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Resmed to Phillips Issues
#1
Resmed to Phillips Issues
This is the kitchen sink version so excuse the detail.  I have had several sleep studies.  The first resulted in Resmed 9 DME being prescribed for my sleep apnea which I attempted to use for some time and finally stopped using the device as I could not get used to the mask/hose combination.  When I heard about the dreamwear mask I underwent a second sleep study so I could resume receiving cpap supplies via my insurance.  Since that time, the company who did my sleep studies has gone out of business.  I used the resmed for years but insurance became more and more reluctant to provide my suppplies without a constant submission of usage data.  This required me to drive to a local DME provider with my SD card, in the absence of my sleep study doctor, and have a hardcopy printed out for submission to my insurance company along with my request for supplies.  This was a big hassle.

My DME provider was not interested in working with me to obtain a new device via insurance where usage data could be obtained remotely, so I switched DME companies and worked with a rep who helped me obtain the Phillips Dreamstation.  Using the data from the Resmed device (which I still have), my DME provider set up the Dreamstation (yes, I had it replaced as a result of the recall).  The Dreamstation has never worked like the Resmed.  I've attempted to work with my DME provider on adjusting the Phillips machine but I've never been able to obtain the same satisfaction with the Phillips device that I experienced with the Resmed.

The issue with the Phillips device is when I stop breathing, pressure never builds up to force me to start breathing again which defeats the whole purpose of using the device.  As a result, I breathe through my mouth and wake many times throughout the night needing a drink of water.  This did not occur with the resmed/dreamwear mask combination.  I would prefer not to have another sleep study but since my original prescribing sleep doctor is no longer in business, I'm left with working with the DME company in order to try and resolve my issues, which continue.

I've finally stumbled across this board, downloaded the Oscar software (see report attached) and am attempting to try and solve the issues I'm having with the Phillips Dreamstation myself.  Any input would be greatly appreciated on what might be my next steps short of another sleep study.

Aubrey Stewart


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#2
RE: Resmed to Phillips Issues
You'll likely receive suggestions from significantly more qualified members with much greater expertise.  I wish I could see a snapshot of how your pressure changed throughout the evening, instead of just highlighting a very narrow window of time.  My first thought is your very wide testing range of 4-25 for IPAP.  Given your 95% IPAP level, and considering where your VS started to kick in at only about an IPAP of 6, I'd narrow that range to something like an IPAP of 6-11 for testing - but again wait till you get additional opinions from more qualified people.  Also, your PS has a very wide range of 2-8.  I'd narrow that considerably.  With narrower ranges, report back after a few days of new data.

It’s regrettable that there are DMEs that do not accommodate the needs and best interests of patients.  

Out of necessity, I switched from Philips to ResMed after many years of thinking they were virtually identical algorithms.  I'm overwhelmed at how my sleep has benefited from ResMed's responsive algorithms.  If only I started with a ResMed system 8 years ago.  (That's coming from only one person's opinion.  YMMV.)  You still have a very capable machine.

Welcome to the Board, and congratulations on your first post.
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#3
RE: Resmed to Phillips Issues
Your settings are not working well and are relying too heavily on the slow Philips automation. I have some ideas for you to try:
EPAP min 6.0
Max Pressure IPAP 14.0
PS 3.0 min PS 4.0 max

Why? With your current settings of EPAP min 4.0 max pressure 25 cm and PS 2.0 to 8.0 your therapy looks and probably feels awful. You need a higher EPAP min to knock out the obstructive apnea and more pressure support for the hypopnea and flow limitation. Try the settings outlined above for a night and post results. I suspect you will move toe PS 3.5 or 4.0, but we should observe the results of this incremental change.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
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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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#4
RE: Resmed to Phillips Issues
Thank you so much for your prompt response and helpful info!  Glad I found this group.

Just the info I was looking for and thank you so much for your prompt response.  I'll definitely try these settings and report back.  Much appreciated!
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#5
RE: Resmed to Phillips Issues
See my attached statistics from last night.  I had a SIGNIFICANTLY more comfortable night of sleep with the new settings.  However, in my testing of the device response when I quit breathing, there is still not an adequate enough increase in pressure to be effective.  I would be grateful for suggestions of additional tweaks that might improve my experience with the Phillips device.  Thanks again for your help.


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#6
RE: Resmed to Phillips Issues
Unfortunately, we don't have the trigger sensitivity setting on your Philips BiPAP like we do on the Resmed. It makes a huge difference. In several ways, this looks pretty good, and I'd like to see another night or two with these settings to establish a baseline, then I'm going to look at an increase of EPAP min to 6.5 and increase PS min to 4.0.
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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#7
RE: Resmed to Phillips Issues
Hi aubreyjs,

I am happy for you that you had a better night , hopefully last night was even better.

I thought I posted last night, I guess I never hit send before I fell asleep. I only thought of it after I shut down.

In OSCAR, can you make a new profile name and put your Resmed 9 data on it. It may be helpful to know the machine mode/settings that worked for you.

On the AirCurve 10 VAuto, I don't know if the FOT keeps adding the small oscillations until a breath is taken.



From a 2014-11 Resmed AirCurve 10 VAUTO and Resmed AirCurve 10 S models guide:

[Central sleep apnoea detection
Central sleep apnoea detection is available in VAuto, CPAP and S modes (when Easy-Breathe is
enabled) on AirCurve 10 VAuto device.
The AirCurve 10 has central sleep apnoea (CSA) detection. The Summary and Detailed Data of these
parameters are available to view on ResMed's patient compliance software (data availability
depends on device mode and parameter measured).
The device detects both obstructive and central sleep apnoeas (CSA). CSA detection uses the
Forced Oscillation Technique (FOT) to determine the state of the patient’s airway during an apnoea.
When an apnoea has been detected, small oscillations in pressure [1 cm H2O (1 hPa) peak-to-peak
at 4 Hz] are added to the current device pressure. The CSA detection algorithm uses the resulting
flow and pressure (determined at the mask) to measure the airway patency.]
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#8
RE: Resmed to Phillips Issues
aubreyjs,

I am trying to understand your statement from your opening post. Pressure does not build up in masks because of the flow vent holes to expel air. The machine increases pressure to clear airway.

When you wrote, "...I stop breathing...", are you referring to Central apneas. Resmed has these machines types for treating Centrals: ST, ASV or iVAPS. Some medical conditions may prohibit use of any of these machines. Ask medical doctors.

Actually I was looking for a Philips Respironics DreamStation Auto BiPAP, but could not find one. I like the fact that flow limitations and RERA show up in the event section of OSCAR

I have no idea how the fine tuning of the Resmed AirCurve 10 compares to the Resmed 9/Philips Respironics DreamStation Auto BiPAP.

[The issue with the Phillips device is when I stop breathing, pressure never builds up to force me to start breathing again which defeats the whole purpose of using the device. As a result, I breathe through my mouth and wake many times throughout the night needing a drink of water. This did not occur with the resmed/dreamwear mask combination. I would prefer not to have another sleep study but since my original prescribing sleep doctor is no longer in business, I'm left with working with the DME company in order to try and resolve my issues, which continue.]
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#9
RE: Resmed to Phillips Issues
Another thought, the AirCurve 10 has a "Backup Rate" do not know if you used that with the Resmed 9.
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#10
RE: Resmed to Phillips Issues
My VAuto manual indicates that only the ST and T modes have a backup rate setting. Neither the Vauto nor S modes support setting a backup rate.

Check the Clinicians' Manual to see other mode dependencies.
Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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