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Differing AHI results from Resmed & Dreamstation
#1
Hello
When first diagnosed  about 7 weeks ago I was given the Resmed air sence 10 auto to try. I found it too aggressive as it rapidly  increased  the pressure from 6 to 14. I couldn't  tolerate the higher pressure and turned  it off and on to start the ramp again. I was getting  an AHI around 6 with this machine. I was then given a Philips  Dreamstation  auto to try, I found this machine  so much more  comfortable  as it didn't  overwhelm me with pressure, and I preferred  it over the Resmed, but the AHI rate was over 10.

I asked if I could use the Resmed again to see if if I could get my AHI down. So I got an airsence 10 back and this time my AHI is below  3.

Both machines were in auto, with pressures between 7 to 15. I had the ramp set on 7 for 30 mins on the resmed, didn't need ramp on dreamstation.

So my question  is which one is right?, is it just software differences  between machines . All I know is I still stop breathing under treatment, and still don't  feel any better  since using apap.

I have attached  a chart showing my last night  on the Dreamstation  and  last night  on the resmed with oxcimatry.

Thanks
Robo64


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#2
Did you have a titration study, and did it show a lot of Centrals? Did they titrate you on an ASV?
It's looks to me that you may be heading toward an ASV machine.

As far as trying to compare different APAP's on different days should not be a basis for choosing a machine. You said you felt more comfortable on the DreamStation.

And remember, the AHI number will vary from night to night.

They are both good machines and will treat your apnea, but neither will treat the Centrals which make up a good portion of your AHI.

This is a discussion you need to have with your doctor to see if an ASV machine would be better for you.
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#3
Robo64, this is an interesting comparison, but what you need to focus on are the OA and H events which is what CPAP can treat. Based on this limited sample, the Dreamstation is far less effective for treatment of your obstructive apnea, given the setup here. While the Resmed nearly eliminates H and OA, those events are (4.8+1.6) well above accepted therapy levels with the Dreamstation.

I would suggest you operate the Resmed at a range of 7.0 to 10.0 and see if that takes the edge off the pressure increases and minimizes the CA. Note this recommendation is based on a max-pressure above your 95% pressure and you might be able to lower it even more if H and OA continue to be adequately treated.
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#4
Robo64,

1 day of data on each machine is not enough information to make a definitive decision on whether one machine is significantly better at treating your apnea. The AHI can vary (quite a bit) from day to day, even when using the same machine night after night.

That said, there are a couple of relevant things in your post.

First, you say:
Quote:I was then given a Philips Dreamstation auto to try, I found this machine so much more comfortable as it didn't overwhelm me with pressure, and I preferred it over the Resmed
In the long run, you may be much better off with the Dreamstation because the first thing that has to happen for PAP therapy to work is that you have to actually be able to sleep with the machine all night, every night. Comfort issues are very important and it seems that the steep pressure increases in the Resmed bother you quite a bit. And that could make it more difficult to really learn how to sleep well with the machine.

Next, let's talk about the AHI's: First, each company does have it's own proprietary system for scoring the data recorded by the machine. The differences are usually not enough to make a huge difference, but it's possible that the DreamStation is scoring OAs and Hs just a bit more aggressively. But that would not account for the huge jump in AHI: If we look at just the OAs + Hs (the obstructive events), the DreamStation did let a lot more events get through. But it also looks like you only turned the DreamStation off and back on two times during the course of the whole night. But you turned the Resmed off and back on four times during the night you used it. So it looks like your sleep may have been a lot more fragmented on the night that you were using the Resmed. And if you didn't sleep as soundly or as deeply, that could explain why the AHI is much lower---many people's apnea is much worse and needs more pressure to control during REM sleep for example.

As SleepRider and OpalRose both point out, there are a lot of centrals being scored on both nights. More pressure usually does not make centrals go a way and more pressure can make them worse. Whether these centrals are "real" is a big piece of the puzzle. And that brings up the question: Were central apneas mentioned on either your diagnostic or titration sleep studies?

Some new PAPers do have a tendency to develop CAs once treatment begins. Sleep docs usually take a cautious "wait and see" approach. The reason why is pretty simple: The excess number of CAs scored for for many of these newbie PAPers disappear on their own as the person's body fully acclimates to sleeping with the PAP. Most sleep docs would be willing to investigate what's going on if the CAI > 5.0 after a month or two of therapy. At that point, a titration study on bilevel or ASV may be recommended.

Here's what I would recommend that you do:

1) Download SH 1.0 now that it's available and look at the DreamStation data in SH as well as Encore. It's a little bit difficult to compare an Encore report to a SH report because Encore doesn't show the flow rate data.

2) Keep the DreamStation since it's more comfortable, but increase the min pressure by 1cm. That might be just enough to help the less agressive PR Auto algorithm respond fast enough to keep clusters of events from happening.

3) Schedule a follow-up appointment with your doc if you don't have one already scheduled. Let the doc's office know that the AHI is mainly composed of CAs on both machines.
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#5
Thanks OpalRose, I had the Titration study a few days ago, what an ordeal. The hospital was in a flight path so had jumbo jets landing for hours. Long story short is I did have centrals and when they tried to increase pressure to what they thought I needed, in excess of 12, I would wake up. I have to make appointment with sleep doc to get results. No they didn't trial a bilevel as I wanted them to do.

(04-02-2016, 08:38 AM)Sleeprider Wrote: I would suggest you operate the Resmed at a range of 7.0 to 10.0 and see if that takes the edge off the pressure increases and minimizes the CA. Note this recommendation is based on a max-pressure above your 95% pressure and you might be able to lower it even more if H and OA continue to be adequately treated.
Thanks Sleeprider, I also thought it would be a good idea to lower the top pressure, as the higher pressure wakes me up which isn' t doing me any good.

Thanks Robysue, I will try and get the Dreamstation back for another try with a higher lower pressure. It might be helpfull to show sleep doc results of my trials. Hopefully at some point I can try an ASV.

Thanks all again for help and suggestions, this forum is great.
Robo64

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#6
One night won't really help you unless it's a comfort issue. I used the Respironics for a week on auto before switching to a straight pressure because it just would not work for me. My AHI is always under 1 with a Resmed, but was NOT the first few days I used it. Also, the leak rate seems to be calculated differently. Or, at least the Resmed notifies you of leaks at a lower rate than does Respironics.
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