My AirSense 10 AutoSet for Her experiment

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Pugsy
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My AirSense 10 AutoSet for Her experiment

Post by Pugsy » Mon Aug 21, 2017 10:14 am

Many of you know that I like to experiment whenever I can. It helps with the boredom of 8 years on cpap/xpap/whatever pap.
I recently got my little paws on a very slightly used AirSense 10 AutoSet for Her machine.
Back when I was first starting therapy I started with the old Respironics M Series APAP....never had the chance to try a ResMed APAP at all.
I did try the ResMed S9 VAuto in auto mode but never thought to make it function like an APAP. I did play with cpap mode and EPR to see if EPR felt like Pressure Support but that was about it.

I have been curious as to what the "for Her" apap mode might do that the regular apap mode doesn't do.
So I have 3 nights with the regular apap mode under my belt and last night was the first night trying the "for Her" apap mode.
So far I can't really tell any difference in anything reported. Some minor variations that could simply be normal nightly variations because we don't sleep the same each night and especially in my situation because I have other issues that mess with my sleep quality anyway.

I have often wondered if the slightly more aggressive ResMed Auto adjusting (apap) algorithm might have been "better" for me in my situation. So far in terms of the minimum pressure needed to hold the airway open that does seem to be the case.
With the Respironics apap mode I needed a minimum of 10 to keep the REM clustered OAs away. With the ResMed I am getting the same result with a minimum of 7 cm (and I am using EPR of 3) so that means I drop to 4 cm during exhale.
With the Respironics apap mode at 10 minimum I was dropping to maybe 8 cm during exhale.

This slight difference isn't a make it or break it thing for me but I can see it maybe being a factor comfort wise for some people.
Especially people who get aerophagia issues pretty bad or need pressures in the upper teens.
For this reason I probably will recommend the ResMed even more so over the Respironics when people have a choice and don't know how they will react to cpap pressures in general.

The jury is still out on the "for Her" apap mode...at least for me anyway. I thought for sure that the less aggressive mode would have me end up with higher AHI numbers and it didn't. I also thought that I would see the Flow Limitation graph show a lot more activity than regular apap mode but it didn't. As far as sleep quality goes...I can't really tell much because I have those other non OSA issues messing with my sleep quality which makes it hard for me to evaluate sleep quality in general.
I did get about 1 1/2 hours more sleep with the "for Her" mode last night than I had been getting but that could simply be from the fact that I had so many 6 hour nights before last night that it finally caught up with me...or the fact that I took extra pain medication last night to help "sleep through" the pain stuff that messes with my sleep quality.

In terms of how the machine is reacting in response to whatever I might have in the way of airway collapsing warning signs...the pressure line is pretty much doing what I expected it to do. It hit 18 once briefly which is what I used to see on the Respironics apap.
90/95% numbers varied considerably and looks like with this machine those are going to be pretty much what I used to see.
The main difference is the minimum...No way would I ever get sub 1.0 AHI numbers with the Respironics apap if I used 7 cm minimum.
Heck, I was getting AHI 10 or more with dense REM clusters when I was using 8 cm minimum on the Respironics apap.
My OSA is worse in REM sleep...so I always see higher pressures needed in what appears to be probable REM stage sleep.
It's why I prefer auto adjusting pressures...I can use lower pressures for the bulk of the night and let the machine auto adjust to take care of the REM stuff.

Oh...past experiments with side sleeping vs supine sleeping pretty much took sleeping position out of the pressure needs thing.
Didn't seem to make any difference for me anyway. Even with a wall built to make sure I was on my side all night I would still see the same pressure needs in probable REM stage. Now some people sleeping on their backs will make a significant difference in pressure needs but for me it didn't. That's why I don't make any special effort to stay on my side....I am going to sometimes need higher pressures no matter what position I sleep in.

Anyone have any special questions about this machine?
I will post some detailed reports in a bit.
So far the first night was the highest AHI night...2.89 with the rest of them being sub 1.0.
My first thought after the first night was that I needed more minimum but I stuck with my settings because I know that the AHI can vary a lot from night to night anyway and I always try to keep any settings for at least 3 nights before I change something.
The exception might be if a setting seemed to cause obvious problems...like if that 7 cm minimum had ended up giving me AHI of 20 something with very dense clustering. Then I wouldn't have waited to repeat an obviously bad result before changing something.

About EPR...that's personal preference and I happen to like having a difference between inhale and exhale. That's why I migrated to the bilevel machines. It just feels better to me and EPR creates a bilevel situation. It's more comfortable and natural feeling and when I am more comfortable then I simply sleep better. My primary goal has always been get good decent sleep and I don't care about what numbers take me there. We don't get extra points for growing a pair anyway.
If a person likes EPR...then use it...if they don't like it then don't use it. Pretty simple.
Sometimes using any form of exhale relief can let the airway collapse during the exhale phase...and result in an AHI a bit higher than we want....so if that happens the fix is easy...just increase the minimum pressure a little bit to offset that drop.
Not everyone will have it happen though...in my situation it hasn't happened even with the drop to 4 cm on exhale.
It's like everything else associated with cpap therapy...comes with a big YMMV sticker.

Play with your settings....if you feel that some sort of exhale relief just feels better...use it no matter what the setting might be.
If you feel like your breathing feels better and more natural with the exhale relief turned Off...turn it off and leave it that way.
If you are like me and you like the difference...then use it to your advantage and doesn't matter what someone else does or doesn't do.

People often pooh pooh off the "comfort" stuff...like humidity or exhale relief but to me "comfort" is an integral part of therapy and very important because if we aren't comfortable we don't sleep so great and the best numbers in the world don't mean squat if our sleep quality is crap.

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Re: My AirSense 10 AutoSet for Her experiment

Post by Guest » Mon Aug 21, 2017 10:36 am

Excellent report.
Bertha deBlues

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Re: My AirSense 10 AutoSet for Her experiment

Post by Cpapian » Mon Aug 21, 2017 11:15 am

Thank you Pugsy, I will be making my decision on equipment in September, and I have been leaning towards this model, so your post is very timely. Let's hope the doc agrees.

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Re: My AirSense 10 AutoSet for Her experiment

Post by Pugsy » Mon Aug 21, 2017 11:17 am

A word about the slightly more aggressive apap alogrithm that ResMed has.
We are talking ever so slightly more aggressive in terms of how quickly the ResMed apaps respond when compared to Respironics.
It's not like the ResMeds are speed demons and the Respironics are crippled turtles.
We are talking maybe a couple of minutes difference...not hours....not even 5 minutes.

Respironics machine still will increase the pressure in response to whatever it senses is going on (we may or may not see evidence of it on the detailed reports) and maybe it takes a couple minutes longer to get to where it thinks it needs to be than the ResMed.
Maybe during that couple of minutes of getting there the airway does collapse anyway.
Respironics also reduces the pressure more slowly...so maybe it holds the airway open better during the reduction than the ResMed which drops a little faster. So there are pros and cons to either way they do their jobs.

They both will get to the same destination...they just take different roads to get there and for some people one road might be a better trip than the other road.
Unfortunately most people don't have the luxury of trying both brands to see which road works best for them.
Some people it won't matter at all the road they take....some people it might matter.

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Re: My AirSense 10 AutoSet for Her experiment

Post by Pugsy » Mon Aug 21, 2017 11:27 am

About the for Her apap mode...is it critically needed....dunno. It might be of benefit to some people for some reason and I am always of the opinion that it is better to have something and not need it than need it and not have it.

ResMed marketed this algorithm towards women but from what I have read it really is more like the old A10 algorithm we saw on the S8 and older machines. Maybe not totally the same but similar.
I can't see that women would be the only people who might benefit from the slightly kinder gentler response of the for Her mode.
I think a disservice is being done to the guys because I bet there are some guys out there who might like it better.

I don't know if this new mode would be useful for UARS patients or not. Again it's one of those things where I say better to have it and not need it than need it and not have it and since UARS people have such a difficult time anyway...I think it's good to have an additional way to do stuff just in case.
If RERAs (as reported by the machines) are good marker....then the For Her machine might be a better choice for someone who might have UARS.

I have yet to see a RERA flagged but then my primary diagnosis has been OSA. I was hoping to see one flagged in regular apap mode to see if I had one of those AutoSets that flag RERAs in all modes. It used to be that they were only flagged in the for Her apap mode but some people are seeing them flagged in the regular apap mode....and I don't know what to tell people to look for to make sure they get one of those machines.

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Re: My AirSense 10 AutoSet for Her experiment

Post by Pugsy » Mon Aug 21, 2017 12:18 pm

Here are 3 of the detailed reports. Some very minor differences but nothing that isn't/wasn't explainable by normal nightly variations.
The first night with the higher AHI...some of that is SWJ and some was real. I had a bad night in terms of back pain so part of that AHI isn't real anyway. Even if it was all for sure asleep stuff I don't change things based on one night of data anyway because I can see some big difference with no changes at all.

Regular apap mode....7 minimum 20 maximum...EPR 3...first night with new machine.
Image

Regular apap mode...same settings...second night with the new machine.
Image

For Her apap mode....7 minimum 20 maximum...EPR 3...last night or the 4 th night with the new machine.
The stuff around 2:10 mark....good chance that is SWJ from the looks of the flow rate. Might have been with Ruthie (cat) decided I needed to love on her...when she wants to be loved on she gives me little "love bites"...and she did that at some point in the night last night because I woke up because her little love bites hurt. I didn't have the presence of mind to turn the machine off to mark the spot though.
Image

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Re: My AirSense 10 AutoSet for Her experiment

Post by Goofproof » Mon Aug 21, 2017 1:04 pm

Pugsy wrote:About the for Her apap mode...is it critically needed....dunno. It might be of benefit to some people for some reason and I am always of the opinion that it is better to have something and not need it than need it and not have it.

ResMed marketed this algorithm towards women but from what I have read it really is more like the old A10 algorithm we saw on the S8 and older machines. Maybe not totally the same but similar.
I can't see that women would be the only people who might benefit from the slightly kinder gentler response of the for Her mode.
I think a disservice is being done to the guys because I bet there are some guys out there who might like it better.

I don't know if this new mode would be useful for UARS patients or not. Again it's one of those things where I say better to have it and not need it than need it and not have it and since UARS people have such a difficult time anyway...I think it's good to have an additional way to do stuff just in case.
If RERAs (as reported by the machines) are good marker....then the For Her machine might be a better choice for someone who might have UARS.

I have yet to see a RERA flagged but then my primary diagnosis has been OSA. I was hoping to see one flagged in regular apap mode to see if I had one of those AutoSets that flag RERAs in all modes. It used to be that they were only flagged in the for Her apap mode but some people are seeing them flagged in the regular apap mode....and I don't know what to tell people to look for to make sure they get one of those machines.
I don't think There will be much of a disservice here, many of our members can't decide M or F on their profiles. I imagine they could go any way. Jim
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Re: My AirSense 10 AutoSet for Her experiment

Post by Arlene1963 » Mon Aug 21, 2017 1:36 pm

Thanks for posting this Pugsy, and also for your input on EPR.

I'm a big fan of EPR. For me it goes way beyond a comfort feature, it proved to be the missing link in transforming my breathing on CPAP from feeling somehow labored and restrictive to feeling natural and effortless. I'm happy to say that I'm sleeping longer and longer, I thought 6 1/2 hours a night was enough, but now I'm getting closer to 7 1/2 hours and more.

As you always say, YMMV and how true.

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Re: My AirSense 10 AutoSet for Her experiment

Post by Journey1968 » Mon Aug 21, 2017 7:01 pm

I had been using a Respironics machine for the past two years and recently switched to a ResMed auto set 10. I liked both machines but the ResMed worked better for me, Just my opinion.

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Re: My AirSense 10 AutoSet for Her experiment

Post by Pugsy » Tue Aug 29, 2017 9:57 pm

I have been playing with the "for Her" apap algorithm.
One of the things it says in the manual about the algorithm is if 2 OAs happen within a minute of each other then the new minimum pressure (still trying to figure out how it comes up with a new minimum) becomes the minimum for the rest of the night no matter what happens. It goes up a bit and stays there all night even with nothing much going on.

I finally had a couple of events happen really close together and I got a chance to see this new minimum at work.
You can see it at work here at approx 5 AM right after the 3 OAs. As to how important this might be in terms of therapy or how I might feel...dunno. I have seen this 4 nights now. Some nights I just don't have 2 events real close together so it won't kick in.

Currently working on the pain issues that are messing with my sleep quality so I can't really tell if the special algorithm impacts anything. I have had to do something that I don't like to do when doing experiments and that's make more than one significant change in something but it had to be done. More on that later after I know if what we did helps the pain much or not. So far it looks real promising but I have only one night under my belt with that change and medications that I normally don't take were involved. So I need more nights without that medication in my system. It's gone now...so will see what the next few nights feel like in terms of sleep quality relating to pain or in this case...less pain.

Image

and here is a night where it didn't kick in and instead went up and down pretty much all night like I have always seen.

Image

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Re: My AirSense 10 AutoSet for Her experiment

Post by Pugsy » Fri Sep 01, 2017 10:14 am

Wouldn't you just know it....Murphy's Law struck again. Most of the time my forgetting to put the SD card back in the cpap machine isn't that big of a deal as I don't really miss the graphs but the one time I would kinda like to see the graphs...
Yep...night before last. AHI 0.01....one lousy event and I would liked to have looked to make sure it was real and not SWJ.
But some dumbass left the SD card sitting right on the laptop instead of putting it back in her machine.

Side note....and I can't explain it but my leak rates are much improved with the AirSense 10 machine... I first thought it was because I wasn't seeing as high of pressures but last night I hit almost 17 cm and my max leak rate was 5 L/min (and very brief at that and didn't happen at the 17 pressure anyway) ....for me that is unheard of good. Have no idea why...sure didn't do anything any different. Maybe the aliens decided to take pity on me.

Image

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Re: My AirSense 10 AutoSet for Her experiment

Post by Sheepish » Fri Sep 01, 2017 11:03 am

That popup notification when you close Sleepyhead sure flashes by quickly.
Sleepyhead Reminder: Don't forget to put the datacard back in your CPAP machine.
So I suppose it can happen even to the best of us.

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Re: My AirSense 10 AutoSet for Her experiment

Post by Pugsy » Fri Sep 01, 2017 11:34 am

Sheepish wrote:That popup notification when you close Sleepyhead sure flashes by quickly.
Sleepyhead Reminder: Don't forget to put the datacard back in your CPAP machine.
So I suppose it can happen even to the best of us.

See I did pull the card out and laid it on the mouse pad surface on my laptop...so that I would see it before closing the laptop for the night.
But the aliens came and hid it from me and I didn't see it with their invisible cloaking shield.

Which reminds me...right now got but the damn card back in the machine.

That SH notice....I promptly forget it once I see it and most of the time I don't even see it. I have selective memory just like some people have selective hearing.

Oh well....it sure wasn't the first time I did it and I am certain it won't be the last. I get too many irons in the fire and don't always remember which iron goes where at the right time.

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Re: My AirSense 10 AutoSet for Her experiment

Post by Cpapian » Fri Sep 01, 2017 3:10 pm

When you get up tomorrow you might find last night's data on the SD card. Not full, but quite a bit. That's what happened to me and my machine is older than yours. I was able to see events but not flow rate.

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Re: My AirSense 10 AutoSet for Her experiment

Post by Pugsy » Fri Sep 01, 2017 3:33 pm

Cpapian wrote:When you get up tomorrow you might find last night's data on the SD card. Not full, but quite a bit. That's what happened to me and my machine is older than yours. I was able to see events but not flow rate
Nope, won't happen.

You are using a Respironics machine and it does save a lot of the graph data in it's internal memory so when the SD card finally gets put back in the Respironics machine all that is stored will go on the card. Actually all that is missing is the flow rate stuff. Pretty good job on Respironics' part.

ResMed machines don't store any of the detailed graph data stuff on its internal memory. All it saves is some basic summary numbers and that's all I get.
That big blank sheep page...it will always be a big blank.
With ResMed machines the SD card absolutely has to be in the cpap machine during the night or when used because all those data files go directly to the SD card. There is no way around it. One of the "joys" of owning a ResMed.

So if you ever do get that ResMed machine we talked about....make sure the card is always in the machine at night or whenever you are using it or you will end up with summary data only like you see on mine. Normally not a big deal for me but I am trying the for Her AutoSet in the special apap mode and I am kinda watching the details a little closer.

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