From Remstar M DS100HS to FP Icon Auto

I've used Remstar M DS100HS since 2007, an older Remstar 2001-2007. Have always used a gel nasal mask. Pressure is 12.

I live in Southern California, Inland, so it has very dry climate most of the time. A humidifier is essential for me. Used original Remstar for a few weeks and had serious dry sinus issues (frequent sneezing and terrible runny nose). A Fisher Paykel Humidifier solved that problem, but rainout has always been an issue.

Went to the DS100HS in 2007, but the humidifier was ineffective (just wouldn't put out enough humidity at the highest setting, 5), so I use the DS100HS with the old Fisher Paykel Humidifier to avoid dry sinuses, and even then I have to turn on the Remstar humidifer in the driest weather (like now) to avoid dry sinus issues.

I will be getting a new Fisher Paykel Icon Auto with heated tube next week. My recent sleep study titration resulted in a new pressure of 9; the doc says it's due to a 50 pound weight loss I've achieved over the last 10 months. My fear is that my sinus issues will resurface with the new equipment. Any users with sensitive dry sinus issues out there have experience with the Fisher Paykel Icon Auto?

Also, this will be my first use of a full feature machine that reports sleep statistics. I will have to read about them to understand, but any advice from experienced users will be appreciated. I've browsed this forum occasionally, but now I've registered and will watch for replies. Regardless, I will keep the group informed through this thread, in case results may help others.

I assume you are getting a new F & P humidifier with the Icon? If so, I think you will be very pleased with the new humidification system and the heated hose.
Heated hoses let us use more humidity and have less rain out.
There are a few Icon users here and I imagine some of them will chime in with their experience.
I haven't used one but F & P has always had a good humidification system and these new heated hoses are very nice. I have a Respironics machine and I also like lots of added moisture and battled rain out for 2 winters until this past winter when I decided to buy a heated hose that would work with any machine...huge improvement. I think you can probably put that worry out of your mind.

Thank you for the response, Pugsy.

The first night (Feb 29) using the Icon Auto was not restful. I did OK for the first three hours or so, but then I woke up several times later in the night and I don’t feel as rested as usual today.

I’ve found that I must often allow for this kind of result whenever I change something about my normal sleep routine. For example, a few years ago we got a new bed and mattress. The first two nights were terrible, but I settled in and now I wouldn’t trade for anything.

First concern, the humidifier with heated hose dispensed only about 250 ml of water, far less than the usual 400 ml I had with the Remstar Series M with F&P HC100. The Icon settings were 5 for the heater with a boost of 2. The strange thing is it seems to have been sufficient.
I’m not suffering any effects I usually assign to the lack of enough moisture.

Second concern, there are no statistics available after the first night. The machine is definitely set on “Auto.” The pressure settings are 6 low and 14 high. Any Icon Auto users out there that can comment?

To be honest, I don't know how to read the stats directly off the machine display. I think you can do it by turning the wheel to one of the bottom icons and looking at the data there, but I am not 100% sure. I'll print off a report from the Infocare software, and see if I can find the corresponding data on the display. I am off to Mexico for a little vacation though, so can't do this for about two weeks from now....

EDIT>>>>From the F&P Online Manual...
Sleep Data

Turn the SmartDial™ to the Sleep Data setting and press to enter. (Note...the "Sleep Data" setting in near the 5:00 position...the one with the little "graph" symbol)

Turn the SmartDial™ to either the Centers for Medicare and Medicaid (CMS) report (US specific) or Patient report and press to enter.
Turn the SmartDial™ to scroll through each of the following statistics:
• Total Compliant Hours .
• Average Compliant Hours over the last 30 nights . Press the SmartDial™ to access the average for the last 7 nights and again for the last night.
• Percentage of nights used greater than 4 hours over the last 30 nights . Press the SmartDial™ to access the percentage for the last 7 nights, and again for the last night.
• The number of nights used since therapy commenced .
• Check Sum .
NOTE: A symbol will appear on the Display Screen when the Sleep Data is within the compliance requirements. Once CMS requirements are met, the data within the CMS sub-menu
will stop logging.
• Exit the Sleep Data setting.
Additional Sleep Data (NOTE: This information may be restricted by your healthcare provider.)
• AHI for last 30, 7, and last nights.
• Leak for last 30, 7, and last nights.
• 90th percentile pressure for last 30, 7, and last nights.
• SensAwake™ for last 30, 7, and last nights.
• Exit the Sleep Data setting.

END EDIT>>>>


Is the above what you were asking about?

To read my data, I am using a copy of the F&P Infocare software I downloaded to read all the stats from the machine. Take a little bit of doing to get the software running as it is a large client/server database application and not really designed for a single "home" user. It was really designed for office use, and supports multiple patients etc. To get it running it's has to install a number of components on the computers.

Configuring the software once you have it running is pretty easy, but I ran into one bug the sleep therapist told me how to get around. I had to DELETE the data directory on the memory stick, and let the ICON re-create it before it would work properly.

Other than that, the power of the Infocare software is nice if you can get it running.

From what I am told by my sleep therapist, F&P is supposedly setting up a WEB based interface, so you can go to their patient WEB page, sign in, insert you memory stick on your computer, and their WEB site will print the report for you...but not sure when that will be available.

I would really like the Sleepyhead software to read the data properly as it would be a much simpler method of access. If anyone involved in the Sleephead project is around here, I would be happy to "guinea pig" and beta test as I can do side/side comparisons with the Infocare software etc.

Grant

Thank you for the reply GrantT.

I got home last evening and voila, the data was there! I forgot to consider that the machine is probably set up to aggregate sleep data for a 24-hour period, and I read a post somewhere on this web site recently that each day starts at Noon.

My AHI was 3.1/hr and leak rate was 25 l/min. The 90 %ile pressure was 9.5 and there were 12 Sensawake events. I have no idea if any of these are good or bad, but the only one that bothers me intuitively is the 12 Sensawake events.

I sneezed a few times yesterday at midday and had a slight runny nose, so I raised the humidity setting from 5 to 6 last night. The machine dispensed about 300 ml of distilled water. That data won’t be available until I get home this afternoon. I slept better and seemed to wake up less, so I’ll see what the machine reports.

I would definitely like to get software to analyze the data rather than reading it from the machine, but my biggest concern right now is a smooth transition from RemStar M to the Icon Auto. So far, so good.

The Icon is far quieter and I don’t suffer from rainout. My bedstand is far less cluttered now since I replaced a CPAP, humidifier and alarm clock with the Icon.

I have been using the Icon Auto since Dec and have found the software. Send me a PM if you need help finding it. I have only had good success installing on Windows XP though and the package is quite big (it is designed for a clinic setting with a server). SleepyHead is experimenting with adding Icon support so that should be available down the road.

You are correct, the Icon series calculates stats at noon every day for the full 24 hrs prior. If you take naps it won't give you separate stats both on the unit and in the software. SleepyHead should give you that capability.

Cloud computing. (grimaces)

Thank you KrisasMan. I have been promised a copy; if they don't come through, I'll let you know.
Chunkyfrog. I'm a bit dense, so dense that I didn't even grimace. I'll study on it and maybe I'll wake up at 3 a.m. laughing.

Here's my data so far. I believe the AHI is very good. Haven't the foggiest about the leak rate. Am concerned about the pressure spike on 3/2. Does it come from the higher leak rate that night? Sensawake events baffle me.

3/1/2012 hrs=6.8 AHI=3.3 Leak=23 Pressure =9.5 Sensawake=12
3/2/2012 hrs=7.7 AHI=2.4 Leak=36 Pressure =13 Sensawake=14
3/3/2012 hrs=7.8 AHI=1.8 Leak=22 Pressure =8 Sensawake=16

Any comments are welcome. I'm pleased with the transition so far, but I must admit even with the decent amount of sleep, I feel a bit like I didn't get enough sleep.

From what I have read it is tough to get used to new numbers on new machines. Pressure vs Leak Rate is a tricky one, as the pressure goes up so does the leak rate of your mask, kind of a chicken or eggs dilema. Is the leak rate high because the pressure is high or is a high leak rate (poor fitting mask) causing sensitivity issues and the machine thinks you are having events so it is ramping up pressure?

I know the ResMed machines are programed with mask leak rates so they will calculate excess leaks. For the rest of us we have to look at the mask specs and find what the leak rate for a specific pressure is. Your mask leak rate chart is here.

My Icon is set to CPAP mode so the pressure never changes making it easy to look at my leak rate and see how well it fit last night. My pressure is 9 and my mask leak rate is ~28 at that pressure, hence my machine generally reports 28-30 for the leak rate.

Looking at your data for 3/2 I would have a few questions. You state your pressure was titrated to 9 but clearly your machine is in APAP mode, do you know the range it is set to? If we knew the maximum we could guess whether the leak rate of 36 is indicating a poor mask fit or just a really high pressure level. Once you have the software we could see the pressure level at any given moment and see the corresponding leak rate.



As far as SenseAwake, it is simply a way of ramping down pressure when the machine thinks you are awake so you don't take off the mask. They have a description here. It appears to monitor breathing patterns and assumes you are awake when it changes and reduces the therapy pressure. Try turning it off and see if you feel more rested, maybe you have a naturally irregular pattern and it is getting tricked. I don't use it myself.

Thanks again, KrisasMan. I really appreciate your help and hope to learn enough to pass it on before long.

The pressure range is set at 6 low and 14 high. The titration I referred to was a sleep study performed last month that led to a new machine. I chose an autopap because I plan to continue to loose weight.

The link to the mask leak rate data is helpful. The values reported on the Icon line up with the intentional leak rate at the pressures I reported. Thanks for the tip about the Sensawake. I am going to disable it tonight and see what happens.

Two things I've noticed, unrelated to the above. When I take the water chamber out to fill it before bed time, it feels warm. Do you have the same observation? Also, I have the humidity set at 7 with a boost of 2. I get some condensation in my mask, but none or little in the heated tube. I don't want to lower the humidity setting because I need it to avoid sneezing and runny nose for a day or two if I let my sinuses dry out too much. I'm going to use a boost of 3 tonight to see what happens.

Thanks again for your help.

chunkyfrog wrote:Cloud computing. (grimaces)

Sounds like a rainy day, I don't buy into it either. Jim

Yah, the chamber is warm for me too. I have considered filling the tank early in the evening to improve the humidity when it starts up but with 2 kids and one on the way I am too distracted to remember. I also have the humidity set to 7-2. I turned it up to 7-3 when I had a cold and it felt good but I got my first taste of rainout.

I have found that the heat in the hose isn't enough for cold nights here in Minnesota, I have to tuck it into the blankets or I get rainout. I have considered getting a wrap for it but worry that the 2 prong connection has no temperature monitoring so it may overheat. I will see this summer if the A/C is an issue, then again I won't need as much humidity added then. For now I only have to worry when the temp here gets below 0 with it set at 7-2.

PS if they don't get you the software I just found out that SleepyHead 0.9.2-2 for Mac reads Icon Auto data and provides more info than the manufacturer. If you are a Windows user keep an eye out for 0.9.2+ to be released.

F & P machines report total leak (vent rate plus excess leak) and a while back I read in some of their literature that they don't get excited about leak numbers until someone starts getting 90 L/min and above.

Quality Zees wrote: Am concerned about the pressure spike on 3/2. Does it come from the higher leak rate that night?

Your higher leak number is more likely a result of the higher pressure because the vent rate for a pressure of 13 is going to be more than a pressure of 9. What you see as an increase in leak number is really going to be pretty much the normal vent rate which has increased due to pressure increase.
Overall, your leak numbers are quite acceptable and I imagine that if we saw the leak line itself in graph form that you had minimal leaks for the bulk of the night. If there were any rather large leaks they weren't very long or that average leak number would be higher.

So you are well below the 90 L/min territory where F & P says we should worry about leak affecting therapy or data collection.

Thank you Pugsy for the feedback.
Thank you KrisasMan for the info. I should be getting the software today or tomorrow. I'm a Windows XP user, so I'l have to wait a bit for Sleepyhead.

Well, I definitely made a mistake disabling the Sensawake, I think. My numbers for last night are:

6.9 hours
2.4 AHI
82 leak rate!!! (expecting 28 for my mask)
14 pressure (which is the maximum range setting)
Boost of 2

I woke up OK, took out the water chamber and it was dry! As the day progressed today, my sinuses have rebelled. Sneezing and runny nose, which is a sign of not enough humidification for me.

I’m going back to Sensawake tonight, and I’m upping the boost to 3. Hope that helps. I think I’ll set the alarm for bed time plus four hours to make sure the chamber isn't going dry. This is a disappointing result. I don’t remember any discomfort during the night, and my mask was on as far as I know.

AlsoI I'm going to look for a hygrometer to put in the bedroom just to see if there's a relationship between room humidity and results. Thanks to all for your continued interest and support.

I don't quite understand the Sensawake feature. Half the time, i wake up with the machine blowing at the full pressure i've set - it certainly hasn't sensed that i've woken. Then again, maybe the machine is faulty.