ResMed Autoset II Data Schedule and Meaning

[SleepFast]

I have been on my first CPAP machine (ResMed AutoSet II) for about 16 days. I have yet to obtain the ResScan software, but have been writing down all of the efficacy and utilization data daily. I have a question on how these data are derived and what time period they represent.

I have read the user and clinical manuals and can't find my answers there. But from what I can understand from CPAPTALk posts, the machine considers 12 noon to be the beginning of a new "series" or day and wipes out data from the previous "series" or 24 hour period. That is displayed as a medium of mediums for a week, month, 6 mo, or year. The ResScan software can pull detailed data for the last 5 days (not available on the machine's LCD).

I have two basic questions:

1. I understand that settling time is a period when the machine does not try to start its autoset process. Does having a zero settling time have an impact on your AI, HI, and AHI data? In other words, does it count the time in settling and the events that happen during that time into the final totals for the day (24 hour session)? Or does it start counting after the settling period? If you fell asleep during settling, you could anticipate incidents happening that are not being controlled.

2. If you take a nap during the afternoon -- say one hour -- with your CPAP on, I assume these results are combined with your subsequent night's sleep in proportion to the time you spent in the nap. So it would seem adding nap time into night sleep time will inflate your results. Especially if your settling time is zero and it counts those results. But even the fact that most incidents probably happen while the machine is trying to find your titration level.

The reason I am asking these questions is that my efficacy data for short naps (one hour) is horrible. Like AHIs of 40 and AIs of 12. If I don't take a nap, my night time AHI is between 5-7. If I take a nap my final AHI is 12 - 17 for the session. If I raise the settling time to 30 minutes, these numbers seem to go down. Not enough data to pinpoint that yet.

Should I not use a zero settling time in order to get more accurate measurements?

Should I not use the CPAP for naps in order to get more accurate measurements during the nights?

Finally, will the user of the ResScan 3.7 software explain these data to me (and will it capture the 5 days of detailed data in the machine? Will it allow me to see when the AIs and HIs are happening during the night?)

I love the machine and the mask I am using and rarely have significant leaks (0.20 mean). My titrated pressure was 12 in the sleep test, but I seem to be 11 or less most of the time. My range is 8-16. My initial AHI was 57 and it is down to 7-8 on days I don't take a nap. On days I take a nap it is in the teens.

Final Final question: Which is a more important event -- an AI or an HI. It would seem to me the AI should be waited more heavly in the AHI index (unless they are equal). I can see them being equal if they both pull you out of getting to REM. But the AI has got to put more stress on your body.

Sorry for all of the questions, but I am an newbie trying to understand.

Thanks in advance:-)

John

[Paul56]

I have been on my first CPAP machine (ResMed AutoSet II) for about 16 days. I have yet to obtain the ResScan software, but have been writing down all of the efficacy and utilization data daily. I have a question on how these data are derived and what time period they represent.

I have read the user and clinical manuals and can't find my answers there. But from what I can understand from CPAPTALk posts, the machine considers 12 noon to be the beginning of a new "series" or day and wipes out data from the previous "series" or 24 hour period. That is displayed as a medium of mediums for a week, month, 6 mo, or year. The ResScan software can pull detailed data for the last 5 days (not available on the machine's LCD).

I have two basic questions:

1. I understand that settling time is a period when the machine does not try to start its autoset process. Does having a zero settling time have an impact on your AI, HI, and AHI data? In other words, does it count the time in settling and the events that happen during that time into the final totals for the day (24 hour session)? Or does it start counting after the settling period? If you fell asleep during settling, you could anticipate incidents happening that are not being controlled.

2. If you take a nap during the afternoon -- say one hour -- with your CPAP on, I assume these results are combined with your subsequent night's sleep in proportion to the time you spent in the nap. So it would seem adding nap time into night sleep time will inflate your results. Especially if your settling time is zero and it counts those results. But even the fact that most incidents probably happen while the machine is trying to find your titration level.

The reason I am asking these questions is that my efficacy data for short naps (one hour) is horrible. Like AHIs of 40 and AIs of 12. If I don't take a nap, my night time AHI is between 5-7. If I take a nap my final AHI is 12 - 17 for the session. If I raise the settling time to 30 minutes, these numbers seem to go down. Not enough data to pinpoint that yet.

Should I not use a zero settling time in order to get more accurate measurements?

Should I not use the CPAP for naps in order to get more accurate measurements during the nights?

Finally, will the user of the ResScan 3.7 software explain these data to me (and will it capture the 5 days of detailed data in the machine? Will it allow me to see when the AIs and HIs are happening during the night?)

I love the machine and the mask I am using and rarely have significant leaks (0.20 mean). My titrated pressure was 12 in the sleep test, but I seem to be 11 or less most of the time. My range is 8-16. My initial AHI was 57 and it is down to 7-8 on days I don't take a nap. On days I take a nap it is in the teens.

Final Final question: Which is a more important event -- an AI or an HI. It would seem to me the AI should be waited more heavly in the AHI index (unless they are equal). I can see them being equal if they both pull you out of getting to REM. But the AI has got to put more stress on your body.

Sorry for all of the questions, but I am an newbie trying to understand.

Thanks in advance:-)

John

When in settling mode the machine does not score events.

Any usage of the machine between 12 noon day 1 and 12 noon day of the next day are included in the results.

Set your settling time for the amount of time you think it takes you to get to sleep. If you are not sleeping and the machine starts scoring events then that data is meaningless... because you are awake.

The software will show you at what times and how long your events are. I have the software... rarely use it anymore.

Focus on the AI numbers and get those down as low as you can. Resmed machines score the HI's higher than other brands so the notion here has been batted about that one should consider dividing your hypopnea score by 2 to get something more accurate. In any case, focus more on your apnea events.

AHI = AI + HI ...it is that simple.

[billbolton]

Resmed machines score the HI's higher than other brands so the notion here has been batted about that one should consider dividing your hypopnea score by 2 to get something more accurate.

More accurate?

The sleep clinicians I have talked to about AHI scoring think that Resmed has the most realistic scoring.

Cheers,

Bill

[ozij]

Machines (of all makes...) can't make sense of any data they confront when you're awake. They need the regular, smooth breathing of sleep to start figuring where that breathing is interrupted, and go through the calculations of "what kind of breathing interruption is this?". By giving the machine a "settling time" you give information about how long you expect to tatk to fall asleep. I happen to think nap data is more confusing than anything else - my software gives me the data per session and I don't add any session of less than an hour to my calculations.

As for the machine's accuracy: Sleep techs do not use Resmed machines with the way we do. If they did, they would not have even one snore recorded in any PSG. Resmeds (and sleep techs) use ResLink when they want to report all possible data. I doubt any sleep tech - even a patriotic Australian sleep tech - would tell us that when the Resmed ResScan withou ResLink reports no snores, that means the person in not snoring. As a matter of fact, a Resmed auto machine does use snores and flow limitation to guide its pressure setting (see http://www.resmed.com/en-en/clinicians/ ... clinicians) and it reports neither in when the ResScan reads the flow generator data.

So what? The question of objective accuracy is rather academic for those of us who don't intend to use the data in order to set up another machine. We use the data to help us find the best settings and best subjective results, and as long as the data is consistently skewed (no matter what the machine) reliable, it doesn't matter all that much if it is exactly the same as that gathered in a PSG, or by another machine, for that matter.

All the data reporting machine machine base their reporting on a man/woman created algorithm that analyses the breathing pattern and its interruptions. If you're very interested in the technical aspects of apnea hypopnea recognition in mechanical devices you can read up on that in the various patents (patent.google.com, search for the company name and "algorithm", for starters....).

But you can get perfect therapy without reading the patents.

Some of us (the majority) can get perfect therapy on all machines. Some of us do well with one algorithm, and not with another.

O.

[Paul56]

Resmed machines score the HI's higher than other brands so the notion here has been batted about that one should consider dividing your hypopnea score by 2 to get something more accurate.

More accurate?

The sleep clinicians I have talked to about AHI scoring think that Resmed has the most realistic scoring.

Cheers,

Bill

It would be nice to see some real world testing / reviews of the various machines so all the theories that are floating about could be confirmed or denied.

[alnhwrd]

John,

I would not use a settling time of zero. Any info gathered by the machine while you are awake isn't of any value, hence the purpose of having the feature.

You SHOULD use your CPAP 100% of the time when sleeping, even for naps. Of what value is the best data if you are compromising your therapy to get it? The next logical question is, why do you still need naps? Aren't you getting enough sleep during the night?

Some might disagree, but I think your leak rate is high. You do realize that the Resmeds calculate the expected leak rate and display what is above this in the Efficiency menu? In other words, if your mask is supposed to leak .40 and is actually leaking .60 it will display .20 in the efficiency menu. You might be leaking enough air out to allow some events to happen. Also be sure that you have the correct mask selected in the Clinician's menu.
BTW, the machine does not wipe the data at noon, it rolls it over into the weekly, monthly, annual average. You can check these averages in the Efficiency menu too.

I tend to focus on my AI numbers rather than the HI. Having said that, I notice that I feel better when I have a low AI AND a low HI than I do with a low AI and a high HI. An apnea is a complete stoppage of breathing whereas a hypopnea is a significant restriction of airflow. Both reduce the amount of oxygen getting to your brain and other vital organs.

I'm glad to hear you are loving the machine and its benefits, and that you are taking charge of your therapy. I hope some of this helps.

[SleepFast]

Thanks to all for the valuable information. I have already put it into practice by setting the settling to 30 minutes. I have the correct mask setting (Swift) and am getting leakage of 0.2. The Swift manual does not say what is acceptable for leakage, but the S8 clinical manual says that .2 is a very good fit (I don't know if that is adjusted for expected leakage). When I use the S8 mask fit feature it shows Excellent. So I assume my mask isn't leaking too much.

The 30 minute settling time has pulled my numbers down to <11 pressure, AHI = 5.1, AI = 0.1, HI = 5. So it seems to be working well after getting rid of the zero settling time.

As for naps, it could just be a habit. I have read that humans evolved sleeping 7 hr per night and one during the day (nap). Are naps bad for OSA? I usually sleep 45 min to 1 hour (1 REM cycle). What if I raise the settling to 45 minutes during naps to minimize the effects of nap sleep on my night sleep results?

One more question. Does settling time count into the hours of use?

I just received my card reader and the software. Now for the fun of trying to get it to work on my XP machine. Yikes!!

Thanks again for all of the information

John

[SleepFast]

Update:

I tried every trick on CPAPTalk for loading ResScan 3.7 on my XP SP3 computers. The computers say the driver loades successfully, but then ResScan can't see it. I have three of them (laptops). Including assuming my data card was corrupt and using a spare one. I still get the dreaded "No device available for downloading data". I must have spent 4-5 hours trying.

It seems to be a conflict between certain drivers as it works on many XP machines. I'll try an older ME computer today. Don't know how to go back to SP2, but then again I should not have to.

The Resmed card reader is not even good for a paper weight. Anyone have any ideas? Oh Well:-( My numbers remain good.

Thanks,

John

[billbolton]

It seems to be a conflict between certain drivers as it works on many XP machines.

You should disable drivers for any WiFi cards you may installed on your laptops and see if that helps.

Cheers,

Bill

[SleepFast]

Thanks. I've tried all of the work-arounds suggested in CPAPTalk including disabling Wifi and NIC drivers, installing the ARC38 driver in safe mode, and many rebooting and application load sequencing suggestions. Unfortunately I have three laptops that are identical and have the same ResScan installation problems -- "No device is available for downloading data". Hate to buy another laptop just to run this application. Guess I'll try the app on a willing friend's computer.

The good news is that I am feeling better every day -- now 21 of them! Thank goodness for the Swift LT. I can't tollerate the larger masks as easily.

John