[Equipment] trouble moving from RemStar Auto to AirSense 10

[Sleeprider]

Jim, I think 4-20 is going to be a bit much for you and based on results from the Remstar, you could set a fixed pressure or maximum pressure on the Resmed Airsense 10 that might be better for you. I'm going to suggest for the Resmed that you set the minimum at 7.0 and the maximum at 9.0. It will likely hit hte maximum and staty there due to flow limitations you are showing, but I think it will adequately control events to near 1.0 AHI. The idea is to get comfortable with the machine and control the pressure at an effective, but not too high level. If you were going to set a fixed CPAP pressure I think I agree with Fred that 9.0 is a good fixed pressure, but in auto, try 7-9.

[jim.evo]

does it appear that the RemStar has been working for me in regards to managing my apnea based on the readings? (I know it's only one night...)

Your right, it is only one night.  With that said, take into consideration the high leak rate for that night.
There comes a point with a high leak rate that the machine is unable to tackle Apnea events and may miss a few.  I would think that the low AHI may be suspect.

Correct me if I'm not reading this correctly, but the RemStar the one i've been using for several years shows a Leak Rate of 0.00 and Total Leaks of 0.00 (although the graph shows some action from 6-7am) while the ResMed (the new one) has a Leak Rate of 26.40 and lots of spikes....this is the one I'm having trouble with.

[jim.evo]

Jim, I think 4-20 is going to be a bit much for you and based on results from the Remstar, you could set a fixed pressure or maximum pressure on the Resmed Airsense 10 that might be better for you.  I'm going to suggest for the Resmed that you set the minimum at 7.0 and the maximum at 9.0.  It will likely hit hte maximum and staty there due to flow limitations you are showing, but I think it will adequately control events to near 1.0 AHI.   The idea is to get comfortable with the machine and control the pressure at an effective, but not too high level.   If you were going to set a fixed CPAP pressure I think I agree with Fred that 9.0 is a good fixed pressure, but in auto, try 7-9.

Thanks for yours (and Fred's) reply. Still trying to understand all of this....

So if go to with 7-9 does then mean that the minimum pressure will always be at 7 even if I'm not in need of assistance? that does seem much more than the 4 i've been used to - if I understand this correctly....

[Melman]

Yes, the minimum pressure will always be 7, with the exception that the pressure when you exhale will be reduced by your EPR setting if you are using EPR.

[OpalRose]

The leak rate on the RemStar looks fine on the graph.  I don't know what it has been over the years.  

And you are only showing us one night with the ResMed.  Are you mouth breathing?  
What I am saying is this:  for just the one night you are showing.....you can't trust a low AHI
reading when  you are having a lot of leaks.

As far as comparing a Phillips Respironics machine and a ResMed, you should go with the one that feels comfy for you.  Their algorithms are not the same.  The PR machines are slower to act than the ResMed machines.  That doesn't make them less effective.  It's just a matter of maybe using a slightly higher minimum pressure on a PR machine.

I think you need to pick comfort when it comes to a machine and also work on mouth breathing.

You also state in your first post, that if the ResMed didn't work out, they would be willing to give you the latest upgrade to the PR. I assume they meant the DreamStation Auto. It's a good machine too, don't rule it out.

[Sleeprider]

Yes, the minimum pressure will always be 7, with the exception that the pressure when you exhale will be reduced by your EPR setting if you are using EPR.

Good catch Melman.  Jim, the Resmed Airsense 10 has a comfort feature that reduces exhale pressure by 1, 2 or 3 cm pressure on exhale.  So if Exhale Pressure Relief (EPR) is on 3, and your starting minimum pressure is 7.0, then your pressure will actually be 7.0/4.0 (inhale/exhale IPAP/EPAP).  This would range up to 9.0/6.0.  If you used that much EPR.  I would suggest you start with an EPR setting of 1, and if you feel you need more pressure relief, try 2 and finally 3.  Remember that as you increase the EPR setting your EPAP pressure drops and may allow more OA.  As you can see, it becomes a balancing act between comfort and effectiveness.

To turn on EPR enter settings by pressing the control knob and home button at the same time.  You can then go to settings/Comfort/EPR on the machine screen.

[jim.evo]

I'm uploading the past week or so for the RemStar. Thanks again to everyone for your help!

[OpalRose]

I don't know how you stayed with that minimum pressure starting at 4cm, even if just for comfort and not feeling air starved.
The Flow Limitations and Rera's were begging for a higher pressure.  But who's to say, your AHI wasn't bad on this machine, but if
you had been using a range like 6-10, you may have seen less apnea events.  

The one good thing if your stick with the ResMed machine, you have EPR to give you exhalation relief, whereas the Phillips Flex doesn't quite work the same.

[jim.evo]

Last night I changed pressures from 4-20 > 7-9; AFlex from 2 > 3 and System Resistance from 1 > 2 (to match my pillow size).

Initially I felt so much more air coming in, it felt better. Here are my numbers from last night. AHI is up. Any suggestions?

!!! ps. my intent is to get both machines working well, the RemStar for travel (not too often) and the AirSense for home (will be trying that again soon).

[DavePaulson]

Give it a couple more days at this setting and see how it shakes out.