Philips Dreamstation auto or fixed

[stephennic]

Hi all,
I have been trialing the dreamstation fixed and finding it takes along peroid before dosing of to sleep (up to 2 hours). Is that normal for starting on CPAP.
When I do get to sleep I might get 3-4 hours straight and wake up and then take it off so I can get back to sleep is that normal? Maybe the pressure at my set 9 wakes me up and keeps me awake. My latest sleep results before CPAP showed sleep apnoa per hour is 51 on back and 12 on sides. The sleep physcian said maybe try a auto machine and set it at 6-12.
The dreamstation fixed is around $1350 AUS and the auto is $2200 AUS (so much money).
Would it worth trying an auto, is it more comfortable and will I get more hours sleep. I tried to do a search on the internet and there seems to be mixed opinion, some prefer fixed especially at low pressure some prefer auto esp at higher pressures. Any thoughts? Thanks in advance.
Cheers
Steve

[justMongo]

To the first two questions: Yes, that's fair to say it's normal. Takes time to adjust.
At 9 cm-water pressure, it shouldn't wake you up.
Yes, there is a bias toward auto at higher pressures -- say > 12 or so.
Also, bilevel auto is sometimes preferred at higher pressure as a larger reduction in exhalation pressure is possible.
Now, some people are disturbed by pressure changes from an auto; so, there's no absolute guarantee you'd like auto better.
As for cost... We have some very helpful members from Oz who know the price differences.
Two that come to mind are Deepbreathing and zonk.
They might be better able to help if they knew which region of Oz you're located in; it seems to vary by where you are.

[green wings]

Hi, Stephen. I found that it took me about 90 minutes to fall asleep most nights when I first started using CPAP. I was only at 7 cm pressure, but it seemed really noisy to me then.

You might look into using the ramp feature on your machine. It's there for comfort reasons, and being kept awake by the noise from the machine is an adjustment/comfort issue. I think the maximum time for plain ramp is 45 minutes. If you're trying to avoid noise, you'll want to choose the lowest starting pressure at which you can breathe comfortably. For me, that's around 7. I think it's an individual thing.

Your machine may have a "smart ramp" - one that estimates from your breathing pattern when you're asleep and only begins to increase the pressure then. I'm not sure about that - you'll have to check your user manual.

If there's no smart ramp and you're using plain ramp, you'll have to hit the ramp button again if you are still awake after 45 minutes and the machine noise bothers you once you reach full pressure.

Getting used to the noise from the machine is a desensitization process. After a few weeks, the sound will be a familiar one and your brain will start to disregard it. Being in the middle of that process takes patience, though.

If you are able to listen to music or to use a sleep-promoting app at bedtime, it makes the time before falling asleep less boring. If melatonin or other sleep aids work for you, those can help during the adjustment period, too.

It took me around 90 minutes to fall asleep when I first started using CPAP. Now it usually takes 15-30 minutes, which is actually faster than I fell asleep pre-CPAP.

[MitchS]

Hello, Steve.

The smart ramp for the DreamStation green wings was referring to applies an auto cpap algorithm during the ramp period. The ramp pressure setting is used as the auto minimum pressure and the cpap pressure setting is used as the auto maximum. This allows the machine to use as low a pressure as possible and still be able to react to events with your therapy pressure, if needed, during the ramp period. The longest the ramp can be set for is 45 minutes.

It may be worth trying the smart ramp. I used it to get used to using my DreamStation and finally phased it out altogether as I got more comfortable with my treatment. I started out with a treatment pressure of 9 also. My DME set my ramp starting pressure at 6 and turned on the smart ramp feature. I eventually set the ramp pressure at 7 because I felt like I wasn't getting enough air with 6 when I first turned the machine on.

[stephennic]

Hi all,
Thanks for all the replies. I did use the RAMP last night at 6 and exhale set at 2. A better night took about 1 hour to get to sleep. Had 5 hours but woke 3 times on my back but did go back to sleep. I had 9.1 AP per hour, normally have 51 without CPAP on back. Is that okay?
What would cause me to wake, the apneas, the 9cm pressure or just been on back?
Thanks to everyone for your help thus far.
Cheers
Steve

[green wings]

Hi Steve. My impression about some of the frequent waking during adjustment to CPAP is that we wake after we finish a "cycle" of sleep stages. I think we typically do this at all times, but it may normally be so brief that we don't remember it. When we're adjusting to CPAP, we wake and hear the noise of the machine and feel the pressure, so we may stay awake for awhile.

There also seems to be some "reordering" of sleep phases going on during the time immediately after we start CPAP. We may not have been getting an adequate amount of time in each sleep stage pre-CPAP due to awakenings from the apnea. I remember that I felt like my awakeness/sleepiness/tiredness state was chaotic for the first month of so of CPAP use. After that, it seemed to settle down a bit.

Since you have the option of using "smart ramp" with the machine you have right now, I would enable it and hit the ramp button if you wake up and the pressure or noise seem bothersome.

[MitchS]

Hello again, Steve.

It looks like you made some progress last night. Getting used to cpap is a matter of trial and error and a determination to make it work. You just have keep trying different things until you find what works for you.

I agree with green wings. I would check to be sure the smart ramp is enabled. You can only do that in the clinician menu. It is different than the regular ramp feature.

You really do need to avoid sleeping on your back as much as possible. It tends to increase obstructive events which in turn disturbs your sleep and increases your AHI.

Hang in there. You will get it all worked out eventually. Just don't get discouraged if you have an occasional set back, we all do.

Best of luck,

[Ockrocket]

As a "new to CPAP" and also using/trialing the DreamStation, in an auto model.

My numbers are slightly better when using in fixed pressure compared to auto, but found I got to sleep quicker in auto... though it still took me an hour or more to fall asleep (which was normally how long it took me before CPAP as well).

Two months down the track I'm "training" myself to fall asleep quicker.

Now on most nights I can fall asleep within a few minutes of my head hitting the pillow.
I have resorted to ramp mode a couple of times when I was having difficulty though.
The other thing that I've found helps is to actually just sit on the side of the bed for five minutes with the mask on and machine running, it seems the DreamStation takes the machine a few minutes to adjust itself to your exhale/inhale pattern and pressure, once it has settled in to my breathing rhythm I lay down and am off to sleep almost instantly.
I wake up during most nights for a wee walk, but can normally get back to sleep again quickly.. though I have sometimes kicked the machine in to ramp mode if I'm having trouble dropping off.

It takes time, but your ability to fall asleep with the mask and machine will improve.

I think the DreamStation is great, quiet, and functional... just wish the auto version wasn't $2,600

But when the time comes to decide on what I purchase, it will be the auto identical to what I'm being tested with at the moment , along with the F&P Eson nasal mask.

[stephennic]

As a "new to CPAP" and also using/trialing the DreamStation, in an auto model.

My numbers are slightly better when using in fixed pressure compared to auto, but found I got to sleep quicker in auto... though it still took me an hour or more to fall asleep (which was normally how long it took me before CPAP as well).

Two months down the track I'm "training" myself to fall asleep quicker.

Now on most nights I can fall asleep within a few minutes of my head hitting the pillow.
I have resorted to ramp mode a couple of times when I was having difficulty though.
The other thing that I've found helps is to actually just sit on the side of the bed for five minutes with the mask on and machine running, it seems the DreamStation takes the machine a few minutes to adjust itself to your exhale/inhale pattern and pressure, once it has settled in to my breathing rhythm I lay down and am off to sleep almost instantly.
I wake up during most nights for a wee walk, but can normally get back to sleep again quickly.. though I have sometimes kicked the machine in to ramp mode if I'm having trouble dropping off.

It takes time, but your ability to fall asleep with the mask and machine will improve.

I think the DreamStation is great, quiet, and functional... just wish the auto version wasn't $2,600

But when the time comes to decide on what I purchase, it will be the auto identical to what I'm being tested with at the moment , along with the F&P Eson nasal mask.

Great to hear it gets better over time. Were you offered fixed or auto machine. Did you try both or just used fixed mode on the auto machine. My pressure is 9cm so hopefully I don't need auto, what your pressure?. At the moment, I can get a fixed one for sale for $1350 with mask and about $2200 for an auto.
Do you find the auto more comfortable for breathing or fixed especially when you wake up? Great to see another Aussie on here.
Cheers
Steve

[stephennic]

Hi all,
Thanks for the ongoing encouragement too to everyone, I nearly gave up a few weeks ago.

I tried the airsense 10 for awhile but found the dreamstation a little easier to breath with. I also tried the Fisher and paykal icon for few nights and didn't like it at all - no expiration relief I just about felt I was choking to breath.

Also the weinmann prism was okay at ramp 6 however at expiration you felt like you were pushing hard to expire the air even at expiration 3 level, but at 9 I felt my face was about to blow off my face - like in gale force winds.

So back trialling the dreamstation and it seems to be the one so far I felt I can relax the most with, I did like the airsense 10 machine as it was the quietest of the bunch but like the dreamstation for its ease of breathing in and out (smooth). Its great you can rent various machines as its a lot of money to fork out and I would hate to buy one and end up not useing it as I have heard that has happened before with others.
Now I have to decide whether the auto or fixed is the best.
Cheers
Steve