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Long time user, first time posting, Like my charts?
#1
Long time user, first time posting, Like my charts?
I've been on CPAP/APAP for about 12 years now. It was love at first sleep for me and I simply feel like I cannot function without it.

I'm normally a SwiftFX pillow guy but have been using a full face during the allergy season since I'm stuffed up solid. Leaks are an issue for me at the moment, but could someone take a look at these charts?

I was on an S9 for years and it was great. AHI was always nice and I felt great. I accidentally left my power supply at home during a vacation and ended up buying an under 100 hour Dreamstation for $50 from a local I found on Facebook marketplace two days into my vacation. Lets just say that I think someone was looking over me and it saved the vacation.

As time went on I kept using the dreamstation since it was newer, and gave my S9 to a friend who needs a machine but doesn't have insurance. I just never really felt like the dreamstation was working for me. The AHI was always higher and the pressure seemed to just climb no matter what. Pressure was all over the place and I've messed a bit but never asked for help optimizing. So I bought a new Resmed S10 and used it for one night...just one. And holy crap I feel amazing today.

Is it all in my head?

   
   
   
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#2
RE: Long time user, first time posting, Like my charts?
The Dreamstation Auto provides very different feeling therapy from the Resmed Autoset. Both of the charts have a lot of excess leaks, but the events are clearly higher on the Dreamstation. If you're around the forums for very long, you will see a strong bias towards recommending the Autoset over any other machine. Your charts do not point to any significant problems, and the AHI less than 1 on the Resmed is excellent. However, you asked, and I'll tell you the rest of the story from my perspective.

When using a Dreamstation, you need to optimize pressure because it is slow to respond. You almost have to set it up like a fixed CPAP and target the 90% required pressure as the minimum APAP pressure. The Resmed Autoset can be set much looser and it will react to flow limitations to increase pressure before apnea hits. Looking at your Autoset results, at 5-20 pressure, your median pressure is about 9.0 and 90% pressure is about 11.4. For the Autoset, I would suggest the median pressure of 9.0 would make a good median, and I suggest increasing EPR (exhale pressure relief) to 2 or 3 to take advantage of the bilevel pressure it provides and target reducing the flow limitation and hopefully increase tidal volume and slow the respiration rate just a bit. Your tidal volume is low and your respiration rate is high, so that balances out your minute vent and keeps your oxygenation in range, but the bilevel delivery of pressure with the Autoset with EPR 3 might help normalize that. Bear in mind that leaks greatly affect the volume recorded.

The Dreamstation has settings of 8-18 and the median pressure was 11.3 and 90% pressure probably close to 15.0. So it takes higher pressure, and still leaves you with more events. Your respiration rate and tidal volume are similar, and I'm curious what your Flex setting was. In both cases, you are not using your nasal pillows mask and these results may not be typical. I used the Resmed Swift FX until the Resmed Airfit P10 was released. I think you will like the quieter mask that seems to reduce AHI and leaks, and is very comfortable.
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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#3
RE: Long time user, first time posting, Like my charts?
(05-02-2019, 10:45 AM)Sleeprider Wrote: The Dreamstation Auto provides very different feeling therapy from the Resmed Autoset.  Both of the charts have a lot of excess leaks, but the events are clearly higher on the Dreamstation.  If you're around the forums for very long, you will see a strong bias towards recommending the Autoset over any other machine.

When using a Dreamstation, you need to optimize pressure because it is slow to respond. You almost have to set it up like a fixed CPAP and target the 90% required pressure as the minimum APAP pressure. The Resmed Autoset can be set much looser and it will react to flow limitations to increase pressure before apnea hits.  Looking at your Autoset results, at 5-20 pressure, your median pressure is about 9.0 and 90% pressure is about 11.4.  For the Autoset, I would suggest the median pressure of 9.0 would make a good median, and I suggest increasing EPR (exhale pressure relief) to 2 or 3 to take advantage of the bilevel pressure it provides and target reducing the flow limitation and hopefully increase tidal volume and slow the respiration rate just a bit.  Your tidal volume is low and your respiration rate is high, so that balances out your minute vent and keeps your oxygenation in range, but the bilevel delivery of pressure with the Autoset with EPR 3 might help normalize that. Bear in mind that leaks greatly affect the volume recorded.

The Dreamstation has settings of 8-18 and the median pressure was 11.3 and 90% pressure probably close to 15.0.  So it takes higher pressure, and still leaves you with more events. Your respiration rate and tidal volume are similar, and I'm curious what your Flex setting was.  In both cases, you are not using your nasal pillows mask and these results may not be typical.  I used the Resmed Swift FX until the Resmed Airfit P10 was released. I think you will like the quieter mask that seems to reduce AHI and leaks, and is very comfortable.

Thank you so much for the information. I'm going to be staying with the S10 for sure.

I changed flex over time on dreamstation from3, then I moved to 2, then 1 because I figured it was the main issue.

I do need to check out new masks. I'm using a Mirage Quattro, so it's not the newest tech.
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#4
RE: Long time user, first time posting, Like my charts?
When you say median pressure for a 9 is that setting the machine 9-20 and epr to 3 effectively decreases the 9 down a bit? That makes the 9 median?
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#5
RE: Long time user, first time posting, Like my charts?
(05-02-2019, 07:08 PM)Matgyver Wrote: When you say median pressure for a 9 is that setting the machine 9-20 and epr to 3 effectively decreases the 9 down a bit? That makes the 9 median?

I think he meant to say that (since) 9.0 is your current median it would make a good minimum.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#6
RE: Long time user, first time posting, Like my charts?
Exactly. Fumble fingers on that post. Your current median of 9.0 would make a good minimum, and with EPR at 3 your starting pressure will be 9/6 IPAP/EPAP.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Optimizing Therapy
Organize your OSCAR Charts
How To Attach Images And Files to your posts
How To Deal With Equipment Supplier
Mask Primer
Beginner's Guide to Sleepyhead

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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