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I have officially joined the club!
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wheaton4prez Offline

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Posts: 13
Joined: Oct 2014

Machine: Philips Remstar Auto AFlex DS560S
Mask Type: Full face mask
Mask Make & Model: Resmed Ultra Mirage FFM
Humidifier: None
CPAP Pressure: Auto (4-20)
CPAP Software: Not using software

Other Comments:

Sex: Male
Location:

Post: #11
RE: I have officially joined the club!
(10-11-2014 10:16 AM)Doc J Wrote:  Welcome back to nose breathing, I too had not been there for a long time. The nasal mask is great if you can keep your mouth shut. I like most would over tighten my full faced mask and have great pain from it. On the whole pressure range thing, if you find the average pressure it is going to is say 11 then you don't really want it trying to go down to 4. So once you find the average you could bring the lower setting up to 2 or 3 below. It will work that way it is but some people find 4 very low like your not getting any air.

The DME said that I wouldn't be able to change the pressures myself. They had to adjust it. Is that true? Or, is there a work-around so that I can go in and make those changes?

The first night it said that I average 9.5 pressure. Last night it averaged 12.5.

(10-11-2014 04:20 PM)Galactus Wrote:  Glad to hear you are progressing, the getting started is the hardest part, it is all downhill from there.

Just for the next time you see him and he doesn't believe you just tell him respironics system one 200 60 series unit, a brick. The only data it records is compliance data. Unfortunately for me I did not find any help like this board till I was almost 2 months in and could not get them to exchange the unit. Not only a brick but straight CPAP at 18 pressure was my initial setting. When I called after 6 months and told the Dr (or his nurse I should say) that I wasn't feeling better and had bloating headaches etc., they sent through an order to lower my pressure by 4. They had no efficacy data, they had no real information just my complaint and they were just going to lower it...... I smelled something funny and I had just taken a shower. And no it wasn't retired guy either, he's too far away to smell him. So I started asking if anyone thought this was odd, and that was my turning point. I bought a BiPAP and now I know it is working 13/20 and I can see the data and I can see some nights IPAP is even at 19, so the hell with this "They don't give out bricks", talk to the hand, lol.

Good you found this site before hand, I wish I knew then what I know now.

I suspect that the guy has just been at that one company for many years and doesn't know what other companies are doing.

Their company is Apria Healthcare. They sound like a huge operation with facilities all over the US. Apparently they are placing over a thousand APAP machines a day across the company. So, they buy these units by the "palette load".

(10-11-2014 06:32 PM)archangle Wrote:  
(10-10-2014 07:30 PM)wheaton4prez Wrote:  I ended up with a Philips Remstar Auto AFlex Model DS560S. It collects data and is auto. That's a decent unit, right?

The guy who showed me how to use it was really helpful and detailed. I told him that I read that I should be concerned about being given a sub-par unit. He said that those old units without data aren't given out by any company any more. So, where is that concern coming from? He didn't know.

The PRS1 560 is an excellent machine.

Your DME is either really stupid, or is being willfully ignorant, but you did get a good machine. If your doctor hadn't prescribed an auto machine, you would probably have gotten screwed with a brick.

Philips Respironics makes a PRS1 DS160, a PRS1 Plus (DS260), and a PRS1 SE model. They all collect "compliance data," i.e. the time you turn the machine off and on. They only tell whether you're using the machine or not. Most insurance will refuse to pay if you don't meet "compliance" requirements, usually 4 hours a night.

Lots of DME's are still selling these "brick" CPAP machines.

You could still have extremely severe apnea even on CPAP, and the machine would give and your doctor absolutely no clue this is happening. As long as you breathe one a minute or so, the machine makes no indication of problems at all. Neither you nor your doctor will have any clue that your treatment is not working.

It's like treating high blood pressure without bothering to keep checking the blood pressure on an ongoing basis.

Your PRS1 Auto, and the PRS1 Pro, are like having a mini sleep test every night. It records every breath you take all night long. It detects and records apneas. It tells whether you have leaks. It also tells you a whole lot more information.

You can download the free SleepyHead program and look at the data yourself. There are some pictures of what kind of data it gives you here:



ResMed's newest machines, the AirSense 10 series, have one model that isn't quite a full brick, but it only records nightly averages, not the minute by minute information that the fully data capable machines record. The better ResMed A10 models are just as data capable as the good PRS1 models.

I don't think the doctor specified an auto machine. It sounded like this unit is the only model that this company gives out. The schedules got messed up. So, they did the mini-class for another guy at the same time as me. He got the same unit. But, his doctor added the humidifier so he got that while I did not.

I believe that other DMEs are selling the bricks. But, maybe this DME doesn't and I just lucked out.

Night 2 of using the machine went a little better than night 1. I still took it off for the last few hours of the night because my nose ached. But, I tried sleeping on my back which helped a lot. Before the machine, it was impossible to sleep on my back. I would just immediately choke and wake up once I fell asleep.

It looks like the machine worked harder with 12.5 instead of 9.5 from the night before. I wonder if that's because of sleeping on my back and the gravity is different?

I'm going to download the sleepyhead software now. Can I just pull the data card out of the machine? Or, do I need to have the software "eject" it first like USB on a computer?
10-12-2014 10:29 AM
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wheaton4prez Offline

Members

Posts: 13
Joined: Oct 2014

Machine: Philips Remstar Auto AFlex DS560S
Mask Type: Full face mask
Mask Make & Model: Resmed Ultra Mirage FFM
Humidifier: None
CPAP Pressure: Auto (4-20)
CPAP Software: Not using software

Other Comments:

Sex: Male
Location:

Post: #12
RE: I have officially joined the club!
I imported the data from 2 days into SleepyHead. Not sure what I am looking at though.

A lot of people here talk about the AHI. Is that the statistic I should be paying attention to? It has mine at 7.56...
10-12-2014 11:16 AM
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Galactus Offline

Advisory Members

Posts: 1,384
Joined: Jan 2014

Machine: Phillips Respironics System One PRS1 DS760P Auto BiPAP
Mask Type: Nasal pillows
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: System One Heated Humidifier + Climate Line
CPAP Pressure: E/I 13/20 PS 4/7 BiFlex 3
CPAP Software: SleepyHead EncoreBasic

Other Comments: Sleep can be a good thing.

Sex: Male
Location: USA

Post: #13
RE: I have officially joined the club!
Hey there, soooo first of all whoa nellie there. You want the humidifier, you need the humidifier, if not right this second, you will, it is a major cause of dried out sinus, dry mouth and overall not so great experiences. So if you didn't get one get on the phone with your Dr and make sure you get one. I'm not sure what is causing you to take the mask off during the night, or have it bother you, you say your nose hurts, but no details, if the inside of your nose is sore that could be lack of water vapor to moisturize your nasal passages and the lack of a humidifier. This is just another instance of having to know what you should get, it's not as bad as giving you a brick, but this is how they save $20 and you get the shaft, not right.

I have Apria lovingly referred to on this board everywhere as Crapria. They were the ones that gave me the brick. Most people here will tell you they are a very bad company, my experience was pretty decent except for the brick, and I'm not sure if that is a Dr to DME thing or just DME etc., overall people complain about double billing CC billing you when they should bill the insurance company etc. My experience is they have done nothing like that to me, they ship my orders rather promptly and they have overall been ok. But expect to hear bad things about them they have a bad reputation and be vigilant about checking the bills to make sure you don't get billed if they get to lazy to bill the insurance company.

As to pressure settings, there is a clinicians manual available by emailing or on line, see links above at top of page for manuals. You can most certainly change it yourself, I have 100% setup my new machine with the help of people here on this board. Make sure you understand what you are setting up and how it is affecting you before you do it. It is a bit complicated at first depending on the machine and what you are doing, but once you understand it it's as easy as changing the channel on the TV remote. Yes you are completely able to do it.

As to AHI that is a result of the night of treatment, the gold standard is AHI under 5. Many here achieve under 1 or even 0 on a regular basis. Start by shooting for under 5 as that is apnea treatment that is under control. For your first few nights you seem to be on the right path. It will get better as you go along.

As to looking at sleepyhead there is a whole long and short description of what you are looking at. For the start just look at AI and pressure, they will give you what you want to know, and that is really if this is working. You can post a chart and people here will advise you on how it looks as just the AHI doesn't tell the whole story because the breakdowns of AHI are important as well because AHI is just an addition of the numbers of events but doesn't tell us exactly which events so we can assist better.

If everyone thinks alike, then someone isn't thinking.
Everyone knows something, together we could know everything.
(This post was last modified: 10-12-2014 11:38 AM by Galactus.)
10-12-2014 11:27 AM
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retired_guy Offline

Preferred Members-2

Posts: 2,744
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: ResMed
CPAP Pressure: 10.6/14, EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #14
RE: I have officially joined the club!
The 7.56 is one of the more important indicators for you. The other is what are your average pressures? ..and what are your leak numbers.

To begin with, your sidebar indicates the machine is set to a minimum 4, maximum 20 pressure setting. That's way too big a range. It's the default settings and the idea is the machine will figure out what it needs to do. But getting from point "a" to point "b" can create a lot of problems. So if it were me, I would move the minimum up to at least 6, preferably 8, and I'd drop the top end from 20 to at most 16. Then I'd see what my results are over the course of the next few days.

The other issue is the ramp and ramp time. Ramp pressure typically starts low and builds over a specified time to therapy levels. The thing is though, any apnea events occurring during the ramp time cannot be responded to, or reported. So the ramp time needs to be a pretty short period, say not more than 5 or 10 minutes. I prefer "off."
10-12-2014 11:39 AM
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wheaton4prez Offline

Members

Posts: 13
Joined: Oct 2014

Machine: Philips Remstar Auto AFlex DS560S
Mask Type: Full face mask
Mask Make & Model: Resmed Ultra Mirage FFM
Humidifier: None
CPAP Pressure: Auto (4-20)
CPAP Software: Not using software

Other Comments:

Sex: Male
Location:

Post: #15
RE: I have officially joined the club!
(10-12-2014 11:27 AM)Galactus Wrote:  Hey there, soooo first of all whoa nellie there. You want the humidifier, you need the humidifier, if not right this second, you will, it is a major cause of dried out sinus, dry mouth and overall not so great experiences. So if you didn't get one get on the phone with your Dr and make sure you get one. I'm not sure what is causing you to take the mask off during the night, or have it bother you, you say your nose hurts, but no details, if the inside of your nose is sore that could be lack of water vapor to moisturize your nasal passages and the lack of a humidifier. This is just another instance of having to know what you should get, it's not as bad as giving you a brick, but this is how they save $20 and you get the shaft, not right.

I have Apria lovingly referred to on this board everywhere as Crapria. They were the ones that gave me the brick. Most people here will tell you they are a very bad company, my experience was pretty decent except for the brick, and I'm not sure if that is a Dr to DME thing or just DME etc., overall people complain about double billing CC billing you when they should bill the insurance company etc. My experience is they have done nothing like that to me, they ship my orders rather promptly and they have overall been ok. But expect to hear bad things about them they have a bad reputation and be vigilant about checking the bills to make sure you don't get billed if they get to lazy to bill the insurance company.

As to pressure settings, there is a clinicians manual available by emailing or on line, see links above at top of page for manuals. You can most certainly change it yourself, I have 100% setup my new machine with the help of people here on this board. Make sure you understand what you are setting up and how it is affecting you before you do it. It is a bit complicated at first depending on the machine and what you are doing, but once you understand it it's as easy as changing the channel on the TV remote. Yes you are completely able to do it.

As to AHI that is a result of the night of treatment, the gold standard is AHI under 5. Many here achieve under 1 or even 0 on a regular basis. Start by shooting for under 5 as that is apnea treatment that is under control. For your first few nights you seem to be on the right path. It will get better as you go along.

As to looking at sleepyhead there is a whole long and short description of what you are looking at. For the start just look at AI and pressure, they will give you what you want to know, and that is really if this is working. You can post a chart and people here will advise you on how it looks as just the AHI doesn't tell the whole story because the breakdowns of AHI are important as well because AHI is just an addition of the numbers of events but doesn't tell us exactly which events so we can assist better.

Thank you. It sounds like I got lucky getting the good machine.

I plan on calling the doctor tomorrow to get the humidifier order in. It sounds like that should be easy to get. I definitely do need it. My mouth was really dried out last night.

I take the mask off because the achiness on my face builds up, especially on the bridge of my nose. It still aches right now, 4+ hours after taking the mask off. There is an adjustment on the mask that relieves pressure on the nose bridge. But, when I make it loose enough to be comfortable the mask seems like it starts to leak.

How do I post the data? Is 2 days enough to really analyze yet? Or, could my adjustment to using this cause it to give off data?

Looking closer at the data, it's showing a lot of Clear Airway and Hypopnia events. Reading more about that, should I be concerned now that I have a condition is going to need treatment beyond this machine?

(10-12-2014 11:39 AM)retired_guy Wrote:  The 7.56 is one of the more important indicators for you. The other is what are your average pressures? ..and what are your leak numbers.

To begin with, your sidebar indicates the machine is set to a minimum 4, maximum 20 pressure setting. That's way too big a range. It's the default settings and the idea is the machine will figure out what it needs to do. But getting from point "a" to point "b" can create a lot of problems. So if it were me, I would move the minimum up to at least 6, preferably 8, and I'd drop the top end from 20 to at most 16. Then I'd see what my results are over the course of the next few days.

The other issue is the ramp and ramp time. Ramp pressure typically starts low and builds over a specified time to therapy levels. The thing is though, any apnea events occurring during the ramp time cannot be responded to, or reported. So the ramp time needs to be a pretty short period, say not more than 5 or 10 minutes. I prefer "off."

Average pressure is 9.92 (14.6 max 14.10 90%).
Average leak rate is 2.3 (9.0 90% and 1.07% time above leak rate threshold)

What type of issues can having too big a range cause? I do want to eventually change the range. But, not sure if I want to dive into that level of self-adjusting after only 2 days.

I'm not sure what the ramp time is set to. Is that something I can see in the machines screen?
10-12-2014 11:50 AM
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retired_guy Offline

Preferred Members-2

Posts: 2,744
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: ResMed
CPAP Pressure: 10.6/14, EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #16
RE: I have officially joined the club!
(10-12-2014 11:50 AM)wheaton4prez Wrote:  Looking closer at the data, it's showing a lot of Clear Airway and Hypopnia events. Reading more about that, should I be concerned now that I have a condition is going to need treatment beyond this machine?

No. It's way too soon to make any conclusions such as that. CA's can be an issue, but can very often be transient caused by the newness of therapy, or even mask fit issues which I believe you have.

As to the fit, research that a bit. Ask Mr. Youtube for help. It sounds like you've got that thing cranked down pretty good, and that's what is causing your morning discomfort. Also, you can make a mask liner out of an old t-shirt that will help a lot. Just trace around the border of the mask leaving some overlap, cut out the material and cut out the center where your cute little nose goes, and you're all set.

The clinician manual should allow you to find all the settings regarding ramp.

[/quote]
10-12-2014 12:00 PM
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Galactus Offline

Advisory Members

Posts: 1,384
Joined: Jan 2014

Machine: Phillips Respironics System One PRS1 DS760P Auto BiPAP
Mask Type: Nasal pillows
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: System One Heated Humidifier + Climate Line
CPAP Pressure: E/I 13/20 PS 4/7 BiFlex 3
CPAP Software: SleepyHead EncoreBasic

Other Comments: Sleep can be a good thing.

Sex: Male
Location: USA

Post: #17
RE: I have officially joined the club!
I would not be overly concerned about 7.5 in two days, it isn't great but it isn't awful.

Rule of thumb is 7 days between changes to get at least 7 days of data. That's a decent idea of what is going on. Now having said that please note that 4-20 is too wide of a "setting", in fact it's not really a setting at all it is just the units default parameters with the idea being the machine will figure it out. In theory it's ok, in practice it causes issues based on such a wide range. First issue is many feel they aren't getting enough air at 4, that starts the problems. The units algorithm creates a hunt and peck situation, and when the machine is wide open like that it gets cranky. Based on your pressures over the last few days I'd say you should raise the low end to at least 8, which is a decent start. Top end can be lowered to say 18 with no issues based on that max.

The leaks look ok, nothing to be concerned about.

Don't worry about other conditions, much too early to even think about that.

Also take a look at the graphs on the top right and note the times of the events. Are you asleep? Or did they occur as you went to bed? Are they when you woke up? If they are at the very start and the very end they can be discounted as it is sleep apnea, when you're awake it doesn't count.

If everyone thinks alike, then someone isn't thinking.
Everyone knows something, together we could know everything.
10-12-2014 12:14 PM
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wheaton4prez Offline

Members

Posts: 13
Joined: Oct 2014

Machine: Philips Remstar Auto AFlex DS560S
Mask Type: Full face mask
Mask Make & Model: Resmed Ultra Mirage FFM
Humidifier: None
CPAP Pressure: Auto (4-20)
CPAP Software: Not using software

Other Comments:

Sex: Male
Location:

Post: #18
RE: I have officially joined the club!
(10-12-2014 12:00 PM)retired_guy Wrote:  
(10-12-2014 11:50 AM)wheaton4prez Wrote:  Looking closer at the data, it's showing a lot of Clear Airway and Hypopnia events. Reading more about that, should I be concerned now that I have a condition is going to need treatment beyond this machine?

No. It's way too soon to make any conclusions such as that. CA's can be an issue, but can very often be transient caused by the newness of therapy, or even mask fit issues which I believe you have.

As to the fit, research that a bit. Ask Mr. Youtube for help. It sounds like you've got that thing cranked down pretty good, and that's what is causing your morning discomfort. Also, you can make a mask liner out of an old t-shirt that will help a lot. Just trace around the border of the mask leaving some overlap, cut out the material and cut out the center where your cute little nose goes, and you're all set.

The clinician manual should allow you to find all the settings regarding ramp.
[/quote]

Got it.

Who is Mr. Youtube?

(10-12-2014 12:14 PM)Galactus Wrote:  I would not be overly concerned about 7.5 in two days, it isn't great but it isn't awful.

Rule of thumb is 7 days between changes to get at least 7 days of data. That's a decent idea of what is going on. Now having said that please note that 4-20 is too wide of a "setting", in fact it's not really a setting at all it is just the units default parameters with the idea being the machine will figure it out. In theory it's ok, in practice it causes issues based on such a wide range. First issue is many feel they aren't getting enough air at 4, that starts the problems. The units algorithm creates a hunt and peck situation, and when the machine is wide open like that it gets cranky. Based on your pressures over the last few days I'd say you should raise the low end to at least 8, which is a decent start. Top end can be lowered to say 18 with no issues based on that max.

The leaks look ok, nothing to be concerned about.

Don't worry about other conditions, much too early to even think about that.

Also take a look at the graphs on the top right and note the times of the events. Are you asleep? Or did they occur as you went to bed? Are they when you woke up? If they are at the very start and the very end they can be discounted as it is sleep apnea, when you're awake it doesn't count.

Ok. I will try to get the range settings adjusted before bed tonight.

Interesting. The graph shows that many of the events are happening as I'm going to sleep. In fact, almost all of the Clear Airway events are at that time. The OSA events almost completely go away after the first 30 minutes.

There are a lot of "Vibratory Snore" events later during sleep...
10-12-2014 12:41 PM
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Galactus Offline

Advisory Members

Posts: 1,384
Joined: Jan 2014

Machine: Phillips Respironics System One PRS1 DS760P Auto BiPAP
Mask Type: Nasal pillows
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: System One Heated Humidifier + Climate Line
CPAP Pressure: E/I 13/20 PS 4/7 BiFlex 3
CPAP Software: SleepyHead EncoreBasic

Other Comments: Sleep can be a good thing.

Sex: Male
Location: USA

Post: #19
RE: I have officially joined the club!
Well see there you have it, if you are awake when it is happening, as you go to sleep then it is just the unit picking up data that doesn't really matter. If when you are asleep there is nothing than you are doing better. I'll ost a chart so you can see, and compare.

Mr Youtube can be found at http://www.youtube.com there are many videos there after a search of what you are looking for.

If everyone thinks alike, then someone isn't thinking.
Everyone knows something, together we could know everything.
10-12-2014 12:50 PM
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retired_guy Offline

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Posts: 2,744
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: ResMed
CPAP Pressure: 10.6/14, EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #20
RE: I have officially joined the club!
(10-12-2014 12:41 PM)wheaton4prez Wrote:  Interesting. The graph shows that many of the events are happening as I'm going to sleep. In fact, almost all of the Clear Airway events are at that time. The OSA events almost completely go away after the first 30 minutes.

There are a lot of "Vibratory Snore" events later during sleep...

Anything that occurs when you're awake doesn't count. It's called "Sleep Apnea" because the breathing thingies that occur when we're asleep are different than the breathing thingies that occur when we're awake. The machine, not being Santa Clause, cannot tell the difference between when we're awake and when not. So your observation regarding the CA's showing up while you're going to sleep make sense. They're bogus, and can be ignored.

Vibratory snore does not necessarily mean "snore" snore. It may just be mask leakage.
10-12-2014 12:59 PM
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