id="Mask Bright" style="width:728px;margin:auto;float:center";z-index:8"> Free CPAP Advice and Sleep Apnea Treatment Help Board • View topic - APAP Duration of Increase after Occlusion / Obstruction
FAQ
It is currently Tue Jan 19, 2021 4:14 am

As an Amazon Associate, I earn from qualifying purchases.
Please consider a small PayPal donation to FreeCPAPAdvice.com above.Thank you so much for your support!



Author Message
EnlightenMe
Unread post  Post subject: APAP Duration of Increase after Occlusion / Obstruction  |  Posted: Sat Oct 31, 2020 5:38 am

Joined: Sat Oct 31, 2020 5:11 am
Posts: 20
PAP Mask: ResMed Airfit F30i
PAP Machine: ResMed AirSense 10 (on Soft Mode)
Pressure Setting: 6-12

Offline
Hi! I'm new here and new to CPAP / APAP.

I've searched high and low on the Internet and this board and can't seem to find the answer. Once an occlusion is cleared by increased pressure, how long before the pressure is reduced? My DME Tech said it was a few breaths, but I'm finding that even after several minutes, the pressure doesn't come down. IDK if my machine is defective or if this is the way it's supposed to work.

For instance, woke this morning (after 2nd night) and pressure was 8.8 (very uncomfortable for me). Lay awake for 5 minutes and pressure didn't ramp down. Restarted machine and pressure stayed at minimum of 6 until I turned it off 15 minutes later.

There are some other strange things going on. I have an appointment at the DME next week for them to look at it. Went out and bought an SD card and reader last night so will set up Sleepwalker and Oscar. Hoping there's helpful data and not just the basic stuff that's on the screen and the useless Dreammaker app.

Thanks in advance! I may be asking several question so please bear with me.

--Leslie

P.S. Preview is not showing my sig line with my equipment list despite having entered it and checking the "display signature" box. So:

Dreamstation APAP dsx500h11c w/humidifier
Philips Respironics Nuance Pro Nasal Pillow
Pressure: 6-12


Top
LSAT
Unread post  Post subject: Re: APAP Duration of Increase after Occlusion / Obstruction  |  Posted: Sat Oct 31, 2020 6:50 am

Joined: Tue Sep 05, 2017 9:40 am
Posts: 657
Location: WI
PAP Mask: F & P Simplus
PAP Machine: Airsense 10 Autoset
Pressure Setting: 12-20

Offline
That's the way it's supposed to work. You have an auto machine. With a minimum pressure setting of 6..it should stay in that area if there is no apnea action....If there are breathing irregularities the machine will adjust the pressure as needed...in your case between 6 and 12. Both are low settings. If the pressure was 8.8 when you woke, that is awake pressure...you have no idea what your pressure was while sleeping.


Top
Pugsy
Unread post  Post subject: Re: APAP Duration of Increase after Occlusion / Obstruction  |  Posted: Sat Oct 31, 2020 6:59 am
User avatar

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 2112
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirCurve 10 VAuto

Offline
1....the auto adjusting pressures don't do anything at all during the apnea event. It can't "clear" and obstruction. It doesn't respond at all during the event. There is no pressure increase during the actual event unless the machine is an ASV type of machine which yours isn't. That's not how the auto adjusting algorithm works.

2....It can take 20 minutes or more for any real changes in pressure to occur either upwards or downwards with the Respironics machines. They respond slowly. It's just how they work. If you wake up and feel the pressure is too high the best and quickest way to have it return to lower pressures is to do what you finally did. Turn it off and restart it.

The pressure on the auto adjusting algorithm goes up in an effort to prevent the airway from collapsing and it factors in not just any apnea events that it might have sat through but also flow limitations and snores that might have happened. There was a lot more going on to get your machine up to 8.8 cm than just one apnea event and there is a good chance the flow limitations kept the pressure up.

_________________
I may have to rise but I refuse to shine.


Top
EnlightenMe
Unread post  Post subject: Re: APAP Duration of Increase after Occlusion / Obstruction  |  Posted: Sat Oct 31, 2020 8:00 am

Joined: Sat Oct 31, 2020 5:11 am
Posts: 20
PAP Mask: ResMed Airfit F30i
PAP Machine: ResMed AirSense 10 (on Soft Mode)
Pressure Setting: 6-12

Offline
Thanks for the responses.
Pugsy:
1) I'm using the terminology the guy at the DME used. It might not be correct terminology. But if CPAP doesn't do anything to "clear" (insert terminology of choice here), then why do we use them? From what I understand, when there's an occlusion (I've heard "occlusion" and "obstruction" used interchangeably) or an obstructive apnea event, the APAP machine ramps up the pressure until the airway is forced open. Am I missing something?

Also, my machine is an APAP which utliizes adaptive pressure based on my breathing patterns (hence my pressure range of 6-12). I double-checked because I was unfamiliar with the term ASV. I have watched the pressure go up and down on the display while using it.

I was able to learn a bit more here:
http://www.aastweb.org/blog/what-is-asv

2. Thanks for that info - makes the sustained pressure of 8.8 make more sense and leaves me with less confidence in the DME (along with other things). But - Hmmmm - I have watched the pressure go up and then down fairly quickly. I'm new to all this, so maybe I need to just spend some more time to get to know my machine

LSAT:
What you and Pugsy are describing makes more sense than the simplified explanation the DME dude gave me.

Anyone with Medicare ever fired their DME and gotten their machine from somewhere else? If I return this in 30 days, they won't bill Medicare. He told me it was an $1800 machine but I've found it for as little as $400 - mostly in the range of $700-800. I'm not sure what my rental cost will be over 13 months, but if it exceeds $160, I'd rather pay $160 up front (20% of $800) than pay more.

Sigh. So much to learn. Thanks again for the replies.


Top
DeltaBravo3.8
Unread post  Post subject: Re: APAP Duration of Increase after Occlusion / Obstruction  |  Posted: Sat Oct 31, 2020 9:05 am
User avatar

Joined: Sat Jul 04, 2020 8:38 am
Posts: 459
Location: Waynesboro, Pennsylvania, USA
PAP Mask: F&P Vitera & Simplus, ResMed F20 N/P30i & old Amara View
PAP Machine: RT says I need NIV ResMed Astral 150 soon
Humidifier: not now
Pressure Setting: wait for NIV

Offline
Respironics machines need to be set very close to where your airway is kept open. They do respond slower to events than a ResMed. I always base my thinking on therapy that you need to prevent the airway collapse, not expecting the PAP machine to attempt to open the airway after a collapse.

ASV is a type of machine I have that combats Central Apnea and Obstructive Apnea. ASV-Adaptive Servo Ventilation. Your Auto CPAP is not ASV. The ASV is the most expensive CPAP class machine there is, and it's specifically for combat of CA. The ASV is a bilevel machine with backup breath rate. It is not prescribed or issued to everyone.

Almost every DME drastically overprices their machines. They have to accept the agreed to pricing from the insurance, Medicare or whoever. If you were to buy a machine yourself, the local DME is not a good buy for you however, as they will price it as if you're insurance, but you have no agreed price contract.

If the option to return the rental to the current DME and you can move the therapy to another without incurring fees, you may wish to consider it.

And if you do so, I suggest very strongly you consider getting a ResMed AirSense 10 AutoSet or AutoSet For Her. Why? It has been proven to offer better therapy for 90% or more PAP users. And the machine typically lasts longer for most as well. I hear less feedback on problems with therapy or machine quality with ResMed. Is it enough of a difference to bother? Absolutely yes.

Where your Respironics is slow and you need to set pressures at therapy need, the ResMed is more forgiving due to quicker response, it also has a trick up its sleeve, EPR or Exhale Pressure Relief. It is a reverse acting Pressure Support of the Bilevel Pressure Support that reduces exhale pressure by 1, 2, or 3 cmH2O to be more comfortable and increase therapy effectiveness.

_________________
Dave K9DWB 73s

https://www.sleepfiles.com/OSCAR
http://www.apneaboard.com/wiki/index.php/OSCAR_Help
http://www.apneaboard.com/wiki/index.php/OSCAR_Chart_Organization


Top
Pugsy
Unread post  Post subject: Re: APAP Duration of Increase after Occlusion / Obstruction  |  Posted: Sat Oct 31, 2020 9:21 am
User avatar

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 2112
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirCurve 10 VAuto

Offline
We use the cpap/apap machines so that the minimum or baseline pressure will hold the airway open and PREVENT the collapses/obstructions (doesn't matter what you call them) from ever happening in the first place.
The pressure acts like a stent to hold the airway open. The increase come about from special pressure needs situations like when we might be on our back or maybe during REM stage sleep which can worsen OSA and/or cause more pressure to be needed.

These machines can't force airway tissues to be opened in the event of a collapse. They can't generate that much pressure. Even at 20 cm it won't even blow up a balloon so it sure won't move a floppy tongue or saggy airway tissues.

The person who supplied you the machine...quite honestly doesn't know their butt from a hole in the ground in terms of function.

With Medicare your first month cost for the 13 month rent to own thing will be your most expensive monthly cost. This is because the first month includes the humidifier cost which is an up front purchase as well as probably the hose and mask. Subsequent monthly rental 20% cost to you will be a lot less at least until January when the Part B deductible starts all over again. CPAP equipment falls under Part B coverage.
Depending on where you live and what they do in Jan...expect to pay roughly 30 to 40 bucks a month "rental" for just the machine.
Usually when using Medicare alone (not the Advantage plans which opens up a whole different can of worms and if you have an Advantage plan we need to talk) your total out of pocket will still be less than if you purchased the exact same machine online somewhere.

But yes, you can fire the DME and buy a machine yourself if you wish and not worry about the DME hassle....and actually still use the DME for masks and other supplies if you wish...and you can change DMEs if you wish.
I did just that when I started cpap. The first DME lied to me and I ended up finding the machine I wanted on craigslist locally for essentially the same as my copay would have been if I had used my Medicare. I went to another DME for my masks and other supplies. Told them I had my own machine and wanted to use them for other supplies. While they would have loved to also sell me a machine...they were more than happy to just supply masks and file my insurance. Probably hopeful that at some time in the future I would end up getting a machine from them.
That's okay...I don't blame them for that. It's been 11 years now and they still haven't got to sell me a new machine. I have always shopped smart and found maybe slightly used machines at much less than what my 20 % copay would be. Plus I avoid big brother compliance requirement issues.

Medicare compliance usage requirements so that they will continue to pay for the machine...you have 90 days to have 30 consecutive nights where you use the machine at least 4 hours a night for 70% of those nights....so 21 nights essential. PLUS you have to have a face to face visit with your doctor documenting that use plus the fact that it is working. If you don't have that face to face visit (or might be via internet in the covid age) then Medicare won't pay for the machine at all.

Now I always knew I would more than meet the compliance usage and going to see the doctor for that face to face wasn't a big deal but I just prefer doing my own thing and not have big brother watching over my shoulder. Plus if I wanted to change something on my machine I didn't have anyone telling me "you shouldn't do that".

But you can change DMEs if you wish at any time and you can go the self pay route if you wish. A little bit of paperwork is involved if you change but it can be done.

Now if you do want to change....find out if a DME in your area who works with Medicare sells/dispenses ResMed machines. The ResMed AirSense 10 AutoSet is essentially the equal to the Respironics Auto CPAP model DSX500....but its auto adjusting algorithm is a bit quicker in its response both up and down with the pressure changes. While still not as fast as you might have thought changes should happen... but faster than the Respironics will change pressures. None of these machine will change pressures in the blink of an eye or do anything at all when the soft tissues in the airway are blocking things. They simply won't do it.
They all work best on the premise of preventing the airway from collapsing in the first place.

You use the machine to prevent something bad from happening...not to fix it when it is actually happening.

_________________
I may have to rise but I refuse to shine.


Top
EnlightenMe
Unread post  Post subject: Re: APAP Duration of Increase after Occlusion / Obstruction  |  Posted: Mon Nov 02, 2020 8:35 am

Joined: Sat Oct 31, 2020 5:11 am
Posts: 20
PAP Mask: ResMed Airfit F30i
PAP Machine: ResMed AirSense 10 (on Soft Mode)
Pressure Setting: 6-12

Offline
Thanks again for your help! I've decided to fire my DME and am shopping for a new one. I'll be getting the ResMed based on your recommendation. I also have some questions that I'll search on first and then post a new topic if necessary. You all are the best!


Top
DeltaBravo3.8
Unread post  Post subject: Re: APAP Duration of Increase after Occlusion / Obstruction  |  Posted: Mon Nov 02, 2020 9:52 am
User avatar

Joined: Sat Jul 04, 2020 8:38 am
Posts: 459
Location: Waynesboro, Pennsylvania, USA
PAP Mask: F&P Vitera & Simplus, ResMed F20 N/P30i & old Amara View
PAP Machine: RT says I need NIV ResMed Astral 150 soon
Humidifier: not now
Pressure Setting: wait for NIV

Offline
Myself I'd keep the new posts here unless the new posts are completely unrelated to this current conversation. I think it's easier to keep the convo. going with the whole thread intact. We get to see new info and refresh the memory as necessary in the same one stop shop type of thing.

_________________
Dave K9DWB 73s

https://www.sleepfiles.com/OSCAR
http://www.apneaboard.com/wiki/index.php/OSCAR_Help
http://www.apneaboard.com/wiki/index.php/OSCAR_Chart_Organization


Top
Display posts from previous:  Sort by  
Print view

Who is online
Users browsing this forum: No registered users and 10 guests
You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum
Jump to:  


Delete all board cookies | The team | All times are UTC - 8 hours [ DST ]

Powered by phpBB © 2000, 2002, 2005, 2007 phpBB Group
DAJ Glass 2 template created by Dustin Baccetti
id="Mask Bright" style="width:728px;margin:auto;float:center";z-index:8">