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[Equipment] I Hate My AirSense
#1
I Hate My AirSense
Hi friendly, helpful people. I'm hoping someone can steer me in the right direction about this.

When I first started sleep therapy (around a year or so ago? I think?) I was given a Dreamstation Auto (I think?). This was life-changing from pretty much the first night. Routinely six to eight hours of uninterrupted sleep, feeling amazingly better during the day, started badgering friends and strangers to get sleep-tested, etc. Well, maybe six months into this bliss something suddenly changed and I was waking up with the worst dry mouth I'd ever experienced in my life. From what I know now it seems like the mask may have had an undetected leak (or the humidifier was on the fritz, though it was using water). 

Anyway. My provider elected to replace it with an AirSense 10 Autoset, which was fine with me as that's what my wife used and I appreciated the smaller footprint, quieter operation, and easier humidifier-refill procedure. But I have not slept as well since. There is still a positive impact when I use it, but it's so much less dramatic that my compliance has been absolute crap -- maybe 50% in a good month? 

Following instructions on this board I was able to improve things a little bit, but I'm still extremely frustrated by what feels like a dramatically inferior experience and wondering if I should request a replacement. So here's what I was wondering:

Can anyone tell me how the AirSense is supposed to respond when it detects a central apnea? In the instructions I've found, it says only what it doesn't do (increase pressure), but I can't imagine it does nothing at all? I say that because when I first got the Dreamstation I would test it by holding my breath; and no matter what, I would notice an immediate change in pressure. With the AirSense, when I hold my breath two different things can happen: If I'm keeping my airway closed, I feel the gentle oscillation followed by an increase in pressure. But if I just refrain from taking a new breath, keeping the airway open, there's *nothing*. According to the instructions, it sounds like it should use the oscillation to *detect* whether it's an OA or CA, but when I fake a CA there's no oscillation at all. 

Can anyone tell me if this is expected behavior? And if there could be some other difference between the machines that would impact my experience so significantly? I'm kind of at a loss here and not even sure what to talk to my provider about.

Thanks for any guidance you can provide. 

All the best,
-joe in Ohio
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#2
RE: I Hate My AirSense
Joe, if you have a computer, then download the free OSCAR software, and make sure you have a SD card in the slot of your Autoset. Follow the tutorials in my signature below for Organizing Your Oscar Chart and Attaching Files. You made one decision on lack of information, but with Oscar, we can narrow this down quickly. Regarding the Resmed Airsense 10 Autoset, it's the best CPAP machine I know of. You upgraded, but it's not a one size fits all. We need to tailor it a bit.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#3
RE: I Hate My AirSense
Roger that. I wasn’t supplied an SD card with my machine but today I realized there was one in the house I could repurpose. Formatted and inserted. Will post some details ASAP.

Your response makes me feel optimistic this can be addressed in software rather than hardware so fingers crossed. 

All the best,
-joe
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#4
RE: I Hate My AirSense
Welcome to the Board.

Make sure your SD card is between 2-32GB, an SD or SDHC, and brand doesn't matter. Make sure it's not locked as well.

Your CPAP is the best in the segment and it did what it should when you simulated a Central, nothing. That's because your PAP isn't designed to deal with CA, so the best thing in that case is the nothing response.
Dave

OSCAR
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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: I Hate My AirSense
All right, here's one night of data. I included the whole night, a zoom in on one CA event, and a zoom in on a series of three CAs — this last image *may* have been me deliberately holding my breath, so take it with a grain of salt. (There is also another cluster of CAs and one OA at the very end, which was *definitely* me deliberately trying to illustrate how the machine is responding to CAs. The earlier cluster is right around when I woke up, but I could have sworn I only tested the machine once. Probably best to ignore, though.)

Please let me know what other details I can provide. 

Thanks in advance for any help.

Best,
-joe

All night: 
   

Middlle-of-the-night CA:
   

CA cluster plus OA:
   
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#6
RE: I Hate My AirSense
Do you have any data regarding the sleep study, assuming you've had one? If you do, scan the report into your PC and post the redacted detailed report. Since you're in the USA, HIPAA states you are able to get the report when requested. It's good to have it in a personal file anyway. I'm fishing for data regarding the CA specifically to see the type of these CA.

Regardless, your flow rate pattern is a bit off to me. I'm not the greatest at the OSCAR reading so we'll need others to comment.

If the CA will behave, I'd consider turning EPR up to combat the flow limits, along with a corrosponding increase in Min pressure to give EPR room to work.
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: I Hate My AirSense
Good set of charts. On the full night we know you are using your Airsesen 10 Autoset with a minimum pressure of 5.2, maximum pressure of 20 and EPR at 1. Your median pressure is 7.6 and 95% is 10.5 cm which shows  us pretty quickly your minimum pressure setting is too low.  We can also see a lot of flow limitation in your results. These happen when there is airway resistance, and the CA you highlighted is surrounded by respiratory flow waves with flat tops which means you can probably use a little more pressure support to make the air flow smoother.

I'd like to get you back to where the therapy feels good and is more refreshing, so your charts show us what is needed.  I'd like to see the minimum pressure increase to 8.0, and increase EPR from 1 to 2.  These changes will put you in the sweet spot for your therapy needs and will reduce much of the pressure variation through the night, which will be less disruptive to your sleep.  The EPR will also reduce those flow limits making it easier to breath both in and out. This will reduce respiratory effort related arousals which have a big impact on how your feel. 

Your third chart shows several CA events, but the pattern is of awake sleeping, so you can disregard those events.

[Image: attachment.php?aid=29725]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#8
RE: I Hate My AirSense
Well, we've got two votes for increasing min pressure and EPR so I will try that tonight and report back with more results. 

I can't thank you both enough for your time and know-how. 

Best,
-joe

I have been unable to locate the sleep study results but I do know my AHI was 36. So obviously even this is a huge improvement. (And truth be told, last night was one of the most comfortable I've had in a while, and the first in many weeks I haven't woken in the middle of the night at all.)
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#9
RE: I Hate My AirSense
Well, that was...not great. Twice I woke up fully, and I felt incredibly groggy in the morning. Here's what the night looked like:
   

One weird thing I noticed was this stretch:
   

Those two essentially flat segments around 1:17 that aren't flagged at all — is that normal? Could that be one of the times I was awake? Similar events seemed to appear throughout the night, without getting noticed by the machine. 

Any suggestions on where to go from here? Any more detail I can provide?

Thanks again.
-joe
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#10
RE: I Hate My AirSense
IMHO it looks like you have knocked down the events to the point you are able to observe specific events.

The zoom shows hints of your CO2 levels affecting your breathing, enough to watch your CA levels but not worry about them.   

I'd try EPR=3, watching both hypopneas, which I think may be central hypopneas, and Central apneas.  You would need to let us know which feels better.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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