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Pugsy: the doctor has already increased my pressure once thinking that that’s what I needed because I’m gasping for air at night when trying to fall asleep. I think I saw on my machine that the pressure is starting out at 10? Not sure if that’s low or high? Anyway, if I could just manage to get past the “gasping for air” episodes while trying to fall asleep & actually fall asleep for a change I’d probably be fine. But what usually happens is the gasping starts when I begin dosing off & while I’m half asleep(on another planet) I rip the mask off and don’t even know that I did it until I wake up the next morning. This entire scenario is getting rather old and I think about throwing in the towel everyday. However, at the same time I realize that if I ever want to get good well rested sleep(which might I add I haven’t had in over 5 years) I need this CPAP machine to help me get there. My doctor says I am fighting the machine too much & to just relax! Well that’s easier said than done! I do have a lot of anxiety issues which I’m sure may be some of what’s keeping this from helping me the way it should. But the doctor should realize my anxiety is not a light switch, I can’t just turn it off and turn it on whenever I feel the need to. He wants to tell me what I’m doing wrong but doesn’t want to offer any solutions. So even though I have a doctor, CPAP supplier, family & friends I’m pretty much on my own. I can handle that. After all, if there is any possibility that this is going to help me I have to be the one to make the effort. At least then in the long run even if I do fail I won’t have to beat myself up & down because at least I tried. That’s all I can do. Anyways, thanks for the help! You’ve already helped me more than my own doctor has

Here's the deal...if you are really having apneas of the central kind when you first fall asleep (and it is possible) then more pressure simply doesn't help. More pressure won't help central apneas because the airway is already open...you just aren't breathing...and it's fairly common for people to have what is called a sleep onset central apnea. You could be having that happen.

More pressure will help if the apnea is obstructive but not if central.

That's why I wanted to see the details of your breathing for when you are first using the machine and are maybe starting to fall asleep and the you gasp and panic and wake up and turn the machine off.
If it is indeed apnea related it will show up on the software flow rate...as no breathing.
If it is anxiety there won't be any lack of air show up on the flow rate. And then we figure out some way to get past the anxiety.

To fix a problem you first have to identify the problem if at all possible and it is possible with the aid of the software to at least get a fairly good idea what is actually happening.

Hi there,
This sentence in your response seems to highlight precisely what I have experience:
I need to read up on this medication...so remind me if I forget but I need to see what the machine is recording at the same time.
It's possible that you are experiencing what we call a sleep onset central apnea that is freaking your brain out causing the panic.

I am using an Aire10 on AutoSet. This machine, unlike my 12-year old Respironics System One machine, does not have a "Pressure Pulse" feature, which is what I think helped eliminate many of my apneas.

Do you (or anyone in the group) know if the Aire10 has an equivalent function to the Respironics? Second, is the Aire10 CPAP function "identical" to the Respironics System One CPAP function? I feel (but can't prove) that I get more and better sleep on the Respironics machine, rather than the Aire10.

ewriter wrote: ↑

Tue Feb 07, 2023 9:10 pm

Hi there,
This sentence in your response seems to highlight precisely what I have experience:
I need to read up on this medication...so remind me if I forget but I need to see what the machine is recording at the same time.
It's possible that you are experiencing what we call a sleep onset central apnea that is freaking your brain out causing the panic.

I am using an Aire10 on AutoSet. This machine, unlike my 12-year old Respironics System One machine, does not have a "Pressure Pulse" feature, which is what I think helped eliminate many of my apneas.

The Pressure Pulses on PR machines are part of the algorithm that PR uses to distinguish a central apnea from an obstructive one. The PPs have nothing to do with "eliminating" apneas: They are not designed to force a collapsed (obstructive) airway open.

Do you (or anyone in the group) know if the Aire10 has an equivalent function to the Respironics?

The "equivalent function" on the Resmed machines is the FOT (Forced Oscillation Technique) that uses many small oscillations in pressure to determine whether the airway is clear (open) or obstructed (collapsed).

In both the PR Pressure Pulse system and the Resmed FOT system, the machine is measuring what happens to the backflow caused by the short burst(s) of increased pressure. The PR machines record when the PP occur, but the flow rate curve and the pressure curve are not at a sufficient resolution to see what is going on. The Resmed's FOT algorithm, however, is clearly visible in the mask pressure curve and the flow rate curve. More on this in a bit.

Second, is the Aire10 CPAP function "identical" to the Respironics System One CPAP function?

No, the CPAP function on the Resmed AirSense 10 (and 11) machines is not the same as the Respironics System One CPAP function. Here's a list of obvious differences:

1) Resmed's EPR system for exhalation relief works very differently from Philips Respironics's Flex system for exhalation relief.

2) Resmed's FOT algorithm for classifying apneas as OA or CA works very differently from PR's PP algorithm for classifying apneas as OA or CA.

3) Resmed's heated humidifier & ClimateLine hose system works differently than PR's does, and the System Ones didn't even have a heated hose option. Even the humidifiers work somewhat differently: Resmed's is always a "smart" humidifier that takes into account the ambient room conditions, but the PR humidifier has two modes---smart and classic. In classic, the machine ignores the ambient room conditions and this typically means both more water vapor is added to the air and more chance of rainout.

4) The Resmed and PR machines use slightly different criteria for scoring hypopneas, and there is some evidence that ever since Resmed introduced the S9 machines, that the Resmed criteria for scoring hypopneas is more lenient. In other words, for a given set of breathing, a PR machine may be a bit more apt to score a hypopnea than a Resmed machine is. The way the two brands of machines score snoring and flow limitations is quite different, and Resmed machines don't try to score RERAs, but PR machines do.

If you add in using Auto mode on a Resmed machine vs a PR machine, there are even more differences. The differences between the Auto algorithms include:

1) Resmed machines respond more aggressively to events than PR machines do. A Resmed machine typically keeps increasing the pressure in response to OAs, Hs, snoring, and flow limitations until it believes the breathing has stabilized. The PR machine increases the pressure by a 1-2 cm in response to 2 or more events (OAs, Hs, RERAs) scored close together and then waits to see if the breathing stabilizes at the new pressure. And while PR machine responds to snoring and flow limitations by increasing the pressure, again, the machine is likely to only increase the pressure by 1 or 2 cm at a time.

2) The PR machine has a "pressure search" algorithm: It periodically increases the pressure by 2 cm just to see if the breathing improves, even when there seems to be nothing special going on in the breathing. If the breathing improves, the pressure is left at the higher level. If the breathing is not improved, the pressure is lowered to the previous setting. These show up as triangles in a PR machine's pressure curve.

3) The Resmed machines typically start decreasing pressure as soon as the machine is happy with the breathing. This results in the characteristic "waves" in a Resmed's pressure curve, where the waves have steep fronts and gentle backsides. And the machine keeps lowering the pressure until the next event happens or the min pressure setting is reached. The PR machine typically waits to reduce the pressure until it goes through a "pressure search" cycle for testing whether a decrease in pressure causes the breathing to deteriorate. If the machine detects any deterioration in the breathing, it bumps the pressure back up to its previous setting.

I feel (but can't prove) that I get more and better sleep on the Respironics machine, rather than the Aire10.

I believe you when you say that you get more and better sleep with the Respironics machine. But most people on the forum will tell you that they believe they get better sleep with a Resmed machine. And then there are people who will honestly tell you they can't tell the difference.

As for me: I had such an awful time trying to get used to xPAP with Resmed's EPR on an S9 AutoSet that I was eventually switched to a bilevel machine. My first bilevel was a PR System One Auto BiPAP, and I much preferred the way it did the transitions between IPAP and EPAP over the Resmed EPR system. I also believe that PR's variable PS on their Auto BiPAPs was a significant advantage for me. But when I started seeing black specs in my Philips Respironics DreamStation Auto BiPAP this fall, I bit the bullet and bought a Resmed AirCurve 10 VAuto. I have been able to tweak the Ti_min, Ti_max, Trigger, and Cycle settings (which are NOT available on Resmed AirSense 10/11 CPAP/APAPs) to come pretty close to mimicking the way my PR Auto BiPAP does the IPAP/EPAP transitions, and so I now find I sleep just about as well (maybe a bit better) with my new AirCurve 10 VAuto than I was sleeping with my PR DreamStation Auto BiPAP a few months ago. However, I am finding that my nose and lips are less happy with the new machine because they're more dried out.

ewriter wrote: ↑

Tue Feb 07, 2023 9:10 pm

I am using an Aire10 on AutoSet. This machine, unlike my 12-year old Respironics System One machine, does not have a "Pressure Pulse" feature, which is what I think helped eliminate many of my apneas.

Do you (or anyone in the group) know if the Aire10 has an equivalent function to the Respironics?

As I said before, the Philips Respironics Pressure Pulse feature is an algorithm that PR machines, like your 12-year old System One, use to distinguish between CAs and OAs. You can't actually "see" what the machine uses to make the distinction after it does a pressure pulse in the data: The pressure curve just doesn't have the resolution to see what's happening with the pressure, and so it's also difficult to tie how that might be related to what the machine sees in the flow rate curve.

The Resmed FOT algorithm, however, is easy to spot in the data.

Here's an example of the Resmed FOT deciding that an apnea is a CA:

Note that when Resmed flags something as a CA, you will see small oscillations in the mask pressure curve that coincide exactly with small oscillations in the flow rate curve during the apnea. The magnitude of those small oscillations in the flow rate curve is what Resmed uses to decide the airway is clear (not collapsed).


Here's an example of the Resmed FOT deciding that an apnea is an OA:

When Resmed flags something as an OA, you will still see small oscillations in the mask pressure, but the flow rate curve will not have corresponding small oscillations in it.

ewriter wrote: ↑

Tue Feb 07, 2023 9:10 pm

Hi there,
This sentence in your response seems to highlight precisely what I have experience:
I need to read up on this medication...so remind me if I forget but I need to see what the machine is recording at the same time.
It's possible that you are experiencing what we call a sleep onset central apnea that is freaking your brain out causing the panic.

I am using an Aire10 on AutoSet. This machine, unlike my 12-year old Respironics System One machine, does not have a "Pressure Pulse" feature, which is what I think helped eliminate many of my apneas.

Do you (or anyone in the group) know if the Aire10 has an equivalent function to the Respironics? Second, is the Aire10 CPAP function "identical" to the Respironics System One CPAP function? I feel (but can't prove) that I get more and better sleep on the Respironics machine, rather than the Aire10.

Fixed pressure is fixed pressure.
The only difference is the difference between CFLEX and EPR, where CFLEX raises the pressure towards the end of your exhalation, which tricks many people into thinking that the machine is trying to 'rush' their breathing.

Resmed's EPR, however, doesn't do that, and doesn't raise pressure till you start inhaling.

Also, as robysue pointed out, you're quite wrong about the point of the pressure pulse, it has nothing at all to do with stimulating breathing, it's just the machine trying to guess if you're having a central or obstructive apnea.