Longtime CPAPer, Newbie APAPer

I've been using a CPAP machine for 10 years now, and it has worked really well for me. My last continuous pressure unit was a ResMed S8 Elite, which served me faithfully for years. My pulmonologist just prescribed a more modern auto-pressure machine with data recording, a Philips Respironics System One REMstar Auto A-Flex (I'm thinking Phillips marketing needs to work on product names). It has been interesting to view the data generated each night, viewed through SleepMapper (too skimpy) and SleepyHead (more info than I can handle). I now have a data question and a machine-specific question:

1. My original sleep study yielded an AHI of 131, which my doctor considered, 'a little bit scary'. I've used a CPAP pretty much every night since then. Now that I'm downloading data off my APAP, I'm seeing an average AHI of 0.8 and have never had a night that rose above 1.0 . I realize that these are excellent numbers, but my basic question is, does this just mean that my machine is doing a really good job at controlling my apnea, or does it also mean that I no longer have as many apnea/hypopnea events? It makes me wonder what would happen if I had another sleep study done today.

2. One of the best features of my old ResMed S8 was the rapid auto-on and auto-off. The machine started up before I finished drawing my first breath through the mask, and shut down a few seconds after I pulled the mask off. My new PR System One machine has the same features and they have been turned on from the setup menu. However, it takes several breaths to get the unit to start blowing, and when I pull the mask off, the machine continues to merrily blow away until I manually shut it off. Do other users have a similar experience, or is there something I could do to get my System One to do a better job of auto-starting and -stopping?

For question number 1....that low AHI simply means the machine is doing a bang up good job for you. There is no way to count the number of airway collapses (apnea events) that were prevented unless you want to go back to the sleep lab and have another sleep study without using cpap at all and see if the original cause (whatever it was) for your OSA miraculously went away.

For question number 2...the Respironics machines have to available options for the auto on and auto off feature to kick in.

For the machine to start when it senses your breathing...that's the Auto On setting and it is set to On....unfortunately it isn't instantaneous and there really not much you can do unless you can breathe bigger and deeper and faster to see if it kicks in sooner for you. With mine it never took more than 2 breaths to kick in.
If your starting pressure is on the low side it might take a little more to get it to sense that there is a person on the other end of the hose....so if using ramp you might try not using the ramp...or if you are using APAP mode and your starting pressure is on the low side increasing that minimum pressure a little might help the response time.
Sometimes a combination of mask and low pressure makes it a bit harder for the machine to know you are attached....like nasal pillow mask with low starting pressure.

The Auto Off feature is separate from Auto On with the PR S1 machine....So for it to turn itself off if it no longer senses you are attached Auto Off feature has to be set to "ON"...so check to make sure the Auto Off is set to ON.
If it is already set to "ON" then you need to understand how the response thing goes normally...and the machine won't turn off immediately (which is pretty much what those ResMed units did) and instead the PR S1 will take 60 seconds (I am pretty sure it is 60 seconds) before it will turn off.
Nothing you can do about it to shorten that 60 seconds.
For me I would make use of the Auto On feature easily but I always just manually would turn the machine off if I got up or wanted the machine off. I found that 60 seconds was simply way too long and seemed more like 6 minutes to me.

Puggsy,

Thank you for the detailed reply. I sure wish that there would have been a way to figure out if I had similar low AHI when using a constant pressure machine for all those years. My new APAP is clearly doing a good job, but I certainly don't feel very different, in terms of degree of wakefulness during the day. I've talked with a number of CPAP users, and nobody had anywhere near my big AHI during their sleep study, but nobody has anywhere near my low AHI as reported by my machine.

I did confirm that both Auto-On and Auto-Off are turned on. It is a shame that these features don't work as well as on my old ResMed machine. I must admit that I never waited as long as 60 seconds to see if the Auto-Off actually turned off at that point. I agree that there seems little point for having an Auto-Off if it takes that long; might as well just turn it off.

Al F.

Your machine does have cpap mode (which is what your old Elite offered) or you can adjust apap mode to mimic cpap mode to see what it was like when using the old fixed cpap pressure but it still can't tell you what might have been prevented.

Or...to see a potentially how bad thing might could be...run a low pressure to see how many events show up.
It isn't a true comparison to without cpap but if your AHI is 15 at at pressure of 6...it will give you an idea of what the higher pressure is preventing.
Plus you might feel like crap and find out that while you might not feel as good as you hope...you can sure feel worse.
I had this happen when I happened to have to do without my machine one night due to forgetting something on a trip.

ALF wrote:My new PR System One machine has the same features and they have been turned on from the setup menu. However, it takes several breaths to get the unit to start blowing, and when I pull the mask off, the machine continues to merrily blow away until I manually shut it off. Do other users have a similar experience, or is there something I could do to get my System One to do a better job of auto-starting and -stopping?

the respirs are *much* less responsive for auto on/auto off than the resmeds are... they seem to be very grudging "ok FINE, I'll start up since you're so damn insistent"... and then they don't want to quit, you can hear like 5 pressure pulses "are you there? are you there? hellooooo? where are you???? " for like a minute.

and, as pugsy mentions, there are separate on and off settings.

that's one of the many little reasons I like resmeds better, yes, yes, I'm a fanboy.

My numbers are similar to yours - I have great AHI readings on cpap, usually between 0 and .5. I have used cpap 100% of the nights since being diagnosed about 7 years ago. I had a clinic sleep study in January 2015 and my AHI was 80. So the machine is doing the job that it's supposed to do, and doing it very well. Even after many years of use, I still very much need it.

Just be happy that it works so well for us - we're lucky!

Oh, and I noticed the same thing about the auto-start and auto-stop on my new machine versus my old machine. I've adjusted to it as pugsy said - I know it's going to take a few breaths to auto-start and I just hit the stop button when I'm ready to get up. It's slightly less convenient, but not a big deal and balanced by the fact that the newer model machines give much better therapy than the older ones.

I was quite happy with my ResMed S8, so when my Doc said I should go with an auto machine, I told him I'd like an S10. He told me that he much preferred the PR Sys One because it was 'less aggressive' in upping the pressure in response to events. He said that he also liked the PR reporting software better than ResMed's. I don't know if 'less aggressive' is better for me or not, but I like the PR Sys One (except for the slightly annoying delay in auto-start and the ineffectual auto-stop).

That IS a good idea to go to CPAP mode with my old constant pressure setting and see what happens.

Al F.

I have "auto off" enabled on my machine and I only need it maybe once during the night when I get up to the washroom. I just let it go and by the time I am back to bed it is off. In the morning, I do the same - just let it do it's about 60 sec thing.
I need to have it set during the night because I have severe Rheumatoid Arthritis and stiffen up at night. I could not reach the button to turn it off myself so it's most helpful for someone like myself.

ALF wrote:Puggsy,

..... I sure wish that there would have been a way to figure out if I had similar low AHI when using a constant pressure machine for all those years.......

Al F.

You said your previous machine was a Resmed S8 Elite. Those machines collect efficacy data, too!. If you still have access to the machine, download it's data and load it into Sleepyhead. It will tell you your AHI.

I still have the ResMed S8 Elite, but there was never a card in the slot. I thought about getting a card, but it is not a standard size and I don't have a card reader for it. I looked into getting a card reader, but couldn't fine one, so I never got a card.

Hose_Head wrote:

ALF wrote:Puggsy,

..... I sure wish that there would have been a way to figure out if I had similar low AHI when using a constant pressure machine for all those years.......

Al F.

You said your previous machine was a Resmed S8 Elite. Those machines collect efficacy data, too!. If you still have access to the machine, download it's data and load it into Sleepyhead. It will tell you your AHI.

The ResMed S8 series along with the Respironics M Series (and prior models) aren't compatible with Sleepyhead (or vice-versa). Has to be PR System One or ResMed S9 (or newer) to use Sleepyhead with those two manufacturers.


Den

.

I may have missed some of your reply, but do not hesitate to return to the cpap mode on your machine. The Elite will only provide the cpap mode, but your newer model will provide both. Try out the autopap mode for a while. See if the numbers are good and if you feel better. If not, switch back to the cpap mode. I try the autopap mode maybe once or twice a year, but eventually switch back to cpap mode.

Sheriff

Thanks everyone for the replies. I am definitely going to try going back to CPAP mode to see if that changes my stats. However, I am going to stay on APAP mode for the next month until my next Dr. appt., so he can look at the APAP data.