HELP - Switched from S9 to DS and had massive attack

[neils]

A lot of great people on this board, willing to dive into other people's sleep problems and graphs, what a great community. Thank you for diving into mine. While everyone gave valuable feedback, I think Holden4th may have hit something. That night, either before going to bed and putting on my mask, or shortly after my attack (lack of air), I noticed that I had one nostril that was almost completely blocked. I sometimes block one nostril to see how I would breathe with the other one, and it was not great. I recall even getting up to go and get some vicks and rubbed it inside and under my nostril to try and unblock it. So who knows, maybe in a deep sleep, I could not exhale enough, and woke in a panic.

With respect to the other comments, if I turn off A-Flex (or eventually EPR when I change machines), how will this make therapy better ? My guess is that without the comfort setting enabled, I would have a higher available pressure throughout, assuming I can sleep properly without it. I guess it is worth the try, BUT, do I have access to shut it off (or adjust it) myself, or is that setting locked in ?

Also, some of you mentioned raising the min setting (from 6). How would that help me ? Isn't it better to have a wider range, such that the machine can also react to lower pressure events too ? I would hate to raise it to say 7 or 8, and then start having more events down lower, where the machine does nothing. But I guess my limited data I provided (2 days) shows otherwise.

You guys also came to the same conclusion as my initial concern, why is this machine (a temp rental until I get my new one) max'ing out at 8, when the max setting is 16 ? On the other hand, maybe the machine did not need more than 8 to get me out of most of my events. So, here is what I am going to do, because you guys have got me going now with this Sleepyhead app. I am going to go and grab my S9 card and read the data and compare it to the DS, to see what the differences are, and I am expecting differences, because the S9 is tried and tested on me for 6 years, and never did I wake with an attack/lack of air. I am currently back onto the S9 until I get back from my cruise, after which I will switch out the DS for an AS.

Will format the S9 data and post it here for comparisons.

[neils]

As I expected, very different results and data from the DS (where I had my attack) versus my older S9. Now not necessarily blaming the DS (anymore) for my attack, could have been due to a number of other things, improper settings on the DS, blocked nostril, anxiety/panic, etc

But the data definitely shows different results and therapy between the two, and I can only assume that the new AS will work the same as it's older S9 brother. Now perhaps I was more aggitated or tired one night versus the other, cannot be a straight compare, but still....

quick stats S9 compared to DS:
AHI lower (1.28 vs 3.12)
95% pressure higher (9.90 vs 8)
Min pressure (same 6)
Max pressure higher (11.24 vs 8)
EPAP 95% higher (8.90 vs 5.70)
Snore Max lower (0.08 vs 3)

Events S9 vs DS:
Flow Limit (0 vs 3)
HYP (6 vs 20)
OSA (1 vs 3)
RERA (0 vs 4)
Snore VS (0 vs 1)
Snore VS2 (0 vs 9)

Also noticed EPR set to Full Time on S9, level @ 1cmH2O. Ramp set to off.

Oops, HELP !!! Seems like the attachment quota (512) goes beyond 1 day, how does that work ? I cannot attach my S9 graph, reached max quota from yesterday's posts.

[Crimson Nape]

neils,
It's better to use Imgur or Photobucket and link the images.  Look at the bottom of my post for links to help.

[Sleeprider]

Rather than attachments, hosting our images off-site at a site like Imgur or Photobucke, you won't have limitations or have to delete old images. The historic data is valuable, and it's a shame to see people delete that reference point just to post another graph. Read the second link in my signature.

On your Dreamstation graph, you may have noticed an early hypopnea and flow limitation. very shortly after your therapy began. The machine should have responded to this with a pressure increase, but did not. This may be a machine fault. In my opinion, your pressures are quite low, and that's fine because it mostly works for you; however the use of AFlex is causing a very low pressure during exhale that you can see as the lower pressure graph. Your exhale pressure loiters at about 4 cm, and I think this is where you're getting into trouble on events. I would simply turn off Flex, or use a setting of 1 at most. Flex doesn't work for everyone and it is a different animal than EPR. This alone may explain the great difference in your experience with Philips vs Resmed. I think you can see the two machines use very different algorithms to provide auto pressure, and the Resmed works better for you. The solution is (as said before) to increase the minimum pressure on a Philips machine. This will reduce the hypopneas and prevent flow limitations from occurring in the first place. Medical professionals will recommend a pressure, or pressure range for patients, but they do not take into account how different machines work. Simply put, you cannot run the minimum pressure of a Philips as low as a Resmed, and get similar results. More importantly, your particular machine is not even reacting to events like snores, flow limitations and hypopnea in the way I usually see Philips auto CPAP react.

[neils]

Thanks for the tip on using IMGUR, let's see if this works. Note, I followed the instructions to copy/paste the Linked to BBCode, but when I paste it in the post, it puts the actual image there, not a clickable link (even if I try to paste as text too). While the image is viewable in the post, I don't think you can click on the image to blow it up to see it closer. 

As mentioned above, stats and therapy very different between the 2 machines, and as some have suggested, perhaps the DS was also faulty in not dealing with some of the events. The number of events are also drastically reduced on the S9. So I guess my only concern now, is that when I get the new AS, that it will react the same way as my S9, with the same settings.

Resmed S9 Feb 23


DS Feb 21 (night of attack @ ~11:30)

[Sleeprider]

Airsense 10 Autoset uses the same algorithm as S9, but has some additional features such as standard (like S9) and soft auto. It is in a more compact form, and has a more intuitive menu. I think you'll like it. Get those leaks under control, eh?

[neils]

Not sure if you were joking when you said, get those leaks under control EH ? Are you Canadian sleeprider, because that is how us Canadians talk EH...

Thanks for all the input. Loving this sleepyhead app, very detailed data in there, very disappointed that PR or Resmed does not offer this level of detail in their own apps.

First thing I noticed was that max pressure was much higher on the S9 than the DS, which could point to a faulty DS machine, after all, it is a rental on loan until I was supposed to get my new one in a couple of weeks. Second thing is that I did not have any snoring with the S9, but did with the DS. In fact, I think someone said that they noticed that the DS did not react after a snoring event, and the DS recorded 3 during the night (a lot better than my sleep study number of 129/HR, 750 total over 10 HRS). The S9 seemed to have handled them all without a hickup.

Not putting down the DS, but as many have said in this post, it just needs to be tweaked more precisely to work better, where as the Resmed is more forgiving.....

Thanks for all the help !!

Neil

[Crimson Nape]

Not sure if you were joking when you said, get those leaks under control EH ?

We do have a sense of humor down here.  

I agree with you on the DS. It seems odd that it plateaued a 8cm.

[SleepyBee]

have you tried wearing your mask awake and "faking" various apnoea events (holding your breath etc) to see how the machine responds. If it is faulty and something is preventing it going over 8cm (faulty blower or sensor) en you should be able to see that during an awake run.

[chill]

Yeah, the plateauing at 8 looked very odd to me too.  It is looking more and more like he got a bad machine.  That does happen with both brands.