high air pressure

lookingforrest · Post by **lookingforrest** » Sun Jan 15, 2006 10:43 pm

My question is: Is anyone with high air pressure using apap without c-flex?

I've had a pressure of 7 for 4 years, now my doctor is raising it to 15 and I'm a little concerned about exhaling at that pressure.

I used an apap for 2 nights and slept ok (didn't wake up too much) but woke with a slight headache. The pressure seemed to hurt my throat but after I turned the humidity up it was better. I'm hoping that this is something that just takes a little getting used to, but then again what if it gets worse. I have to buy my machine outright so I can't switch for a different one. I was planning on getting the PB 420e but not sure now because of the high pressure.

My doctor gave me 2 perscriptions so I could purchase whatever machine I wanted. One is for a cpap with a setting of 15, the other is for auto cpap with a setting of 8-16.

LDuyer · Post by **LDuyer** » Mon Jan 16, 2006 5:44 am

Hi,

I'm a little confused by your post (it's early, so it could be my mind not functioning ).

So you mean you've tried the auto cpap for two nights at your new high prescribed pressure? Is that right? And is that your machine of 4 years, and does it have c-flex? I'm asking because I'm wondering what has been working for you so far. Are you having trouble exhaling now?

Everyone seems to be different. I have a pressure of 18 and I use a bipap. It was the first machine prescribed for me, and my prescribed exhale pressure is 14. I recently tried an auto cpap with c-flex fixed at its max, hoping I might be able to handle a straight cpap or auto cpap. And I simply could not handle it, couldn't handle the exhale. I felt like I could not exhale completely without considerable force or effort and it felt unnatural. But then I know someone with the same 18 pressure I have and he handles a straight cpap (I think with c-flex) just fine. So I don't know what makes the difference. If you are able to currently exhale at the high pressure using your machine, then that might be fine. Don't know.

It took me quite awhile to get used to this wind tunnel high pressure but eventually I got used to it. Much of it had to do with just getting used to it, over time. But it also helped that I had my mask adjusted to fit just right. Good luck.

Linda

sir_cumference · Post by **sir_cumference** » Mon Jan 16, 2006 8:13 am

Hi

I can't answer for the C-Flex bit, but as your pressure seems to have changed so radically I think you would be very wise to get an apap and not a straight cpap. I find my pressures can vary by as much as 3cm night to night - so if you get an apap you will only be treated at the level you actually need, which may in practice be far lower than 15cm for most of the night and only 15cm occasionally. And, if it comes to a worse case senario, any apap will act as a striaght cpap if needed.

If you stick with straight cpap you will get 15 come what may, weather you need it or not. Hope this helps.
sir_cumference

lookingforrest · Post by **lookingforrest** » Mon Jan 16, 2006 9:16 am

Sorry for the confusion. My machine is a resperonic tranquility quest and I have a Sullivan heated humidifier. Both are 4+ years old as I'm sure they weren't new when I got them. My machine is like sleeping near a wind tunnel it's so noisy.

I wanted to get a small machine for travel and a much more quieter one too, so I asked my doctor for a perscription. He in turn wanted to check my pressure before giving me a perscription. He had me use one of his apap machines for 2 nights. I slept ok with it, but it hurt my throat and I woke with a slight headache.

I want to get the PB 420e because of it's size, but when I saw the high pressure I wondered if I should change my mind and get the machine that has c-flex.

sleepylady · Post by **sleepylady** » Mon Jan 16, 2006 9:30 am

Hi lookingforrest,

I beat you with a pressure of 16 Right now I'm on a straight CPAP and don't have any problems with the exhaling. I do have a prescription for an APAP and am getting a PB 420e, hopefully this week. I'm hoping that by using an APAP I'll be able to be at a lower pressure. I was originally at a 14, however, still was feeling very tired so it was upped. I'm wondering if my problem might have been because of major air leaks with my mask. Plus when they did my titration, the tech made me sleep on my back. I'm a tummy sleeper.

Are you still using the APAP? You may want to see if you can use it a couple more days. This way you can judge better if exhaling is going to be a problem.

Best of luck,

Melinda

rested gal · Post by **rested gal** » Mon Jan 16, 2006 10:56 am

lookingforrest wrote:The pressure seemed to hurt my throat but after I turned the humidity up it was better.

I think you'll do well with the 420E, forrest. The setting of 8 - 16 your doctor is recommending sounds like a reasonable, good range. As you already found, you may want to tweak your humidifier settings to get really comfortable.

Among the many nice things about the 420E is that it has a true "Ramp" feature. Other autopaps I've used don't have "ramp" when they're in auto mode. I don't use Ramp, but for a few days while you're getting accustomed to the new Rx, you might want to set the 420E's ramp to give you time to get to sleep.

I'd strongly suggest getting the Silverlining software to monitor your own nightly results with the 420E. Or, if you don't get the software, do take the 420E in for a download of the data within the first few days you use it.

Here's why: A few people (and I emphasize FEW) need to have the PB 420E's "IFL1" trigger turned OFF in the Advanced Settings. The factory default is "on". The only way you can know if IFL1 needs to be on or off for you is by looking at the data. If the data shows that the machine almost immediately runs up to the maximum pressure setting and spends a lot of time up there, you might want to experimentally turn off IFL1. Even just one night of data can give a good indication of whether you're one of the FEW who need IFL1 turned off. There's another IFL setting called IFL2 which should be left on.

It's a great little machine. I think you'll like it!

Janelle · Post by **Janelle** » Tue Jan 17, 2006 12:47 am

If you are worried about being able to exhale at the pressure of 15 with the 420e, don't be. While it doesn't have a CFlex feature per se, it does seem to have an automatic "breathing" synchronization where the pressure is automatically lowered for a few seconds in a breathing pattern. I think you'll also discover that using an APAP is going to give you better therapy. No one needs to be at a constant pressure all night long, and in fact, using a higher pressure than needed can lead to pressure induced central apneas which are not a good thing.

Guest · Post by **Guest** » Tue Jan 17, 2006 8:01 am

Janelle wrote:If you are worried about being able to exhale at the pressure of 15 with the 420e, don't be. While it doesn't have a CFlex feature per se, it does seem to have an automatic "breathing" synchronization where the pressure is automatically lowered for a few seconds in a breathing pattern.

I was not aware the PB 420e did this. This is great news. Everyone always talks about the CFlex option on a Respironics machine or the EPR option on a Resmed machine but no one ever mentioned this automatic pressure drop on the PB 420e machine. You would think they would want to get this information out so people would know the PB420e has the same sort of pressure relief on exhale as the others.

Janelle · Post by **Janelle** » Tue Jan 17, 2006 8:32 am

I think this was given by one of our lovely techically oriented folks on the forum last year who had studied the alogrithms and white papers on several different products. And if you have a 420e and can hear that breathing pattern you will realize that is what happening. Before I turned off my F1 I would get pressures up to 19, but found I could easily exhale against it and wondered why. But if the alogrithm is set up that way, it would certainly make sense, wouldn't it.

Guest · Post by **Guest** » Tue Jan 17, 2006 8:57 am

How much of a drop in pressure on exhale are we talking about with the PB420e? Is it like Respironics cflex where the drop depends on how hard you exhale?

rested gal · Post by **rested gal** » Tue Jan 17, 2006 4:11 pm

I use a 420E autopap. Have used two of them, actually. Between using the 420E's, I used two REMstar Autos, one with C-Flex. I've also used four different Bi-level machines. I also tried a ResMed S8 cpap with EPR, briefly, but long enough to see how EPR drops pressure during exhaling.

I know what pressure reduction on exhaling feels like. At no time, using either of my 420E autopaps did I ever feel even the slightest, shortest drop in pressure upon exhale. Not even for the briefest moment at the start of the exhale.

I may be wrong, but I seriously doubt the 420E gives any reduction in pressure on exhale. That is such a desirable feature for many people, I do believe Puritan Bennett would mention it in their product writeups.

Janelle wrote:I think this was given by one of our lovely techically oriented folks on the forum last year who had studied the alogrithms and white papers on several different products. And if you have a 420e and can hear that breathing pattern you will realize that is what happening

Janelle, the slight revving up and down sound of some 420E's with a person's inhale/exhale is simply a change in sound of the motor, I believe. My first 420E made a noticeable "breathing sound" with me; my second one goes about its work virtually silently. I don't think the "breathing" sound in many 420E's is any indication at all of an actual drop in pressure at the beginning of an exhalation.

It is possible to make the pressure flicker a cm or a half either way by deliberately doing some erratic breathing, including puffing hard into the mask alternating with long deep slow breaths. But that's a far cry from a built-in pressure reduction for exhaling...even a brief reduction.

I'd very much like to see any previous posts you have seen that indicate the PB 420E is designed to drop pressure on exhale...even a little. I really don't think it does.

Janelle, it's good to see you back! Your weight loss report was awesome. Must make all the dog show traveling you do more pleasant when trudging through airports and being on your feet all day judging! Hope all the Beagles are doing well.

Janelle · Post by **Janelle** » Wed Jan 18, 2006 7:42 am

Wish I could remember where I saw that about the algothrms on the 420e, but I do know I've had no problem exhaling at the really high pressures and I'm basically, well, at first, a pressure of 9 titrated.

Yes, I've noticed a big difference with the weight loss on my knee pain, hardly affects me at all, and I don't know if it is a new med or just the weight loss that my back is also much better. Not nearly as much pain in my feet from standing either. Yes, the rush through the airport seems much easier too. Amazing how that extra 40 pounds can affect you. But now all my favorite shoes are too big, stretched because of the extra fat on my feet which never even looked fat!

Of course, I had to buy all new clothes except for underwear. Trying to figure out what size bra to buy was a chore and it is still changing.

Worst part was that without all that padding on my butt, sitting for long periods of time really hurts my tailbone. Wondering is building up the glutts will help that. Couldn't hurt I guess.

Beagles are doing great and I've got some lovely girls out nearly finished or just starting, probably some of the best I've ever bred. I probably show about every 3 months and am currently showing a red girl that is 2 years old that is doing very well considering she hasn't shown in nearly a year and a half. 7 points and one major. The end of the month there is only her and one other female and a big major in dogs, so she could conceivably finish her Championship.

If anyone is interested in seeing my beagles the website is http://www.wildairbeagles.com

Guest · Post by **Guest** » Wed Jan 18, 2006 9:38 am

Alright, so the PB420e doesn't really have any pressure relief when you exhale. I guess that explains why we never heard about it before and why they don't tout it in their literature. I wonder if they'll ever add some type of exhalation relief feature in the future that will work in auto mode like the Respironics cflex does. That would be great. I think its really too bad that Resmed EPR doesn't work in auto mode---they missed the boat on that one in my opinion.

Darth Vader Look · Post by **Darth Vader Look** » Thu Jan 19, 2006 12:22 am

Okay just my thought process working here but it may be a good explanation for what Janelle thinks she is experiencing with reduced exhalation pressure on the PB420E. The machine is up to whatever pressure and Janelle exhales. With the tube full of compressed air, her exhale is sure to trigger a sensor in the machine indicating that pressure is a little high and to slow the fan motor down some. As the exhale finishes up the sensor notices that the pressure is a little low and speeds the fan up some to compensate for it and maybe even a little more on inhalation. This may not be much but the changing motor noise in sync with her breathing may be enough to make you believe it has a reduced exhalation pressure.

Snoredog · Post by **Snoredog** » Thu Jan 19, 2006 1:05 am

I would definitely go with the Remstar Auto with Cflex. Ask those folks recommending the 420E what their pressure is, then decide.

But at 16cm pressure? the 420 is going to be noisy compared to the Remstar at the same given pressure. I've owned both machines, there is a noticeable difference even at 10cm. You'll appreciate the cflex feature at 16cm pressure, and when you don't have it?

The 420 is okay to travel with or use as a backup, but I wouldn't want it as my primary machine, already been down that road.

high air pressure

high air pressure

Re: high air pressure