Aircurve 10 vauto vs. Dreamstation settings

[Winston]

I bought a Phillips Dreamstation Apap two years ago on, my own dime, after a sleep study recommended I get one.
I played with the settings for a few days and ended up with AHI of .4, .5, 1.1 ,.7 etc. almost always below 1 but only two zeros during the last year.
A month ago I boosted the minimum pressure to 8.5 and saw an immediate improvement in AHI. The first several days were .0, .0, .0, .0,.1,.0, .0, .0,
.1, .0 etc. almost all zeros.
So I got excited and decided I need another machine or a backup. I found an Air curve 10 Vauto with 60 hours on it for $200. Based on what I read here I believe it should be able to duplicate the performance of the Dreamstation but I can't figure out how to get the settings correct. My AHI with the new machine run from .4 to 1.1.
I'm hoping for some advice.

Dreamstation APAP settings

8.5 auto minimum
18  auto maximum
Flex  A-flex
Flex  3


Air Curve 10 Vauto settings

Vauto
Max IPAP  20
Min EPAP  5.0
PS   4.0
Ti Max  2.0s
Ti Min   0.3s
Trigger  med
Cycle  med

I'm thinking the PS or min EPAP needs adjustment, but I don't know.

[ajack]

I would raise the epap 1cm at a time, till the OA or UA subside. There may not be a need for more PS. I would suggest you put an oscar chart up, for opinions.

[SarcasticDave94]

If you’re consistently getting under 5, then that’s successful therapy assuming you’re feeling better for it. That’s regardless of machine BTW.

[Winston]

If you’re consistently getting under 5, then that’s successful therapy assuming you’re feeling better for it. That’s regardless of machine BTW.

I suppose that's true. However, once you know you can get zeros it's hard to accept any other number.
I don't feel any different when I get a zero or a .7, it's just the perfectionist in me. I lived with numbers from .3 to 1.1 for a year before I experimented and learned I could do better.
I noticed differences in how the air is delivered with the Aircurve. It seems the air comes on with a rush at the end of the inhale where as the Dreamstation is more towards the beginning. Could that be causing the higher numbers?

If I can't get the same numbers as the Dreamstation I could always use it as a backup but I'm not willing to give up yet.

[SarcasticDave94]

If you’re consistently getting under 5, then that’s successful therapy assuming you’re feeling better for it. That’s regardless of machine BTW.

I suppose that's true. However, once you know you can get zeros it's hard to accept any other number.
I don't feel any different when I get a zero or a .7, it's just the perfectionist in me. I lived with numbers from .3 to 1.1 for a year before I experimented and learned I could do better.
I noticed differences in how the air is delivered with the Aircurve. It seems the air comes on with a rush at the end of the inhale where as the Dreamstation is more towards the beginning. Could that be causing the higher numbers?

If I can't get the same numbers as the Dreamstation I could always use it as a backup but I'm not willing to give up yet.

I can’t be certain at this time, but the therapy difference you’re noticing could change your results. It could also just be differences in how these 2 machines go about administering therapy. As for the zero AHI, I get zero sometimes and at other times it’s between 0-3.8. Personally I’m feeling better when it’s not quite a zero. FWIW there’s nothing in the Apnea “rulebook” that says you can’t try to get zeros consistently. Best wishes for that success regardless.

[Sleeprider]

You seem to be trying to accomplish zero AHI which is unnecessary. Your therapy with the Dreamstation was way above average, and all we need to do is minimize sleep disturbance. I'm pretty amazed you got there with Flex 3, because that rarely works for most people. Data would help, but I would bet with your Dreamstation settings, your 95% pressure was probably under 11.0 cm. Now you have gone bilevel, with 8.5 minimum EPAP and 4 cm PS which is 12.5/8.5, compared to about 11/9 on the Philips and you want to know why your CA events are over 1/hour.

First, your treatment on both machines is exceptionally good. Second, drop your PS to 3 on the Aircurve, and events will be reduced. Finally, maybe a graph would help? Pressures on a Philips Dreamstation CPAP are not comparable to the Resmed Aircurve 10, or for that matter with the Airsense 10 with EPR. the therapy is different, but you continue to do very well. This es a great machine, and we can get you dialed in, but if your expectation is zero events, you're just not being realistic.

[sheepless]

Winston, as you know, ahi is just one measure of effectiveness. ultimately how you feel is paramount.

despite reading frequent admonitions against chasing zero's here on my favorite apnea forum, I totally understand the desire. after more than 2 years I think I finally have my machine adjusted to get more zero's than ever before. however, by way of caution, most of the zero's I got in the past were short nights with fragmented sessions, meaning I didn't reach the deeper sleep that usually produces an increase in events.

making the achievement harder still, even if you have zero 'real' events, you might still have sleep wake junk or ca's flagged during the exertion of rolling over.

zero is psychologically attractive but it doesn't necessarily mean better sleep. but that won't stop me from getting a little thrill whenever I see one.

[Winston]

You seem to be trying to accomplish zero AHI which is unnecessary. Your therapy with the Dreamstation was way above average, and all we need to do is minimize sleep disturbance. I'm pretty amazed you got there with Flex 3, because that rarely works for most people.  Data would help, but I would bet with your Dreamstation settings, your 95% pressure was probably under 11.0 cm.   Now you have gone bilevel, with 8.5 minimum EPAP and 4 cm  PS which is 12.5/8.5, compared to about 11/9 on the Philips and you want to know why your CA events are over 1/hour.

First, your treatment on both machines is exceptionally good.  Second, drop your PS to 3 on the Aircurve, and events will be reduced.  Finally, maybe a graph would help?  Pressures on a Philips Dreamstation CPAP are not comparable to the Resmed Aircurve 10, or for that matter with the Airsense 10 with EPR.  the therapy is different, but you continue to do very well.  This es a great machine, and we can get you dialed in, but if your expectation is zero events, you're just not being realistic.

I have so much to learn!
I checked and my 90% pressure on the Dreamstation was 9.5.
I woke up at 3am this morning and read your suggestion to drop the PS to three, did that and slept just fine.
I'm not sure what mode I need to be in with the Aircurve.
The one thing I'm sure of is that I prefer a bit of help on the inhaling side. Slightly higher pressure there feels beneficial.
I'm not sure what bilevel means. I only bought this machine because I thought it could duplicate the Dreamstation. I'm sure it's a better machine. I would like to retire the Dreamstation to a backup machine but will need help from you guys in that area. Thanks for your help.

[SarcasticDave94]

An actual bi-level, BPAP or BIPAP if a Respironics, are Sleep Apnea machines that deliver true 2 level therapy. There’s machine settings on most CPAP machines that mimic BPAP in operation, so be aware of that, that isn’t exactly the same.

BPAP or bi-level machines have 2 distinct pressures, one for inspiring (breathing in) and another one for expiring (breathing out). BPAP has the inspiration capability to achieve the pressure of 25. Patients that are having certain medical issues that a CPAP can’t treat successfully are candidates for BPAP. One example was like myself where I needed more exhalation pressure relief that a BPAP provides.

[Sleeprider]

You seem to be trying to accomplish zero AHI which is unnecessary. Your therapy with the Dreamstation was way above average, and all we need to do is minimize sleep disturbance. I'm pretty amazed you got there with Flex 3, because that rarely works for most people.  Data would help, but I would bet with your Dreamstation settings, your 95% pressure was probably under 11.0 cm.   Now you have gone bilevel, with 8.5 minimum EPAP and 4 cm  PS which is 12.5/8.5, compared to about 11/9 on the Philips and you want to know why your CA events are over 1/hour.

First, your treatment on both machines is exceptionally good.  Second, drop your PS to 3 on the Aircurve, and events will be reduced.  Finally, maybe a graph would help?  Pressures on a Philips Dreamstation CPAP are not comparable to the Resmed Aircurve 10, or for that matter with the Airsense 10 with EPR.  the therapy is different, but you continue to do very well.  This es a great machine, and we can get you dialed in, but if your expectation is zero events, you're just not being realistic.

I have so much to learn!
I checked and my 90% pressure on the Dreamstation was 9.5.
I woke up at 3am this morning and read your suggestion to drop the PS to three, did that and slept just fine.
I'm not sure what mode I need to be in with the Aircurve.
The one thing I'm sure of is that I prefer a bit of help on the inhaling side. Slightly higher pressure there feels beneficial.
I'm not sure what bilevel means. I only bought this machine because I thought it could duplicate the Dreamstation. I'm sure it's a better machine. I would like to retire the Dreamstation to a backup machine but will need help from you guys in that area. Thanks for your help.

I think you made a pretty good guess on settings.  You set:
Mode: Vauto
Max IPAP  20
Min EPAP  5.0
PS   4.0
Ti Max  2.0s
Ti Min   0.3s
Trigger  med
Cycle  med

This looks fine, but is more pressure support than you probably needed.  Moving back to PS 3 was probably all you need to be comfortable.  That starts pressure at 8/5 and it can respond to obstructive events from there.  Please don't worry about AHI above zero or even at 2.0.  There is a lot of natural variation, and the objective with the therapy is to minimize sleep disturbance from respiratory events.  Everyone has a few events normally, and the first thing to do after a night is not to check your data, but to judge how you feel.  You may be surprised to find, you feel just fine on less than perfect nights.