Skeptical of Numbers

[horsepower]

Hello everyone.

Bit of background on myself... Was diagnosed in 2011 with OSA and was given a Respironics System One CPAP machine with full face mask. I was prescribed the rate of 6.0. I tried using the thing, but after 3 weeks, I could not deal with it, and stopped using it completely. I was feeling smothered, uncomfortable, massive leaks, etc. etc. etc...

I should have gone back to the place to get it rectified, but I didn't... 

So the machine sat on my shelf for 7 years, not being touched.... 

So earlier this month, I decided, since I was in a new job, regular hours, regular sleep time, and the incredible feeling of being tired all the time, I would give it another shot... I dusted off the machine, got new hoses, and went in and got a nasal pillow mask to try..

At first, I was feeling the exact same... The first night, I had it on for an hour or so, and couldn't deal with the restricted breathing... Second night, the same thing.... Then, on the third night, something changed (not sure if I had the pillows set on correctly, or what), but I became used to the sensation, and easily got over 8 hours sleep with it on...  Since then, I have had pretty good luck with using the machine... That is not where I am having questions..

So after reviewing my numbers, I was seeing AHI's of 5.0 to 8.0 on a regular night sleep, and 11, 12, 13 on nights where I used it for shorter periods (which makes sense, when you divide the event numbers by the hours used)....  My settings are 6 - 20, no ramp.  The reports show that the pressures hover in the 13 to 18 range most of the night. I also do not feel any immediate benefits of using the machine.  Still pretty groggy... In talking with my healthcare provider in analysing the numbers, I asked if the age of the machine would have anything to do with the efficiency... She said it could be, and said that those models did well in treating OA events, but not Hypopneas....  My OA index was 0.8 or so, and the bulk of the AHI was made up of Hypopneas. Quite a bit of snoring detected as well.. She mentioned that I could try an Airsense 10 to see if it was any different...

I tried it last night, with the same settings as the old machine and got a good 8.5 hours on the machine, and checked the AHI, and it showed 0.1! I looked at the data in sleepyhead, and it only showed one event all night, and it was a hypopnea. Woke up, and felt the same as I always do.

So looking at these numbers, I am highly alarmed and skeptical... Is this even possible?  I will post my reports here when I can so you can look at, just wondering if anyone knows if this makes any sense??

Thanks in advance! I have learned a lot about the condition from this board!

[OpalRose]

Yes, it makes sense. Respironics machines are known to react much slower to Apnea events compared to ResMed machines. Although, you can use a higher setting on the Respironics machine and get better results.

Don’t forget, you let you apnea condition go untreated for 7 years, and it more than likely has gotten a bit worse. If you start to use your Cpap consistently, you will feel better in time. It doesn’t always happen overnight.

Post some data here. Use the links in my signature line below to guide you.

[Sleeprider]

With the Resmed machine you also have a feature called EPR (exhale pressure relief) which can provide a drop in pressure on exhale from 1 to 3 cm. This can be an important tool in resolving hypopnea and of course in increasing comfort. More important, the machine tends to be proactive with regard to OA and H rather than reactive like the Philips. Even with a lower AHI, it may take some time to feel recovered. Be patient and give it a chance to resolve your chronic sleep debt. If you'd like us to take a look at some detailed results, a Sleepyhead graph would be easy to post here as an attachment.

[horsepower]

Thanks everyone... I am going to post the comparison graphs when I get home and get some time... I am relieved to hear someone backing up what the therapist said... I just kinda thought the numbers were too good to be true... I understand that it will take a bit of time to get everything dialled in and feeling better... I am just glad that after the horrible experience I had with everything 7 years ago, I am able to get some sleep with it now!

[horsepower]

Here are comparisons

[attachment=7827][attachment=7828][attachment=7829][attachment=7831]

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Sorry for the small screenshots... Laptop is pretty old and screen real estate is not very plentiful

[Sleeprider]

What's the difference? EPR and the Easy Breath pressure shaping instead of Flex. You have a 3-cm pressure support with the Resmed, and at pressures between 4 and 10 it is magic for you. With the Philips you ended up in an endless cycle of fighting the machine.While both machines seem to accurately determine your respiration rate and tidal volume, the big difference here is that the Philips doesn't properly interpret your inspiration/expiration times or transitions. It imposes Flex at the wrong time and that is what totally ruined your therapy. The Resmed follows your respiration rather than predicting it. Just look how finally you have a correct I/E ratio. I think the Flex algorithms in Philips machines is the one of the major sources of failure in comfort and using those machines. It certainly works for some people, but I keep finding myself thinking as I look at many different charts on this forum, if only they weren't using the Philips! The use of predictive Flex pressure transitions and the slow reactive pressure changes of the Philips auto machines just increase events, vs the reactive EPR and proactive pressure changes on Resmed.

Congrats, you should feel the results soon.

[horsepower]

Thanks so much for the insight! Completely makes sense... When I go back and look at the old charts, the pressure slowly builds until it hits the maximum threshold. Not much good at that point!

Its so great to have a resource like this with people who have "been there, done that" with these devices, and understand how they work!

[ShaunBlake]

Sorry for the small screenshots... Laptop is pretty old and screen real estate is not very plentiful

horsepower, I think your screenshots would be better by resizing SH to include the significant data in the left pane and resizing the graphs so that the significant ones will fit in that screen, then use the F12 key or the menu option 'View' in the top menu bar, and 'Take Screenshot' in the middle of the menu.

[greatunclebill]

What's the difference?  EPR and the Easy Breath pressure shaping instead of Flex.  You have a 3-cm pressure support with the Resmed, and at pressures between 4 and 10 it is magic for you.  With the Philips you ended up in an endless cycle of fighting the machine.While both machines seem to accurately determine your respiration rate and tidal volume, the big difference here is that the Philips doesn't properly interpret your inspiration/expiration times or transitions. It imposes Flex at the wrong time and that is what totally ruined your therapy. The Resmed follows your respiration rather than predicting it.  Just look how finally you have a correct I/E ratio.  I think the Flex algorithms in Philips machines is the one of the major sources of failure in comfort and using those machines. It certainly works for some people, but I keep finding myself thinking as I look at many different charts on this forum, if only they weren't using the Philips!  The use of predictive Flex pressure transitions and the slow reactive pressure changes of the Philips auto machines just increase events, vs the reactive EPR and proactive pressure changes on Resmed.

Congrats, you should feel the results soon.

Thank you for that explanation to the same question i've had.  same situation, different numbers. with phillips 550 my ahi was 5-15, very seldom lower, sometimes higher. with the new autosense, my ahi is usually below one to around 5, sometimes higher, but never up to 2 digits.  and i really do feel better.