best CPAP for REM-predominant OSA

[North Star]

Hi, newbie question. I recently received an OSA diagnosis from a diagnostic sleep study and have been relying on this forum extensively while trying to choose a setup.  Great, great resource; thanks to all contributing here!

My AHI was quite variable--8 for non-REM and 47 for REM--so I plan to choose a CPAP with auto capability, which I need anyway because I haven’t done a titration study.  In general I see a lot of people pleased with the market-leading AirSense 10 Autoset / Autoset for Her and Dreamstation Auto, without a clear favorite between the two.
 
So my questions:

1.  Is there any reason to prefer the AirSense or the Dreamstation system and algorithm for the specific case of REM-predominant OSA?

2.  On the AirSense side, I notice from the ResMed site that the “for her” algorithm includes, among other features more or less targeted for women, one supposedly targeted for "predominantly REM-based events:  If 2 apneas are detected within a minute, an ‘adaptive minimum pressure’ prevents therapy pressure decaying below this level for the remainder of the session.  Minimum pressure will not exceed 10cmH20.”  Can someone explain how this helps for REM-predominant OSA specifically?  I guess the idea is to prevent the pressure level from decaying between REM cycles?

3.   My understanding from earlier threads is that the only difference between the AirSense “Autoset” and “Autoset for Her” in their current iteration, other than color, is this third “for her" algorithm on top of the "standard" and "soft" algorithms.  Is that correct?  (It sounds then like, even though I’m male and appreciate the “how much blacker could it be?” aesthetic of the base AirSense, I would lose nothing functionally from choosing the “For Her” version, even if I end up selecting the traditional "standard" or "soft" algorithm?)
 
I appreciate any other tips on treating REM-predominant OSA.  I’m assuming this case doesn’t argue for a particular mask type, other than one that will stay on all night?
 
Thanks in advance!

[Sleep2Snore]

I have tried both machines and I preferred the ResMed Autosense10autoset to the Dreamstation, however, once I was asleep I can't say I noticed all that much between them, on saying that the ResMed is on the quieter side, but not by a lot.  I would say without bias if you want the best go for a ResMed Airsense10 Autoset.  This is of course you do not need a more complex machine, if it is straight forward Sleep Apnea, that is fine, but some need other types of machines and although you might save money by buying you own without a study.  It might cost you more in the long run, keep in mind there is other things can make you fatigued during the day.  Unless someone has seen you stop breathing during the night during sleep, it might not be Sleep Apnea.
You should get a test done, however, if you want to try a machine to see if you have it go for the ResMed Airsense10 Autoset or if you want to waste money go for the for her.  It is really for woman and the extra cost I don't think is worth it, unless you want a nicer looking machine!

[Walla Walla]

I would get either the Air Sense 10 or the Air Sense 10 for Her. They're both good machines and both will work for you. If you want to spend a little more than you get the extra algorithm. But I've seen a lot of people told to switch from that algorithm to the regular one here on the Board. The reason was it wasn't responding to events.

[Gideon]

1: AirSense™ 10 AutoSet™ for Her
2: AirSense™ 10 AutoSet™
3: Philips Respironics DreamStation Auto CPAP Machine (DSX500x11)
4: fully data capable CPAP machines from ResMed and Philips Respironics

That said, could you post your sleep study(s) please.  We have seen them mis-interpeted.  That way we can better advise you on your potential path, though it does sound like the above would be good.

Fred

[Shin Ryoku]

In general I see a lot of people pleased with the market-leading AirSense 10 Autoset / Autoset for Her and Dreamstation Auto, without a clear favorite between the two....

Is there any reason to prefer the AirSense or the Dreamstation system and algorithm for the specific case of REM-predominant OSA?

Based on scientific studies, there is no reason to prefer one vs the other.

Based on anecdotes , the conventional wisdom on sleep apnea forums tends to be that the Autoset should be better since it increases pressure faster than the DreamStation Auto. I've never seen convincing primary data show better head to head efficacy for the Autoset, but it's often said to be better.

I don't know if my OSA is much worse during REM since I didn't get enough REM sleep during my study to make a firm conclusion about that. However, my obstructive episodes do come in clusters overnight, do not appear to be positional in nature, and so I wonder if they are REM-related.

I own both the AirSense 10 Autoset for Her as well as the Dreamstation Auto, and based on my experience they are equally effective in treating my OSA. Your mileage may vary.

All best,
Amin

[trish6hundred]

Hi North Star,
WELCOME! to the forum.!
Good luck as you start CPAP therapy.

[North Star]

Many thanks, everyone, much appreciated.  Sure, if you have tips based on my study results, or for REM-predominant OSA in general, please pass them along.

My diagnosis was "Moderate obstructive sleep apnea-hypopnea syndrome with exacerbation in REM sleep with REM AHI of 47/hr. Short sleep latency with normal sleep efficiency. Normal REM latency with reduced duration of REM sleep, normal N1, normal N2, excessive N3 sleep. Significant sleep fragmentation with high arousal index was noted. No EEG or EKG abnormalities were noted. Few PVC's were noted in epochs 466, 467. No significant periodic leg movements in sleep or parasomnias were noted."  

I'm not sure where she gets the "moderate" part. My average AHI of 13.1 and non-REM AHI of 7.6 seem to be firmly in the "mild" category on all the charts I see.  We didn't do any titration, so the Rx just reads "auto-PAP pressure setting: 6 to 12 cmH20," "mask of choice".

I've pretty much decided on buying an AirSense 10 Autoset or Autoset for Her online.  Next decision: mask.  I seem to breathe through my nose, so I tried on a few nasal pillows and masks at a local medical supply but didn't note one to fit particularly better than another.  Should I go to my insurance company's DME (Apria) for a consultation?  Given all the reported DME billing problems, who knows what, if anything, they might charge me back through my insurance if I consult with the Apria tech.  I don't know if I could buy a mask through Apria even though I plan to buy the CPAP elsewhere.  I'm tempted to take my chances on just mail-ordering a P10--perhaps from Supplier #1, the only one I'm aware of who takes returns.

Thanks again for all the advice.

   

[Gideon]

Overall it looks pretty good, No Central Apnea and only 4 Mixed Apnea.  This says The ResMed AirSense 10 AutoSet or the ResMed AirSense 10 AutoSet for Her is the best choice for you.
The For Her model offers an additional mode that you can use IF you need it.  Either will be more than satisfactory.

You do not look like you will require a more advanced machine that the AutoSet above.  That is what I wanted to verify.  The 18 RDI you have puts you into the "Moderate" category by the chart in the report.  


Your respiratory effort related arousal (RERA), 30 events, is what is stated, you aroused 30 times from respiratory events.thru the night.  CPAP treatment will help those so don't worry about them. 
The end result is that you need to be treated/should be treated for sleep apnea.

Fred





From an PM

Hi, you'd asked me in my recent thread to post my sleep study so you could better advise.  Thanks for you interest; I posted it to the thread.  You'll note the non-REM AHI is 7.6 while the REM AHI is 47.4. Any guidance specific to my study? 

I'm still curious if, though male, I should seek out the "For Her" version of the AirSense 10--if the extra algorithm would be beneficial to my case--and if there's a way to know what mask would work well, short of buying and trying.  I did't notice anything in the study about mouth breathing.  I may just take my chances with a ResMed P10 pillow.  Thanks again!