A little guidance please

[TonyJ]

Last night was my first night using a ResMed machine. Have for the last 6 years used Respironics. The first nights results are completely out of character and I am trying to get a handle of what could be the primary issue. As you can see almost all of my events are centrals. Pressure range set 9-20 with an EPR at 2. For the most part of the last couple of years I had been using fixed pressure at 9.5 or 10 and the 95% shown on this night appears within that range. The leak rate shown is double my usual so don't know if that plays a part.
I am sure there is probably a simple solution but I don't consider myself anything of an expert on these machines. This is also my first experience posting a report so please be nice if I screwed up. My usual ahi with the Respironics was in the 1-2 range although winter seems to bring out some sort of bogeyman and it goes up a bit. Hopefully someone has a simple answer. Any guidance would be greatly appreciated. Thank you.

[Gideon]

Welcome to the forum.

ResMed machines are more responsive than Respironics. Let's work on getting this dialed in.

First let's decrease both your min pressure and your EPR by 1. I want to keep your exhale pressure the same.

I want to see a 2 minute view of 2 different ca clusters. Specifically I want to see if they are being brought on by increased flushing of CO2 from the ResMed machine.

[OpalRose]

I suspect its the use of EPR that is causing the Clear Airways. I would dial it down to 1 or even off.

Did you use the Flex feature on your Respironics machine?

[Osiris357]

To add to the above if they are Co2 based centrals and drastically reduce with EPR on 1 or off completely, you should be able to raise the exhale pressure relief back up to 2 or even 3 slowly as your body gets used to the increased ventilation. I had to do the same thing.

[Sleeprider]

I think the idea of reducing the minimum pressure to 8.0 and EPR to 1.0 as suggested by Bonjour is on-target, however, don't be in too big of a rush to judge your therapy on the Resmed based on the first night. Some CA events are normal when making a therapy change, and I suspect if you did nothing, the event rate would drop.

On future charts, you can replace mask pressure with flow limitation since mask pressure has the same data as pressure. What mode are you using? For her, or Standard?

[DaveL]

TonyJ I'm very interested in your post. You have a machine that I wish I had!

I'd like to read along.

The people here are so knowledgeable and helpful. That machine will soon be tuned, and your treatment will improve. I know you've been here a while.

[TonyJ]

Thanks for the replies to date. I will try adjusting the pressure and EPR as some of you have indicated. I know that a lot of those centrals were junk as I had a very restless night .. trouble falling asleep and when awakened falling back to sleep. The centrals after 6 am I was definitely awake. However I must say I was somewhat anxious because it was my first night on new brand so that might have had an influence there.

Fred... not sure what you mean : "I want to see a 2 minute view of 2 different ca clusters. Specifically I want to see if they are being brought on by increased flushing of CO2 from the ResMed machine". How would I be able to do this? To help me understand the science... why the lowering of the min. pressure? 

Rose: yes I did use flex on the Respironics

Sleeprider: I am set to the standard mode

My first impressions of the ResMed are that I hate their on/off button and much prefer the Respironics in that regard. Same goes for the humidifier setup. I think although the Respironics takes up a bit more space the humidifier in my opinion is much easier to work with on the Respironics. Regardless it is what it is just my 2 cents. I am prepared to see ResMed come out with a new machine soon that will be better in that way just to p me off.

With the PR1 my main problems were with hypopneas. I would occasionally see some centrals but usually mostly just junk i.e less the 10 second duration or when awake.

Thank you all for taking the time to respond to my SOS. It is much appreciated.

[Sleeprider]

Tony, with the Resmed, turn on Smartstart in settings and you will never use the on-off button. The machine is very responsive to turn on within a breath or two, and will shut down within 5-seconds of taking off the mask. I'm still pretty certain you would see fewer events, even without setting changes, and I suspect we will eventually add back the EPR we are taking away.

[OpalRose]

My first impressions of the ResMed are that I hate their on/off button and much prefer the Respironics in that regard. Same goes for the humidifier setup. I think although the Respironics takes up a bit more space the humidifier in my opinion is much easier to work with on the Respironics. Regardless it is what it is just my 2 cents. I am prepared to see ResMed come out with a new machine soon that will be better in that way just to p me off.

I have the same thoughts as you do above.  I'm currently trialing a ResMed machine and tend to compare.  Yes, the Respironics is bigger and bulkier, but in my opinion made sturdier than the ResMed.

Also, I think it's normal to have a restless night when trying out something new. We are creatures of habit.

With that said, I believe the ResMed will give you better results in the long run, so try out the suggested settings, settle in and give it some time.  

[Gideon]

Fred... not sure what you mean : "I want to see a 2 minute view of 2 different ca clusters. Specifically I want to see if they are being brought on by increased flushing of CO2 from the ResMed machine". How would I be able to do this? To help me understand the science... why the lowering of the min. pressure? 

Click on an event multiple times until you are down to a 2 minute window so we can see the breathe by breath view of your charts so we can analyze what is happening.
EPAP or Exhale pressure is what treats obstructive Apnea. Reducing EPR, because it subtracts from the inhale pressure or IPAP, effectively raises your effective treatment pressure. We don't want to do this in your case so we compensate by raising your min (IPAP) pressure to keep your exhale pressure the same.