breathing with or against pap?

I am not new to Pap machines, but I’m about to try again having failed previously to adapt for variety of reasons.

I totally understand that there are a variety of factors involved in successfully adapting to pap therapy. I previously tried cpap, bi, & apap, so you’d think I would understand this by now.

That is: outside of Apap, are you the patient expected to
1. adapt your breath rate to the machine rate of inhale exhale? (eg Bipap)
2. supposed to get adjusted to the fact that sometimes you will be breathing *against* the machine and sometimes not? (c/bipap). or
3. slowly get your doctor to adjust the pressure and timing so that it matches your average breath rate during sleep overall?

thx!

I'm not aware of any set-up where you adjust to the machine - it should adjust to you. And pressures are adjusted by how well you do - how high/low your AHI is - at particular pressures which would then be adjusted if you aren't doing well.

PS we all adjust our own pressures - you don't need the doctor to do it for you because the clinician manuals explain that, or people here can help, but I'm referring to the actual 'doing' of adjustment, not necessarily saying you should just wing it with regard to which pressure(s) you need.

With the exception of the ASV models these machines really can't learn how we breathe or adjust to us at all and even ASV relearns each night. These machines can't retain anything once we turn them off.

The only real exception is the machine adapting to our respiration rate is when/if it drops the pressure during exhale...if we have some sort exhale relief turned on.
If exhale relief isn't turned on then the machine simply does its thing and we have to adjust to it. The machine never does any adjusting....our bodies and brains do the adjusting. Now we can make changes to various settings to make it an easier job for the brain/body to adjust to things but the machine itself doesn't go about doing any adjusting on its own.

Why have I always heard/seen the opposite - that we shouldn't try to adjust our breathing to the machine?

AT FIRST, I perceived the pressure switching before I was finished with a breath.
I felt like it was trying to make me breathe faster. It was not.
Eventually, I realized the pressure was never high enough to force me to do anything,
and I continued breathing normally.
That is just the way it works, and now it feels perfectly normal.

Julie wrote: ↑

Sun Apr 10, 2022 8:59 am

"try"

One should not "try" to adjust to the machine. One should let one's brain adjust to the machine.
Much like it adjusts to the mask on one's face, the cervical collar/chin strap one may be using,
or any other device or setting one uses to get optimum therapy.

JPB

Julie wrote: ↑

Sun Apr 10, 2022 8:59 am

Why have I always heard/seen the opposite - that we shouldn't try to adjust our breathing to the machine?

We tell people to breathe normally and not target focus on matching the machine's rhythm because when we do that we start worrying more about breathing and that in turn promotes insomnia trying to "match" the machine. We are trying to get the people just to breathe normally and not fixate on their breathing.

In either mode (fixed or auto adjusting) WITHOUT EXHALE RELIEF of some sort the machine doesn't do anything but blow air at the pressure that it is set to deliver. How is the machine going to adjust to anything???? Think about it. What function in the machine would do any sort of "adjusting" to the patient at all??? The machine has no ability to change anything no matter what our respiration rate might be. The only thing that has any ability to "adjust" to anything is the human involved.

Now when exhale relief is being used in some form or another there is that little thing the machine can do based on respiration while transitioning between inhale and exhale that is supposed to adjust to how each person breathes....EasyBreathe on the ResMed machines and Flex on the Respironics and whatever it might be called on the other brands. It's a small change that occurs with each breath and can change as the breathing changes but the machine isn't "learning" or "remembering" anything. It's just responding to each breath as they occur. The machine doesn't remember our breathing pattern during the first 15 (or whatever) minutes and try to get you to match that pattern 2 hours into the night.

These machines don't remember anything in terms of how it responds to anything.
The only exception would be the ASV machine and the respiration rate it establishes at the beginning of the night and intermittently during the night so that people with central apneas get that breath when they aren't matching their own respiration rate. This is where the back up rate function gets involved. And once the machine gets turned off...it totally forgets what it was doing and when turned back on everything starts all over just like from day one.

Your machine doesn't remember anything and apply something to a different time in the night.
Think about it. What in the machines inner programs actually remembers and will make adjustment because of what it remembers? It can't remember anything. It's not designed to remember or learn to match what the human is doing.

Now there is the small change during the transition from inhale to exhale when exhale relief is offered but that change is based on each breath every time the breath is taking...in the present...and not on how the person was breathing 15 minutes ago (or whatever time ago).

We tell people to not try to match the machine and instead just "breathe normally" so that they don't fixate so much on their breathing.
The machine doesn't or can't change anything anything....but the human brain does change how it looks at what is going on and eventually it changes to the point that this new way of breathing with the machine is now the new normal.
They think the machine learned to match their breathing but in reality the brain just adjusted to the new normal.
When we tell people to breathe normally and not focus so much on their breathing it is a way of telling the brain what is normal or not. We retrain the brain....not the machine.

Now making use of the little tweaking functions available for comfort...that can certainly be done but the human is doing the adjusting....not the machine doing it without human input.

OK, got it! Thanks!

I had at-home "titration" on a Phillips Respironics machine, with exhale pressure relief, and I felt as though it was constantly hustling me to stop exhaling and start inhaling. It was a huge relief to switch to the ResMed Airsense 10 Autoset, which Kaiser gave me after the first week. The ResMed algorithm always follows my breathing to perfection. The same is true with my current machine.

Thanks for all the answers. I've got a ResMed Aircurve 10 right now. Historically, I have always, always felt, in my prior pap attempts with a variety of machines (other pap problems notwithstanding like mask type etc), much like the other posters. Either I always felt like I could never get enough breath out before it wanted me to start inhaling again. Or, when that was mostly fixed, which I think it is now, if I find myself breathing with the machine timing, even when i'm feeling like i'm getting enough oxygen, it feels forced and unnatural, keeping me awake. If I try to breathe at my own rate, then i note that periodically I am trying to breathe against the machine tempo.

So it seems like the advice is basically, get the machine providing enough air to prevent obstructions, with as few other side effects as possible, and then just keep wearing it until you yourself have hopefully adjusted to the machine tempo.


I have another question but will post that separately to keep this thread about the topic.
Thanks pap-ers. : )

There are some comfort settings on the AirCurve that you can alter and get the machine to sync with your own respiration rate a bit better.
Unfortunately I am not able to explain the settings and advise because I have never messed with them and don't understand which way to go.

I will send a note to someone that does understand it better but we need to know exactly how you feel that the machine isn't in sync as well as you would prefer.
Does it seem like the machine is wanting you to start a new breath before you are ready to or is the machine lagging behind?

Oh...you might keep all your thoughts and questions in this one thread just for consistency right now.

I saw your tingling hands thread. It really needs to be here in this thread.
Yes...hyperventilation can of course cause the tingling and if you were complaining about it at the beginning of the night I would be more inclined to blame hyperventilation but we don't hyperventilate during sleep...usually anyway. So after 4 hours of sleep to wake up with tingling is very odd indeed.

We really need to see the OSCAR software detailed reports to see if anything in it might point to something weird going on.
Otherwise we are just doing WAGs....wild ass guesses.
We prefer not to do WAGs when we have access to data.
The detailed report should show if you were hyperventilating just prior to the wake up and the notice of the tingling symptoms.

johnspartan wrote: ↑

Sun Apr 10, 2022 7:17 am

1. adapt your breath rate to the machine rate of inhale exhale? (eg Bipap)
2. supposed to get adjusted to the fact that sometimes you will be breathing *against* the machine and sometimes not? (c/bipap). or
3. slowly get your doctor to adjust the pressure and timing so that it matches your average breath rate during sleep overall?

1) no, the machines (every one except a bilevel ST or ASV (or VAPS) machine is triggered off YOUR breathing.
2) no
3) possibly

Miss Emerita wrote: ↑

Sun Apr 10, 2022 10:52 am

I had at-home "titration" on a Phillips Respironics machine, with exhale pressure relief, and I felt as though it was constantly hustling me to stop exhaling and start inhaling. It was a huge relief to switch to the ResMed Airsense 10 Autoset, which Kaiser gave me after the first week. The ResMed algorithm always follows my breathing to perfection. The same is true with my current machine.

Respironcs exhale relief (*flex) has a process that, on paper (which I'm sure is as far as they went with thinking it through) looks good. As you're finishing your exhale, it raises the pressure back up to the non-exhale relief pressure, in preparation for start of the next inhalation, this (again, in theory) makes sense, your airway is open when you're exhaling, so get the pressure up to keep it open for the next inhalation.

Like so many un-thoughtout ideas, it's not as good a idea as it seems. The flaw in this one is it makes many users *THINK* that the machine is trying to rush them to take another breath, I've heard the same comments from MANY people.

In fact, the machine isn't rushing your breathing, it just *feels* like it is, and that is, understandably, quite disturbing to people that notice it. another 'bright idea' from Respironics that really isn't

johnspartan wrote: ↑

Mon Apr 11, 2022 9:09 am

Thanks for all the answers. I've got a ResMed Aircurve 10 right now. Historically, I have always, always felt, in my prior pap attempts with a variety of machines (other pap problems notwithstanding like mask type etc), much like the other posters. Either I always felt like I could never get enough breath out before it wanted me to start inhaling again. Or, when that was mostly fixed, which I think it is now, if I find myself breathing with the machine timing, even when i'm feeling like i'm getting enough oxygen, it feels forced and unnatural, keeping me awake. If I try to breathe at my own rate, then i note that periodically I am trying to breathe against the machine tempo.

So it seems like the advice is basically, get the machine providing enough air to prevent obstructions, with as few other side effects as possible, and then just keep wearing it until you yourself have hopefully adjusted to the machine tempo.

I need to know what the settings are on your machine, (as Pugsy mentioned when she asked me to comment on this thread) and in addition to the graphs that we normally request ( https://www.cpaptalk.com/wiki/index.php/Oscar:organize ) please show me the inhalation time graph.

I *suspect* that you've got some amount of pressure support set, and you're trying to breathe slowly, and hitting the TiMax time (default 2 seconds) where the machine drops pressure even if you're not finished with your inhalation.

Most machines are purely driven by you and have no respiration rate timings of their own. Specialized machines like the ST, ASV an iVAPS do have backup rates and will force air into you when you don't try to breathe normally, because they're programmed to treat central apnea, or lung diseases where people *don't* try to breathe on their own.

johnspartan wrote: ↑

Mon Apr 11, 2022 9:09 am

I have another question but will post that separately to keep this thread about the topic.

We wish you wouldn't, because your issues are often interrelated, the real topic is YOU and making your sleep more effective.

palerider wrote: ↑

Mon Apr 11, 2022 12:26 pm

We wish you wouldn't, because your issues are often interrelated, the real topic is YOU and making your sleep more effective.

very well put, sir.