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'Aggressive' ResMed
#11
RE: 'Aggressive' ResMed
(10-13-2019, 08:37 PM)bonjour Wrote: MyAir is designed to encourage compliance.  The best program to use is OSCAR.  It is what we base most of our suggestions on.
An AutoSet works best when optimized, but you can use a wide range to see what those values should be.

I will get into OSCAR but I just clicked on your link and remembered that I had done so once before and I need to find out if my Win10 is 32 or 64; and I do not know what UBUNTU means...
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#12
RE: 'Aggressive' ResMed
You can safely install the 32 bit version on either 32 or 64 bit machines. UBUNTU is a flavor of UNIX.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#13
RE: 'Aggressive' ResMed
Brilliant, thank you for those explanations, particularly the 32/64.  That simplifies matters a bit...

I'll digest your interesting ResMed vs Respironics in the morning.  Need to sleep now - well, try to anyway...
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#14
RE: 'Aggressive' ResMed
It's a little late and beside the point now, but I wonder why you felt the need to abandon your Dream Station in the first place....?
Serial Tapist
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#15
RE: 'Aggressive' ResMed
(10-13-2019, 08:27 PM)guiniviere Wrote: It is interesting that you also have just changed from the Dreamstation to the ResMed fo Her.  If you don't mind my asking, what was your reason?  For myself, I simply thought that if it was designed specifically for women then it ought to be better.  I 'm not convinced and I really dislike the childish smiles and the scoring in myAir.

Fred has largely covered it, but from my perspective:
- By responding more quickly to the airway closing, the Resmed does not need to raise the pressure as much. The Dreamstation was slow to respond but would actually go higher and stay there longer. This disturbed my sleep and sometimes caused Central Apnea.
- Resmed does a better job of adjusting to my ever-changing sinus congestion, changes in sleeping position, etc.
- If I have any congestion at all, the Dreamstation Flex doesn’t seem to last long enough. I have trouble getting enough air out before I need to take the next breath, so I feel air-starved. Resmed EPR is capable of reducing the pressure more and keeping it reduced longer. Dreamstation Flex 3 reduces the pressure 1.5~2 at most, and it only goes that low for a moment.
- Breathing just feels more natural to me with EPR.
- I may wake less often with the Resmed, but more importantly, I go right back to sleep. With the Dreamstation, I had a hard time getting back to sleep every time I woke up.

I don’t use myAir, and found DreamMapper to be fairly useless too. It’s main purpose is compliance monitoring, like MyAir.

You can enable more detailed info on the Resmed by setting Essentials to Plus in the Clinician menu. With that enabled, you’ll see AHI (apnea hypopnea index), AI (apnea index), and the Central Apnea index. You can view these averaged for the day, week, or month.

The Dreamstation does have one feature the Resmed does not. Opti-Start will start your pressure at the 90% level from the previous session. This does make the excessively wide defaults easier to live with, but it also assumes your needs will be the same from night to night. Mine certainly aren’t.

My Rx pressure was 13. This is actually pretty close - IF my sinuses are clear, I stay on my side all night, and I’m using a pillows mask.

With the Dreamstation and Resmed both set to 13-16, and their pressure relief on their maximum settings, Resmed keeps the pressure in a tighter range, provides more relief while exhaling, and disturbs my sleep less.

While it’s tough to make an apples-to-apples comparison, my AHI has generally been lower with Resmed - including one night that was 0.0.
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#16
RE: 'Aggressive' ResMed
I'd like to explain why OSCAR is important in this case. Guinivere complains of high pressure, and is using the default settings of 4.0 minimum to 20.0 maximum. We don't know without the data or some assistance from G, what the median, and 95% pressures are, and at what point it becomes intolerable. We also don't know the reason why her pressure is rising, although we can easily suspect it is Flow Limitations. The chart would tell us all of this.

In addition, we don't know if G is using EPR which would reduce flow limitations and hypopnea and make her pressure feel more tolerable. At 4-20 with EPR off, she starts therapy at 4.0 cm. If she has flow limitations, the For Her autoset algorithm will start increasing pressure rapidly up to 12 cm and level off. At that point, further pressure increases would occur only with OA and H events. If we knew at what pressure OA events are resolved, we would target that pressure as a maximum, but add in EPR to relieve the flow limitations and any hypopnea. We're really good at this stuff! We could then point her to this tutorial to easily make the changes we recommend https://www.apneaboard.com/resmed-airsen...setup-info

One last thought. I have been guilty of calling the Resmed Autoset "aggressive", but it is more accurately described as proactive. Unlike Philips Respironics it increases pressure fairly rapidly when flow limitation is detected. This way obstructive events that are preceded by flow limitation are prevented. The Philips auto algorithm is relatively unresponsive to flow limitation and relies more on snoring and actual hypopnea (flow volume/minute) and apnea to increase pressure. In addition, pressure is raised slower, and tends to fall back toward the minimum fairly quickly. Unless the user is a snorer, events are not prevented and we see a pattern of numerous hypopnea as that user bounces along just below their therapeutic needs, and the "FLEX pressure relief used by Philips actually makes this worse, and unlike EPR has no apparent therapeutic effect on flow limitation and hypopnea. So the term "aggressive" is generally meant in a positive context, with one exception; a person with chronic flow limitation may experience a "run-away" pressure increase to, or near the maximum pressure setting. This may describe G, and is the reason we sometimes need to establish a maximum pressure.
Sleeprider
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#17
RE: 'Aggressive' ResMed
The For Her algorithm will only go up to 12 for OA/H, but will go up to 20 (depending on the range set) for FL and Snore. It is intended for mild to moderate apnea and UARS.
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#18
RE: 'Aggressive' ResMed
(10-14-2019, 08:05 AM)ragtopcircus Wrote: The For Her algorithm will only go up to 12 for OA/H, but will go up to 20 (depending on the range set) for FL and Snore. It is intended for mild to moderate apnea and UARS.

To clarify, that only applies to the For Her mode. My OSA is severe, so I use the Regular mode.
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#19
RE: 'Aggressive' ResMed
Oh dear, oh dear, I rather think I may have 'shot myself in the foot'!  I had asked to go back to the Dreamstation before I read all the interesting and informative stuff in this thread.  The DME were giving me a bit of a hard time about it so I thought I would just drop the matter and go on with the for Her and followup on the various pointers made here that had more or less persuaded me that I was better off with the ResMed; but wouldn't you know, they turn up with a Dreamstation the following day (did it have something to do with the fact that I pointed out to them that there was 461 hours on the ResMed, I wonder?).  Anyway, I set about programming the new Dreamstation only to find that this machine had 2,200+ hours on it!  A further fuss with the DME and I am now onto my 4th, and this time, NEW machine - a DreamStation none-the-less.

I've been feeling a bit frazzled with all this carry-on which is why I am so late responding to everyones' kind and informative messages, and I do apologize.

I do have to say, though, that back on the Dreamstation I did get 6 hours with only one awakening,  so though the Dreamstation may not be 'reading' my events correctly and to my best advantage, given my level of sleep deprivation, I have to be thankful for those hours...

I'm now going to download OSCAR and see if i can 'see' what is going on.

Thank you all once again for all your most helpful messages...
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#20
RE: 'Aggressive' ResMed
guiniviere,
Sleeping 6 hours is a plus. Smile

Don't forget to post a screenshot here, there are many that can help.  
Follow the links in my signature line, and pay attention to the Organization of the graphs.  Include left sidebar, get rid of calendar and pie chart so that all the statistics show.
OpalRose
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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