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BRAEBON FAQ's- PSG Diagnostic Systems, Sleep Sensors & Outcomes Software


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Thermistors (Airflow Temp. Sensor)
Airflow Pressure Transducers
SmartBelts
Nasal and Nasal+Oral Cannulas

Snoring Microphones

What is Snoring?
Snoring is unwanted sound produced by tissue vibrations during sleep as air passes through the upper airway. It is an alarm that something is wrong with breathing during sleep. The BRAEBON Snoring Microphone lets you record actual snoring sounds. Research indicates snoring frequency is between 200 Hz to 600 Hz. The best human ear can hear between 20 Hz and 20,300 Hz.

What's the difference between the BRAEBON Snoring Microphone and a Snoring Sensor?
The BRAEBON Snoring Microphone uses sophisticated AHA technology to "hear" the snoring much like you hear with your ears. For this reason the BRAEBON Snoring Microphone is best placed somewhere on the face close to the source of snoring. The BRAEBON Snoring Microphone is designed to capture all sound within the 100 Hz to 700 Hz range. In contrast, a snoring sensor uses simple piezo technology to indirectly infer snoring from the surface vibration of the side of the neck. There are a number of problems associated with piezo snoring sensors: (1) signal quality is very dependent on patient weight with overweight patients often showing poorer quality signals; (2) signal quality will vary with sleeping position; (3) movement and EKG artifact are more frequently observed with piezo snoring sensors rather than the BRAEBON Snoring Microphone.

Why is the BRAEBON Snoring Microphone better than any other snoring device?
First, the BRAEBON Snoring Microphone is designed to record actual snoring sounds from the upper airway. Second, the BRAEBON Snoring Microphone has the smallest footprint of any snoring device on the market. Yes, it's even smaller than the dime-sized piezo snoring sensors. Third, the BRAEBON Snoring Microphone captures snoring signals with equal quality regardless of body position when properly placed on the face. Fourth, we're so confident about this product it has the only 6-month unlimited use warranty of any Snoring Microphone.

Where do I place the BRAEBON Snoring Microphone?
For best results, position the snoring microphone on the forehead, tip of nose, cheek, or chin using hypoallergenic medical tape as shown below: The forehead, tip of nose, and chin are best during diagnostic polysomnograms because the microphone is equidistant from the source of snoring regardless of body position. For use during CPAP, consider placing the microphone on the chin. You may use surgical tape
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What amplifier settings should I use?

We recommend using a hardware low frequency filter (LFF) as high as possible, typically 10 Hz or higher. Turn your hardware notch filter on, and set your high frequency filter (HFF) as desired. Your gain should be somewhere between 10 uV/mm and 150 uV/mm (or around 9300 X gain) depending on your polygraph system. Some polygraphs allow you to use software filters. Set your software low frequency filter as high as possible, perhaps 40 Hz or higher.

How can I clean the Snoring Microphone?
Never immerse the Snoring Microphone into any liquid, but you may gently wipe the housing clean with a soft cloth.

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Nasal and Nasal+Oral Cannulas

Can I use any cannula?
Yes, you can use any cannula with the BRAEBON safety filter and not void the BRAEBON warranty. We insist you use the BRAEBON safety filter because it will protect both the transducer and your patients. Not all people are the same. For this reason we offer the widest variety of Pressure Transducer cannulas on the market: Nasal, Nasal + Oral, Dual Lumen Nasal + Oral, ETCO2 Dual Lumen Cannulas, Pediatric, and Infant - we offer them all!

Why is the BRAEBON Nasal + Oral Cannula better than any other?
BRAEBON was the first to offer a Nasal + Oral Cannula and the competition still hasn't caught on. The BRAEBON Nasal + Oral cannula is the only cannula which has a separate chamber for nasal and oral flow. This means there is never internal turbulence caused by nasal and oral breathing. Other nasal/oral cannulas can't make this claim and you'll see the difference in the clarity of your signal. The Nasal + Oral cannula from BRAEBON needs very little modification. Other nasal/oral cannulas actually instruct you to cut and customize the cannula for each patient. The BRAEBON safety filter has substantially less resistance than filters used on other cannulas. All of these features unique to BRAEBON cannulas combine to create the best Pressure Transducer Cannulas on the market. Compare and see for yourself why the exclusive design of the BRAEBON Nasal + Oral Cannula offers better product and signal quality for your money!

Why do I need to use the safety filter at the end of the cannula?
The safety filter (actually called a hydrophobic filter) has two important functions: (1) prevent damaging moisture from entering the Pressure Transducer; and (2) prevent patient cross-contamination by eliminating airborne contaminants. For these two reasons we insist you only use the BRAEBON safety filter. Unlike filters used by other manufacturers, the BRAEBON safety filter will not restrict your pressure signal.

Can I trim the cannula?
Yes, you can trim the cannula piece around the nose and mouth if you need to, but remember that you must have part of the nasal prongs actually going into the nose. You can trim the oral section of the BRAEBON Nasal + Oral Cannula by opening part of the reverse oral side and shortening the length.

What about oral breathing?
According to some published research, patients breathe through their nose for the vast majority of time. For this reason, most sleep technologists feel that Nasal and Nasal + Oral Cannulas are more than adequate at detecting both nasal and oral breathing. If oral breathing remains an issue, you can always use the BRAEBON Dual Lumen Cannula or the BRAEBON Oral-Only Thermistor to further investigate the presence of oral breathing.

Do I need to tape the cannula onto the patient?
This comes down to personal preference. Some sleep technologists find they do not require tape, others feel the tape is needed. Patient comfort is the only reason to avoid tape use.

Why are the cannulas described as "Single Use"?
All cannulas are classified as Single Patient Use by manufacturers. The cannula comes into contact with mucous membranes and secretions so adequate sterilization is questionable. For this reason it is recommended to discard the cannula after each patient's use.

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Thermistor - Airflow Temperature Sensor

What's the difference between a thermistor and a thermocouple?
Thermistors vary their resistance to changes in temperature. Since exhaled air is warmer than inhaled air, the resistance values reflect changes in air temperature. These resistance values are sent to the recording system as sinusoidal waveforms (normal airflow). Thermistors require a small power source to produce a signal. Thermocouples are two dissimilar types of metal which produce a change in voltage potential in response to changes in air temperature. Thermistors are preferred over thermocouples for airflow measurement for two reasons: (1) thermistors provide a stronger quality signal; and (2) thermistors are linear response temperature devices whereas thermocouples are not.

Why is the BRAEBON Airflow Thermistor Device the best?
The BRAEBON Airflow Thermistor offers you the strongest, most reliable signal at the best price and with the highest quality and highest comfort level - it doesn't go up your nose! Independent pull-test studies have found that the BRAEBON Airflow Thermistor is 50% stronger than competitors' devices. BRAEBON continues to be the only manufacturer to offer a no-hassle seven-month warranty.

What's the cost difference between a reusable thermistor and a disposable airflow temperature device? Enormous.
Assuming a price of $5 per disposable sensor and a frequency of five recordings per week for 48 weeks:

What's the best way to attach the thermistor to the patient?
You may bend and adjust the thermistor as per the photos below. Remember, the thermistor is not intended to go up the person's nose. This makes it much more comfortable. Use medical grade tape to affix the wires close to the patient's nose and run the wires over the ears and to the headbox.




How long is the warranty?
The BRAEBON Airflow Temperature sensor is covered by a seven-month no-hassle replacement warranty. The current record for the longest life-span of a BRAEBON Airflow Temperature Sensor is 22 months and belongs to a sleep disorders lab in Belleville, Ontario, Canada.

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Airflow Pressure Transducer

Why is the BRAEBON Pressure Transducer the best on the market?
All BRAEBON Pressure Transducers only use laser-trimmed silicone wafer differential pressure transducer technology which is precisely calibrated with built-in circuit overload protection. This technology is highly stable and linear for both positive and negative pressures. Look carefully and you’ll find inferior competitors’ devices branded as pressure transducers, but containing piezo sensors inside. A piezo sensor is light years behind true differential pressure transducer technology. Additional reasons why BRAEBON Pressure Transducers are the best: All BRAEBON Pressure Transducers have On/Off switches; Only BRAEBON Pressure Transducers are smart enough to automatically turn off because your sleep-deprived techs will often forget; Quality, reliability and a one-year hassle-free warranty.

Why use a BRAEBON Pressure Transducer?
To accurately and reliably detect flow limitation and Upper Airway Resistance Syndrome (UARS). Published research has concluded that monitoring flow noninvasively with a nasal cannula can detect flow limitation extending your diagnostic reach to include UARS. Flow limitation appears as a flattening or plateau on the inspiratory waveform and is best viewed with a low frequency filter of 0.01 Hz or less (decay time constant of 5 seconds or longer). For those of you who remain interested in using the gold standard of Respiratory Effort Related Arousals (RERAs), BRAEBON’s Dual Pressure Transducer is rated for use with air-filled esophageal catheters (BRAEBON only recommends Ackrad Laboratories’ catheters). The simplicity of the BRAEBON Dual Pressure Transducer plus the comfort of modern air-filled catheters results in simple esophageal monitoring. Note: If you’re not using a BRAEBON Pressure Transducer, make sure your pressure transducer is both stable and linear with negative pressures before use. What you may discover may surprise you!




What age groups can I record with a Pressure Transducer?
Any age group can be recorded with a Pressure Transducer. Ensure that your cannula, catheter, or mask is age appropriate and recording will be straightforward.

Should I use an AC or DC connection for Polygraph settings?
If you have a low frequency filter of 0.01 Hz or lower plug the transducer into your headbox (AC). If you only have a low frequency filter of 0.1 Hz then use a direct coupled connection (DC). For DC connections you may require a connection cable from the patient room to your amplifier. These cables may be from 6 feet to 100 feet in length, but high quality co-axial cable must be used. BRAEBON recommends RJ-174U shielded co-axial cable.

What polygraph settings should I use?
BRAEBON recommends you start by using the following settings, but what works for you will depend on your patient's breathing and your amplifier.




How do I connect the Pressure Transducer for CPAP and Esophageal Recording?



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Do I need to calibrate the Pressure Transducer if I use a nasal cannula?
No, a pressure transducer used with a nasal cannula essentially functions as an uncalibrated pneumotachograph. As such, calibration is not needed when using a nasal cannula.

How do I calibrate the Pressure Transducer for Esophageal Pressure Recording?
Data required for esophageal pressure recording can be obtained when the system is calibrated with a water manometer. The 0580Pes device is already calibrated when it leaves the factory. If you wish to perform additional calibration proceed as follows: Material required: one piece of ¼” diameter (6.25mm) clear flexible tubing) six feet in length; two 3-way stop-cocks; two 10cc luer connector syringes; one piece of board for mounting the tubing; luer connectors as needed.

Fill the baseline syringe with water (colored water may help in reading values)
Connect the baseline syringe to the stop-cock on the bottom of the water manometer
Turn the stop-cock so that you can adjust the baseline water level.
Adjust the baseline water level to read 0cm H2O
Before connecting the sensor to the water manometer make sure that the sensor’s baseline voltage is set to the proper value. This is usually zero volts DC.
Connect the sensor to the stopcock with the pressure adjust syringe. Ensure a hydrophobic (safety) filter is properly installed. 
Set the pressure in the system by moving the pressure adjust syringe until the manometer reads the correct pressure. Usually ±10 cm H2O.
Adjust the sensor’s gain until the sensor’s voltage is set to the proper value. Usually ± 0.75 volts DC is set to equal ±10 cm H2O. 
Repeat steps 7-8 for each pressure-voltage setting.
   
 



Here's an alternate way of calibrating your esophageal pressure transducer and catheter:

Attach the catheter to the oral input side of the transducer and inject 1cc of air into the catheter. Attach the output signal cable from the transducer to your amplifier’s DC input. Lay everything flat on a desktop or table. Perform a DC calibration on your collection software and “tell” your software that the low DC value is 0 cm H2O. Now, take a water-filled cylinder and insert the catheter into the cylinder so that the middle of the catheter is 10 cm below the surface of the water. Perform a DC calibration on your collection software and “tell” your software that the high DC value is 10 cm H2O. You’re done! Because all BRAEBON Pressure Transducers use high-end components the linear calibration you just performed will be stable and reliable up to +/-350 cm H2O.

What is the Nasal Differential port on the BRAEBON Dual Pressure Transducer?
The Nasal Differential port is your baseline. When you attach nothing to it you are using atmospheric pressure as the baseline for your Nasal Input. If you attach a CPAP circuit to the Nasal Differential, you are now using CPAP pressure as the baseline rather than atmospheric pressure.

There are a lot of outputs from the BRAEBON Pressure Transducer. Do I have to use them all?
No. If you do not want to look at snoring with the pressure transducer it is recommended that you use the Airflow Signal (Filtered) output only. This will give you a better opportunity to view the flow limitation because snoring may mask the plateau on the inspiratory waveform – which is a real important reason why you’re looking at the pressure signal.

How long will the battery last?
This depends on the model of Pressure Transducer you are using. Alkaline AA batteries in the Dual Transducer will last about 35 8-hour recordings; lithium AA batteries will last longer. The battery in the Single Input Transducer will last about 30 8-hour recordings for the high gain version, and about 150 8-hour recordings for the low gain version. Actual battery life may vary.

How do I know if the Pressure Transducer is working properly?
Turn it on and look for the blinking green status LED. The proper LED sequence is one green blink followed immediately by one red blink, two second pause, one green blink, followed by an extended pause and then one green blink every 10-15 seconds indicating the unit is on and functioning properly.

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Why do I see continuous green-red flashing on the LED?
Change the batteries. If it doesn’t go away call customer service.

Why do I see a spike about every 10 seconds?
Your batteries are dying and need to be changed. The product was designed to give you visual cues to let you know when to change the batteries. Because the Pressure Transducer is in the bedroom you won’t be able to see the LED change from green to red if the battery starts to fade in the middle of the night. We’ve provided an intermittent spike on the output signal which tells you about impending battery life expectancy from the comfort of your computer monitor.

The signal looks funny and doesn’t look like an airflow thermistor. Why?
The signal from an Airflow Pressure Transducer looks sinusoidal during normal breathing just like an airflow thermistor, but appears differently during sleep-disordered breathing. This is what you want to see if your system is set up properly. Specifically, the shape (or morphology) of the waveform looks differently when there is snoring, UARS, apnea, and hypopnea . When the top of the inspiratory waveform looks flat (i.e., there’s a plateau), this means you are seeing a change from the normal sinusoidal waveform and are now observing flow limitation and UARS. Pressure Transducer technology actually offers you much more diagnostic information than a thermistor because all temperature sensing devices – disposable or reusable - have a low frequency filter built into the product. This means the signal returns to baseline faster and reduces your chances of seeing the clinically important flow limitation. On the one hand, the low frequency filter built into the temperature sensing devices will make your signal look clean and smooth, but this signal is actually a function of the electronic circuitry and is not what is really hap pening during sleep. On the other hand, BRAEBON Pressure Transducers do not have low frequency filters to limit your ability and they extend your diagnostic arm by giving you a much more complete picture of what is really going on during sleep.

I've connected the Pressure Transducer using AC directly into the jackbox, but the signal output from the Pressure Transducer looks funny and has sharp mountain peaks and valley troughs. Why?

This is simple. Your low frequency filter setting (LFF) is too high. Set your LFF to 0.01 Hz. If you can’t set your LFF to 0.01 Hz try a DC connection. There are a few polygraph systems out there that allow you to set your software LFF off or very low, but always have a hardware LFF around 0.1 Hz. Check with your polygraph manufacturer to make sure your hardware amplifier doesn’t have a built-in LFF.

Do I need a snoring microphone if I use a Pressure Transducer?
This depends on your preference. Some sleep laboratories use the snoring signal from the BRAEBON Pressure Transducer while others continue to use a snoring microphone. We suggest you judge for yourself and make an informed decision based on your own observations.
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Is a Pressure Transducer better than a disposable airflow temperature sensor?
Absolutely. Both single-use cannulas and single-use temperature sensors are to be discarded after patient use, but disposable cannulas are significantly less expensive, provide more clinical information, and are backed by peer-reviewed published research. Despite claims by the manufacturer, NO disposable temperature device will show clinically significant flow limitation as well as a BRAEBON Pressure Transducer. Furthermore, the BRAEBON Dual Pressure Transducer can be used to record gold standard RERAs with a disposable esophageal catheter. No matter if you are using cannulas or catheters, the BRAEBON Pressure Transducer easily outperforms any disposable temperature device hands down.

How long is the warranty?
All BRAEBON Pressure Transducers are covered by the only one-year no-hassle replacement warranty.

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SmartBelts

What is the difference between the BRAEBON Smartbelt and the BRAEBON Piezo Belt?
The BRAEBON SmartBelt uses proprietary and patented technology to indicate circumferential and hence volume changes during inspiration and expiration. Piezo based respiratory effort sensors use a piezo crystal to measure the force of inspiration and expiration.

Why is the BRAEBON SmartBelt better than piezo technology?
The advantage of the SmartBelt is that it is much more responsive, does not produce false paradoxical effort, and can produce a true DC signal when compared to piezo based respiratory effort sensors. This is important for better detection of subtle changes associated with sleep disordered breathing, such as UARS. BRAEBON has pushed the technology envelope of piezo sensors with the current Model 0528 product offering, but the technology inherent in the SmartBelt design allows for more precision, an upgrade path to the quantitative SmartBelt-Plus system, and more durability all for about the same price as a couple of piezo belts from BRAEBON’s competitors.

What’s the cost difference between BRAEBON's SmartBelt and a couple of competitors’ piezo belts?
Very little. About $10 to $20 per bed.

Can I use the SmartBelt on infants?
No, at this time the SmartBelt is only recommended for use on persons weighing 30 lbs or more (15 kg or more).

How does the SmartBelt attach to the patient?
The SmartBelt is ergonomically designed for ease of use. The sleep technologist attaches it to the patient in the same way as you would attach a piezo belt. The SmartBelt is sold with four different size velstretch bands: 2-feet (60 cm), 3-feet (90 cm), 4-feet (120 cm), and 5-feet (150 cm).

How long is the warranty?
The BRAEBON SmartBelt is covered by a one-year no-hassle replacement warranty.

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