Self-diagnosed on Dreamstation with questions

[0xfeedface]

Ok, new night back to the NP15 with a pressure of 6–9 cm H2O. I really like this mask by the way. Not sure if it is available outside of Germany, though.

I slept only 5:30 hours but feel better than after any of the recent nights where I slept longer. Not sure if this is only due to the pressure or if there are other factors that made this an easy night for the Dreamstation.

[attachment=11716]

[0xfeedface]

"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.

The DreamStation has this OptiStart algorithm where it starts off with the 90% pressure of the previous night. I think I might use that one in the future, once I can tolerate the whole pressure range it might have to use. Until then I slowly increase the min pressure manually.

Are you implying the "responsive" algorithm in the paper is the "For Her" algorithm? So if I got a standard AirSense 10 AutoSet I would not be able to use the responsive variant?

[0xfeedface]

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

I got mine as an open-box but new for about half the price on eBay with even a heated hose, the humidifier and an FF mask. I am sure you can find something similar with only a few running hours if you want.

[ajack]

"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.

The DreamStation has this OptiStart algorithm where it starts off with the 90% pressure of the previous night. I think I might use that one in the future, once I can tolerate the whole pressure range it might have to use. Until then I slowly increase the min pressure manually.

Are you implying the "responsive" algorithm in the paper is the "For Her" algorithm? So if I got a standard AirSense 10 AutoSet I would not be able to use the responsive variant?

Starting at 90% is a sensible thing. They have got that right for plug and play. It gets away from the 4/20 nonsense. It offers no advantage over OSCAR and proper or similar settings.
You are doing the right thing lifting your ramp start pressure, till it's near treatment pressure and then get rid of the ramp.

no, there are both the normal and for her on the chart, both over pressure. Looking at it, the 'for her' picks up something it doesn't like and adds another couple of CM over the normal resmed. Fig 3 in the link, resmed A1, A2.

[jaswilliams]

"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.

The DreamStation has this OptiStart algorithm where it starts off with the 90% pressure of the previous night. I think I might use that one in the future, once I can tolerate the whole pressure range it might have to use. Until then I slowly increase the min pressure manually.

Are you implying the "responsive" algorithm in the paper is the "For Her" algorithm? So if I got a standard AirSense 10 AutoSet I would not be able to use the responsive variant?

The optistart algorithm is not a good thin to use. It does not work in the way you think it does, it will limit the therapeutic benefit of the machine.

[0xfeedface]

Thanks for the heads-up Jas, for the foreseeable future I will adapt things manually.

Slight regression today despite a .5 minimum pressure increase. Most events seem to be SWJ, though. Should probably have resisted that glass of wine in the evening.

[attachment=11750]

[jaswilliams]

Thanks for the heads-up Jas, for the foreseeable future I will adapt things manually.

Slight regression today despite a .5 minimum pressure increase. Most events seem to be SWJ, though. Should probably have resisted that glass of wine in the evening.

I see the need for a bit more minimum pressure here to reduce the hypopnoea and OA’s further butyour nearly there

[ajack]

You also need to lift the max pressure out of the way. I would try min 8 max 15.

@jas, You have said some good things I have agreed with. If you could explain why you think I'm mistaken about optistart, it would help with my knowledge. I may have the wrong end of the stick. I haven't used optistart and have only read the philips description.

[jaswilliams]

I think opti start waits for 30 hrs before it decides to raise the start pressure to the 90 % pressure this means that on an average 8hrs of sleep per night it takes nearly 4 days to adjust the start pressure, great in theory and allows lo pressure start for a new user, but for someone who needs more startup pressure waiting 30 hrs is too long

[ajack]

They have had a few systems. This seems to suggest it is from the last session. It may also reduce from this 90%, to be within the min max parameters. So it may not provide new min from that number. I didn't see 30 said in this philips description.
Auto-Adjusting Pressure and Opti-Start Technology
"The DreamStation Auto monitors the user throughout the night to provide pressures as needed when events occur. The machine remains at the lower pressure of the auto-adjusting range, and if an event is detected, increases pressure up to the upper pressure of the range to support the airway. With Opti-Start enabled, the machine begins therapy at 90% of the pressure reached in the previous session to help address residual events that may occur early in therapy."

The remstar I can think of that did the increase every 30 hours, was one of their older cpap. It did in fact raise the set cpap pressure. It was arguably a better system, than both resmed and philips use now for plug and play

System One REMstar Auto with A-Flex
Auto-Trial mode for flexible delivery
"Auto-Trial mode delivers breath-by-breath auto-CPAP therapy for up to a total of 30 days, after which the device automatically transitions into the CPAP-Check mode at the pressure the patient was at or below 90% of the trial period time."

CPAP-check mode for optimal pressure
"CPAP-Check mode checks on the user every 30 hours to determine if therapy pressure is optimal. If it is not optimal, it automatically adjusts the nightly fixed CPAP pressure by 1 cm H2O to obtain ideal pressure."