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Give fixed pressure a try with the pressure support and see where that goes. I had forgotten we went to fixed pressure with the Dreamstation for a reason, and that may apply with the Vauto as well. If you decide the Dreamstation is more comfortable for you, it's not the first time that has happened (however you will be a freak of nature and poor judge of character as a result ). I agree with your assessment, and we sometimes need to be reminded that therapy and comfort with it is an individual experience.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
I don't really care which brand provides better therapy. I do care about consistently good therapy. You get the 2 machines on similar settings, and then you may notice ResMed does better for you. If it does not, certainly use Respironics. I do think this was needed to indicate therapy weakness in the past. We now know pressure swings isn't well tolerated for you.
Now to go back to the question, "...why pay for the Resmed if the Phillips with constant pressure is working?" I've not visited the beginning of this thread in a while. But was the Philips really giving you great results? I'm not here to tell you what you feel, but if the Respironics was really doing well, we'd not be on page 15 of posts. There was some lack in therapy that we were chasing after.
FWIW in 2017 right after I was issued a DreamStation BPAP Auto, I felt the older REMstar CPAP was better. For me it was because I have lots of CA. No I'm not saying you do as well, regarding CA. The point is comparisons of 2 totally different therapies can't really do much, but it did reveal you don't like variable pressure.
Try the ResMed with limited pressure variability as you said you were doing. Get it to apple vs apple. Then see which works better.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
I will try the Resmed with similar pressures/modes.
I also have a SCC coming in tonight to see if anything changes there.
I don't want to sound like an ingrate, I appreciate all feedback, god knows you guys are helping me more than my doctor, and I will try almost everything you guys suggest.
Yes the Phillips took a while to dial in, I feel like that is simply the normal tuning process and not necessary a weakness of the Philips machine. With the Philips we were trying to balance Central against Obstructive Apnea, maybe the Resmed will handle that better.
I also know my mask setup is limited, but since it's my preferred mask option, I'm trying to maximize my results with the mask that is the most comfortable for me.
So far we have made good progress, we took an AHI of 18-25 and reduced it to ~5 or less for the most part with the Phillips machine, can we get lower, I'm sure we can, the question to me now is at what cost.. if it costs me significant discomfort and impacts my rest, I feel that is just as detrimental to the actual apnea. I honestly don't care about the money that much, my health and rest is worth whatever it costs.
Since the DME gave me a much more capable machine at an incredible price, I'm inclined to keep both machines, who knows, as I live with XPAP on a daily basis I may be more inclined to graduate to more aggressive mask setups and learn to tolerate them more.
Bottom line, I appreciate all the help, I'm trying to get better, but prefer to be as comfortable as possible while getting my Apnea to a controllable level, if not completely rid myself of Apnea...
The treatment of sleep apnea is not static. If and when you need to modify your treatment, the Resmed is more flexible at adapting to this. The Philips firmware is getting a little long in the tooth, and it is showing its age compared to the Resmed's. That is one of the primary reasons for the Resmed being recommended here.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
In CPAP mode you would select a fixed pressure and use EPR at 2 or 3. If you set the CPAP pressure to 10 and EPR at 3, the resulting pressure will be 10/7 (inhale / exhale).
In Vauto mode, you choose EPAP Min 7.0 and PS 3 with maximum pressure 10, and will get fixed pressure of 10/7.
In VPAP S mode, you choose EPAP 7.0 and IPAP 10.0 and still get fixed pressure of 10/7.
All three options produce the same pressure. With Vauto and S mode you can use the trigger sensitivity if needed, and the pressure support can be in fractions rather than whole increments (i.e. 1, 2, 3). In S-mode you can turn Easybreathe on or off. With Easybreathe off, the pressure delivery can be controlled by rise time. This is going to feel more like the Philips. As you can see, the Vauto has many different options to arrive as approximately the same pressure, but results may feel subtly different.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
The fixed pressure seems to work best for you, and the use of EPR or pressure support makes the EPAP pressure more consistent. There are differences, in that you can use more or less EPR or PS as you choose. I think any further optimization we will consider, will focus on fixed pressure. SpO2 chart looks excellent. Still some flow limits, but nothing major.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
). I agree with your assessment, and we sometimes need to be reminded that therapy and comfort with it is an individual experience.
