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Is this normal or my APAP is simply stupid?
#11
RE: Is this normal or my APAP is simply stupid?
How does your machine define normal?  

A hypopneas is defined as a reduction from normal for 10 seconds or more.

In the first view I can see, barely because of scale, many flow limitations which may be hypopneas, can't determine because there is insufficient normal breathing,

The second is way too long a duration to see the detail to evaluate.

The first flow calls for an increase in pressure support to treat
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#12
RE: Is this normal or my APAP is simply stupid?
What Fred is saying is that you have flow limitation, or more accurately, an upper airway restriction the reduces the peak flow rate during inspiration that reduces your tidal volume and minute vent. You respond with a drop in SpO2 and recovery breathing, which is larger amplitude rlow rate that raises the tidal volume.  This is without a doubt associated with an arousal.  Pressure support is the best way to resolve this problem. Pressure support is the difference between IPAP and EPAP, but it has to be delivered at the right time and your Philips Dreamstation can't do that.  The ideal solution is bilevel, but even the Resmed Airsense 10 Autoset can provide 3-cm ofba pressure support which a a lot better than what you get now.  

Many people upgrade from CPAP to bilevel (machines like the Resmed Aircurve 10 Vauto) when they experience flow limitation, hypopnea and arousals as is the case with you.  These events are extremely difficult on your sleep and sense of well-being because they persistently arouse you through the night. Your AHI looks fine, but your sleep still sucks.  I'll post an image of how pressure support helps to replace physical effort to get a breath with an increase in pressure as you inhale and relief of the pressure as you exhale.  It all feels completely natural and you would not "feel" the pressure support, but it makes it really easy to breathe. In the graph below the blue wave is mask pressure and it follows your flow rate, increasing during inhale and decreasing as you exhale. Note how each breath is supported. (this chart is the zoom resolution we would like to see from you so we can really see the flow rate problems).

There are two ways to go about makng this happen. Talk to your doctor to upgrade your prescription based on your intolerance to CPAP and continued fatigue, or self-fund a new or used machine.  It's really up to you how long you want to continue with your current situation, and whether your insurance will cover the upgrade at all.  Many of us self-funded the first bilevel, I did.

[Image: attachment.php?aid=16846]
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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#13
RE: Is this normal or my APAP is simply stupid?
Another victim of the Respironics ScreamStation not being capable to provide acceptable therapy? Sincerely hope you can change out that machine maybe to ResMed's VAuto.
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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#14
RE: Is this normal or my APAP is simply stupid?
https://youtu.be/RtAF7DpDnjc

Here is the video, I have zoomed in and I have shown how these look from close up...

Please everyone check asap..

I am really stuck here and I am willing to sell my car and buy a new machine if that is what will help me. I will wait for no appointments, no sleep studies... 

This machine did help me indeed I can sleep second half of the night sort of but the first half is horrible and I guess that is where the deep stages of sleep are. I guess even with this dreamstation thing I am missing out on them. 

I hope video is clear. Let me know if there is something more I can do.

I would like to select screenshots out of that video, useful ones so someone reading later maybe can see it all as well... if this indeed is flow limitation that can be solved with bipap
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#15
RE: Is this normal or my APAP is simply stupid?
https://youtu.be/RtAF7DpDnjc

Hello to you too, thank you sooo much for helping me out. I have no idea how to pay back and do something for you guys...


Here I made a video to show close up of what was going on there... Please let me know if this does indeed look like flow limitation or something else?!
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#16
RE: Is this normal or my APAP is simply stupid?
First there are no guarantees here.  There is a lot of experience and overall we have very good success in people.  I even have a canned response for the difference between Dreamstation and ResMed. here it is.


Quote:ResMed AutoSet hands down.
Why ResMed?

1. Faster algorithmic response to events than PR.
2. Lower average pressure
3. Better to avoid Aerophagia.
4. EPR provides for better treatment of hypopneas, RERAs, Flow Limits, UARS, and snores
5. EPR acts like a BiLevel up to a limit of 3cmw (1,2,or 3cmw) and a max pressure of 20 cmw
6. EPR follows your breathing where as Flex predicts it with a feeling of fighting to get a breath when it predicts incorrectly
7. More flexibility in treating a greater variety of Apneas and respiratory events.
8. In general provides better therapy.

I have frequently told many DreamStation users that they need to get either the ReaMed AutoSet or BiLevel to get better therapy. 

Respironics costs less
While a BiLevel will not always provide "better" treatment than a Dreamstation or an APAP, it will always be at least as good.  The VAuto will give you more options in treatment.
Look for a low hours ResMed VAuto on the secondary market. Get a screenshot of the run hours in the about the menu and the front faceplate to validate the model and the run hours.  There are several vendors in the US that frequently ship overseas.  I'll let those more familiar with that than I comment further on that.

IMHO you should get the ResMed AirCurve 10 VAuto, though as Sleeprider said the ResMed AirSense 10 AutoSet is lightyears ahead of the Dreamstation.

edit: What is remarkable about your chart is how few breaths are not flow limited to some extent.
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#17
RE: Is this normal or my APAP is simply stupid?
In all sincerity, your DreamStation is blind to far too many events and you get stuck with unacceptably poor therapy.
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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#18
RE: Is this normal or my APAP is simply stupid?
sorry if I understood you correctly you are saying 

"remarkable is how few events are not flow limited to some extent"

are you trying to say that that speaks against flow limitation since some of them are not limited?

OR 

this what we see indeed is flow limitation since only a few of them are not limited?

PLease clarify because English is not my native language and if this is the flow limitation, tomorrow right away I am driving to closes town and buying a new machine. I dont care about money, I am desperate and willing to try anything
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#19
RE: Is this normal or my APAP is simply stupid?
If you are buying a new machine, the Resmed Aircurve 10 Vauto is best for your condition. I think my previous posts pointed to your flow limitations and suggested pressure support would resolve the problem. If CPAP is your only option, the Airsense 10 at least gives you 3-cm of pressure support. Give us the chance to coach you on bilevel, and you will never look back.

Your video confirmed what I had already concluded. You have very flow limited breathing, and the Philips CPAP is simply unresponsive to that condition. It is the major reason I consider that machine a failure for anyone with upper airway restriction. You will do better changing. If you want more analysis on the video, let me know. There is ta lot there, but it all point to the need for pressure support as I said in my previous post.
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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#20
RE: Is this normal or my APAP is simply stupid?
Hello thank you so much...

I do have one question... isnt A FLEX on my dreamstation actually same as pressure support?
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