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[Equipment] Problems with Auto CPAP with OA occurring at start of exhale - DreamStation
#1
Problems with Auto CPAP with OA occurring at start of exhale - DreamStation
A longtime CPAP user, I have recently graduated from a ResMed S8 CPAP set at 15.0 to a new DreamStation Auto CPAP with a range of 10.0 to 20.0. 
I believe I have identified three design problems or defects with my Auto CPAP:

FAILURE TO IDENTIFY AND RESPOND TO OA EVENTS OCCURRING AT THE START OF EXHALATION
  • My machine does not seem to be sensing when apnea occurs at the beginning of exhalation. The data summaries say that I am getting good results, but I am not. Frequently I awake during the night struggling to exhale, in spite of using my APAP. As best I can tell, the problem is with obstruction DURING EXHALATION, and when I have checked the APAP pressure immediately following these events, the pressures seem random, between a high of 13.2 cm and a low of 10.0 cm, (the minimum setting). 

RESETTING ITSELF TO THE MINIMUM PRESSURE AT RANDOM TIMES
  • The machine appears to reset itself to the minimum pressure at random times. The reason I suspect this is that even with the minimum pressure set at 10.0, I often awake because of breathing difficulty, only to find the machine operating at the minimum pressure.

NON-FUNCTIONING OPTI-START FEATURE
  • Via the Clinical Menu, I attempted to activate the Opti-Start function so that the machine will restart at the previous session's 90% pressure rather than at the minimum pressure. The Opti-Start function is inoperable. Even though the screen says that it is on, the machine reverts to the minimum pressure every time it is restarted. I suspect there is a malfunction of some sort, either hardware or software related. Unfortunately, there does not seem to be any way to set the starting pressure any different from the minimum pressure.

I HAVE MANAGED TO MITIGATE THESE PROBLEMS, BUT NOT TO CORRECT THEM, BY:
  • maximizing my humidification, which requires waking in the middle of the night to refill the reservoir (what idiot would design a water reservoir not large enough to last the night?!?). With less inflammation, there seems to be less apnea for the APAP to control;
  • increasing the minimum pressure, so when the machine is started, and when it randomly resets, at least it is at a more effective pressure;
  • turning off the flex feature entirely, so that I will have the full pressure upon exhalation.
I know that OA upon exhalation is less common. Some questions:
  • Has anyone with this form of apnea had similar problems with APAP?
  • Has anyone with this form of apnea had better results  with a different machine?
  • How do I know for sure that there is a problem with my machine?
  • How do I know whether my machine malfunctions or if this is a design problem?
  • How do I convince my providers that my problem is real?

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#2
RE: Problems with Auto CPAP with OA occurring at start of exhale - DreamStation
If you could download and install the free #Sleepyhead program, you would be able to visualize precisely the nature and timing of any obstructive apnea by looking closely at the flow chart. It is very unusual to have OA during exhale for the same reason a straw does not collape when you blow through it, but may collapse when you suck on it, due to resistance and structural collapse. It really doesn't happen. Using the flow charts might help narrow down exactly what is happening.

An auto CPAP does not respond to an apnea of any kind while it is in progress. Your auto CPAP is only able to increase pressure in response to snores, flow limits and apnea when the apnea is over.

The Dreamstation auto frequently "loiters" near the minimum set pressure and is slow to increase pressure, especially in certain people with poor warning cues for OA. This is a common problem with that particular machine compared to a Resmed Autoset.

Can't respond to the Optistart feature without knowing more about your median and 90% pressure. I have no personal experience with it.

The Flex feature is a problem for some people, and many do better with a setting of 1 or off. It sounds like you need a higher minimum pressure.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#3
RE: Problems with Auto CPAP with OA occurring at start of exhale - DreamStation
Get some charts up, most people can find some improvement in treatment here.
I fixed block on exhale with me. By raising my min pressure, till the block on exhale stopped. I think it is soft tissue and more min pressure increases the air splint. The machine won't respond to it, I don't think it sees it
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#4
RE: Problems with Auto CPAP with OA occurring at start of exhale - DreamStation
I agree with SleepRider.

Regarding the OptiStart, it seems to me that It's not functioning, and you might consider having it fixed (if you care about that function).

The DreamStation isn't as quick to respond, and it likes to stay at the min pressure, so I think it's better to have a min pressure closer to your 90% pressure.

I have had the same issue with apneas upon exhalation with the DreamStation.  I think it has to do with the Flex, as SleepRider said.  I don't have this problem with the ResMed.  So I have to set my exhale relief to give less relief.

All of that said... I prefer the DreamStation over the ResMed because my daytime alertness is better when I use the DS rather than the RM.  With the adjustments to min pressure and exhale relief, it has helped my DS experience to be better.
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#5
RE: Problems with Auto CPAP with OA occurring at start of exhale - DreamStation
Hi robstanback,
WELCOME! to the forum.!
Good luck as you continue CPAP therapy , hang in there for more responses to your post.
trish6hundred
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#6
RE: Problems with Auto CPAP with OA occurring at start of exhale - DreamStation
Thanks to all of you for your responses. Turning off the Flex feature and increasing my minimum pressure to near my 90% pressure has made a world of difference. I no longer spend my days looking for the next opportunity to take a nap, or finding myself forced to nap at inopportune moments.

I have become resigned to the fact that my problem of expiratory OA does not exist, so far as the medical profession is concerned -- although my doctor has gone from no longer calling the possibility "dubious" to calling it "intriguing", so that is progress. I am also resigned to the likelihood that no machine has the capability to identify and adapt to expiratory apneic events, since it is medically an unrecognized phenomenon. I believe I am now getting the best my machine has to offer, and thankful my doctor hasn't "fired" me for seizing control of the clinical menu.

I only wish that doctors had the humility to admit that they don't know what they don't know that they don't know. This is the same profession that insisted we give up eggs, and switch from healthy butter to unhealthy oleomargarine laced with trans-fatty acids. They scoffed at anyone who thought differently, but now they have been forced to reverse themselves. 

Those of you who are responsible for keeping this website running are providing an invaluable service. Thank you!
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#7
RE: Problems with Auto CPAP with OA occurring at start of exhale - DreamStation
Glad to hear things are working better. The Flex relief has different results for different people. You found your answer and that's a good thing. All patients should seize control of their settings. Making changes with an objective in mind is a lot different from "dial winging". Most of us get it right.
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: Problems with Auto CPAP with OA occurring at start of exhale - DreamStation
I can only comment on the Opti-Start feature.

Opti-Start must be on and running for 30 hours.  After the 30 hours, Opti-Start will reset the minimum pressure closer to the average or 90% pressure used during the 30 hours of use.  
If Opti-Start is left on, it will repeat the cycle, and reset the minimum pressure based on the average 90% readings.

This feature does not reset your pressure every night, but only after 30 hours use.
OpalRose
Apnea Board Administrator
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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#9
RE: Problems with Auto CPAP with OA occurring at start of exhale - DreamStation
(01-24-2018, 11:43 AM)Sleeprider Wrote: The Flex feature is a problem for some people, and many do better with a setting of 1 or off.

Is there a setting in the clinician menus to turn Flex off? IIRC when I went to change this from user menus my only choices were 1, 2, 3. There was no "off" choice.
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#10
RE: Problems with Auto CPAP with OA occurring at start of exhale - DreamStation
Thanks, OpalRose, that's good to know, but I don't think my OptiStart is working at all, as the machine resets to the minimum every time I turn it on, even though I am well over 30 hours. I wonder if the 30 hours starts over every time there is an upload. Something isn't working right, but I have worked around it by raising the minimum pressure.
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