Disaster Night with my new PB 420E

OMG. I am so hoping for help here. Have been using my Remstar M Apap for about 11 weeks, and fairly stable over past 2-3 weeks with AHI's now consistently around 2-3, leak rate consistently around 25-28 with my teriffic Swift LT, at pressure setting of 10/20 APAP with Aflex set to 1 and HH set to 1. Only one "bad" night in all that time following a very stressful day.

So last night was my first night to test-run a new PB 420E which I bought for travel and back-up. This was the worst night I have had in at least 20 years. I did not sleep. Set it up with the same APAP pressure min/max, same HH at 1, using my same trusty mask. From the time I turned it on, the pressure seemed higher than I've ever experienced. Thought it was the lack of flex, so I tried to bear up under it. After 2 hours of being awake tossing & turning, struggling to exhale, I finally had the sense to look at the machine, and it was blowing at 15 and 16!! I've never hit anything over 13 yet until this night. The whole night was a nightmare of leaking mask, way-way-way too high pressure, and dry mouth with chipmunk cheeks and blowing out my mouth tape (have NEVER done that before!).

What could be wrong?

Peggy, turn off the setting called "FL". Set FL for 0.

If you go into the clinical menu through the software, that setting is called IFL1 in the Advanced Settings. Leave IFL2 on. Turn off only IFL1. Leave the Max Pressure Command for Apnea at 10.

Let us know how your next night goes with IFL1 off.

Thanks Rested Gal. I can't use my software yet because I don't have an open port on my computer--groan~~~ (Is ther a way to get an adapter for the cable that will use USB?) But I have now set FL to O. What will that do?

I would set:

IFL1=0 (default=1 enabled)

IFL1, when ON, responds to flow limitations and increases the pressure in an attempt to reduce them. Sometimes people's shallow breathing is mistaken as a flow limitation (FL). Think of a FL as an obstruction not severe enough to be classified as a hypopnea.

You can find good explanation from Ozij in this post: viewtopic.php?f=1&t=35212&p=301899&#p301899

and this post may answer your question about the cable:

viewtopic/t36217/viewtopic.php?f=1&t=30 ... 4&#p268174

Here's an old topic about IFL1 and IFL2:

Jan 11, 2005 subject: Bman: Spirit Overnight Indices
viewtopic.php?t=817

Topic started by -SWS accidentally logged in as "Guest".

Even though that topic starts out talking about the ResMed Spirit autopap, the topic moves quickly into a very thorough discussion about the PB 420E autopap's IFL1 and IFL2 triggers. It's a "many pages topic", so keep turning the pages!

plr66 wrote:(Is ther a way to get an adapter for the cable that will use USB?)

Yes, I bought a "Serial to USB" adapter (from Office Max, I think...it's been a long time ago) for my 420E download cable. That let me plug it into a USB port on the computer.

You'll be fine with IFL1=off and a serial to USB cable.

Page 12 on the manual

Setting the device
To restrict patient access to certain settings on the GoodKnight 420 Evolution, and allow complete access to the settings by the physician or home care provider, a hidden key has been provided on the device. It is located under the letters “Go” in the “GoodKnight” name and detectable to the touch as a hollow.

O.

AHH~~~SWEET SLEEP AGAIN!! Thanks to every one of you. Yup--it was that little detail that I did not understand about the FL needing to be set to 0. All is well again. Still can't see my results for a few days. Shopped around by phone today and the going price on the serial to USB adapter was $35-$40. Online, they are easily available for about $12 including shipping!! So I'll order & wait.

Although I just got home and haven't yet had time to read all the links given above, I wanted to say that I do have very shallow breathing, and in fact was amazed that I did not show centrals in my sleep study. I have often found myself not breathing at all for seemingly minutes, and very peacefully, when in a semisleep state. So from what I gather, the FL setting would see that as a signal to kick in with the big guns of pressure?

Anyway, I'm a happy camper today. Was so worried that I had a defective machine.

Nice thing with the 420e is that it will hold 96 hours of detailed sleep data. So pace yourself!!

Glad you sorted out the runaway IFL1. Some people seem to need it on , and others not. Wishing you many more good nights.

I wish Puritan Bennett would NOT set IFL1 to "On" when their machines leave the factory. Perhaps having that "on" is ok for most people, but, my gosh... when it DOESN'T suit a person, the consequences could be awful.

If a PB GoodKnight 420E were given to a person to use for a week or a month, because the doctor had ordered "autotitration" at home to find out what pressure the person should be prescribed....

And if IFL1 "on" creates a runaway pressure scenario as it did for Peggy (plr66)...and for me, and for ozij, and for.... where's that list of people on this message board who have had to turn it off, ozij? LOL!! .... then...

Just think what happens out there in the world to people who have been given a 420E. The DME isn't going to download the machine for weeks, probably.

Neither the DME nor the doctor are going to look at any of the detailed data....probably.

Even if they did look at the detailed 96 hour graph, it's most unlikely that either the DME or the doctor would have the slightest clue that it MIGHT be that IFL1 didn't suit the person and that THAT was why the machine had used high pressures a great part of the night. I really doubt that most sleep doctors or DMEs or RTs or RPSGTs are even aware of the IFL1 and IFL2 settings in the 420E, with what they are for, or with what to look for to see if IFL1 should be flipped off. That should be looked at within the first couple of days that a 420E is being used in autotitating mode. But that's not going to be the case if left to a DME to handle.

The person who downloads the machine...the DME or the doctor... is not going to do a download until the trial period is over. And then they're simply going to look at the 90th percentile pressure the machine used for autotitration.

If IFL1 caused a runaway, the hapless patient is going to be prescribed a RIDICULOUSLY high pressure. At the end of the trial, the unlucky person will be switched to "cpap" set for a much higher pressure than necessary. Perhaps causing difficulty exhaling, and difficulty with mask leaks.

It's probably a good thing that when an autotitration trial at home is ordered, most DMEs send people home with a Respironics or ResMed machine.

Don't get me wrong. I absolutely love my little 420E. But until -SWS kindly took a look at the data from my first month of using that machine, it was hitting pressures of 18 and 19 with me on a regular basis. With IFL1 turned off, it settled down to using the MUCH lower pressures that have treated me well for five years.

If a person has the Silverlining software to SEE how the treatment goes with the 420E, and is lucky enough to come to this message board where he/she can find out what to watch out for with "IFL1" , it's a super nice machine.

It still amazes me that -SWS knew what to suggest... "try turning off IFL1." The man had never used a 420E. He looked at the squiggly lines and marks on my Silverlining report, explained what he thought might be happening, what to do about it, and...bingo, he was right. I wouldn't be surprised if that machine were the first 420E in the world to have someone turn off IFL1.

While the majority of people might get along fine with IFL1 "on", I can't help but wonder if there's enough useful benefit from that setting anyway, to warrant taking the chance of wreaking treatment havoc with a few. Puritan Bennett should have their 420E's leave the manufacturing line with IFL1 turned "off" at the factory, imho. Grrrrrr.

Apparently the Sandman Auto, which is made by Puritan Bennett/Covidien, is well behaved about looking at flow limitations.

I would keep that IFL1=0 or disabled

[quote="rested gal"]<snip>

And if IFL1 "on" creates a runaway pressure scenario as it did for Peggy (plr66)...and for me, and for ozij, and for.... where's that list of people on this message board who have had to turn it off, ozij? LOL!! .... <snip> [quote]

The poll was here - 5 for IFL1=off 4 for on..... viewtopic.php?p=259673#p259673

And snork1

O.

rested gal wrote:I wish Puritan Bennett would NOT set IFL1 to "On" when their machines leave the factory. Perhaps having that "on" is ok for most people, but, my gosh... when it DOESN'T suit a person, the consequences could be awful.......
[Break]
If IFL1 caused a runaway, the hapless patient is going to be prescribed a RIDICULOUSLY high pressure. At the end of the trial, the unlucky person will be switched to "cpap" set for a much higher pressure than necessary. Perhaps causing difficulty exhaling, and difficulty with mask leaks..........
[Break]
While the majority of people might get along fine with IFL1 "on", I can't help but wonder if there's enough useful benefit from that setting anyway, to warrant taking the chance of wreaking treatment havoc with a few. Puritan Bennett should have their 420E's leave the manufacturing line with IFL1 turned "off" at the factory, imho. Grrrrrr.

Wow, Laura. Your post above was profound, and I found it hard to break it up here in the quote box. I'm wondering how rare it really is for IFL to need to be turned off for folks. I can tell you that if I had been in my first week of neophyte treatment with this machine and had not had this forum, I would have taken the machine back to the DME and probably ditched the entire idea of cpap as completely absurd for continuing treatment. I could not have continued with such a nightmare experience over and over again....And I agree completely that the DME and doc would likely not have had a clue as to what the problem was. What an education here! I so appreciate you.