Diary of a new hoser

Liam, and I won't touch your nuts, I promise, you say you have sinus stuffiness? Are you taking anything for this. Is it all day, only during the night? Have you tried a steroid (no, they are not habit-forming) nasal spray when you go to bed. This is something most people do not think of. My ENT prescribed it and said I'd probably have to use it for life, If I wanted to breathe at night. Every night I forget it, I get up shortly and use it. There is a scientific reason your nose clogs up when you lie down but I forget what it is. Something to do with body fluid migration.

I think you will like the Swift. It is what I use. I ordered it from cpap.com and had it the next day. No backorders there. Very light on the face and you can actually wear the straps a bit loose and not lose the seal on the nasal pillows. Only problem I have is I think it is breaking my hair on the back of my head since I am loosing hair at an alarming rate every day.

I too use the 420E and have the 1FL set to 0, thanks to Rested Gal. My titrated pressure was 8, but I find I can only breathe comfortably on ramp at 7 and my pressure often goes up to 10 or 12.

I was reading some of the postings with people talking about the discomfort of their masks. I have one that very much resembles the same kind of tubes used when one receives oxygen. No mask over my nose pressing on my face. It's really not uncomfortable at all. I would recommend this to anyone, it's called Nasalaire I believe. That is not my problem with it. I've had it for about 2 months now and really have not noticed much of a difference in how I've been feeling. I rarely have a day when I don't take any Provigil or Ritalin or just fall asleep in the late afternoon- sometimes even after taking the meds. I guess I was hoping or expecting to have seen a difference by now. I wear it faithfully, usually all night long because discomfort is not an issue, it's not difficult to keep it on. I was just wondering if anyone else took this long to feel the results....

Janelle wrote:
I too use the 420E and have the 1FL set to 0, thanks to Rested Gal. My titrated pressure was 8, but I find I can only breathe comfortably on ramp at 7 and my pressure often goes up to 10 or 12.

Janelle,

A few things. First, I don't know what causes the stuffiness. I tried the steroid inhalants, they gave me bloody noses and sinus pain, so my doctor had me stop.

The problem is getting better as I age, not sure why, and I find that the pressure of the nasal mask helps too. When I first started, I expected I'd be able to get by with a nasal mask about 1 day in 4, instead of being UNABLE 1 day in 4.

I'm not worried about hair loss, and if you saw how little hair I have, you'd understand why.

CPAP.COM does have the swift in stock, and I have ordered one.

I think that's everything I wanted to say.

Liam, who can't think of anything cute to say here.

wading thru the muck! wrote:The PB420E is one of the machines I have and I love it.

Thanks for the recommendation. I'm always a little leery of Puritan Bennett stuff, because it's so much cheaper, and it always seems to be the "also ran" when people are talking about equipment. As in "The ResMed <X> is great, as is the Respironics <Y>. Oh, and the PB <Z> is good too."

Hearing something listed as an afterthought that often makes me wonder.

On the other hand, if it's the only one that has a feature I will want, then it's worth buying for that alone.

Liam, who can't decide between being cheap and ordering quality.

On what forum is the PB listed last. A little while back (before you arrived) this forum was once acussed of being an unabashed shill for the PB420E. Suprizingly it was by the guy who I hope will be telling you why your Docs all wet and that the PB420E IFL settings make it the machine for you. The PB420E is the first choice of myself and many on the forum. It is in no way of lesser quality than the other machines. They have just fiquired out how to make a great machine and sell it at a great price. Funny that you list the Resmed machine as number one. That machine based on the S7 is near obsolete. They are expected to come out with a new line [S8] this year. Fixed pressure machine first, auto machine later. It is reported to be more compact and portable like the PBs. When you've got the competition copying you, you're not at the bottom of the list.

wading thru the muck! wrote:Suprizingly it was by the guy who I hope will be telling you why your Docs all wet and that the PB420E IFL settings make it the machine for you.

I'm actually looking forward to the post by this guy you're talking about. I've been trying to do some independent internet research (because as much as testimonials are nice, they're by no means definitive), and have not found much luck finding anything that states clearly why APAP is better or worse than CPAP under different circumstances.

Liam, always willing to learn, and yet somehow never learns.

Thanks for the info. I go for my cpap titration in a couple of weeks and I am very nervous. I SO want this to work for me because I have been sleeping my life away. Even got the Dr. to give me ambien for the 2nd phase of the study so I can be asleep and tolerate it. Your diary has given me hope. I know that it won't be easy at first, but you have given me insight. I have even purchased a Activa mask (everyone says they are great) to try out and get used to so I don't panic. Hope this theory works.

wading thru the muck! wrote:On what forum is the PB listed last. A little while back (before you arrived) this forum was once acussed of being an unabashed shill for the PB420E.

Heheh! I never called Wader an unabashed shill for the 420e! Rather I recognized him as a justifiably avid 420e fan with plenty of recommendations that helped build that machine's popularity here. For what it's worth I have been reading the literature, message board posts, patent descriptions, and even white papers on the AutoPAPs for a few years and I do not think the 420e is any lesser than Resmed or Respironics (my current AutoPAP). I regret other message boards where the exact opposite social dynamics have happened: where the 420e's popularity has actually been stifled by conversational social dynamics. One influential poster in particular had a very bad experience with PB/Tyco warranty coverage on a dead three-day-old 420e, and the 420e was regularly bashed on that forum thereafter. That isolated experience and those particular social dynamics hampered the 420e on that popular message board for the vast majority of the 420e's existance to date!

The IFL1 and IFL2 settings unique to the 420e do give therapists/patients exactly four binary chances of better coping with rare albeit highly difficult hypopnea/flow-limitation type patients that tend to receive UARS diagnoses. These patients really do present a genuine pressure-therapy treatment challenge. Quite often they fare better on CPAP, and quite often they fare better on AutoPAP. The 420e is probably the best bet for these difficult UARS patients. Did I mention that I just ordered a 420e because I am a hypopnea-intensive patient? I'll use it for travel, but if it does a better job on my hypopnea-intensive breathing pattern than my Remstar Auto (which does a superb job for me, BTW), then it becomes my every night machine of choice. Plain and simple.

Liam, you can see in my other post that I do kind of suspect your doctor is not shooting straight with you. The other possiblity, of course, is that both your breathing pattern and your doctor's insight into the design details of AutoPAP algorithms are very rare.

Hey -SWS,

I'm trying to make a point here! I know you didn't refer to me as an unabashed shill. In fact I didn't recall it was you raising that issue until after I typed the comment. That said, though you did not make that specific comment, if I recall correctly, that was the way the comment you made was received.

Thank you for providing your excellent analysis (again) on the auto-pap subject. I can tell Liam is putting a lot of thought and effort into getting the "right" equipment. Your insight is invaluable in making an informed decision.

I'm glad to hear you are buying a 420E. I know when you get one "in your hands" you will marvel at such a highly technical machine packaged in such a feather light simplistic package. It certainly has set a new standard for cpap form factor.

We are ever indebted to you on "this forum"

Thanks,

Wader, who is an unabashed shill for the PB420E

Crisp wrote: "Giving a straight pressure cpap to a newbie should be against the law! Why do they do it ? Because its cheaper for the insurance company. The docs dont (or wont) understand it. New patients dont know any better. It might put some sleep centers out of business.

But think how boring this board would be if everyone received an Auto straight away. ZZzzzzzzzzzzzZZZzzzzzzzzzzzzzzzz "

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I am finally getting setup on my Cpap tomorrow morning!! I told the home care person that I want an Auto-pap and nasal pillows. They told me that is not what I have an "order" for. So, to answer Crisp's question above.... I guess when we orginially talk to our Doctors this is when we need to let them know to write up our orders for an Auto-pap and not the Cpap! What do the docs know about us? Besides our health, they don't sleep with us to know what we need during the middle of the night!!

Oh, well... I guess I will have to give it a try!! How long should I give it? I have a followup appointment with my doc the first week in March.... should I give it til then and then tell him I would prefer the Auto-pap? What do you all think?

It really would be great to get answers now rather than wait to see if anyone replys to this message......

I hope to hear from you (who-ever is up to the challenge) soon!

Thanks!

The 420e wouldn't work for someone who needs the c-flex technology, would it?

hhunt -
You asked:

The 420e wouldn't work for someone who needs the c-flex technology, would it?

If a person absolutely needs as much relief as possible on exhalation and wants an autopap rather than a bipap or a cpap, then there's only one autopap that even offers C-Flex: Respironics REMstar Auto with C-Flex.

The 420E doesn't have C-Flex or anything equivalent to drop pressure on exhalation. No autopap currently available has that except the new REMstar auto.

This is really kind of ironic, since the other message board that was mentioned as being somewhat anti-420E was where I spent all my time "learning". I had a 420E and was doing great on it (after following some valuable advice from SWS about the settings.) I began to mention how well I liked my 420E. But still, all I ever read over there was Remstar-this and ResMed-Spirit-that ... and a couple of posters knocking the 420E a lot.

I still like the 420E, even though I don't have it now. I sent it to a friend who particularly needed to be able to make the kind of changes that were possible only in that machine. I would have bought another 420E, but in the meantime I had acquired a REMstar auto just as a backup. It worked fine too, so the backup became my primary machine once the 420E went on its trip. I got equally good results from either machine.

Since the REMstar proved to do as well for me as the 420E, and since Respironics added C-flex to their autopaps, C-flex is the one and only reason I chose recently to get a Remstar auto with C-Flex rather than another 420E. I'll probably get another 420E in the future...such a powerhouse in a neat size, and I've always been partial to the Silverlining software it uses.

For relief on exhalation added to an autopap, yes, REMstar auto is the only autopap that has that kind of feature (C-Flex).

But as pure autopaps go, I like the 420E auto and the REMstar auto equally well. Equally. If I had a ResMed Spirit I imagine it would be a three-way tie as far as only "autopap" goes. Heck, probably I could point a hair dryer on cool at my face and get adequate treatment!

.......

What's a "shill"?

LDuyer wrote:.......

What's a "shill"?

Hey, there, friend!

Shill: One who poses as a satisfied customer or an enthusiastic gambler to dupe bystanders into participating in a swindle.

There was no posing or duping on Wader's part. He really did and does get great results from his 420e. Absolutely no reason to blame anybody for being completely enthused about what works well...

I have been using the 420e for 2 weeks now (and love it!!!!). It's on autopap with a pressure range of 4 to 20. On the sleep study, I was titrated at 8.

Here are some of the numbers over the past 2 weeks:

Used pressures (Average) :
Average pressure : 4.2 cmH2O
Low pressure : 4.0 cmH2O
High pressure : 6.0 cmH2O
Pressure efficient more than 90% of time :5.0 cmH2O

Events :
Number Apneas : 47
Index/h Apneas : 0.4
Number Apneas/CA : 37
Index/h Apneas/CA : 0.3
Number Hypopneas : 51
Index/h Hypopneas : 0.5
Number Acoustical Vib. : 36
Index/h Acoustical Vib. : 0.3
Number Runs (FL): 615
Index/h Runs (FL): 5.8

Cycle states :
Normal cycle : 80 %
Intermediate cycle : 14 %
Flow Limited cycle : 6 %
Invalid cycle : 0 %

During the first part of the split night sleep study done 3 weeks ago, I had 12 apneas and 106 hypopneas for a/hi of 30.9/hr (jumping up to 53.7/hr while on my back).

Would the above numbers suggest leaving well enough alone or suggest playing with IFL1 and IFL2? (Both are currently on.)

--Bob

-SWS wrote:<snip>
The IFL1 and IFL2 settings unique to the 420e do give therapists/patients exactly four binary chances of better coping with rare albeit highly difficult hypopnea/flow-limitation type patients that tend to receive UARS diagnoses. These patients really do present a genuine pressure-therapy treatment challenge. Quite often they fare better on CPAP, and quite often they fare better on AutoPAP. The 420e is probably the best bet for these difficult UARS patients. <snip>.