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Self-diagnosed on Dreamstation with questions
#1
Question 
Self-diagnosed on Dreamstation with questions
Hi,

I have had the occasional bad night for quite a few years. During the last 2 years those have been increasing steadily and I now have episodes where I don't feel like getting proper sleep for weeks on end.

I have an under-mattress sleep tracker, which can estimate the time in different sleep stages. Several times it alerted me that I had interrupted breathing during sleep and should see a doctor. Therefore I made an appointment for a sleep study, which will be in August (earliest possible).

I tried a home-fitted dental appliance, which gave some relief but not consistently. When I could not take it any longer, I bought a Dreamstation Auto CPAP off of eBay after doing some research. I set it to a pressure of 4–20 and Flex at 3. I tried a Flex setting of 2 after reading the forum but couldn't sleep with it.

I get a pretty decent AHI with this machine and these settings (see charts). I do not wake up sweating and unable to fall back asleep anymore. But I still have morning headache and don't really feel rested. At least in part this seems to be because I don't get enought REM sleep. At this point I don't know whether this is because of arousals from apeas/hypopneas or because of the pressure I am still not used to. Probably a combination of both.

One thing I dislike about the Dreamstation is that it increases pressure while I am awake. This happens both when I am trying to fall asleep and in the morning when I am already awake. I tried to combat this with a ramp setting but it didn't help much as the "Smart Ramp" goes into full mode as soon as it reaches the lowest therapy pressure. The last night I reduced the max pressure but would not like to keep it that low as this limits the machine's ability also in the case should such a pressure be actually needed.

Any ideas on how to improve things further would be greatly appreciated.

Thanks in advance!

Before CPAP:
   
With CPAP:
   

   
   
   
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#2
RE: Self-diagnosed on Dreamstation with questions
The machine is seeing your normal, irregular awake breathing and thinks it needs pressure. That will settle down as your brain learns not to upset the machine. Given you are needing low treatment pressure 95% is 9.4, I would try min 9 and review. 8 may also work for you.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#3
RE: Self-diagnosed on Dreamstation with questions
I personally struggled with the Dreamstation.

I found it too aggressive in the end, and difficult at time to sync breathing with it....it seems to want to anticipate your breaths too early for me!

Play around with your pressures....I have ended up on 7-16.....seems you require lower than that though.

I searched high & low for reviews on different machines and ended up on a Resmed Autoset "For Her"

I find the for her setting less aggressive, and I believe it responds quicker
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#4
RE: Self-diagnosed on Dreamstation with questions
A lower flex may have helped, but I agree the resmed is better for most people. It does over treat an apnea with pressure, compared to other machines. So in that way, a resmed is more aggressive
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005142/
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#5
RE: Self-diagnosed on Dreamstation with questions
l don't know whats with all the misconception about REM sleep, but what you want is deep sleep and not REM, REM has nothing to do with feeling rested or resting for that matter. During deep sleep (stage3/4) the brains limphatic vessels open up and clear out the waste.
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#6
RE: Self-diagnosed on Dreamstation with questions
First you have Sleep Apnea.

I'll take a more conservative approach, set your min to 6 with the expectation to increase it to find your sweet spot.

Second, use it while awake. While watching TV reading a book or playing a game on your phone.

A Dreamstation works best with it's min closer to your theraputic pressure because it does take a while to respond and that gives it a head start
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#7
RE: Self-diagnosed on Dreamstation with questions
I'll agree with Fred, but point out your events are clustered and may be positional (chin tucking).
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#8
RE: Self-diagnosed on Dreamstation with questions
Hi all, thanks for you replies.

(05-03-2019, 02:52 AM)Pete G Wrote: I personally struggled with the Dreamstation.

[...]

I searched high & low for reviews on different machines and ended up on a Resmed Autoset "For Her"

I find the for her setting less aggressive, and I believe it responds quicker

I also read about ResMed. They claim their machines to have sleep-onset detection. Does that work for you?

(05-03-2019, 03:31 AM)ajack Wrote: A lower flex may have helped, but I agree the resmed is better for most people. It does over treat an apnea with pressure, compared to other machines. So in that way, a resmed is more aggressive
[redacted as I am not allowed to post links]

Thanks, interesting article! The ResMed algorithms seem to be the most aggressive of the ones tested. If you however have to increase the DreamStation's min pressure considerably for it to end up above the pressure required to clear the airways you might end up with a higher average pressure than on a ResMed device. Are you aware of any studies that tested this with different device settings? Also the integral of the pressure curve might be an interesting number to minimize for comfort while still keeping airways open.

(05-03-2019, 04:30 AM)crowtor Wrote: l don't know whats with all the misconception about REM sleep, but what you want is deep sleep and not REM, REM has nothing to do with feeling rested or resting for that matter. During deep sleep (stage3/4) the brains limphatic vessels open up and clear out the waste.

I know, but I have found a strong correlation with feeling bad in the morning and a lack of REM sleep for me. Might be just that REM sleep is the most fragile of all and is thus easily impaired by apneas.

(05-03-2019, 07:47 AM)bonjour Wrote: First you have Sleep Apnea.

I'll take a more conservative approach, set your min to 6 with the expectation to increase it to find your sweet spot.  

Second, use it while awake.  While watching TV reading a book or playing a game on your phone.

A Dreamstation works best with it's min closer to your theraputic pressure because it does take a while to respond and that gives it a head start

Since I had a stuffy nose today, I used an F20 mask that I got together with the Dreamstation. I did no change the pressure yet as I wanted to modify only one parameter but I added a nose dilator that I also used previously together with the dental appliance.

With the full-face mask the pressure felt much "softer" somehow. I could easily tolerate the pressure going up to 8 cmH2O and also Flex at 2 was not a problem. However I still got apneas at 8 cmH2O. Can it be that the same pressure coming from the machine has a different effect depending on the mask? I hope I will be able to use my F15 again today and will try the recommended pressures.

(05-03-2019, 10:02 AM)Sleeprider Wrote: I'll agree with Fred, but point out your events are clustered and may be positional (chin tucking).

I already tried a "soft" collar but found it too stiff and couldn't sleep with it at all. I have ordered a Releaf and will try that one when it arrives. Hope that will feel better.

Last night with AirFit F20, Nasal dilator, pressure 5–8
   
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#9
RE: Self-diagnosed on Dreamstation with questions
"Thanks, interesting article! The ResMed algorithms seem to be the most aggressive of the ones tested. If you however have to increase the DreamStation's min pressure considerably for it to end up above the pressure required to clear the airways you might end up with a higher average pressure than on a ResMed device. Are you aware of any studies that tested this with different device settings? Also the integral of the pressure curve might be an interesting number to minimize for comfort while still keeping airways open."

Yes I think you have it right. It just means you do need the dreamstation closer to the 95% than resmed. I think it is better to have a higher pressure and resolve apnea that would happen under this pressure, It's just a matter of how many times a night you want to choke, before you are up to treatment pressure. I've got no reason to change my initial suggestion. Find out if a higher min pressure will help resolve your obstructions. It either does or doesn't. Standard titration is you raise the min pressure 1cm at a time till the obstructions resolve. Using near the 95% is a short cut and review. If you start getting into the teen numbers, then I would work more on the collar or similar.

It is sound that resmed increases the pressure more than the apnea required. It stops future ones at the lower pressure for a period. The test resolved at 12cm, Resmed treated at 14 to 18. It's like taking the 95% pressure and adding 2-4 with standard resmed and up to 6cm for the resmed for her. Unless I'm colour blind.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#10
RE: Self-diagnosed on Dreamstation with questions
(05-04-2019, 09:09 AM)0xfeedface Wrote: Hi all, thanks for you replies.

(05-03-2019, 02:52 AM)Pete G Wrote: I personally struggled with the Dreamstation.

[...]

I searched high & low for reviews on different machines and ended up on a Resmed Autoset "For Her"

I find the for her setting less aggressive, and I believe it responds quicker

I also read about ResMed. They claim their machines to have sleep-onset detection. Does that work for you?

I think so....I don't use any ramp features etc

I prefer the F20 mask too, although for a while I tried the N20 nasal but it was either an awesome sleep, or crap, due to I think being a mouth breather

Part of me wants to try a Dreamstation again...I have gained so much more knowledge since

I also work away quite a bit for work, so want to try a mini/travel unit....but get sinus issues so I do like proper humidification!


So many wants, not enough $$....LOL
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