Setting up a new Airsense 10 Autoset

[KLAussie]

Hi all.
I was diagnosed with sleep apnea a few weeks ago following an at home sleep study (in Malaysia). I had a recorded AHI of 66 (and a wife who said I constantly snored and would wake her up with my gasping…).

I have been following this forum ever since, and learning a great deal of information. Thanks!!

Since my diagnosis I have been using an Apex XT Auto CPAP machine with humidifier, which appears to be working well, and has my AHI down to an average of 1.9 (from 9 nights of data). This has been a rental machine, and I can only get access to the data once the rental company visits and downloads the data onto their SD card etc.
I looked at buying a data recording machine in Malaysia (where I live) but found that they were 2 to 3 times as expensive as buying one in the USA, so I ordered a new Resmed Airsense 10 Autoset online from the USA, which has just been delivered today, and I plan to set it up over the weekend (I’m currently outside of Malaysia).

I am hoping that one of you highly experienced members can have a look at my data and confirm that what I am planning is correct?

My Apex machine was set to have a low pressure of 4, and a high of 14. Having reviewed the limited data available (provided as a PDF from my doctor) I am intending to set the Resmed machine up with a low pressure of 6, and leave the top pressure at 14. I will review the new machine data daily (on sleepyhead) and see if the top pressure ever goes that high and adjust accordingly if required.
I can see from my graphs that I have had a few nights with large leaks which led to me removing my mask (a nasal wisp) and going back to sleep, but I am working on this and getting better nights now.
Attached is a graph from a good night, where I didn’t get large leaks and appear to have slept well for a decent period of time. To me it looks as though the apneas are well under control, and that hypopneas are infrequent, however there still seems to be a decent amount of snoring.

From 9 nights of data I had an average pressure of 6.3, and my 90th percentile pressure was 7.2cm. The pressure has never reached 8 or above.
Any advice would be greatly appreciated, especially on my planned pressure settings.

I will provide an update on how I went with the new Resmed machine after I get a couple of nights data.

Charts:
https://imgur.com/tfTAywq

Data:
https://imgur.com/yk68qWP

Thanks again!

[ajack]

I would have min 6 max 10 and get some sleepyhead charts up. Just to make sure nothing else sticks out.
https://www.apneaboard.com/resmed-airse ... setup-info

[USMCVet]

Those leaks don't look horrible. I like your plan though.

[KLAussie]

Thanks for the quick reply guys. Thats amazing, and great to know I'm on the right track with my settings.

Here are the graphs from the following night where I had a large leak and believe I removed the mask. I've woken in the morning a few times now with the mask off, and no recollection of doing it. I have managed a good 8 hours each night with the mask on for the last 3 nights, so definitely feel that I am getting more used to having it on.

https://imgur.com/BZAi8tE

I will set the pressures at 6 & 10 and post some sleepyhead charts once I get some new data.

Thanks again.

[Julie]

There is no need to lower the high setting to 10 and you'd be better off leaving it higher, many even keep it at 20 (the default high... 4 is the default low).

[ajack]

10, 15 or 20 would be fine, given the max was 8. I don't think one of these numbers would be better than the other, at his stage.
I would chose min 6, because it is just below the median 6.3 and is in line with auto titration procedures. It's still a low pressure for most and will also vent the mask enough, not to feel like you are short of air.

[Pugsy]

Here's the thing about maximum pressure settings in the auto adjusting mode....if the machine never goes there it doesn't really matter what you set it at.
So you can set it tight or wide open and if the machine never has a need to go higher it becomes a moot point.
It we could set it for 100 (which obviously we can't) but it never goes above 8...then it wouldn't matter if we set the max at 9 or 10 or 20 or even 100.

Now sometimes the machine might want to go there for some reason or other. Something weird maybe in REM or on our backs maybe.
If you set the machine too tight with that max then the machine can't go up if needed...so the maximum is really a "just in case it's needed" thing.

Up to you what max you want to choose but since you have data from another machine pointing to it not going over so and so pressure it doesn't really matter what you choose. If this was your first machine then I would be more inclined for more open range just to see what it will do but since you already have that information..you have some choices and all of them are actually good choices.
Just watch the data for those "just in case" moments that might happen and make adjustments if needed.

I don't know anything about the Apex auto adjusting algorithm or how sensitive it might be to flow limitations, snores, etc but the ResMed machine is fairly sensitive to those things. So it may or may not auto adjust the pressure like the Apex machine did.
If you want to be on the conservative side...a tight range or if you want to see what the machine wants to do...a bigger range.
You will do fine with either since you can quickly evaluate either.

My personal opinion...middle of the road to start with since the machine only goes up if it thinks it needs to.
Maybe 6 min and 12 max....and then see what it does.
It is a different brand and different algorithm and it might respond a little differently than the Apex ...and again it might respond in the exact same manner. We just don't know and can't know until you actually use it.

Now for some people the machine might want to go up and the going up causes more problems than what it is trying to kill by going up...when that happens we sit back and re-evaluate things and maybe limit the max.

[ChicagoGranny]

... I ordered a new Resmed Airsense 10 Autoset ... Having reviewed the limited data available (provided as a PDF from my doctor) I am intending to set the Resmed machine up with a low pressure of 6, and leave the top pressure at 14. I will review the new machine data daily (on sleepyhead) and see if the top pressure ever goes that high and adjust accordingly if required

Impressive. You will do very well. ARE doing very well.

[tedtomato]

Here's the thing about maximum pressure settings in the auto adjusting mode....if the machine never goes there it doesn't really matter what you set it at.
So you can set it tight or wide open and if the machine never has a need to go higher it becomes a moot point.

Apart from the fact that some people do get woken up from high pressures and also the masks are likely to start to leak more, and wake up the person. Being woken up by a CPAP/APAP machine is the opposite effect of what they are meant to do.

I set mine to a maximum of 12, and it does reach the maximum a few times during the night. Machine would go higher if my maximum was higher. It means some obstructive apneas or hypo, but they don't last a long time...

[Pugsy]

Here's the thing about maximum pressure settings in the auto adjusting mode....if the machine never goes there it doesn't really matter what you set it at.
So you can set it tight or wide open and if the machine never has a need to go higher it becomes a moot point.

Apart from the fact that some people do get woken up from high pressures and also the masks are likely to start to leak more, and wake up the person. Being woken up by a CPAP/APAP machine is the opposite effect of what they are meant to do.

I set mine to a maximum of 12, and it does reach the maximum a few times during the night. Machine would go higher if my maximum was higher. It means some obstructive apneas or hypo, but they don't last a long time...

Please note what I said "if it doesn't go there it doesn't matter"
Yours wants to go higher and would go higher if you let it.
If yours didn't want to go higher then it wouldn't matter what the maximum was set.

If a machine doesn't want to go higher...it won't go higher. Pretty simple. Just because it can go higher doesn't mean it will go higher.
Now yes...sometimes if it does want to go higher and the going higher causes more problems than whatever problems the machine is trying to kill might be causing and when that happens we limit the max and make compromises like you have done.

and that's why I included this last line in my above comments

Now for some people the machine might want to go up and the going up causes more problems than what it is trying to kill by going up...when that happens we sit back and re-evaluate things and maybe limit the max.

I have my max set to 20...sometimes it wants to go to around 16 to 18 ..sometimes it doesn't. Sometimes I might see 10 as the highest the machine wants to go.
Now I am lucky in that when it does go to 18 I never know it until I might see a report. Never has caused me to wake up..never caused aerophagia or any problems. If it had caused problems then I would do like you...find a max that doesn't cause a problem and I would make a compromise.

When someone is just starting out on cpap therapy we have no idea what problems (if any) someone might have and we have no idea what pressures they might need. Gotta start somewhere though.

[ChicagoGranny]

I set mine to a maximum of 12, and it does reach the maximum a few times during the night. Machine would go higher if my maximum was higher. It means some obstructive apneas or hypo, but they don't last a long time...

Choose your poison.

A. Set it high and be awakened by high pressure.
B. Set it low and be awakened by breathing events.

I choose A. I don't like breathing events, and high pressures rarely awaken me.

[freetimecreations]

Here's the thing about maximum pressure settings in the auto adjusting mode....if the machine never goes there it doesn't really matter what you set it at.
So you can set it tight or wide open and if the machine never has a need to go higher it becomes a moot point.

Apart from the fact that some people do get woken up from high pressures and also the masks are likely to start to leak more, and wake up the person. Being woken up by a CPAP/APAP machine is the opposite effect of what they are meant to do.

I set mine to a maximum of 12, and it does reach the maximum a few times during the night. Machine would go higher if my maximum was higher. It means some obstructive apneas or hypo, but they don't last a long time...

Exactly, I'm set up the same way as you. Oh well, my machine missed a couple of apenas. Sleep is supposed to be fun.

To keep a good balance
I look at Sleepyhead's "AHI graph" to see if they lasted too long.
Also, if I wake up, I glance at the clock and in the morning check if it matches any "flow limit" or apnea cluster.

[KLAussie]

So I completed my period of using the APEX machine, and have switched over to the Airsense 10 Autoset.
I really like that I can now see the detailed data with Sleepyhead - though did get some very interesting data over the last couple of nights...

Here is the SH data from Monday night (with Airsense):
https://imgur.com/U7nRIBU

And Tuesday night:
https://imgur.com/DGFRDmt

What really suprised me was the pressure that the machine was reaching.
On Monday I also received the final set of data from the APEX machine, which now had 18 days of data for comparison.

Here is the Efficacy summary from the APEX machine.
https://imgur.com/zbmV7jF

The APEX machine pressure very rarely went above 7, and only stayed there for 5-15 minutes if it did. The Airsense machine pressure is regulary approaching 12, with a median of 8 and a 95% pressure of 10.8.
I think the results (number of AHI events) are very similar from both machines, however I do find leakage from my mask to be an issue causing some awakenings, especially as the pressure goes up.

Does anyone recommend lowering the max pressure (back to 8 or 10) and see if my AHI is affected, or should I just let the new machine do what it wants to, and continue working on correcting the mask leaks?

I am also aware that the duration of sleep, and amount of time asleep are not ideal yet, and am also working on those. I do find that it can take me a long time to settle into sleep with my mind buzzing, often focused on my breathing etc, which will hopefully improve with more time.
I also have two young kids in the house, who often wake during the night - hopefully that will improve with time as well!

Any feedback, suggestions or thoughts would be greatly appreciated!

[Okie bipap]

If you think you would sleep better at a lower pressure, then lower the pressure. The goal is to get the best sleep you can. If that means having a few more events, then so be it. I have lowered mine from the 20 to 25 I first had to 14 to 25. It seldom goes over 16.

[ajack]

mate, you are on a decent machine, trust it. you will get use to the pressure, Use the EPR, that will make breathing feel more natural.
I would lift the min to 8 and leave max where it is, if you want to. Review in a few days.
When you are ready, I'd use epr 3 because it will work like a mini bpap and see if that increases your tidal volume and lowers your breathing rate a bit.