Choosing the best PAP machine for my hyperreactive nose--Resmed 10 For Her?

[Sanne]

I want to upgrade my Remstar 460 to a new machine and I am hoping you can give me some reasoned recommendations.

 
I know a lot of you are advocates for the Resmed and I'm considering a Resmed 10 in the "For Her’ version.  I wonder if you think it would suit my particular issues. 
 
My key issue is my hyperreactive nose, which may be related to my large turbinates and deviated septum.  I'm usually fine, but occasionally I respond to higher cpap pressures, temperature, and/or humidity that make me sneeze uncontrollably and make it impossible for me to sleep or continue using the CPAP.  There is no set pattern for my nose sensitivity and I don't think it's the filters, because I change them regularly.
 
I use a low CPAP setting (6) so as not to irritate my sensitive nose and this works most of the time, i.e., my AHI's are usually <5 if I sleep on my side.  This is not always true however, and once or twice a week I have bad nights with AHI spikes to around 9 or so.  
This nose issue is also why I wear a full face mask to avoid direct pressure in my nose, although I’m a nosebreather and easily can sleep with a nasal mask (Resmed N30i for days when conditions are good)
 
I like to sleep cold, but at times it is at odds with the nose to breathe the cold air, so it is important for me to be able to control the CPAP temperature and humidity better than I do now. 
 
My hope for a new machine is to improve my sleep overall and tolerate the CPAP without irritating my nose.
 
Please share your thoughts about: 
 
1.     The Resmed 10 versus other machines (Respironics) available on the market. 
2.     I read that the "For Her" algorithm is more aligned with a woman's breathing patterns and I wonder if it may be better for my mucous membranes. Does anyone have experience with this and what are your thoughts?  
3.     What peripherals for humidity control, air filtration, or other features should I request?
 
Thanks and sweet dreams!  
 

[Cpapian]

I looked at your OSCAR graphs. That night your pressure was all over the place and you had a lot of pressure pulses.

I think you would like the Resmed because they don't have the pressure pulses. They use FOT which is, IMO, less disturbing. In my experience, I was able to be better treated with the Resmed at lower pressures and no sleep disruptions from the pressure pulses.

When your pressure is going up and down numerous times during the night, two things happen ... one it is a bit disruptive to your sleep and possibly to your sensitive nose and two the mask fit needs to adjust for the varying pressures. Your leaks aren't bad, but you mentioned them, so perhaps they bother you.

I like the Resmed better and you will find a lot of people here agree. The for her model is a no-brainer because you get everything the black machine has plus an extra bonus of the for her algorithm.

[Sleeprider]

The Resmed Airsense 10 Autoset For Her has 3-modes of auto CPAP therapy and one fixed CPAP mode. It has the capability to provide up to 3 cm difference between inhale and exhale, and is a far more flexible, superior choice for your therapy than the Philips 460. Once you get the new machine, you can set it up with your same CPAP pressure, or use a range of pressure that suits your comfort and needs. I would suggest starting at a minimum pressure of 5.0 and maximum pressure of 11.0 with EPR 1 in Autoset For Her mode, and we can review results and help you to optimize to far better than the <5 AHI you are currently getting.

[Sanne]

Thanks so much for your inputs and elaborations.
You both confirmed my intuition about the Resmed For Her.
I'l let you know how this plays out...
Thanks again, I appreciate your help!

[becker44a]

I want to upgrade my Remstar 460 to a new machine and I am hoping you can give me some reasoned recommendations.
. . .
Please share your thoughts about: 
 1.     The Resmed 10 versus other machines (Respironics) available on the market. 
2.     I read that the "For Her" algorithm is more aligned with a woman's breathing patterns and I wonder if it may be better for my mucous membranes. Does anyone have experience with this and what are your thoughts?  
3.     What peripherals for humidity control, air filtration, or other features should I request?

Hi Sanne,
I recently upgraded machines to a Resmed Autoset For Her, and the experience has been outstanding.  I was doing reasonably well with my old machine (Resmed S9 Autoset), but I am subject to Aerophagia (air swallowing).  For such people, less pressure is better.  So after I got a baseline with the new machine, I tested the other Auto modes, and it seems that the Autoset/Soft response setting works best for me.  My 95% pressure dropped from about 14.6 to just over 11 in the tests.  This has been great for an Aerophagiac.

Re #3:  The machine comes with a humidifier built-in.  I ordered the new machine with a Climateline tubing, and added a hose cover (cheap on Amazon).  This has improved my drymouth issues significantly.  The heated tubing will give you more control over delivered humidification.

Re FFM:  I have used a Fisher&Paykel Simplus for years now.  It is roomy and seals well for me.  I like it much better that the Mirage Quattro I started with.  I wouldn't add such a change to other changes at the same time, but it might be worth your while to try out the Simplus or its successor, the Vitera.  A number of members have reported good results with both.  Supplier#26 has a great mask return policy, which makes it simple for such tryouts.


Good luck on your quest.

[Sanne]

Thanks much for yet another “Resmed For Her” recommendation from a satisfied user.
I have now ordered my machine and I can hardly wait to get it (a couple of weeks or so)!

Great idea to get the climateline hose as you say, the heated tubing will give more control over humidity, which will be helpful I’m sure, at least part of the year where I am. I think it will be a challenge to figure out the balance between temperature and humidity because the conditions change a lot here in my area. On the one hand moisture is very important for our breathing comfort, but on the other hand, for me too much can trigger my nose. So yes, a delicate balance to understand and maintain, that I hope this intelligent machine can help me figure out.
Thank you for the recommendation also about the hose cover and mask!

[Sanne]

I've been using my ResMed 10 For Her and I'm including selected charts from my first 15 days. It was easy for me to leave the Remstar 460 behind.  
I love the new machine.
 
Issues  are: 
1.  Incorrect time when I upload data to OSCAR; 
The time is off by 3 hours.  On my Remstar it used to only be off by 1 hr.  Can you please tell me how to fix this?  
 
2.  Mixup between my husband's data with mine even though they are in separate profiles onOSCAR on the same computer.  Please tell me how I separate these two OSCAR profiles and correct my statistics for the first four days (20-23 Nov) of data from my new Resmed.  OSCAR includes my husband's data (he's using on my old Respironics 460).  On 23 Nov it states: 

Sessions exist for this day but are switched off.
 
3. Fitting a mask
I've tried:
--Airtouch F20, tried both S 'for her' and M standard--neither were the right fit for my face, but I adore the memory foam.  Did consider Airtouch N20, but I didn't try it.  Does anyone have experiences to share? 
--F30i size Small.  The mouthpiece is so long it rests on bottom of my chin instead of under my lip and is extremely leaky.
--N30i worked best, but I don't like havingthe heavy heated hose on top of my head.  I will try a P10 next to see if I can tolerate pillows and use a chinstrap. 
 
In general FF mask are too wide and sometimes too long. I'm hoping you can give me feedback about how you got to the best mask for you? 
 
4. I am a nose breather most of the time, but I wonder if the amount of available air in the reservoir on a nasal vs. fullface mask has influence on treatment efficacy.  I think I prefer the lightness and ease of nasal masks and I got consistently lower AHI numbers when I used the N30i, compared to the fullface masks, but I must say that I feel that I get more air when I use a fullface mask and I usually feel better in the morning.  This is puzzling and perhaps contradictory, but given that it is necessary to set the type of mask on the machine, there must be a difference in how the machine deals with different masks...  Is this just my perception or are there really differences in the volume of air available in these different masks?    
 
Does the fullface mask really give me more air than the nasal mask?  
 
I have leaks with both types of masks, but FF masks are worse.  I will try nasal pillows next to minimize leaks and see if it gives me a better sleep.  I know this is complicated, but I'd like to optimize and understand what's going on as much as I can.
 
All feedback is welcome.  
 
Thanks

[SarcasticDave94]

I've not used all of Fisher & Paykel masks, but I do have both the Simplus and the newer Vitera. If you like the ResMed F20 then you'd love these F&Ps. Both are full face variants. F&P touts a RollFit technology, basically it means the silicone cushion has a one fold bellows that leverages the air pressure to create and maintain the seal while requiring less strap pressure. And it works great. Less leaks and very light strap tension, 2 wins. They do have some nasal and pillows that are similar in the differing formats. One called Pilairo Q is very new and unique, very minimal and somewhat like a ResMed P10. There's 2 headgear options, one is just a band that goes around the head.

As for OSCAR charts, it doesn't look bad except for a bit high on the AHI. If you're wanting the benefit of EPR/exhale pressure relief of 3, you need to bump minimum pressure to 7, up from 4. As is at 4, there's nowhere for EPR to drop as it's already at 4 Min. Try it and see if it helps out.

On the time, which of OSCAR or the PAP is off and 3 hours too fast or too slow?

Also on masks, check in the settings for Mask Type. Set it to the type you're running of Nasal, Pillows, or Full Face. It tends to compensate for the mask type. ResMed models like F20, N30i, P30i the cap letter F N or P types these as Full Nasal Pillows. On the N30i, even if it is N nasal use Pillows due to design. I do recall someone else asking that mask's type and found it out there from ResMed.

PS a F&P Pilairo Q looks like this

[attachment=28540]

[Sanne]

Thanks for your feedback, Dave!
As for the pressure I will up the minimum pressure.

Regarding the time problem, my charts on OSCAR are 3 hours ahead; i.e., it is 3 hours later, than they should be.  I didn't find a clock-time on the Resmed machine, but I'll look into it. 


Thanks for the hints about the Fisher & Paykel Simplus and Vitera masks. I agree that to maintain the seal with little strap pressure is the key. At this point, I was only offered Resmed masks, but if it doesn't work out, I'll look into the F&P, including the Pilairo Q. 

I have been sure to set the ResMed settings for Mask Type correctly as you point out, including the N30i as "Pillows," but I'm curious about the difference in treatment from FF to N masks.
 
There are so many things to figure out and so little help from the "professionals."  I'm glad for OSCAR and our Apnea Board!  

[SarcasticDave94]

OK the clock data may be based on you AutoSet configuration. I was able to access the clock on my ResMed ASV via the clinical setup menu by way of holding Home and Dial in for 5 seconds. Then select settings and scroll down a few display pages to configuration and see date/time there. Be aware, it may erase your therapy settings so have all that noted first.

I think nasal an pillows masks feel a bit different as they feed air directly into your nose versus a full face which pressurizes the cushion area. No idea if that helps. I have tried N/P30i combos but I still mouth breathe too often for them to be of good use right now for me so I have minimal nasal or pillows suggestions.