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CONCERNED, what machine to use?
#1
CONCERNED, what machine to use?
I will be seeing my pulmonologist soon and I want to discuss getting a new machine. And I am not sure what would serve me the best. 
2 years ago I was able to use a Resmed Airsense 10 Auto and a For Her model. I had been using a system PR System 1 and am now using a PR Dreamstation. 

My experience with the 10 auto is that whatever pressure I set it at  it would go to the max setting unlike my PR unit. Also my respiratory rate would go up, sometimes drastically and my respiratory rate graph would become more erratic than usual.

[Image: BanFLMW.png]

[Image: 89tSes7.png]

The For Her model seemed worse although I do not remember what mode I was running it at. 


[Image: 3e717zI.png]


[Image: Tk3sTCU.png]

Here is a screenshot of my typical results on the Dreamstation.

[Image: tgkJlkr.png]


Thank you for your input, Car54
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#2
RE: CONCERNED, what machine to use?
Car54, where are you ?

We have talked in the past, and your therapy is marked by significant flow limitation which is the driver for your pressure. The solution for flow limitation is pressure support (difference in pressure between IPAP and EPAP). You are getting pretty good AHI from your current therapy, so you don't need more CPAP pressure, but you do need more pressure support (PS). Your Resmed Airsense 10 Autoset has EPR which will provide up to 3-cm difference between inhale and exhale pressure. That is where you should start. If setting EPR at 3 does not reduce the flow limitations, you are a candidate for a bilevel therapy like the Aircurve 10 Vauto which can provide more PS. It is the assist of the additional pressure during inhale that makes breathing easier and overcomes the upper airway resistance that causes flow limitation. If you have not already done so, read the Wiki article on upper airway resistance syndrome and bilevel here http://www.apneaboard.com/wiki/index.php..._and_BiPAP
Sleeprider
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#3
RE: CONCERNED, what machine to use?
Car54,
The Flow Limitations will always drive the pressure to the maximum you have set.

The DreamStation capped out at around 11, because that’s the max you set it to, whereas you have a higher max set when you used the ResMed. Plus the ResMed is a more aggressive machine.

Using a higher EPR may work well for you if it doesn’t cause an increase in Clear Airways. That’s a balancing act you have to watch out for.

If the FL are typical for you, I also see a BiLevel/BiPap in your future.
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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#4
RE: CONCERNED, what machine to use?
Thanks for your input. As I said I meet with the doctor soon and somehow I have to get him to prescribe a vauto which I think will be difficult because my RDI is low. I have a lead on a used vauto and I am wondering if that is the way to go while it is available.

Would I actually be better with a vauto as far as getting a better sleep or am I just chasing for a better number? I would say that I am a restless sleeper because I seem to toss and turn often and I usually blame this on aches and pains but maybe some of it is disruptive sleep because of flow limitation problems. Would my respiratory rate flatten out and be more consistent?

Thanks, Car54
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#5
RE: CONCERNED, what machine to use?
A guarantee that you would be no worse with a VAuto, and a very reasonably probability that you would be at least somewhat better
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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#6
RE: CONCERNED, what machine to use?
If you have a line on a good used Vauto at a decent price, grab it. Basically that is how I got my first bilevel machine. Once I had experience in bilevel, I knew there was no going back to CPAP, and my doctor agrees. Taking the initiative and proving it works demonstrates efficacy and improved comfort which is usually good enough for most doctors to continue to prescribe. The sad truth is insurance companies dictate our therapy, and doctors prefer not to have to do a lot of appeal letters. Having experience with the bilevel device and taking insurance out of the loop for the first one, makes everyone's job easier.
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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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#7
RE: CONCERNED, what machine to use?
My FLs weren’t as severe as yours, but I had the suspicion they were contributing to fragmented sleep. I bought a used ResMed VAuto after getting the same advice you’re getting, and I’ve been inching the PS up. The FLs are much reduced, and I’m finding I’m feeling somewhat more rested now. (Getting really rested will have to wait until I can resolve a chronic pain problem.) So for what it’s worth, I don’t think you’ll regret going down this path.
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