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My experience thus far...
#1
My experience thus far...
I was Dx’d w mild OSA (AHI 5.1 on 2 night home study) in June 2019. Started DreamStation APAP June 28, 2019 w DreamWear mask and nasal pillows. Initial pressure 4-20 cm. 

The diagnostic study didn’t show any Central Apneas, only some obstructives and Hypopneas. 

My AHI went down below 5 but I noticed many Clear Airway Apneas which were concerning. My 90% pressure was 7.5-8. I felt a bit air starved at initiation so I changed the pressure settings from 4-20 to 6.5-15. I began transferring my data to OSCAR trying to understand all the information presented there. 

My AHIs were 2-3 for awhile, then they began to increase to 3-5. The Clear Airway Obstructions and Hypopneas were high (10-24 range). 

I then turned off the A-Flex feature on my DreamStation. The Clear Airway Obstructions significantly decreased (1-6 range) but the Hypopneas significantly increased (15-35 range). My AHIs were 4-5; I thought they could be improved. 

My 90-95% pressures per DreamStation and OSCAR were in the 7.5-10 range. 

I then turned off the APAP mode and went to CPAP at 9 cm pressure. It’s only been 3 days since going to CPAP and my AHIs have dropped dramatically to 0.6, 1.1 and 0.5, the best trend yet for me. I still show 1-5 Clear Airway Apneas, 0-4 Obstructive Apneas and 1-2 Hypopneas.  

Symptomatically I’m greatly improved, even from the beginning of this journey. My PCP doesn’t know much about treating OSA. I haven’t seen a sleep physician specialist yet. 

I have ordered a Beddr Oximeter which I will attempt to correlate with my DreamStation/OSCAR Data. I realize the DreamStation over calls many of the Apneas.
If I’m not desaturating, I think my problem may be solved but this is yet to be determined.  

My main question now is weather or not to increase the pressure in an effort to completely eliminate all of the Apneas as recorded by my DreamStation?  How critical is it to completely eliminate all of them?

I would appreciate any advice, thoughts and/or suggestions. I can provide some OSCAR displays if they would be helpful. 

Thanks in advance, Sincerely, BG
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#2
RE: My experience thus far...
It is not important to eliminate ALL events. It is important to eliminate enough so that you can get a good nights sleep. The medical community say this is at 5 AHI. We tend to say about half that.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#3
RE: My experience thus far...
When I started out, I had several CAs for the first year, maybe a bit longer.  Now, I still get maybe two a night, but they're mostly gone.  I'm on fixed PAP, EPR of 2, range between 5.6 and 8.0.

If your AHI are below 5.0, as Bonjour says, and you feel pretty good all things considered, I'd say you are doing well.  The fear would be if the CAs cluster, come more frequently steadily over the next two or three weeks, and if their duration extends well beyond, say, 12 seconds.  If most or all of them are into the 13 second range and quite a bit further, 25 seconds, now we need to get them fixed because you are getting significant desaturation of O2 during those events.  Stresses the heart just like extended and clustered OAs do.
Serial Tapist
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#4
RE: My experience thus far...
If you were able to try a Resmed Airsense 10 Autoset, my experience is that your AHI would be less than 2, and likely less than 1. It's that much better. Your trial with CPAP pressure demonstrates just how bad the auto algorithm of the Philips really is. With the Philips auto pressure and Aflex/Cflex, you probably experienced significant flow limitation and hypopnea, that the Resmed aggressively addresses with pressure and EPR that acts like bilevel therapy. I'm glad you found a solution, but the need to to use high pressure or CPAP mode is pretty common with Philips Dreamstation, and in your case with mild apnea, it really should not have been necessary.

I don't think you need to eliminate all apnea as long as you're feeling more rested. Overcoming the sleep disruption of apnea, hypopnea and flow limitation is really the objective, and you seem to have gotten there. On the other hand, as long as you pay attention to how you feel, increasing pressure is not a bad idea. You can always return to the lower pressure that worked best.
Sleeprider
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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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#5
RE: My experience thus far...
Many thanks for the informative feedback!  Interesting to learn about the poor Phillips algorithm.  That would have been nice to know about before all this got started.

For now I'll stick w CPAP mode at 9 cm pressure as the AHIs are very good.  It will be interesting to integrate SaO2 into the picture.  Last night the AHI was 0.5 again w 0 CAs, 3 Obstructives and 1 Hypopnea.  I do occasionally awake with air leaking from my mouth.  Chin strap doesn't seem to help.  OSCAR says I had 46 leaks, max. leak rate 16.

What leak parameters are important to be considering?

Thanks again for valuable input!

Sincerely, BG
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#6
RE: My experience thus far...
I am overly harsh about the Philips algorithm which has helped many people improve their lives. It is just not responsive to the flow limitation precursors of apnea (it relies more on snores and actual OA and H events) so in this regard it is reactive, not proactive. That tends to leave a lot of events unless the minimum pressure is titrated like we would do for fixed CPAP. This is exactly what you found. So my rant is actually frustration over, what is the point of auto CPAP if the machine fails over a significant portion of sleep disordered breathing, to prevent obstructive events and hypopnea? This tends to be among the individuals with upper airway restriction (UARS) and chronic flow limitation. The Philips auto works quite well for classic obstructive apnea preceded by snores.
Sleeprider
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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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#7
RE: My experience thus far...
Yes, it certainly seems as though the Phillips DreamStation is reactive, not preventative...good grief!

BTW, if anyone has a chance, please inform on how to interpret Leak Parameters as displayed in OSCAR.

Thanks again for the valuable input, I will update when more information is available.

Sincerely, BG
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#8
RE: My experience thus far...
I think the ResMed and Phillips machines have two different objectives.

The ResMed as you said is preventative and prevent most events from happening. It raises the pressure quickly as soon as some flow limitations are detected to prevent full apneas from occurring. Therefore you don't need to set the machine to a narrow range of pressure. It's mostly press the button and it works. The downside of the machine being overly aggressive though is that you have lot of pressure oscillation during the night. It might not be a problem to some people but some others don't tolerate it that well and wake up as a result of it or sleep lightly.

The Phillips on the other hand is more of a safeguard. It waits to see some events accumulating and be sure there is really something wrong before raising the pressure. Therefore it doesn't prevent apneas from happening at first but stop them from happening all night long once it sees that you really need more pressure. The downside of that strategy is that you really have to narrow the pressure range to have the machine performs in an optimal way but the upside is you don't have to deal with huge pressure variations during the night. I personally have better results that way so I'm not sure there is a clear winner. It really depends on what you need and prefer.

Of course, if you don't titrate your pressure correctly on the Phillips machine, the ResMed will always beat it. You can achieve good results with both though so no need to worry.
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#9
RE: My experience thus far...
Alex, that is a pretty good summary, and I would add that both Resmed and Respironics auto CPAPs run better when used in a narrower optimal range. My starting pressure with a Resmed Aircurve 10 Vauto is 13/9.0 which I find comfortable. It rarely varies by more than 2-3 cm. So while Resmed auto machines tolerate a wide range of pressure, it is better when optimized. The Respironics don't raise pressure fast enough, and once pressure rises high enough to resolve OA, it allows pressure to drop below the threshold where hypopnea are prevented, so we ted to see a lot more hypopnea with them. It is much more critical to keep pressure at an effective minimum.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files

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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