Upgraded my machine now I'm in misery

[LSAT]

It's normal to feel that way. The pressure part doesn't come into play until you have a sealed circuit with the mask to establish a pressure and then keep it stable.
There's nothing wrong with the machine.

I agree

[ajack]

it's a low pressure, high flow of air by the motor working as hard as it can, when the mask isn't on. your new machine is capable of a higher flow.

[palerider]

I noticed that if I start the machine up without putting the mask on (I'm holding the mask in my hand) it seems like there air pressure coming through the mask is extremely high, my wife even commented that the it was like a whirlwind of air coming through the pillows, mush higher than my old Remstar machine then when I put the mask on, the air pressure doesn't seem so great. It doesn't seem to matter if the pressure is set to 5-15cm or 10cm, the pressure coming through the pillows is extremely high until I put the mask on. Is it something normal about the Airsense 10 to produce high air velocity when the mask is not on or could their be something wrong with the machine.

I've emailed the DME about this and am waiting for a response.

the machine is set to create a specific pressure. pressure is the result of resistance to flow. when there's no resistance (or very little) like when your mask is off... the machine creates MORE flow, to try and get pressure. but there's no resistance, so the air just blows out, so the machine tries harder, spinning the fan faster, and faster, till it's at full speed, trying to make some pressure, pushing against nothing.... so you get a huge amount of flow with no pressure. it's like turning on the garden hose and letting all the water run out, it doesn't go very far, big flow, low pressure, but if you put your thumb over the end, the flow goes way down but the pressure goes up, and the water shoots a much longer distance.

as soon as you put your mask on, the machine senses the the increasing pressure, and slows the fan down. (it checks maybe a hundred times a second, maybe more, depending on the model.) it slows the fan down till there's only that very gentle set pressure.

[gregnga]

Make the change and see how it goes.

The face to face requirement for insurance (sounds like Medicare) is just to document you are using the machine and it is working.
Insurance doesn't care if you change the settings or not...all they want is to know you are using it the required number of hours.
Now will your doctor care??? Probably not especially if you end up doing better on fixed at 11 cm.

In terms of current settings...most likely the 5 minimum is too low since you were doing well on fixed 11 cm. Without seeing the reports it's hard to say for sure what is going on. Contrary to what some people believe these apap machines sometimes need a little help with a better more optimal baseline (minimum) pressure because it takes a bit of time to increase the pressure to where you need to be to hold the airway open and if it takes too long to get there the airway closes and opens back up while the machine is trying to get to where it needs to be.
If you want to learn more about what your machine shows besides the AHI on the screen you can get the software.
https://sleep.tnet.com/equipment

Someone using fixed pressures for years like you have been doing very likely will find the auto adjusting mode quite a change and made worse if the settings aren't optimal. Some people prefer fixed mode and that's just fine. Some people prefer auto mode and that's fine too. It's all in what you feel works best for you.
It's probably easily fixed to either keep it in auto mode or you can try fixed at 11 cm and see how it goes. If you still have problems at fixed then we could do a little more detective work and figure out the next plan of action.

Oh...do you know what the AHI event category breakdown is? If going to fixed mode doesn't bring it down then we for sure need to figure out the event category breakdown
Like how much is the Central Index and the Obstructive Apnea index and the Hyponea index. If you are seeing predominately central index that is high then we need to have a different discussion.

Start with easy first though...just change it over to what you used to use and see what happens.
Insurance won't care at all and I would be real surprised if your doctor cared or was upset.

I changed it from AUTO to CPAP and changed the pressure from 5 -->15 to fixed 8cm and slept much better last night. In addition, my AHI dropped from 20 to 12.. I'm going to try 10 or 11 cm tonight.

[D.H.]

I am not aware of anybody ever being called on non-compliance for changing the settings. I suggest just doing it!

[TASmart]

Make the change and see how it goes.

The face to face requirement for insurance (sounds like Medicare) is just to document you are using the machine and it is working.
Insurance doesn't care if you change the settings or not...all they want is to know you are using it the required number of hours.
Now will your doctor care??? Probably not especially if you end up doing better on fixed at 11 cm.

In terms of current settings...most likely the 5 minimum is too low since you were doing well on fixed 11 cm. Without seeing the reports it's hard to say for sure what is going on. Contrary to what some people believe these apap machines sometimes need a little help with a better more optimal baseline (minimum) pressure because it takes a bit of time to increase the pressure to where you need to be to hold the airway open and if it takes too long to get there the airway closes and opens back up while the machine is trying to get to where it needs to be.
If you want to learn more about what your machine shows besides the AHI on the screen you can get the software.
https://sleep.tnet.com/equipment

Someone using fixed pressures for years like you have been doing very likely will find the auto adjusting mode quite a change and made worse if the settings aren't optimal. Some people prefer fixed mode and that's just fine. Some people prefer auto mode and that's fine too. It's all in what you feel works best for you.
It's probably easily fixed to either keep it in auto mode or you can try fixed at 11 cm and see how it goes. If you still have problems at fixed then we could do a little more detective work and figure out the next plan of action.

Oh...do you know what the AHI event category breakdown is? If going to fixed mode doesn't bring it down then we for sure need to figure out the event category breakdown
Like how much is the Central Index and the Obstructive Apnea index and the Hyponea index. If you are seeing predominately central index that is high then we need to have a different discussion.

Start with easy first though...just change it over to what you used to use and see what happens.
Insurance won't care at all and I would be real surprised if your doctor cared or was upset.

I changed it from AUTO to CPAP and changed the pressure from 5 -->15 to fixed 8cm and slept much better last night. In addition, my AHI dropped from 20 to 12.. I'm going to try 10 or 11 cm tonight.

As you start dialing things beware making changes too fast, since the results for any one setting may vary quite a lot on a night by night basis, you need to give changes a few days to a week to see how they are going to settle in. Living beings are not like robots we vary somewhat day in and day out.

[Pugsy]

I changed it from AUTO to CPAP and changed the pressure from 5 -->15 to fixed 8cm and slept much better last night. In addition, my AHI dropped from 20 to 12.. I'm going to try 10 or 11 cm tonight.

I actually agree with this idea and see no reason to keep using the 8 cm fixed for a few days to see if a miracle happens and the AHI comes down from 12 to be enough to be acceptable. I don't see it happening unless the AHI was primarily central...that's why knowing what you are fighting with more pressure is really important.

Given that in the past 11 cm fixed was used and successfully...and the AHI at fixed 8 was 12 and almost cut the AHI in half...more pressure is pretty much a given.

Once you get your AHI into an acceptable range then stick with that pressure for a few nights to see if it is stable and a trend is developing.

One night doesn't make a trend but in your situation it's obvious from one night that enough adjustment hasn't yet been made.
12 AHI is still unacceptable if it is primarily OAs and hyponeas and more pressure is the fix.
Now if it was primarily central...we have a different discussion.
Now if you had said your AHI was 4 or 5 with 8 cm and mainly obstructive...I might want to give 8 cm a few more nights just to see if that's the best it would do or not.

So when you are evaluating your AHI and corresponding pressure needs...make sure that what you are wanting to fix with more pressure is indeed fixable with more pressure. Can't go by AHI alone..gotta look at each category that makes up that AHI.

[palerider]

I changed it from AUTO to CPAP and changed the pressure from 5 -->15 to fixed 8cm and slept much better last night. In addition, my AHI dropped from 20 to 12.. I'm going to try 10 or 11 cm tonight.

your best will probably be min11, max20, auto setting... going from a fixed 11 to a min of 5 was just *stupid* on your doctors point.