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There appears to be some confusion about the "Comfort Setting".

I do not have the ramp feature turned on. When I first turn on the sandman, it goes to 10cm (my minimum pressure in auto). It goes to the comfort setting when I have the mask off for more than (I think) 30 seconds or so. So, if I have to get up and go to the bath room and I get back, the sandman will be at the comfort setting. At that point, I usually press the on button and it'll go back to 10. It would be nice for me if I don't have to worry about it being in comfort mode or not. The main question I have, is how will it go from the comfort setting to normal pressures when the ramp feature is set to zero. Now, it's possible that's not the comfort setting and just a "there's such a big leak, we might as well give up" pressure. I'm not sure. I'll change the comfort setting to see if it affects this or not.

-Corey

coreyg wrote:

There appears to be some confusion about the "Comfort Setting".

I do not have the ramp feature turned on. When I first turn on the sandman, it goes to 10cm (my minimum pressure in auto). It goes to the comfort setting when I have the mask off for more than (I think) 30 seconds or so. So, if I have to get up and go to the bath room and I get back, the sandman will be at the comfort setting. At that point, I usually press the on button and it'll go back to 10. It would be nice for me if I don't have to worry about it being in comfort mode or not. The main question I have, is how will it go from the comfort setting to normal pressures when the ramp feature is set to zero. Now, it's possible that's not the comfort setting and just a "there's such a big leak, we might as well give up" pressure. I'm not sure. I'll change the comfort setting to see if it affects this or not.

-Corey

Did you not read the manual?

Unless you have the ramp turned on there is no comfort setting.

Please read my post again.

Mars

mars wrote:Hi coreyq

Post by Thunder Road on 23 Feb 2010, 20:25
If your range is 10-16 I would set the command on apnea setting to 14 or 15. I would also set the comfort pressure to 12. This will stabilize the pressure to remain at 12 should there not be any events and allow it to go up to correct an event within a tighter range if the need arises.

Post by Thunder Road on 23 Feb 2010, 20:43
The comfort pressure should be set somewhere between your minimun and maximimum setting. This will keep a tighter range to prevent a pressure spike should you have an event the machine will not have to 'chase' it to correct it. The comfort pressure should never be lower than the minimum. The command on apnea setting will allow the machine to correct and apnea above 10cm. I would set that close to your max pressure setting.

There appears to be some confusion about the "Comfort Setting".

It is not as described above.

The manual says - page 16 - Using The Ramp Feature -

The ramp feature allows for a gradual rise in pressure to help you go to sleep. Therefore, treatment begins at a low pressure, called the comfort pressure, and rises from there to the pressure prescribed by the physician.

This to allow the user to start with a pressure lower than the minimum, to possibly help the user to go to sleep.

On page 40 of the manual you will find a description of Command on IFL. I suggest you check out your understanding of this feature.

And remember the old computer wisdom, first - read the manual

cheers

Mars

Thanks for the clarification on the "comfort" pressure setting, Mars.

corey, you may find you need to turn off the IFL setting. I, and quite a few others, had to turn that off on the Sandman's predecessor (the PB 420E auto) or the pressure would soar up unnecessarily. Having IFL "on" probably suits most people fine, but there seem to be a significant number that IFL doesn't suit.

I just want to say that I love, love, LOVE my Sandman Auto. It's my third machine, after the REMStar tank and the GoodKnight 420E (which broke--my Sandman was a warranty replacement for the 420E). I love everything about it (except that it doesn't have an auto-on or humidifier pre-heating--but what it does have, I love). I particularly love that I can travel with it so easily.

I haven't bought the software. I had the software for my last machine and I never looked at it, and I've been on CPAP long enough that I feel like my therapy is under control and if something goes wrong, I usually know what it was. If treatment suddenly stops working, then I'll buy it.

mars wrote:

coreyg wrote:

There appears to be some confusion about the "Comfort Setting".

I do not have the ramp feature turned on. When I first turn on the sandman, it goes to 10cm (my minimum pressure in auto). It goes to the comfort setting when I have the mask off for more than (I think) 30 seconds or so. So, if I have to get up and go to the bath room and I get back, the sandman will be at the comfort setting. At that point, I usually press the on button and it'll go back to 10. It would be nice for me if I don't have to worry about it being in comfort mode or not. The main question I have, is how will it go from the comfort setting to normal pressures when the ramp feature is set to zero. Now, it's possible that's not the comfort setting and just a "there's such a big leak, we might as well give up" pressure. I'm not sure. I'll change the comfort setting to see if it affects this or not.

-Corey

Did you not read the manual?

Unless you have the ramp turned on there is no comfort setting.

Please read my post again.

Mars

Did you not read the manual?

On page 41 (in AutoCPAP mode which I am using) The comfort pressure is defined as:

Level of pressure produced by the device when the ramp feature starts up OR when the device detects that there has been no respiratory cycle for more than 2 minutes.

As stated above, the sandman gets into whatever the mode that I'm talking about after I take off the mask. I'm not sure if that's the same as "no respiratory cycle" or not. I actually have "Comfort Pressure" set to 10 (I thought it was 4 but I must have figured out that was wrong when I switched to auto mode) but from the data, the pressure says it's 0.7 after I've taken the mask off. So, it's clearly not the "Comfort Pressure" but what I'm mainly interested in is what it will do after I put the mask back on and how long that will take. I guess I could test this, but 0.7 feels almost like I'm sufficating. Will it go back to normal pressures after a few seconds/minutes?

I could only find the following about Command on IFL(on page 42): "This command raises the pressure if the flow is restricted". I assume this means if I have a Hypopnea, it will increase the pressure. Is that correct? (I have this turned on already).

I just checked and I actually have Max P on apnea set to 16. I must have set that when I changed to Auto. I did go through the manual fairly carefully at that time, I may have forgotten some of that in the last 2 weeks.

-Corey

Hi CoreyG

I think I might be getting a bit nearer to answering your query. If you could let me have the following data I will have a better idea.

In patient mode - autocpap - what is

Max Latency Time
Min Pressure
Max Pressure

In Clinician Mode - autocpap - what is

Mode
Min Pressure
Max Pressure

Comfort Pressure
Max Latency Time
Latency Time

and could you please elaborate on

As stated above, the sandman gets into whatever the mode that I'm talking about after I take off the mask.

and

the pressure says it's 0.7 after I've taken the mask off.

There is a good discussion on Command on IFL at -

viewtopic.php?f=1&t=36712&p=318841&hili ... fl#p318841

Also the software manual for 1.4 has mistakes in it -

viewtopic.php?f=1&t=44048&p=391763&hili ... re#p391763

and finally - when you take your mask off, do you shut off the blower and go back into standby mode?

cheers

Mars

Hi Mars,

In Patient Mode:

Max Latency Time: 0
Min Pressure: 12 (Last night I increased this from 10)
Max Pressure: 16

In Clinician Mode:

Mode: AUTO
Min Pressure: 12
Max Pressure: 16

Comfort Pressure 12 (This automatically increased when I changed min Pressure)
Max Latency Time 0
Latency Time 0



When I get up at night, I take the mask off and I do not turn the sandman off or touch any of the buttons. Within about 10 to 15 seconds, the pressure drops a lot all of a sudden. It's still running but the pressure is very low. When I download the data to the computer and look at the graphs to see what the pressure is set to, it reads 0.7. When I'm about to put the mask back on, I press the on button and the pressure goes back up (I assume to my min pressure) and then I put the mask on. I'm a bit worried that being half asleep, I may forget to press the on button and put the mask back on at the extremely low pressure. So far, I don't think I have but I was wondering what it would do. Will it recognize that I have the mask back on and increase the pressure to where it's supposed to?

Thanks for your help. I think all of the comments about Comfort Pressure where leading in the wrong direction. It doesn't really matter but I'm still not sure what they mean by "no respiratory cycle". I keep thinking that means, if I die (ie stop breathing) with the sandman on, it will drop to the comfort pressure. That really makes me feel better

And thanks for the links on the Command on IFL. I haven't read it yet, but I will.

For last night I got:

OBS AI: 1.2
CNT AI: 0
OBS HI: 6.8
CNT HI: 2.9
Snorings (SNG): 81/hour
Runs: 25

The snorings seem to be what's always increasing my pressure. The CNT HI is higher than normal last night, but that was just one night, I'll see what it does over the next several nights.

-Corey

So far, I don't think I have but I was wondering what it would do. Will it recognize that I have the mask back on and increase the pressure to where it's supposed to?

I bet it will -- but why not try it when you're awake?

O.

coreyg wrote:Hi Mars,

In Patient Mode:

Max Latency Time: 0
Min Pressure: 12 (Last night I increased this from 10)
Max Pressure: 16

In Clinician Mode:

Mode: AUTO
Min Pressure: 12
Max Pressure: 16

Comfort Pressure 12 (This automatically increased when I changed min Pressure)
Max Latency Time 0
Latency Time 0



When I get up at night, I take the mask off and I do not turn the sandman off or touch any of the buttons. Within about 10 to 15 seconds, the pressure drops a lot all of a sudden. It's still running but the pressure is very low. When I download the data to the computer and look at the graphs to see what the pressure is set to, it reads 0.7. When I'm about to put the mask back on, I press the on button and the pressure goes back up (I assume to my min pressure) and then I put the mask on. I'm a bit worried that being half asleep, I may forget to press the on button and put the mask back on at the extremely low pressure. So far, I don't think I have but I was wondering what it would do. Will it recognize that I have the mask back on and increase the pressure to where it's supposed to?

Thanks for your help. I think all of the comments about Comfort Pressure where leading in the wrong direction. It doesn't really matter but I'm still not sure what they mean by "no respiratory cycle". I keep thinking that means, if I die (ie stop breathing) with the sandman on, it will drop to the comfort pressure. That really makes me feel better

And thanks for the links on the Command on IFL. I haven't read it yet, but I will.

For last night I got:

OBS AI: 1.2
CNT AI: 0
OBS HI: 6.8
CNT HI: 2.9
Snorings (SNG): 81/hour
Runs: 25

The snorings seem to be what's always increasing my pressure. The CNT HI is higher than normal last night, but that was just one night, I'll see what it does over the next several nights.

-Corey

Hi Corey

Lets see if I can respond to the above one by one -

When I get up at night, I take the mask off and I do not turn the sandman off or touch any of the buttons. Within about 10 to 15 seconds, the pressure drops a lot all of a sudden. It's still running but the pressure is very low.

I would think that doing the above would skew your results, and I cannot think of any advantage it would have. No doubt there are different sequences that suit different people, but correct data is always a must.

What I do is first of all put my mask on, then get a comfortable fitting, then turn the machine on, then get comfortable again, then lie down. For getting up I turn the machine off, then take the mask off. This will allow accurate feedback.

When I download the data to the computer and look at the graphs to see what the pressure is set to, it reads 0.7.

Are you saying you download to your computer in the middle of the night, whilst the machine is still running?

When I'm about to put the mask back on, I press the on button and the pressure goes back up (I assume to my min pressure) and then I put the mask on.

So the machine is still on, you have a pressure of 0.7, you press a button and the pressure goes back up - if you press the bottom right button at this point the machine will turn off.

The pressure would only go back up if you have the mask on, it would not go back up to your minimum pressure if you have the mask off. So the "and then I put the mask on" does not seem likely.

I think something is missing from this sequence - could you please check it and advise.

I'm a bit worried that being half asleep, I may forget to press the on button and put the mask back on at the extremely low pressure.

If you put the mask on when the machine is on, it will automatically go to your minimum pressure. You do not have to press a button for this to happen. But as that method will give you inaccurate results, I suggest you give my suggested sequence a try.

So far, I don't think I have but I was wondering what it would do. Will it recognize that I have the mask back on and increase the pressure to where it's supposed to?

As stated above, if the machine is on, and the mask is on, it will deliver the pressure.

Should you have the mask on, and the machine off, the most likely thing is that you will sleep without therapy. Or you may not sleep, and realise the machine is off.

I think all of the comments about Comfort Pressure where leading in the wrong direction.

Comfort pressure can be set, but is only activated when both latency times are input. Your latency times are zero, therefore you have never experienced the comfort setting with that zero condition.

Latency times in Auto are similar to ramp times in CPAP.

It doesn't really matter but I'm still not sure what they mean by "no respiratory cycle". I keep thinking that means, if I die (ie stop breathing) with the sandman on, it will drop to the comfort pressure. That really makes me feel better

I think we need to get sorted out on all this other stuff before you worry about "respiratory cycle". It doesn't mean what you think it means, and if you do die with the Sandman on, it will not bring you back to life.

Anyhow, I think the definition is that a respiratory cycle is one breath. For more information on all that stuff (and a lot of other esoteric stuff) you could go to -
viewtopic.php?f=1&t=35298&st=0&sk=t&sd= ... le+sandman
if you have a few hours to spare.

A simpler explanation is at http://www.answers.com/topic/what-is-th ... tory-cycle

Your total Obs AHi is 8.0, and that needs to be brought down to 5.0 or under, as well as the high number of snoring events.

Lets start sorting out all the other stuff, and go from there.

When you describe a sequence of events, please be very careful to be accurate.

Don't get too hung up over one night, it is trends that count.

cheers

Mars

According to the Sandman's clinical manual (page US-13), in auto mode the default value for the comfort pressure (6) is higher than the default value for the minmum pressure (3).

To me, this indicates that the new "Comfort Pressure" is the old "Initial Pressure". When giving therapy, the machine fluctuate above and below the comfort pressure . In auto mode, the machine will drop below the comfort pressure down to a lower pressure -- it breathing and events justify that.
I would be very grateful to any Sandman user would check this for me: Can you indeed set a minimum pressure to be lower that the comfort pressure? I'm not saying to try it in therapy -- it's just the I want to know if my understanding is correct.

O.

ozij wrote:According to the Sandman's clinical manual (page US-13), in auto mode the default value for the comfort pressure (6) is higher than the default value for the minmum pressure (3).

To me, this indicates that the new "Comfort Pressure" is the old "Initial Pressure". When giving therapy, the machine fluctuate above and below the comfort pressure . In auto mode, the machine will drop below the comfort pressure down to a lower pressure -- it breathing and events justify that.
I would be very grateful to any Sandman user would check this for me: Can you indeed set a minimum pressure to be lower that the comfort pressure? I'm not saying to try it in therapy -- it's just the I want to know if my understanding is correct.

O.

HI Ozij

In Auto -

1st -Comfort pressure (CP) can only be changed if there is a value in Maximum Latency Time.

With an auto range of 11 - 13, the CP can only be set between 11 - 13.

With an auto range of 3 - 13, the CP remains what it was, but can now be changed down to 3.

Given that my mind now goes blank every time I hear the words "comfort pressure" ( I have never bothered with it in my 11 months of Sandman use), this is the best I can come up with.

But if more specific questions need to be answered I will do my best. Not sure if I have answered your question

I have not been able to work out when a default value for CP would appear, or be used. There is also a default value for minimum and maximum latency time, again, I cannot see when these would come into play.

cheers

Mars

I suspect that page 13 was translated into English by a French anglophobe

mars wrote:I suspect that page 13 was translated into English by a French anglophobe

I suspect that of the whole manual -- and I also suspect they started writing it before the final decisions were made about the machine would function.

HI Ozij

In Auto -

1st -Comfort pressure (CP) can only be changed if there is a value in Maximum Latency Time.

With an auto range of 11 - 13, the CP can only be set between 11 - 13.

With an auto range of 3 - 13, the CP remains what it was, but can now be changed down to 3.

Thank you, Mars, you have answered my question perfectly.

The situation is as I suspected (we're a suspicios lot today...).

In Auto mode, CP does not equal minimum. It can't be lower than minimum -- but it can be higher.
CP is where the machine will start therapy at.
It will hang there for a default minimum of 5 minutes, then swithch to Auto functioning, taking the pressure higher, or lower (if you've set a lower minimum) depending on the analysis of breating patterns.

This means you can set CP about where your Rx is, and a lower, minimum to which the machine will drop to, if possible.

I'm not sure of how the fast / slow pressure drop parameters join the game here.

O.

Hi Ozij

OK - I think I have now got it.

So the first 5 minutes of non-data collection is at the set CP. Then, as you say, when auto sets in it will -

then switch to Auto functioning, taking the pressure higher, or lower (if you've set a lower minimum) depending on the analysis of breating patterns.

This means you can set CP about where your Rx is, and a lower, minimum to which the machine will drop to, if possible.

I am now testing the Command on Apnea function, with fast decrease. The results are the same as without it - Total Obs and Cnt AHi of 2.2 with a pressure range of 11 - 13 over a period of 10 days. The next 10 days I will be testing the slow decrease in pressure.

I have found that I can use about a dozen different settings, and still get between 2.0 and 2.4 Obs/Cnt AHi on all of them.

What do you think would be a significant difference? e.g. 0.1 or perhaps 0.4.

cheers

Mars

From Puritan Bennett's application to the FDA for the Sandman series, my emphasis:
http://www.accessdata.fda.gov/cdrh_docs ... 080439.pdf

The Puritan Bennett Sandman Auto operates in either Constant or Automatic mode. In Constant
mode, the main function of each device is to delier constant positive airway pressure to the
patient at a fixed level prescribed by the practitioner and between 4 and 20 cmJO.
In Automatic mode (APAP mode), the practitioner determines and sets a maximum and
minimum pressure range above and below the prescribed reference pressure and between
4 and 20 cmH20. The pressure is adjusted within the maximum and minimum limits according to
the patient's respiratory pattern and the type of events detected.

mars wrote:

coreyg wrote:
When I get up at night, I take the mask off and I do not turn the sandman off or touch any of the buttons. Within about 10 to 15 seconds, the pressure drops a lot all of a sudden. It's still running but the pressure is very low.

I would think that doing the above would skew your results, and I cannot think of any advantage it would have. No doubt there are different sequences that suit different people, but correct data is always a must.

What I do is first of all put my mask on, then get a comfortable fitting, then turn the machine on, then get comfortable again, then lie down. For getting up I turn the machine off, then take the mask off. This will allow accurate feedback.

Ok, your suggestion makes sense. I don't like putting the mask on when the air is not on but I'll try it this way and see if I can get used to it. The data is messed up a bit at the start and end but I know that so it's not bad (and sandman software does have the exclude invalid data option).

mars wrote:Are you saying you download to your computer in the middle of the night, whilst the machine is still running?

no, I look at the data the next morning. I can tell where I took the mask off from the graphs.

mars wrote:Your total Obs AHi is 8.0, and that needs to be brought down to 5.0 or under, as well as the high number of snoring events.

Lets start sorting out all the other stuff, and go from there.

When you describe a sequence of events, please be very careful to be accurate.

Don't get too hung up over one night, it is trends that count.

cheers

Mars

I'm actually very happy with Obs AHI at 8.0. That's actually down from 15 to 20 that I had a couple weeks ago. Yes, I'd like to get it even lower, but I'm happy with the current progress. I want to wait a few days since I just made a change yesterday so I want to wait and get more data before adjusting something else.

Ok, I'll try to explain the lower pressure that I'm talking about a little better. If I turn on my sandman auto without the mask on, it starts up at the min pressure (12cm). If I wait about 30 seconds (without putting the mask on), it drops the pressure way down. You may actually think it turned itself off, but it is still blowing a very small pressure (the data says 0.7cm). That's the pressure I'm talking about that I'm wondering if it goes back to normal pressure if you put the mask on. I just tried putting the mask on when it was at this lower pressure and after a minute it didn't go back to my normal auto settings. I don't understand why it has this low pressure setting. It could just turn off or it could stay at the min pressure but why does it go to a very low pressure and then it seems to not go back to normal auto settings? I see this lower pressure when I take the mask off in the middle of the night and I don't touch the sandman. In the future, I'll try to turn the system off before I take the mask off, but when I'm half asleep at night, I'm not entirely rational. My biggest problem when I started CPAP was taking the mask off in the middle of the night. I've mostly broken that habit but I still take it off from time to time an hour or two before I'm supposed to get up.

-Corey