Who needs auto machines?

I would call it all round relief but definitely related to exhalation.

I guess if we take the expression 'exhalation relief' we can apply it two ways

1) in terms of an added feature to a cpap machine

or

2) a goal of designing xPAP machines.

I am confident we will continue to see advances in technology in these machines that all have the primary goal of making it easier to exhale no matter what pressure a sleep study recommends.

The angle I am coming from is as RG explained.

an xPAP machine

1) Is designed to solve as best as possible the problems associated with SA & OSA

2) To make it as easy as possible for the patient to exhale (allowing that 1 above covers the inhale aspect)

3) To solve as many of the problem side effects associated with xPAP therapy such as mask leaks (a side effect of air pressure allowing some air to escape), swallowing air (usually due to higher pressures), and the general discomfort of breathing out against any pressure.

RAMP was one of the early features to help deal with breathing out (exhalation) on a xPAP machine.

Cheers

DSM

NightHawkeye wrote:But really it's about how you feel. So, how do you feel, fcaen? Is your treatment helping you? Are you having trouble adjusting? Let us know. People here will try to help.

I feel I'm sleeping much better than I used to before getting treatment for my severe apnea.
I also feel like I'm swallowing a lot of air. It's not really painful, but definitely uncomfortable.
And I have a hard time exhaling againt the pressure of 15.

From what y'all wrote, sounds like an APAP would help with both issues. And CFlex would help with the latter.

Thanks everyone for the great feedback. I really appreciate!

I'm going to try asking this once more and then if I still don't get it I promise I'll just chalk it up to not enough brain cells and quit trying to understand. Exhalation relief means the pressure is lower for the exhalation than the inhalation pressure, right?
[quote="Anonymous"]I'm confused. I thought only a Respironics machine with the C-Flex feature offered exhalation relief for a machine in auto mode. I know the ResMed EPR doesn't work in auto mode, so there's no exhalation relief on that one. I know the PB420e doesn't offer exhalation relief in any mode.

The question was, "Auto machines, even those without CFlex, offer some relief during exhalation?" DSM, how can you say the answer is yes, when neither the ResMed Auto or the PB auto have an exhalation relief feature? I hate to admit to being so dense, but I don't get it.

Swallowing air (on 15cms) became a big problem for me. Luckily since moving to a BiLevel (not specifically for that reason) the problem went away (say 95%).

The effects of swallowing air (as I'm sure you well understand) aren't nice not for ourselves & not for our partners & others

Anyone experiencing the problem (aerophagia) has my greatest sympathy & I hope you are able to find relief as you adapt.

Cheers & Good luck

DSM

Anonymous wrote:Swallowing air (on 15cms) became a big problem for me. Luckily since moving to a BiLevel (not specifically for that reason) the problem went away (say 95%).

Lemme try to understand this. A BiLevel reduces the pressure when you exhale, right? So does the swallowing of air happen at that time? That's why going to BiLevel resolved the problem?

Anonymous wrote:The effects of swallowing air (as I'm sure you well understand) aren't nice not for ourselves & not for our partners & others

Yeah, it bothers my wife quite a bit...
Thanks for the support!

Anonymous wrote:I'm going to try asking this once more and then if I still don't get it I promise I'll just chalk it up to not enough brain cells and quit trying to understand. Exhalation relief means the pressure is lower for the exhalation than the inhalation pressure, right?

You may be seeking too tight a definition.

What *I* said was "

>>To gain exhalation relief from the pressure of CPAP <<

Somehow that has been warped (not by me) into your comment ..
>>
The question was, "Auto machines, even those without CFlex, offer some relief during exhalation?" DSM, how can you say the answer is yes, when neither the ResMed Auto or the PB auto have an exhalation relief feature? I hate to admit to being so dense, but I don't get it.
<<

Please don't feel confused, taken in your context exhalation relief as a 'feature' of an xPAP machine (your words & context) means just what you say.

But my point was always exhalation relief is a goal in designing xPAP machines & I said AUTOs fit into this design goal.

The confusion I see is 'context' - once we both are in the same context we are talking about the same thing.

Cheers

DSM

fcaen wrote:

Anonymous wrote:Swallowing air (on 15cms) became a big problem for me. Luckily since moving to a BiLevel (not specifically for that reason) the problem went away (say 95%).

Lemme try to understand this. A BiLevel reduces the pressure when you exhale, right? So does the swallowing of air happen at that time? That's why going to BiLevel resolved the problem?

Anonymous wrote:The effects of swallowing air (as I'm sure you well understand) aren't nice not for ourselves & not for our partners & others

Yeah, it bothers my wife quite a bit...
Thanks for the support!

RG will probably add her input on this as she has direct experience that will add to mine but for me the swallowing air part was occurred in two ways

1) When on 15 & with cflex set to 3 - I noticed a big jump in the effects of aerophagia - I turned cflex off altogether for a while & that helped but it remained a problem.

2) I was able to determine that it was occurring in my case, during the exhalation cycle - I put this down to the combination of the 15cms pressure + my breathing out pressure, pushing the combined pressure in my mask way up (I can see this on my PB330 dial when it is in CPAP mode - the PB range of machines run a pressure sensing tube up inside the air tube & thus can accurately read the pressure in the mask on the PB330 this pressure shows on the LCD - I have seen it jump to 18 when I breathe out)

The BiLevel has allowed me to set exhale (EPAP) pressure to as low as 8 and from the day I did that the aerophagia went. I have tried increasing the Exhale pressure from 8 to 12 and did notice some swallowing of air start to show at this 12 cms EPAP.

I went to a BiLevel for the Assisted Control (Central Apnea control) - the aerophagia going away was a surprise bonus.

Cheers

DSM

Last night I put 8.7 hours on a just received REMstar Auto with C-FLEX. The C-FLEX technology definitely made falling asleep easier. The features of AUTO enabled a full night of sleep without any of the discomfort that I had experienced using a regular CPAP. And to top it off; a headache I have had for a week (from not using CPAP at all) is gone. I found the minimum pressure to be a little low and have bumped that up a little for tonight. I also purchased a card reader to analyze the data written to the machines smart card and can't wait to begin analyzing the data and tweaking the settings for peak sleep performance. Good luck with whatever choice you make, but by the sounds of it you'd be best off to go for the AUTO with CFLEX feature. I purchased mine though cpap.com and am very pleased with it so far.

Anonymous wrote:1) When on 15 & with cflex set to 3 - I noticed a big jump in the effects of aerophagia - I turned cflex off altogether for a while & that helped but it remained a problem.

Wow! So CFlex makes aerophagia worse? That's good to know.

Whoa!!

I said that for me it made it worse - WillSucceed also found this for him, but later I was very happy using a cflex setting of 2 when my machine was in AUTO mode and running at a lower cms than 15.

There are *many* people here who swear by cflex at 3.

There are sooo many factors that come into play here.

Cheers DSM

fcaen wrote:I also feel like I'm swallowing a lot of air. It's not really painful, but definitely uncomfortable.
And I have a hard time exhaling againt the pressure of 15.

From what y'all wrote, sounds like an APAP would help with both issues. And CFlex would help with the latter.

fcaen, considering your high pressure and the aerophagia, you might want to consider one other possible machine, the Respironics Auto-BiPAP. It's a nice machine, although also more pricey than an APAP. On the other hand, I'm sure that you don't want to continue to experience aerophagia. You need to be aware that the Auto-BiPAP has four modes, and only four modes;
1) CPAP
2) BiPAP
3) Auto-BiPAP (automatically determines inhalation & exhalation pressures)
4) Auto-BiPAP with BiFlex (like C-Flex)

If the machine had APAP also, I'd consider it a universal machine, but alas, it doesn't. It'll do straight CPAP but not APAP. In auto modes and in BiPAP mode, the difference between inhalation and exhalation pressures must be at least 3 cm.

This is probably more than you wanted to know, but you have a little time to digest things now and make your decisions.

Hope this helps.

Regards,
Bill

Re why AUTOs were designed.

RG, I just googled this doc published in 2004 that reflects my belief that AUTOs were designed to improve on CPAP rather than specifically for doing sleep studies. The Author does add that point in as a secondary benefit.


The Author was evaluating multiple AUTOs and the first para includes the following ...

http://www.breas.ru/media/CPAPTest.pdf

>>
Patients with obstructive sleep apnoea syndrome (OSAS)
are often chronically treated with continuous positive airway
pressure (CPAP), which may induce several side-effects,
limiting treatment tolerance and compliance. Auto-adjusting
positive airway pressure (APAP) systems have been developed
and clinically tested for several years [1-7]. They are aimed at
improving effectiveness and, possibly, reducing side-effects
of CPAP by providing optimal pressure, which is found, on
average, to be lower than a continuous level [8], They may
improve tolerance by reducing mask pressure (Pm) and,
probably, mask leaks. It has been demonstrated that, in
patients requiring high pressures, compliance was statistically
increased [7]. However, the clinical significance of this
observation remains unproven. APAP are also potentially
cost-efficient auto-titrating systems [9, 10]. Nevertheless, in
some reports, failure of the APAP required manual resetting,
whilst, in others, undesirable cardiorespiratory complications
have been described [11-14]
<<

I accept that this particular Author sees both points as valid.

Cheers

DSM

NightHawkeye wrote:
If the machine had APAP also, I'd consider it a universal machine, but alas, it doesn't. It'll do straight CPAP but not APAP. In auto modes and in BiPAP mode, the difference between inhalation and exhalation pressures must be at least 3 cm.

Bill,

Why would you want APAP mode as well (mode with IPAP = EPAP) ?

What is that going to offer by way of improving therapy over what the
machine offers with all the other modes.

CPAP is a given as it is the fall-back therapy.

Cheers DSM

Anonymous DSM wrote:Why would you want APAP mode as well (mode with IPAP = EPAP) ?

What is that going to offer by way of improving therapy over what the
machine offers with all the other modes.

DSM, I'm not smart enough yet to answer that question. I'm still a neophyte. The subject does seem to come up regularly though, so I thought I'd point out the limitation.

I do have to wonder why the designers left APAP out of the mix for the Auto-BiPAP though.

Regards,
Bill

dsm wrote:I accept that this particular Author sees both points as valid.

I accept that that's the way that particular author sees it....yes.

What I'd be interested in seeing is what the original developers of the very first auto-titrating cpap machine had in mind as the main purpose of such a machine. I think they were probably envisioning it as exactly what they called it -- a machine to do automatic titrations -- as opposed to attended (sleep tech's hands on the wheel, if you will) titrations. I think relief from pressure was a side benefit that the original developers might have realized could happen, but was not their main purpose for inventing an auto-titrating machine in the first place.

Not arguing with you, Doug...just interested in the "why" of inventions. You apparently think the inventors had more in mind at the very beginning than I do.

This would be an interesting topic for Perry to take part in, wouldn't it?