ResMed Spirit Auto and A10 algorithim??

Morning All- My DME has indicated that she will let me borrow a different Auto machine to see if I get any better results as far as addressing my continued fatigue. She does not have any Sandman Auto machines available but does have a ResMed Spirit and possibly a Respironics Auto. Is the Spirit going to give me the same difficulty with the A10 algorithim as the ResMed I have now?? What about a Respirionics machine? I am going to try just about any option now to see if I can figure out why I remain so tired.
I know I do better on straight CPAP but the aerophagia just kills me. Lower pressures (to avoid "gas") on straight CPAP just do not give me good enough therapy either. SO this rock and hard place thingy just continues to prevail!!
My DME is very nice and I may just try another machine to see if that will give me any relief. Any thoughts?? GG

Is the Spirit going to give me the same difficulty with the A10 algorithim as the ResMed I have now??

Yes. All Resmed automatic machines - whatever their name - use the A10 algorithm.

O.

What pressure(s) have you been using? If it's over 10 cm., then "yes", the A10 algorithm could be problematic as all ResMed Autos use it. There are no guarantees as to what will work for different people as far as dealing with aerophagia. But, at least the Respironics machines will treat events over 10 cm. If you get hold of an M Series Auto w/A-Flex, you'd have quite a few options to try.

Den

I was titrated at 12. I have been using the auto at 9.4-13.4 and the aerophagia is MUCH better, however the fatigue is NOT! I realize that some people are sensitive to the auto because of the sudden pressure changes during the night but I feel like right now I have no choice. My stats are very good, low AHI , AI and HI leak rates of around .10. So, you see my problem?

Have you determined what single pressure may be the "threshold" for your aerophagia?

"Fatigue" can be caused by many things......like from still paying off your "sleep debt", other health conditions or not getting enough sleep (in addition to changing pressures).

Den

No Don I have not yet attempted to find out what my "threshold" for aerophagia is using straight CPAP. I must admit I haven't wanted to risk the horrible bloating and also I don't know exactly where to start. I know that if I go too low I will feel like crap the next day and if I go too high the "gas" will blow me away!! Right now my APAP morning stats usually indicate that my 90% pressure is somewhere close to 10.4(with low pressure at 9.4) so maybe I should start there. GG

grumpygirl wrote:No Don I have not yet attempted to find out what my "threshold" for aerophagia is using straight CPAP. I must admit I haven't wanted to risk the horrible bloating and also I don't know exactly where to start. I know that if I go too low I will feel like crap the next day and if I go too high the "gas" will blow me away!! Right now my APAP morning stats usually indicate that my 90% pressure is somewhere close to 10.4(with low pressure at 9.4) so maybe I should start there. GG

Sounds like around 10 cm. (or 9.5) would be a good place to start. If there are still problems, then lower it just a bit......or if no problems, you could try just a little bit higher. If you see (reasonably) good numbers AND no aerophagia at some pressure, then quit while you're ahead.

Den

I'm pretty sure the A10 algorithm will treat events above 10cm as long as they are accompanied by flow limitation or obstruction. The reason it would avoid some is to avoid increasing the pressure for possible "central" apneas. At least I think that's correct.

I am trying to understand the A10 algorithim myself. My titrated pressure was 11 but I am finding that 11.5 to 12 elminates my snoring events. If I am understanding the A10 algorithim, the ResMed Auto does not effectively respond to my flow limitations .. which is something that I was seeing in my reports. I

Here's a link to a discussion.....with some additional links......from ozij.

Now, you can all brush up on how the ResMed Autos work with their A10 algorithm.

viewtopic.php?f=1&t=36570&p=316992&hilit=A10#p316992


Den

Wulfman wrote:

grumpygirl wrote:No Don I have not yet attempted to find out what my "threshold" for aerophagia is using straight CPAP. I must admit I haven't wanted to risk the horrible bloating and also I don't know exactly where to start. I know that if I go too low I will feel like crap the next day and if I go too high the "gas" will blow me away!! Right now my APAP morning stats usually indicate that my 90% pressure is somewhere close to 10.4(with low pressure at 9.4) so maybe I should start there. GG

Sounds like around 10 cm. (or 9.5) would be a good place to start. If there are still problems, then lower it just a bit......or if no problems, you could try just a little bit higher. If you see (reasonably) good numbers AND no aerophagia at some pressure, then quit while you're ahead.

Den

I think that's a must before you can come to any rational decision on any other type of machine. Set a minimal constant pressure, (Den's suggestions are great) keep a log of:
Hours you slept
Quality of sleep
Amount of aerophagia
How you feel during the day.

Keep each pressure for a week or even two. Move the pressure up in 0.2 cm. increments. Be patient. You've been running around this problem for much longer than the time it will take to find out the info.

Just do it, one step after the other - and fill in the log daily. You don't need software for it - only perserverance and patience.

Once you know who you respond at different pressures, you can make better decsions.

O.

So with my ResMed, set to 12-16, to actively prevent the apneas occurring with no snores or flow limitation (may be happening in my case), one would need to find the minimum pressure that prevents those events as well when in Auto mode. As I understand it, Respironics machines will try to treat those apneas if 2 (or more?) occur within 3 minutes, and if they aren't responsive will back down on the pressure?

tattooyu wrote:So with my ResMed, set to 12-16, to actively prevent the apneas occurring with no snores or flow limitation (may be happening in my case), one would need to find the minimum pressure that prevents those events as well when in Auto mode.

Yes. If you eliminate flow limitations and snores, but still have obstructive apneas above 10, the Resmed auto's minimum will have to be set high enough to eliminate the apneas. Or low enough to let the snores and flow limitations drive the pressure up as much as necessary. Generally - but not for everyone - snore and flow limitations are residual events that remain when apneas are eliminated. Resmed autos have no problem treating that type of breathing.

As I understand it, Respironics machines will try to treat those apneas if 2 (or more?) occur within 3 minutes, and if they aren't responsive will back down on the pressure?

Yes. The Respironics machine prefers the "oops. I goofed" technique to the Resmed's "I'd rather err on the side of caution". Resprionics' technique may jog the pressure up 3 times before figuring out it shouldn't have done so, and dropping the pressure.

O.

Thanks, ozij.