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HELP - Switched from S9 to DS and had massive attack
#1
Some history first, I was diagnosed with OSA 6 years ago, AHI was 29, and was given an S9 machine, which worked very welll. BTW, my first obstruction attack was not pleasant, woke up not breathing, heart pounding, and thought I was having a heart attack, and when trying to inhale, nothing was going in. You think you will die right there. Ever since using the S9 (on and off), had only 1 more major attack like that (I was not using the S9 at the time), but every other time, no attacks with the S9.

Fast forward to these last few weeks, where I decided to upgrade to a new machine and mask (insurance covers for a new machine every 5 years). I figured cool, new tech, Bluetooth, apps, this will be fun. Passed another sleep study, new AHI was 26.5, but the time of not breathing was between 24 sec (on my side) and 57 sec (on my back). The 57 sec explains the massive attack and heart attack feel.

Conclusion was to stick with the same therapy range (6-16), and pick up a DreamStation. First night went well, but last night, had another massive attack, and this one the worst ever, I thought I was a done, and that my wife would find me on the floor the next morning. I was like wtf ??? Why didn't the DreamStation work and save me !!! 

So I immediately download the data to the DreamMapper app, and it shows that the attack came 30min into usage, and the next morning, when I downloaded the data again, it showed 3 Obstructive Apneas. Not knowing what that number meant, I look it up, only to find out (I think), that the machine could not assist with the obstruction 3 times using max pressure, or at least not in time to avoid it.

So I come onto this board, to see if anyone else is in the same boat as me with the DreamStation, since I have only heard good things about it. What I found was that the DS reacts slower than the Resmed AirSense, and now I am left wondering if I should bring back the DS and swap it out for the AirSense, since I now have zero faith in it, worried another attack will happen. My S9 never gave me issues, so I am wondering if Resmed is a better machine for me, due to how severe the duration of the obstruction lasts.

Your thoughts ??

Thanks !!
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#2
Hi neils -Welcome

The P-R DreamStations are slower to respond to pressure increases to treat OA's than a Resmed machine.  You may wish to increase your lower starting pressure in an effort to overcome this.  I also would highly recommend using SleepyHead to view your sleep patterns. It will provide a more detailed accounting of your sleep events as opposed to DreamMapper.

Good Luck.
______________________
Useful Links -or- When All Else Fails:
Posting SleepyHead Charts in 5 Easy Steps
Robysue's Beginner's Guide to Sleepyhead
Apnea Helpful Tips
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#3
Just got off the phone with a specialist from the clinic, someone other than the person I recently saw, and the lady was actually quite surprised that I was switched from a Resmed to a Philips. She said while the DS is one of the more recent machines on the market, and a top seller, it has a different algorithm compared to the Resmed when dealing with obstruction events. She said if I did not have any issues using my older Resmed S9, I should stick with the same company and move to the Airsense instead, as it works exactly the same way. 

In fact, contrary to things I have read on this forum, she said the DS is the machine known to be more aggresive is reacting to events, and while the AirSense is just as aggresive, she said Resmed added a new mode to their machines to make it less aggresive and smoother for those who cannot tolerate the standard mode.

What surprised me most about our conversation, and my scary attack last night, is that the 90% max pressure was only 7.0 and the machine never hit the max of 16 to counter the event, which led her to believe that when I woke up suddenly and could not breathe, and my heart rate was pounding, it was not necessarily a complete obstruction, nor a full on apnea event, but rather anxiety and panic because of some abnormality in breathing or position, and one just has to learn to get out of that panic and anxiety by breathing into a paper bag or talking yourself out of it while you catch your breath. Interesting analysis for something that feels like an onset heart attack.

Anyways, since I am leaving on vacation in a couple days, and will be out in the middle of the ocean (cruise), she said not to play with any new equipment, and take my older S9 with me, as it is tried and tested by me, and when I get back, they will exchange my DS for an AS, and I stick it out with Resmed.
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#4
Wow. What a mix of info. The same gal says the AirSense can help, but also a paper bag can help?

Enjoy your cruise! Good call on taking the tried and true with you.
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#5
Yeah I think she quickly came to the conclusion that because the machine did not max out at it's max setting of 16, and the 90% mark is around 7, she thinks i woke up from irregular breathing and had some sort of anxiety/panic attack, hence the paper bag comment.

Sadly I have lost all confidence with the DS from that 1 major attack, and knowing that the algorithms are different, will revert back to Resmed and stick with the AS, a direct upgrade from the S9.
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#6
Hi neils,
WELCOME! to the forum.!
Good luck to you as you continue your CPAP therapy and I hope you will be able to get the machine you really want.
Have a nice cruise.
trish6hundred
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#7
It's really simple, and you may have read my many posts here on the subject. Philips Respironics Auto machines are not programmed to increase pressure fast enough to attack obstructive events, and if pressure is set too low, they will continue to fall below the pressure level necessary to prevent events. The Resmed Airsense 10 machines will easily increase pressure from a low setting and not lose efficacy. The solution is to start the Dreamstation machines at a much higher pressure, and run them more like fixed CPAP. That actually works better on a Resmed as well, but a lower pressure won't result in as many events. In addition to the slow response, I'm not a fan of AFlex compared to Resmed's EPR.

If you can get the Airsense 10 Autoset, get it. If you can't, we can help you find an effective range to make the Philips Dreamstation work. Keep in mind, your settings of 5-16 suggest you have not ever optimized a machine, but you got by because the Resmed tolerates it. That won't work with a Dreamstation, but a higher minimum pressure will work better with both machines.
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#8
I don't think your waking up from an OA event.
I had minute and a half OAs with 02 drops into the 60a and didn't wake up from them.

When I did do what you are doing yrs ago they said it was panic.
Right up to my heart attack.

I'd see a cardiologist
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#9
Thanks folks, great forum, I get more info here than anywhere else (and I am new here). 

I am a little disappointed in having to bring back the DS, because I love the design and look of it. But at the end of the day, if it does not respond to apnea events quick enough, to the point where I wake up with an attack and stop breathing, then the design takes a back seat to function. I slept with my "S9" machine without any issues. I always try to sleep on my side, irrelevant of machine, and this morning, when I woke up on my back, I was like oh oh, that is when I stop breathing for up to 57 seconds (according to my recent sleep study). But the S9 did a great job preventing another attack. I call it an attack and not an event because it feels like a heart attack, just cannot breath at all, takes a while to get out of it when you wake suiddenly.

Anyways, lots of blah blah to say that I sure hope the AirSense Auto is as good or better than the S9, with the exact same functionality pump wise, I was told it is the same algorithm as the S9, so that should help.

Just sad I won't have a new machine to take with me on my cruise, I like the idea of downloading data to the iPad and analyzing it. Oh well, probably not the place to play with new apnea gear, out in the middle of the ocean (with 1 doctor on board).

Neil
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#10
In response to Sleeprider's reply about the range of 5-16 (it's actually 6-16), that range was not only set on my Resmed by a qualified sleep clinic and technicians, but I went thru another sleep study just now, and saw both a doctor and an apnea technician, and the written prescription from the doc said 6-16 as a range. It actually used to be 4-16 on my S9, but I caught myself snoring one night with the mask on, mentioned it to them, and that is when they raised the minimum to 6. So it seems like that range has been thought out by the professionals, and seems to be what I need.

Now obviously, the DS did not react properly within that range, because the 90% pressure showed about 7. If the machine picked up a lack of breathing, and 7 was not enough pressure to alleviate the event, it should have continued increasing up to the max of 16, but it did not. By that time it was too late, and I awoke in a panic with lack of air.

Assuming the Resmed will serve me better, one other thing I noticed was a difference in AHI measurement between the DS and my older S9. The DS showed an AHI of around 3-3.5, where as my S9 was around 0.8-1.5. Pretty big difference. So I am guessing that is proof that the Resmed is doing a better job for me based on algorithm differences.

Either way, I picked up a lot of info and feedback here from you guys so thanks, feel more confident now switching over to the AirSense Auto when I get back from my vacay. Taking the S9 with me to be safe.

One last question, someone mentioned here to use the SleepyHead app instead of DreamMapper (or whatever app AirSense will use). Why ?? To be honest with you, there does not seem to be a lot of data to collect and display as a dashboard. AHI, Mask Fit, Sleep Hrs, pretty basic stuff. Most of the time I just look at the AHI number, and be done with it. So what will SleepyHead show that the OEM apps do not ??

Thanks
Neil
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