period of many minutes... the compressed view in a nights trace make them look scary, but that is an illusion.

robysue wrote: I doubt that I would feel as good on a Resmed VPAP.

it is clear that just as much as I'm a resmed fanboy, you're a respironics fangirl, they don't interest you, you don't keep up on what they do, and that's fine, but I don't believe it's fine for you to turn around and criticize me for 'bashing' respironics. you make pejorative statements about resmed, "aggressive increasing of pressure in the presence of minor flow limitations and possible snoring" and feel that is fine and fair. the fact that I feel they are the number 2 machine line is not "bashing", that I reserve for things like the resmart chinese junk and others in that class, cheap and years behind in technology.