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DreamStation to AirSense Migration -- Dialing in the Right Settings
#1
DreamStation to AirSense Migration -- Dialing in the Right Settings
Hola,

I'm yet another recent migrant to a ResMed AirSense AutoSet 10 as a result of the Philips recall. It appears that I'm going to have to reevaluate my baseline settings because of system differences.

My DreamStation Settings and Results:

 - Pressure: Min 7 / Max 11
 - Last Year 95% Pressure: 7.5
 - Last Year Average AHI: 1.30
 - Average Leak Rate: 0.14 / 95% Leak Rate: 0 -- Respironics DreamWisp mask
 - Heated tube / NO humidity

I am a back sleeper, almost exclusively.

I've basically copied these settings over to the AirSense and I'm trying to dial in the settings. Here are the things I'm trying to resolve:

 - The last night I used the DreamStation, AHI was 2.38, max pressure was 8.5 and 85% was 8.0. 

 - The AirSense is ramping up to a much higher pressure immediately. In response, I've increased the max pressure to 12, but the 95% pressure is 11.96, suggesting the AirSense wants to go even higher. The AHI was 2.19, so it suggests didn't get better therapy in exchange for the added pressure. I could increase it, but then we're getting close to double my 95% on the DreamStation.

 - The leak rates are higher than I'm used to. On the DreamStation, I have basically no leaks, unless I knock the mask off. I tried the P10 and P30i and both report a baseline leak between 6-8 and numerous large leaks. I assume the large leaks are fit issues that I need to resolve. Are the baseline leaks just differences in reporting methodology? I do have the machine set to Pillows, as directed on the mask packaging. I will use the DreamWisp tonight to at least eliminate some of the leak variables.

 - I have dry mouth, which surprises me. I don't usually use humidity on the DreamStation and never experience it on that machine. Is this because of the pressure that I'm not used to?

So, plan for tonight:

 - Use the DreamWisp
 - Leave other settings the same
 - Reevaluate tomorrow

I have tried to upload some OSCAR screenshots but I'm getting errors (ERR_EMPTY_RESPONSE). Once I sort that out, I will share some that highlight what I'm describing.
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#2
RE: DreamStation to AirSense Migration -- Dialing in the Right Settings
Post your OSCAR charts, that is the best data for optimizing on any platform.
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#3
RE: DreamStation to AirSense Migration -- Dialing in the Right Settings
(07-15-2021, 11:57 AM)Gideon Wrote: Post your OSCAR charts, that is the best data for optimizing on any platform.

Yeah, finally figured out how to do that...

Final DreamStation Daily Report

   

Most Recent AirSense Daily Report

   
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#4
RE: DreamStation to AirSense Migration -- Dialing in the Right Settings
Three possible things to consider:
1. Ramp is a possible disruption, ResMed will start every time in Ramp if the Ramp is set with pressure and time. It appears you're using a pressure of 4. For some, transition from Ramp can disturb sleep and it reduces therapy time.
2. ResMed uses flow limits as the key to increase pressure. You have some flow limit activity, so ResMed will increase pressure to enter combat mode. How to reduce FL? Run EPR on 3 and/or increase Min pressure.
3. ResMed's leak graph on OSCAR will have one line versus two on Respironics. All leaks above intended will show on the ResMed. It appears you have some mouth and mask leaks in the latter half of your sleep session. ResMed has a leak redline at 24, so as you approach and exceed that redline, therapy effectiveness is reduced. Yours shows that happened.

Side note, ResMed will respond faster than the Respironics you're used to, and will achieve higher pressures faster and maintain that as needed. Likely your Respironics didn't respond fast enough to some events, the event passed before response, and therefore never increased pressure enough.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: DreamStation to AirSense Migration -- Dialing in the Right Settings
Okay, thanks @SarcasticDave94 -- based on your comments, I went ahead and changed the starting pressure for ramp to 7 and enabled EPR full-time with a setting of 3.
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#6
RE: DreamStation to AirSense Migration -- Dialing in the Right Settings
OK, let us know how your next sleep session goes. You can include the OSCAR shot and tell us how your feel. Be critical and more detailed than an I'm OK type of answer.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: DreamStation to AirSense Migration -- Dialing in the Right Settings
Okay, last night's AHI was 0.19, so no complaints about that. I slept through the night and woke up at sunrise with 5h20m of total sleep. I feel okay -- at least like I felt most nights with the DreamStation.

I went back to the DreamWisp, which I've used for several years and know well, and that eliminated the large leaks. I did have to tighten it some to deal with the substantially increased pressure. I'm still going to try to make the ResMed nasal pillow masks I have work. They're more comfortable.

I did have more dry mouth, but nowhere near like the last two days where I felt like my tongue was stuck to the roof of my mouth.

Questions:

 - 95% pressure was 11.20 and my max is set to 12. Should I increase to 13 or so to give more room for therapy when needed?

 - EPR is now at 3. I had it off previously. Is there any potential advantage to further changing that setting? I didn't find this (or the original) setting uncomfortable.

 - I'm used to no humidity with DreamStation and didn't have dry mouth but I am using humidity now with AirSense. It's set to Auto. I assume if I manually set something higher, it will deal with some of the dry mouth?

 - Is there a pressure level where nasal pillows just don't tend to work as well (requiring a full nasal mask)?

Here's last night's chart. I also see some events with stopped breathing, pulse spikes and / or desaturations that weren't flagged as events. I attached a zoomed-in sample of that as well. 

   

   
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#8
RE: DreamStation to AirSense Migration -- Dialing in the Right Settings
Humidity is a personal choice, because you used no humidity with your DS try that.

P10 pressure limit.  Some say yes, my experience says no. I got my VAuto when my previous APAP was pushing 20 and still giving me bad results.  So I tried 25 on my VAuto with no problems.  I need the increased PS and with that I lowered my pressures to their current levels.

As long as you are not hitting your max you can set it at the machine's max of 20 with no problems.

EPR is the magic in ResMed.  For now leave it at 3, fulltime.  ,,,
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#9
RE: DreamStation to AirSense Migration -- Dialing in the Right Settings
Last night, the only change was to adjust the humidity and give the P30i another try. Can't complain about the AHI of 0.44. Did have dry mouth and a few large leaks. I slept through / don't remember the first group around midnight. The ones at 3:20 and 4:40 woke me up.

It's unfortunate that the P30i headgear strap goes right across the back of my head. First, as a back sleeper, because I feel it all night. Second, if I rotate my head at all, it dislodges the pillows. Tonight, I'm going to see if I can find a DreamWear headgear and match them up, as suggested in another thread. Or, I'll try the P10 again.

   
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#10
RE: DreamStation to AirSense Migration -- Dialing in the Right Settings
I will add my experience from migrating to a responics from a dreamstation.

I was really into getting the least amount of numbers and incidents of interuptions so to speak and became convinced that if i got a airsense my troubles would disappear magically overnight. It didnt. Air Sense has there own issues. The machine wants to compensate for the leaks and it does this pretty quickly. When you notice it and you adjust the mask bam its pretty strong. I corrected this by holding my hand over the exhaust port in front of my face and blew pretty hard into the mask. This seemed to correct the pressur where it acted right for awhile until the next leak. 
I noticed that the sounder the sleep the more relaxed I became the more my tongue would like to relax away from the roof of my mouth and the air would start to blow out my mouth. Im not a taper never was. and didnt plan to be ever. 
My numbers now really depend on the airleaks. no airleaks my numbers are below .9. I can live with that.  With airleaks sometimes 2.5 or so I can live with that also. Hope this helps
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