difference of pressure between Lowenstein and Resmed - bloating

[urielh]

Hlello,
I have a question concerning my new ResMed AirSense 10 AutoSet Elite in comparison to my previous Löwenstein Medical Prisma Smart CPAP .

I 've been using a CPAP for 4 months now, with a Löwenstein Medical Prisma Smart, with an autoset of 4 to 10 (no ramp, no other options activated). The mask I use is the Fisher & Paykel Evora Nasal Mask with Headgea.

Everything was fine with my Löwenstein, but as I'm moving out of the country, I had to buy a new machine (the Lowenstein one is a rental) .

I tried the Resmed Airsense 10 last night, with the same setup "autoset, 4 to 10" but I felt the pressure much strongly. My mask was having more leakage and I experience for the first time since starting using a CPAP , a LOT of bloating (a lot of air in my stomach, which kept waking me up during the night). It's the exact same setting so I don't understand why, even on 4 , it feels like a much stronger airflow. I feel that my lungs are constantly inflated.

Also, I don't know whether that could give more info, generally with the Lowenstein, I was on an average of 5/5.5 to correct my apnea (I'm quite petite, but have apnea because I'm hyperlaxe, so i don't need a lot of pressure) but tonight with the Resmed 10 my average was at 7.8.

I asked my husband to try the two machines side by side, to see if he also noticed a difference and he did. The airflow on 4 feels stronger on the Resmed and it makes you breath harder. It's also more difficult to replace the mask on my nose correctly as the airflow pushes/inflates the silicone of the mask more than with the Lowenstein CPAP.

What could be the reason for experiencing so much bloating (which like as said, never happened to me before), plus this feeling of inflated lungs, even thought the settings are the same on the two machines?

Thank you for your help!

[WisNaeMe]

Generally Löwenstein machines have a reputation for delivering their therapy at lower and more progressively applied pressures, whereas ResMed machines are regarded as having a more aggressive response. While this is fairly subjective, it may account for your experience after changing machines.

You may find that after a few days on your new machine, things settle down as your body becomes accustomed to the changes of their own accord and so you don't need to do anything. But if not, then -

You could consider using a 19mm hose on the ResMed to reduce the air velocity and so soften the response (I’m presuming you currently use a 15mm hose); OR use a VCOM device to reduce inspiratory pressure; OR apply some EPR to reduce your expiratory pressure - I'm not clear if you're experiencing problems with breathing IN, OUT or both. Over the counter 'Wind Relief' tablets (active ingredient - Simethicone) can help with the bloating if it's relatively mild. Each of these might help with your aerophagia (bloating) and / or mask problems too. You’ll find each of their merits described and debated elsewhere on ApneaBoard.

…OR you could adjust / re-titrate your pressures. Though for this, you will need to download OSCAR (free from this site, see links above). But it would then give you a better understanding of what’s going on and the effectiveness of any changes you make. Folks here can then advise further if you post your OSCAR charts to this site. You’ll need an SD card in your machine to use OSCAR (again, see links above).

Others may be along to suggest which of the above might be the better option for you.


As an Aside - Make sure you keep a copy of the data (or hold onto the SD card) from your Löwenstein before you hand it back.

Data from both these machines can be imported into OSCAR. It might then help you (and others here) make sense the differences you are experiencing and see how your therapy is progressing in future. I would advise creating separate profiles in OSCAR for each machine, as having data from different makes of machine in a single profile can get messy.

[Narcil]

Since you didn't mention it, i assume you're using the same mask? Is it a new machine? it's harder on inhale and exhale? maybe turning on EPR if it isn't would help not sure if you were using pressure support with the Lowenstein.

Maybe you can post some data so we can see why the resmed is ramping up pressure.

did you compare pressure in cpap mode or in apap mode? the only thing i can think is of is the different in algorithm applies pressure slightly differently. you wouldn't be the first one to have issues adapting to a new algorithm. possibly that's what is also causing aerophagia, the change in breathing pattern you aren't used to yet.

just guessing here never tried a lowenstein.

[Stubert]

I have had both machines. The Löwenstrein reacts slower to flow limitations than the Resmed, when algorithm setting is in "standard mode". Resmed reacts to them much quicker and therefore, in general, mreaches a higher pressure. You can use dynamic mode on the Löwenstein and then it will be more responsive. It might have had softpap setting enabled, which makes breathing more comfortable?
I would leave out EPR until you have an idea about your optmimal pressure range (if needed, as your pressure range is from 4-10 and small pressure needed. If you have flow limitations after looking into Oscar, it could be necessary to add EPR.
Check that your hose size is correct in settings. If you use 19mm hose on 15mm setting you will have much stronger pressure.

[urielh]

Hello, thank you Narcil  for taking the time to reply. 

Yes, it is a new machine and i'm using the same mask on both. That's what made me realize I wasn't imagining this difference of pressure.
I also thought this could be the reason (the way the machine deals with the pressure, like you said). I will try to keep on using it and see if I adapt to it. If not, I will come back here for some advices^^ 
I'm sorry I'm quite new to CPAP, so I don't know all of the tips and tricks yet! The Lowenstein is a rental via a healthcare provider, and I had a technician take care of everything for the first few months, in order to adapt it to me perfectly. Therefore, I couldn't really modify anything as they were monitoring it quite strictly.
They told me that the only thing I had was the autoset mode from 4 to 10 (and nothing to reduce the exhale pressure).

As for your question "it's harder on inhale and exhale?" I guess the difficulty is with exhale, as I feel that it's pushing air too strongly into my lungs. But the inhale is not comfortable (I have the image of someone blowing air in a balloon, but with my lungs! haha) I have the feeling that, as soon as I inhale a little more strongly than usual, the algorithm pushes air strongly really fast (and maybe too much compare to what I need, or am used to. That might be the reason it feels suffocating) I will have a look on how to turn EPR on =)

***
Thank you WisNaeMe!
Your explanation is really helpful and I think you're right about the difference between Resmed and Lowenstein. The Lowenstein feel way gentler. I guess I will get used to the resmed. It might be a little challenging since I'm quite slim and have hyper-laxity (I lack collagen in the structure of my body connective tissues, therefore a little "push" pushes me a lot more than the average person).
I will try to change the tubing. I think I have a larger one at home. This might indeed be better. I will also try to find a Vcom! (As I was saying above, I have difficulty exhaling, but also have too much air pressure pushed into my lungs when inhaling. I feel like a constantly full balloon ^^ I had never felt that with the Lowenstein (and never had air go into my stomach)

Thank you for telling me about the chart! I haven't thought of that as a beginner! I will download OSCAR and keep the chart from my Lowenstein. I wouldn't have thought of that! Thank you.

I thank you both for your help. I will try all of the above and see whether it makes a difference. If I still have problem in a few days/weeks I will come back here with the charts =)

And thank you for your patience in reading my laborious English (I'm not a native English speaker, I'm French).

Have a great day!

[Deborah K.]

Yes, we need data.  Please download Oscar, a free apnea reporting system that gives us tons of information on each night a person sleeps. You will need to put an empty, up to 32GB, SD card in your machine and leave it there while you sleep.  You can then put that card in your computer to post charts which will help us help you.