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Most people do get used to these little gusts of air, and are no longer bothered by them.

palerider wrote:Pugsy commented on one a couple of days ago about the machine 'sitting there twiddling it's thumbs".

To be fair...the situation where I made that statement isn't a common one. It's an unusual situation and we don't know why.
And we don't know for sure that ResMed would respond any differently.
That situation would be a good argument for a trial of both brands.

The bulk of the time I see Respironics responding as expected. It's not very common for any machine to sit by and twiddle their thumbs but it does happen from time to time.

Thanks for all the replies. They were fairly informative.

However, can somebody please explain this night. There appear to have been four probes. There were five other pressure elevations, only one of which seems to have occurred almost immediately after a probe.

Pugsy wrote:

palerider wrote:Pugsy commented on one a couple of days ago about the machine 'sitting there twiddling it's thumbs".

To be fair...the situation where I made that statement isn't a common one. It's an unusual situation and we don't know why.
And we don't know for sure that ResMed would respond any differently.
That situation would be a good argument for a trial of both brands.

The bulk of the time I see Respironics responding as expected. It's not very common for any machine to sit by and twiddle their thumbs but it does happen from time to time.

PEF is another example of the respironics machine not responding well enough to work for her.

you're right, it's not very common, it's the exception, but when I see someone saying they're tired, and their AHI isn't that good, and the machine isn't taking care of them on auto... it's usually a respironics machine that's not increasing pressure enough to take care of the events. which is why I say it's even more important to get the right minimum pressure when you've got a system one or dreamstation.

I don't know the exact reason for what causes the machine to do what it does. Respironics doesn't give us access to that sort of detailed information.
It doesn't always do the pressure probes because it doesn't think it needs to is the best thing I can tell you.

The increases without a pressure probe nearby were because the machine sensed something it didn't like and it figured it out without a pressure probe being involved. It reduced the pressure because it no longer sensed whatever it was it didn't like and did it without a pressure probe being involved.

The exact algorithm involved that causes the machine to do all the things it does is not something I have ever seen or looked for. It might be in the patent or it might be something they keep hidden on purpose.
I shrug my shoulders, move on, and trust the machine do its job as designed and since I can't do anything about it anyway I don't expend my energy on stuff that I can't do anything about. I have enough to keep busy as it is.

It is what it is...we have zero control over it...if we don't like it there are options available.
I think you are looking for exact answers to questions that simply aren't available with the data we do have available to use.

palerider wrote:PEF is another example of the respironics machine not responding well enough to work for her.

you're right, it's not very common, it's the exception, but when I see someone saying they're tired, and their AHI isn't that good, and the machine isn't taking care of them on auto... it's usually a respironics machine that's not increasing pressure enough to take care of the events. which is why I say it's even more important to get the right minimum pressure when you've got a system one or dreamstation.

With PEF we don't know that the DreamStation wouldn't be able to get the job done with its algorithm because of her aerophagia issues. It's obvious that its "kinder gentler" way of doing things means she needs more pressure to start with (and that's a problem for her) but we don't know that if the aerophagia wasn't involved that the machine wouldn't respond as needed. It's never been given a chance. Its little thumbs have been tied so they don't get a chance to twiddle.

It's obvious that the DreamStation isn't a good fit for her. Personally I would like to see her have the AirSense 10 Autoset for Her to try out. I don't know that the "for Her" algorithm would be useful or not but I think she is a prime candidate to try it out. Plus she would get the RERA data she was looking for when she got the DreamStation.

I never used a ResMed AutoSet...I have only used the Respironics apaps.. but I have used both brands in the auto bilevel line and my pressure needs in auto mode were essentially the same with either brand. I needed the same minimum EPAP on either to get pretty much equal results.
It's only been with the ASVs that I have seen a marked difference in minimum EPAP pressure needs between the 2 brands to get pretty much the same results.

Pugsy wrote:

palerider wrote:PEF is another example of the respironics machine not responding well enough to work for her.

you're right, it's not very common, it's the exception, but when I see someone saying they're tired, and their AHI isn't that good, and the machine isn't taking care of them on auto... it's usually a respironics machine that's not increasing pressure enough to take care of the events. which is why I say it's even more important to get the right minimum pressure when you've got a system one or dreamstation.

With PEF we don't know that the DreamStation wouldn't be able to get the job done with its algorithm because of her aerophagia issues. It's obvious that its "kinder gentler" way of doing things means she needs more pressure to start with (and that's a problem for her) but we don't know that if the aerophagia wasn't involved that the machine wouldn't respond as needed. It's never been given a chance. Its little thumbs have been tied so they don't get a chance to twiddle.

it is strange that she slept better, at lower pressure, on the resmed than at higher pressure on the respironics... dramatically better. something about the little changes, or maybe epr vs *flex.

palerider wrote: it is strange that she slept better, at lower pressure, on the resmed than at higher pressure on the respironics.

I think that a lot of may simply be comfort related and we both know that I am a big advocate for comfort.
When I said the Respironics wasn't able to do it's job I was mainly talking technical restrictions with sleep quality not involved ...just from the therapeutic effectiveness side of thing.
Now I know sleep quality is huge but would she have slept better if the OSA/UARS were better treated IF (I know a big if) the machine had not had its hands tied??? Dunno and doesn't really matter really but I kept help but wonder...
Was it the more pressure that caused the poor sleep or was it the sub optimal therapy that was the cause of the poor sleep?

But hey...the reason I like the ResMed ASV is I can use 6/10 at the beginning of the night while awake...it sure is more comfortable than the 10/14 I had to use with the 960.
That's awake comfort though...I slept the same with either and felt the same.
When I did try the 960 at 6/10...the sub optimal therapy poor sleep reared it's ugly head.

D.H. wrote:Thanks for all the replies. They were fairly informative.

However, can somebody please explain this night. There appear to have been four probes. There were five other pressure elevations, only one of which seems to have occurred almost immediately after a probe.

Without seeing the wave flow data as well as the pressure data there is no way to answer your question.

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.

As a long time user of PR Auto BiPAPs with a husband who uses a PR Auto CPAP, I can tell you the only way to make the pressure probes go away is to set the machine in fixed pressure mode or do the equivalent by making it impossible for the machine to raise the pressure. On hubby's APAP, that's easy to do by setting Min Pressure = Max Pressure in APAP mode. On my new DreamStation BiPAP Auto, I could mimic fixed Bilevel mode by setting Min PS = Max PS = Max IPAP - Min EPAP. But on my old S1 BiPAP Auto, that would have mean setting the thing so that Max IPAP = Min EPAP + 2.

In other words, on a PR xPAP Auto, if Max Pressure > Min Pressure, the machine is going to do periodic pressure probes to see if there is an improvement in the baseline shape of the inhalations with a bit more pressure. And that's true even if the Min Pressure is plenty high enough to technically control all forms of sleep disordered breathing.

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.

Actually if the min pressure is set high enough where nothing can be done to improve the breathing AND you are sleeping really soundly with high quality breathing, those pressure probes become very regular with a frequency of about 10-15 minutes between probes. The probes are present UNLESS there is a lot of "noise" in the wave flow data that indicates an unstable breathing situation. The instability might be from SWJ breathing or it could be from a lot of spontaneous arousals or it could be from an unstable airway that is trying to stabilize under PAP pressure but has not yet stabilized. Sludge used to talk about this from a technical view point, but I can't remember exactly what he said about it; I do know that he seemed to indicate that "more pressure" doesn't always smooth a ragged flow rate out and that under some circumstances increasing the pressure in the presence of an unstable airway could and would increase the instability of the airway. (Guess I ought to go searching through all his old posts under all his various names. Wish I could remember them all, but I can't.)

This may sound a bit silly, but one data point that I sometimes use for determining whether I was or was not restless during the night when I don't remember any restlessness is whether there are missing pressure probes: If I don't wake up feeling particularly well rested AND there are a lot of places where the pressure probes are MISSING, that's a good sign I was doing some serious tossing and turning during the night, most likely caused by things unrelated to my sleep disordered breathing. When I sleep nice and sound, the pressure probes are there marching across my IPAP curve like little toy soldiers all lined up in a neat row.

robysue wrote:This may sound a bit silly, but one data point that I sometimes use for determining whether I was or was not restless during the night when I don't remember any restlessness is whether there are missing pressure probes: If I don't wake up feeling particularly well rested AND there are a lot of places where the pressure probes are MISSING, that's a good sign I was doing some serious tossing and turning during the night, most likely caused by things unrelated to my sleep disordered breathing. When I sleep nice and sound, the pressure probes are there marching across my IPAP curve like little toy soldiers all lined up in a neat row.

it is, in my experience reading others charts and discussing how they feel, exactly as you say, a night full of pressure probes is a night of good restful sleep... when you see the probes, then the machine seems to think everything is optimal.