REMstar Auto with A-Flex System 1 & ResMed AirFit P10 for He

I hope I'm posting this in the correct place. My first (long) message apparently went astray, so I'm starting over again.

I am using the following:

Philips REMstar Auto with A-Flex System 1 (pressure range 5-13; A-Flex = 3; resistance = X4)
Philips REMstar System 1 Heated Humidifier
Respironics/ResMed AirFit P10 for Her Nasal Pillows (previously Swift LT for Her)

I began using the AirFit P10 in February after successfully using the Swift LT for Her, and I LOVE the Airfit P10! However, immediately after making the change, my numbers, previously very "normal," weren't looking quite so good. My AHI, which had averaged 4.3, rose to a high of 12.1, although tends to be mostly about 8+. My Periodic Breathing went from 0% to a high of 4%. My average pressure 90% of the time decreased somewhat.

My local respiratory therapist (RT) told me that if I'm feeling well, not to worry about it...but I'm a numbers person, and it bothers me that these changes occurred. But was it the AirFit P10? Was it that the System 1 wasn't "reading' the information correctly because it was "incompatible" with the AirFit P10 (as an RT from Respironics told me) and that I should try the FX for Her because it' uses different technology -- the RT referred to different algorithm(s) with the AirFit P10. And Philips wouldn't comment about nasal pillows that aren't theirs. I did get one suggestion, and that was to raise the resistance to X4, which I did, but that didn't help. Today I spoke with a Respironics RT again, and she had no comment because...the machine wasn't a Respironics. So I feel as though I'm caught between a rock and a hard place.

I read that if you're using a Philips REMstar System 1 you should set the resistance on X0, that the resistance feature works only with the Philips machine. Well, I don't have an X0 -- just X1, X2, X3, X4, and X5. In other words, it appears that it can't be turned off.

Does anyone have any suggestions? I would be happy to provide more information if needed. I have to reorder my AirFit P10 frame, etc., next week...and I don't want to do so until I'm sure I'm not having a problem with the AirFit system or an issue with its compatibility with my CPAP machine. Again, I really like it, feel that it fits well, and find that it stays in place better than the Swift LT for Her. But why are my numbers worsening?

Judy Madnick
Albany, NY

Is this a model 550P you are using? If so, do you use software such as SleepyHead? That large an increase in AHI bears investigation.

There is no incompatibility issue with the P10 and the PR System One machines. That Resistance control thing is only for Respironics masks and yes, the literature says that if using a non Respironics mask they suggest setting it to zero...which turns off the resistance control feature. Not sure why you don't have a zero setting available.
I use the P10 and I have a PR System One 760 machine.
Before blaming the mask (by the way the Swift FX is a ResMed mask too, how can they say that one okay and the P10 isn't...doesn't make sense) I would want to evaluate the data.

Oh, BTW...a while back I did an experiment with my mask at the time (I think Swift FX) with my PR S1 machine and all the various Resistance control settings including with it turned off and it didn't affect the data or my therapy at all that I could see or feel.

Judy, I have put my P10 on for the very first time about 5 minutes ago, so I am not the best person to be answering. However, I would be looking very closely at what kind of events were causing the increased AHI. I would be asking whether I need an increase in pressure (possible) or a decrease (unlikely) . Did you start or stop any medications? Have any stressful events in your life? Start or stop using the humidifier? When did you change the a-flex setting last? Let us know some answers, and maybe someone can help.

Pugsy, thanks for the information on the resistance levels. Saved me fiddling! Mask is really comfortable and quiet!

I just checked on my machine, and once the System One Resistance is turned on the only way I could find to turn it back to 0 was to go into the clinician's menu.

If you don't want to do that I would set the resistance to X2. That is the setting for the Nuance nasal pillow which would be the closest thing to the P10.

Funny...I have both the FX and the p10 with me, and just 15 minutes ago studied the pillows. To ME the pillow part where air comes into the nose, they look identical. The BIGGEST difference with the way they work, as far as I can tell, is the venting. The FX has an aggressive flow, the p10 diffused. In my case, this means the p10 retains moisture and feels like it doesn't blow enough air, even with identical pressures, as the FX.

This could be something to consider in your case, as well.

Update: I changed my resistance setting to X1 -- and my seven-day AHI average is now 4.8, and my Periodic Breathing is back to 0%!

As for an increase or decreased in pressure -- I'm using a Auto-CPAP, so the pressure adjusts on its own "as needed."

As for "incompatibility," that's what I was told by a ResMed respiratory therapist. Believe me, it wasn't my idea! She claimed that the AirFit P10 is "different" than the earlier generations of nasal-pillow masks. I'm just quoting her.

If X1 is providing better numbers, should I just leave it there? Why might X2 be better?

Thanks, everyone, for your input!

Judy Madnick
Albany, NY

Further update: This morning I went into "provider" mode (based on mention of the "clinician" menu), and that's where the option for 0 resistance exists. So I changed my setting from X1 to 0. My seven-day average is down to 4.2, which is within the range in which it had been before I started using the AirFit P10.

So...what's frustrating is that neither Philips nor Respironics was willing to help me when I initially realized I was having a problem. Yes, one Respironics RT suggested that my RemStar System 1 wasn't "reading" my status correctly and recommended going back one generation to the FX. But I love the AirFit P10 and hope that changing the resistance to 0 will allow me to continue using it.

Thanks for your input, everyone! I'll see how it goes and will take my "card" to my doctor's office in a month or so to see the whole picture.

Judy Madnick
Albany, NY