New CPAP: Twice the prev AHI

[wolson]

An update:

Since I could not get the AHI resolved at the prescription Auto CPAP 10 CWP, and I think that my old machine was putting out less pressure (we will check this next month when the technician comes to town bringing his manometer,) I have been checking lower pressures on the Dream Station. Sure enough, my AHI has gone down to almost acceptable levels. 

I am also doing oximetry along with pressure changes. The oximetry at 9 CWP also seems to be better with and average SpO2 at 98% with a minimum of 91%. With 10 CWP, my oxygen was as low as 82% with considerably more frequent variations corresponding to the high AHI's. It is looking like 9 CWP is the correct setting for me. 

I was down as far as 8 CWP but the AHI increased again. It seems illogical based on the literature that a lower pressure would be better for my condition but the numbers suggest the lower pressures are better than the prescription 10 CWP.  The physician I have (I have kept her in the loop as to what I am doing,) does not recommend APAP. I have also reset the CFlex to 2. 

Another observation that really does not yet make sense to me. We live in a very arid area. With the old machine, I use a constant 5 on the moisture heating system. With the Dream Station, I get "rainouts" at a setting of 3. I went over to adaptable heating. I am not certain what this means. But my water usage is almost nil and I have no rainouts. However, the change in water heating also seems to helped with AHI; that is, the adaptable setting on the water heater correlates with lower AHI's.

I have been on the phone with the technician every few days and I am still working the machine to improve AHI. He also would like me to try higher pressures which I will do. 


Thank you for your suggestions: please do not suggest a different brand machine (although I found out from my DME that it could done.) I am trying to find out what are the variables and adjust on those. If I can't, then I will have to travel 150 miles for another polysomnography which I really don't want to do based on the high COVID in our area. 

[SarcasticDave94]

You say your AHI is down to almost acceptable... why settle for almost? No I've not gone back to prior posting as of this post of my own, so I don't know your history, what you've tried, worked or failed, nor do I know your PSG study results. I'll look but really, is almost acceptable acceptable? If that's honestly the best then I'd suppose it is.

By virtue of you telling us not to mention other brand of PAPs you've placed restrictions and handcuffs on our assistance and advisement. I will mention ResMed anyway. Given just half a chance, the ResMed would knock the DreamStation silly in comfort and therapy... for most anyway. As for requiring a new PSG...to document you have apnea and need PAP therapy, right? You have or should have the proof in your hands, a CPAP. AND saying you'd need another sleep study indicates you've had one already. Where's your copy of the report? That's proof too. Tell the idiot that issued the Philips they are guilty of disservice. Be it as it is. We might be able to help despite the Philips, but you'll need to be of a mind to accept our assist handcuff free.

PS: Now that I've refreshed the memory a bit, you said yourself something to the effect your DreamStation is overwhelmed. Why continue to torture yourself? That next DME of 150 miles away excuse only goes so far and not much at that to me anyway. You can work out shipping the machine to you. My DME 90 minutes or so away has folk that brings machines to me if needed.

[wolson]

"You say your AHI is down to almost acceptable... why settle for almost?"


The point is that I am not settling for almost. I want to understand the variables involved. Only in that way will I understand what is best for me, personally. 

I understand you are wedded to Resmod; OK, that is fine. I am not yet ready to go there.

That does not tell me what the variables are and how they work. Because of that I can't yet say any machine is the best because of x, y and z, provided by that machine. I don't understand the variables yet.

My old PRS1 worked well and gave me good performance. So why doesn't this new machine do the same at the same settings? Until I understand that, I am not ready to commit to any product. So far, I have experimented and have found better, but not perfect, settings that were prescribed. While the technicians are hesitant to support my experimentation fully, my physician so far is fine with it. However, neither my physician or the technician have explained why do these settings that I found work better. I really get the feeling they are in dark as much as I am. So we experiment and communicate the results over the phone and by emails.

Regarding my previous PSG: it has been 5 years since I did it. I am not anxious at this time with COVID to travel anywhere to repeat it. At 73 years old with COPD and some obesity, I am not a good candidate to survive the disease. In fact, a week after a face to face meeting with the technician, she came down with COVID. I have been test twice since and so far negative. I am doing everything possible to remain that way. I generally stay away from people. Maybe after I qualify for the vaccine and get it, I can change my routines. 

[staceyburke]

No one knows the exact why, the machines we use are programed and the best program allows the machine to increase the amount of pressure faster than the poorly algorithms.  It is that simple, we do not have the code to see why one is better than the other but after person after person does better on one brand of machine we advise to get that machine.  And since my being here the ResMed 10S airsense Autoset (cpap) and the Aircurve VAUTO (bipap) have given the best therapy.

[SarcasticDave94]

The folly of Dave, if I'm married to ResMed it's for a good reason. The ResMed works better for most, including me once given the right tools for the job.

Has the DME staff you are supported by currently told you how your Respironics and the variables, the algorithms in it works? No long answer needed, yes or no on have they told you how it works. If they haven't, then your statement of not being able to use ResMed because you don't know how it works is invalidated by virtue that you don't demand that same need to know on Respironics. That just tells me you trust the DME and that if that's the machine they sell then that's good enough, but your own statements say you're not satisfied with the Respironics.

Let me ask this, do you have to know how a CVT transmission works before you'd buy or drive a car with one? No I'll just get in and drive. And as long as it does the job well, and I'm comfortable accepting how it does its job, I'm OK with it. Obviously, CVT car transmissions and PAPs aren't the same machine or for the same purpose. The point is you're willing to not get yourself good and proper medical treatment because you don't know the algorithms involved is at the least misguided, at worst is just an excuse. Again, do you know the workings of the Respironics? You've experienced it and said it's lacking. Your data shows it's lack too.

I'm afraid I can't help you. I offer sound advice and you counter with excuses. Your other DME choice reluctance isn't fully made on sound thought. Fear of contracting COVID is a reality. OK fine. I still say your old test result and current PAP use ought to be enough to get a PAP. As long as you buy your excuses to not make therapy better, expect the obvious it won't improve. You're still seemingly under the false impression the DME is the only one that controls and edits your therapy pressures. At least that's how it sounds.

If I've not made you mad in the past, this statement will. You've given me the impression you would rather complain about the Respironics and poor therapy, but instead of doing something to fix it, you'd rather excuse away the solution. OK well have at it. But don't expect the issue to resolve by your idle complaints. Only you have the power to choose this, here's the choice, complain idly or complain then act.

IF you choose to just idly complain I can't help you.

[wolson]

I'm afraid I can't help you. I offer sound advice and you counter with excuses. Your other DME choice reluctance isn't fully made on sound thought. Fear of contracting COVID is a reality. OK fine. I still say your old test result and current PAP use ought to be enough to get a PAP. As long as you buy your excuses to not make therapy better, expect the obvious it won't improve. You're still seemingly under the false impression the DME is the only one that controls and edits your therapy pressures. At least that's how it sounds.

If I've not made you mad in the past, this statement will. You've given me the impression you would rather complain about the Respironics and poor therapy, but instead of doing something to fix it, you'd rather excuse away the solution. OK well have at it. But don't expect the issue to resolve by your idle complaints. Only you have the power to choose this, here's the choice, complain idly or complain then act.

IF you choose to just idly complain I can't help you.

Well, I do have news for you: Last night, I had an AHI 1.7, much better than the old machine I had! I hope this continues. 

Regarding your advice boils down to, get a new machine. How do I know I won't have the same problems with it?
That is not good advice of how to fix anything. That advice is like telling a person with Ford that has a flat tire to buy a Chevy. I am happy you are satisfied with the ResMod. But I don't have a ResMod, I have a Dream Station. 

No one has said the Dream Station can not do the job it needs to do. I am not complaining about Respironics: my old machine which did well was a Respironics machine. Nor has anyone (except SleepWalker who recommended to reduce the CFlex and  to set it for APAP at higher pressures, which I still need to test although my physician says that is not what to do,) given me advice of what direction to go with the Dream Station, including you. So if I don't take your advice, that is the reason why. I do thank you for being willing to give advice, however.

But I am making headway. Despite not getting helpful advice specifically for the Dream Station, I am moving in the right direction with it.

[staceyburke]

AHI will very each night WITH the same machine set to the same settings. It’s good you had a good night, you will need this to be repeated for several nights to see if things have really gotten better

[wolson]

AHI will very each night WITH the same machine set to the same settings. It’s good you had a good night, you will need this to be repeated for several nights to see if things have really gotten better

Right!

[OpalRose]

wolson,
Let us know if the lower AHI number continues with the DreamStation.  Many folk here use Respironics machines and seem to like them.  I used the 60 Series Apap for 6 years and had decent therapy.

The DreamStation many take a bit longer to tweak for optimal settings than a ResMed, but not impossible.  
Like I said, I used one for 6 years.  Now, I use a ResMed and feel much more comfortable with it.

One thing I'd like to recommend is to use CFlex at a setting of 1 or 2, whichever is comfortable and gives the best results.  A setting of 3 seems to cause breathing problems for some reason.  You do need to use CFlex to help with Reras and Hypopneas, although a ResMed with EPR would tackle this better.  Just something to keep in mind for the future should you ever have the opportunity to change machines.

The first thing you should tackle is the Obstructives which were clustered in some earlier charts. This points to a positioning sleep problem.  Use a bed pillow that is not too tall or puffy as this can push your chin to your chest and cut off your air supply.  Or try a soft cervical collar to help align your head and neck.  If you results continue to look as good as your last post, then you should be ok.

Good luck and give your new settings a few days.  This will show if there is a trend.

[SarcasticDave94]

I hope your success continues with the Respironics. Until you string multiple good night's together it's not a success. Congratulations on the one night trend and I'm sincere in saying hopefully it turns into 2 3 4...

I'll never suggest you get ResMod but I have suggested ResMed. And (Luke) SleepWalker hasn't done a thing to you, maybe SleepRider had had somewhat to say.

Because my understanding is you've not tried ResMed I'll suggest fixing therapy with a better maybe for most, the ResMed. If you've not tried ResMed you don't know it's not right.

Even if I contend ResMed is better than Respironics, and lots here have proved it, how you get there won't matter, as long as you get there. if a DreamStation gets you there yippee congrats. When a person stresses that they're not satisfied with Respironics I'll make the assumption they'd like a change. With you, my assumption to suppose the words not satisfied and they sought change would be good was wrong.

My folly I'll suppose to think that. My folly also to think those posts here that you ask for help then produces possible solutions and then you'd enact them. Why are you indicating you're sitting around waiting for Dr. Quack to decide other settings may be tried?

Great news my folly won't interfere again with you. I don't care if you drive Ford or Chevy, BMW or Lexus or use Respironics or Resmed (not ResMod they don't exist). I volunteer my time and effort here to help others, even you, to help make your therapy better. I use wisdom of what I've seen happen to others just by merely trying ResMed instead of Respironics. And I've passed that on to you. If you do find out my suggestion was right I'll not say I told you so, but do not let them YOUR stubbornness and ignorance of the PAP machine inner workings get in the way of great therapy.

Dave's folly that's suggested ResMed may well have been wisdom instead. And your high and lifted demands to know how a PAP machine algorithm works before seeing it fit for consideration may cost you a good chunk of great therapy time. This isn't a game to prove who's right or the wise or a fool. It's a required action that is acted on to obtain great therapy for you.

I've said enough, my folly I'll leave with you. My silence going forward will not mean I either agree or disagree with you. It does mean that in my folly an attempt at assisting you with PAP therapy was made and you let me know clearly my help wasn't acceptable or wanted.

So long and maybe Luke SleepWalker passes by and has something to say. And the things he says cannot be resisted very easily. It must be a Jedi mind trick.

PS if it helps at all, you said yourself of the DreamStation, it's out of control, had problems, and that you felt the old machine works better. So why prove insanity by using it?