A machine that gives a burst of air when you stop breathing?

[Jayjonbeach]

I'm just wondering if different manufactures handle this differently from anyones experience?

Obviously with CPAP, there is no compensation at all if you stop breathing.

With APAP, algorithms will detect flow loss and increase pressure.

I don't know for sure (since when I used APAP I was asleep! and it was a short period of time) but it seemed to me that any increase was VERY subtle, and probably by design.

What I am wondering is has anyone noticed a machine that is not so subtle about thsi increase?

TIA

[Bons]

My ASV is definitely not subtle. The IPAP and EPAP are set at very different levels. If it thinks I should breathe, the pressure surges.

[Hueffenhardt]

There was a bench trial of 5 APAP machines to see how they responded to apneas among other things. Here is a link: http://www.inspiredrc.com/McCoy%20et%20 ... vices1.pdf

You can see from the graphs that the IntelliPap barely raised the pressure during an apnea. The other four raised the pressure significantly, with SleepStyle 200, S8, and Sandman all responding quickly and aggressively. RemStar was a little slower about raising its pressure, but still got its pressure up there.

[HoseCrusher]

I don't know if I would call it a "burst," but the S8 in both APAP and CPAP increase the pressure a little when it figures it is time for you to breathe in.

[Jayjonbeach]

Thanks for the responses.

There was a bench trial of 5 APAP machines to see how they responded to apneas among other things. Here is a link: http://www.inspiredrc.com/McCoy%20et%20 ... vices1.pdf

You can see from the graphs that the IntelliPap barely raised the pressure during an apnea. The other four raised the pressure significantly, with SleepStyle 200, S8, and Sandman all responding quickly and aggressively. RemStar was a little slower about raising its pressure, but still got its pressure up there.

WOW, that is an awesome doc, thanks very much pretty much exactly what I was looking for

[Jayjonbeach]

I don't know if I would call it a "burst," but the S8 in both APAP and CPAP increase the pressure a little when it figures it is time for you to breathe in.

I don't think ANY machine in CPAP mode will ever increase the pressure since it is a Constant or Continous pressure.

[HoseCrusher]

I have a setting for EPR inhale that I think overrules the straight CPAP mode.

[rested gal]

There was a bench trial of 5 APAP machines to see how they responded to apneas among other things. Here is a link: <snipped -- link appears below this quote>

You can see from the graphs that the IntelliPap barely raised the pressure during an apnea. The other four raised the pressure significantly, with SleepStyle 200, S8, and Sandman all responding quickly and aggressively. RemStar was a little slower about raising its pressure, but still got its pressure up there.

http://www.inspiredrc.com/ - PDF: White Paper: " A Bench Comparison of Five Auto-Adjusting positive Airway Pressure Devices, Rresponse to Apnea, Hypopnea and Flow Limitation"

Regarding bench test comparisons of autopaps:

Very Interesting Article(Long!) - topic started by DoriC - Nov. 4, 2009
viewtopic.php?p=416814#p416814
Note especially the posts by -SWS and ozij

This actually the first such benchmark comparison in which the authors take into a account a point made by -SWS years ago: The mahcines in this simulation are not getting any response from the mechanical device connected to them. And this is the first time (IIRC) that the results are analysed withing this proper context.

I am glad that some writing sleep professionals recognize that feeding the same machine-generated SDB signal into an APAP again and again fails to help assess an overall APAP treatment algorithm. It's kind of like assessing each member of a chess team by watching nothing more than their opening move---again and again and again!

It's especially hard to compare all that when you submit machine-generated opening chess moves to an APAP algorithm. Unfortunately there is no interactive back-and-forth---no crucial sequences of human responses each followed by machine counter-responses--- in any methodology like that. There is thus no unveiling of each APAP algorithm's treatment strategy. And if any given testing methodology precludes observance of that treatment strategy, then that same treatment strategy logically cannot be assessed by the methodology.

___________________________________


Need Resmed education - topic started by carbonman - May 9, 2009
viewtopic.php?p=366979#p366979

Note especially the posts by -SWS, velbor, jnk, and ozij
On page 4 of that topic:

Carbonman, you're absolutely right about myriad variables in physiology allowing for unpredictability. The PAP machine with an algorithm is but one "black box" or system pitted against a far more complex, far more varied, and far more mysterious system: the human body.

Predicting an end-to-end system response or treatment outcome is virtually impossible in most cases, where preclusive factors or information are not apparent. And I have vehemently argued that precise point in the past.

Link to -SWS's "vehemently argued" points: viewtopic.php?f=1&t=16570&p=140802&#p140802

In a nutshell, these two salient factors are remiss in my opinion: 1) the composite patient signal has been stripped of all but one essential component, and 2) A two-way patient-feedback loop between man and machine has been neither preserved nor simulated. Snore in particular is perhaps the single most important missing input. But collectively the missing composite patient-event inputs (some relying on a two-way system feedback loop, some not) are of far greater magnitude than any single deficiency in this methodology.

[Jayjonbeach]

I have a setting for EPR inhale that I think overrules the straight CPAP mode.

Actually I should have mentioned this BUT EPR is for exhale, not Inhale. It also happens automatically and is not compensation for when you stop breathing, which is what I am interested in specifically.

The funny thing I guess is EPR does kind of kick in when you stop breathing, almost before you stop actually, a well documented and discussed issue where people think the EPR kicks in too fast. (and I feel the same about it and have trouble with a higher setting, it feels like you don't get to take your whole breath).

All this EPR is is exhale relief and has nothing to do with you actually having an apnea. If your pressure is 10, you can set the machine so you exhale out against 8, then when you finish exhaling it goes back to 10 for the inhale. So in a way this is a burst of air, just not one that is working for me and not one designed to stop apneas. (though it could who knows)

[HoseCrusher]

I have normal EPR that allows me to reduce the pressure by 1, 2, or 3 cm H2O while breathing out, but in addition to that I have another setting that is labeled EPR inhale. It allows me to chose between fast and medium.

In thinking about it a little more, it could be that if you use an EPR of 3 and have EPR inhale set to fast, the additional 3 cm of H2O pressure may be interpreted as a burst of air. I am usually asleep just as I notice this. I will have to pay more attention and see if that is what is going on.

[HoseCrusher]

I forgot to add that if you have EPR inhale set to fast and EPR set to 3, you would probably perceive the change over as a burst of air.

[Jayjonbeach]

See this document:

http://www.resmed.com/assets/documents/ ... ow_eng.pdf

All the EPR inhale controls is how fast you get back up to your regular pressure from the EPR pressure. So on fast, you get back to 10 faster than on Med (in the example I gave).

Either way, EPR has nothing to do with Apneas and pressure control and that is what I am specifically interested in.

[Jayjonbeach]

There was a bench trial of 5 APAP machines to see how they responded to apneas among other things. Here is a link: <snipped -- link appears below this quote>

You can see from the graphs that the IntelliPap barely raised the pressure during an apnea. The other four raised the pressure significantly, with SleepStyle 200, S8, and Sandman all responding quickly and aggressively. RemStar was a little slower about raising its pressure, but still got its pressure up there.

http://www.inspiredrc.com/ - PDF: White Paper: " A Bench Comparison of Five Auto-Adjusting positive Airway Pressure Devices, Rresponse to Apnea, Hypopnea and Flow Limitation"

Regarding bench test comparisons of autopaps:

Very Interesting Article(Long!) - topic started by DoriC - Nov. 4, 2009
viewtopic.php?p=416814#p416814
Note especially the posts by -SWS and ozij

This actually the first such benchmark comparison in which the authors take into a account a point made by -SWS years ago: The mahcines in this simulation are not getting any response from the mechanical device connected to them. And this is the first time (IIRC) that the results are analysed withing this proper context.

I am glad that some writing sleep professionals recognize that feeding the same machine-generated SDB signal into an APAP again and again fails to help assess an overall APAP treatment algorithm. It's kind of like assessing each member of a chess team by watching nothing more than their opening move---again and again and again!

It's especially hard to compare all that when you submit machine-generated opening chess moves to an APAP algorithm. Unfortunately there is no interactive back-and-forth---no crucial sequences of human responses each followed by machine counter-responses--- in any methodology like that. There is thus no unveiling of each APAP algorithm's treatment strategy. And if any given testing methodology precludes observance of that treatment strategy, then that same treatment strategy logically cannot be assessed by the methodology.

___________________________________


Need Resmed education - topic started by carbonman - May 9, 2009
viewtopic.php?p=366979#p366979

Note especially the posts by -SWS, velbor, jnk, and ozij
On page 4 of that topic:

Carbonman, you're absolutely right about myriad variables in physiology allowing for unpredictability. The PAP machine with an algorithm is but one "black box" or system pitted against a far more complex, far more varied, and far more mysterious system: the human body.

Predicting an end-to-end system response or treatment outcome is virtually impossible in most cases, where preclusive factors or information are not apparent. And I have vehemently argued that precise point in the past.

Link to -SWS's "vehemently argued" points: viewtopic.php?f=1&t=16570&p=140802&#p140802

In a nutshell, these two salient factors are remiss in my opinion: 1) the composite patient signal has been stripped of all but one essential component, and 2) A two-way patient-feedback loop between man and machine has been neither preserved nor simulated. Snore in particular is perhaps the single most important missing input. But collectively the missing composite patient-event inputs (some relying on a two-way system feedback loop, some not) are of far greater magnitude than any single deficiency in this methodology.

Yes the document that was linked above (near top of thread) has some great comparisons in it but yes it is a very inconclusive and small study.

What they should have is an automated "reaction" instead of none, and one that matches how the majority of people and add that to the study.

Thanks for your reply and the other links