Newbie with questions!

Hi everyone,

My name is Magnus and I'm 38; I have sever OSA and I am now at the stage where I need to choose a CPAP machine. I was hoping for input from all of you experienced people to help me choose wisely I've done 2 sleep studies:

1. Slept at home with a monitor

AHI/hour 59 (between 55 and 60 on back or sides, I don't sleep on my belly); 67 AHI / hr in REM
O2 Saturation:
>90% 21.2%
>85% 9.1%
>80% 5.0%
>70% 1.1%
Minimum 58%

From the scans it appears that my worst SaO2 occurs during the REM sleep phase

2. Slept at a lab with a nose mask and an unknown CPAP machine under supervision

Various pressures were tested, with water levels between 4 and 15 cm

AHI/hour 16.5; O2 saturation was under 90% for only 0.6% of the time, with the lowest at 86%

Let me begin by stating that the sleep in the lab with the CPAP was like a huge light bulb going off in my head as I finally felt that I had slept normally for the first time in many many months. It was difficult for me to adjust to breathing through my nose (I have a divided nasal septum since birth) and in the morning I had a dry mouth (though not irritated in any way). The worst was the nose mask - I sweat and the mask was probably on too tight (the report says the average leak was 47 but I do not know if this is good or bad) and it badly irritated my skin.

Since the supervised sleeping session did not produce a sufficient reduction in AHI, I can now choose (via my HMO) a machine from the following CPAP providers: Philips, ResMed, DeVilbis, Weinmann and iSleep. With any of these I can set up a meeting with their specialists and try out their machines and they will read my results and further adjust the machine after one week. I can also go and buy another machine but it is my understanding that the HMO has good pricing from these companies.

So ... what's important for me in the CPAP?

1. Do I need an adjustable CPAP? From talking to the technician in the lab, she said that they were unable to find a good constant pressure for me; I know that there are different machines with 2 and even 3 pressures
2. What mask is right for me? The technician told me that it is much better that I try to adjust to sleeping with a nose mask because I would have better quality of sleep with it than with a full mask, but I would love to hear your thoughts. I do not sleep on my belly and spend almost all of the night on one of my sides.
3. If I get a nose mask, which one will give me maximum seal with minimum sweating and irritation (I will say that it was not too cold in the sleep lab and that the problem might be larger in my mind than it should be ...)? Can I combine masks and CPAPs from different manufacturers?
4. Noise - my wife is a light sleeper and I would like the quietest machine possible;
5. Data - I want to see how I am sleeping and get the most data possible;
6. Ease of use/maintenance - I'm not the most able person with my hands, though not hopeless - I just dislike doing maintenance so if it's relatively simple, it's an advantage!

I do not tend to travel much, so size is not a major concern for me.

Thanks in advance for your input!

Magnus

GPMagnus wrote:1. Do I need an adjustable CPAP?

In your situation with more OSA events in REM sleep I would suggest that you get the adjustable pressure (APAP) model machine because it is possible that you need more pressure in REM and not so much in non REM sleep and the APAP might enable you to use less pressure for the bulk of the night and still increase as needed for REM stage sleep events that might need more pressure. It's not uncommon at all. My OSA is worse in REM sleep. When I was using an APAP machine I would sometimes see my pressures double in REM sleep and drop down in non REM sleep. Supine sleeping also has been known to cause different pressure needs.

I would suggest sticking with Respironics or ResMed machines if you want easy to use, easy to obtain and free software so you can actually monitor your therapy effectiveness. Those are the 2 main players here that you will find lots of users able to help you with those machines. The Devilbiss is a nice machine but the data it offers in its software isn't quite as detailed as the other 2 main players. We don't have many iSleep or Weinmann users here. Software is difficult to obtain and we have zero experience to help you.

GPMagnus wrote:2. What mask is right for me?

This is something you will have to sort out. The right mask for me may not be the right mask for you. The greater the surface area for masks that comes in contact with the skin...the greater the potential for leaks are. If you can normally breathe through your nose okay then I usually suggest that people at least try the nasal cushion (over the nose) or nasal pillow mask (like I use) because they have much less skin surface area contact to have to fiddle with.

GPMagnus wrote:Can I combine masks and CPAPs from different manufacturers?

Yes. Brand machine and brand of mask is not an issue. You can combine or mix either without issues.

GPMagnus wrote:4. Noise - my wife is a light sleeper and I would like the quietest machine possible;

Bear in mind that most of us haven't had the chance to compare noise levels with other machines. I personally have used both the Respironics and ResMed brands and in terms of machine noise it's pretty much a toss up. I have no idea how they would compare with Weinmann or iSleep but due to lack of support for those machines and software obtaining issues I would rule them out anyway.
They are more common in Europe but we can't help you as much with those since the majority of forum users here will be in the ResMed or Respironics brands.

GPMagnus wrote:5. Data - I want to see how I am sleeping and get the most data possible;

ResMed or Respironics...the most complete data points offered and software is easy to obtain and use. A couple of minor differences in how they report a couple of items but in general not any difference is a deal breaker. The Respironcs offers a couple of data points that the ResMed S9 doesn't offer and I prefer the way they show flow limitations on the software. ResMed has a new latest model that sort of catches up with Respironics in terms of flagging RERAs and Periodic Breathing (not available on the S9 but available on the Respironics System One machines) called the AirSense model but it isn't likely available where you are at. It was just released in the US and Canada this week.

Check out my signature line and the SleepyHead tutorial to give you an idea about what the software offers...I think I have examples for both Respironics PR System One and ResMed S9 machines.

GPMagnus wrote:6. Ease of use/maintenance

Both the Respironics PR S1 and ResMed S9 machines are easy to maintain. About all you have to do is change the filter and add water the the humidifier chamber and clean the chamber every now and then. Both are fairly easy to do.

If your pressure needs are in the teens I would suggest going with the ResMed S9 AutoSet. I think that the exhale relief that the ResMed machines offers (called EPR) is likely more comfortable when pressures are above 14 cm than the exhale relief that Respironics offers. It's a small potential difference and while it may not be that much of a factor it's nice to have that ability should it be needed.

For a more detailed explanation as to the differences between the S9 AutoSet and the PR S1 60 series APAP
viewtopic/t94287/viewtopic.php?f=1&t=82 ... AP#p866535

I am also a newbie and have been constantly searching for more information. I was told I have severe AHI but was given no specific data. Should the doctor be giving me these results?

Also, I can't seem to find a mask that I can live with. I'm very interested in the TAP PAP nasal pillow with mouthpiece but can't seem to find any user comments about it. Any help would be greatly appreciated.

TiredVA wrote:I am also a newbie and have been constantly searching for more information. I was told I have severe AHI but was given no specific data. Should the doctor be giving me these results?

Also, I can't seem to find a mask that I can live with. I'm very interested in the TAP PAP nasal pillow with mouthpiece but can't seem to find any user comments about it. Any help would be greatly appreciated.

Yes you should have a copy of your sleep study results.


I wish you well

TiredVA wrote:I'm very interested in the TAP PAP nasal pillow with mouthpiece but can't seem to find any user comments about it. Any help would be greatly appreciated.

There's more than one novel size review thread for the Tap Pap but here's the largest.
viewtopic.php?f=1&t=87232&st=0&sk=t&sd= ... Pap+review

TiredVA wrote:Should the doctor be giving me these results?

Only if you need to talk to him/her about it. The results are the results no matter who tells you. Now if you have questions the yes.

My OSA is severe in REM stage sleep. His nurse told me. I haven't talked to the doctor since the very first office visit where he confirmed the need for the very first sleep study. I haven't needed to talk to him either but then I haven't had any questions either.

You should get a copy of the sleep study results from someone though

Pugsy - thanks for all of your suggestions! In truth, my OSA is severe in REM and non-REM sleep. What I am wondering is how much higher the pressure will have to be (above 15 cm) to reduce my AHI below 5/hour and will I be able to fall asleep with so much pressure ... I read your comparison of the ResMed and Philips and am very grateful for the work you put into it! With so many events (literally every minute), I am a bit concerned that the Philips will not react quickly enough and that gives an edge to the ResMed but I would like to know if anyone can shed light on the Weimann, about which I have read good things.

Thanks!

Severity has nothing to do with pressure needs. A person can be "severe" and need only 6 cm to hold the airway open and a person can have a very "mild" OSA diagnosis and need a pressure of 20. Pressure needs have nothing to do with the number of airway collapses and has everything to do with the floppiness of the airway tissues and how stubborn they are in terms of being held ope.

The Weinmann....I don't recommend you go there. Only one person on this forum that I know of who uses one and he is in Germany and he can't get the software at all. The data available on the machine's LCD screen is very limited.
Read kal81's posts
search.php?author_id=69178&sr=posts
He was not a happy camper.

The bulk of the forum members here are in the US and Canada....the Weinmann isn't something we have available to us.
It sounds like a Respironics type of machine from what I have read about it though.

I can help with Respironics Encore software as well as ResMed's ResScan and SleepyHead but I have no source at all for Weinmann. I wouldn't have a machine that software wasn't easily available.

If your pressure needs are 15 cm....I think the ResMed S9 AutoSet would be a good choice. The EPR feature allows for up to 3 cm drop during exhale which makes it work like a bilevel pressure machine and it feels like a bilevel machine feels. I have used the S9 bilevel machine and tested both cpap mode with EPR at 3 and bilevel mode with 3 difference and it feels pretty much the same....quite comfortable.

OK! That's very helpful - I will try to set up a meeting with both ResMed and Philips

Very much appreciated!

GPMagnus wrote:I read your comparison of the ResMed and Philips and am very grateful for the work you put into it! With so many events (literally every minute), I am a bit concerned that the Philips will not react quickly enough and that gives an edge to the ResMed but I would like to know if anyone can shed light on the Weimann, about which I have read good things.

Thanks!

Jedimark (creator of sleepyhead) had been talking to the weimann folks (they've actually talked to him, and sent him data information, unlike philips and resmed) and from what he's seen, he says he thinks it looks good.

it will be supported in sleepyhead