new member - to auto or not?

[DreamStalker]

After tonight I will have my first week experience with the new CPAP lifestyle. I have been browsing this list for the past few days and decided to become a registered member in order to learn more about what I have gotten myself into.

I first became aware that I snored over 20 years ago but never really felt compelled to resolve the matter until my wonderful wife (of two years now) told me that I should get checked out because she had witnessed me gasping for air during my sleep (not to mention that I was waking her with my loud snoring). I have also noticed that over the past 4 or 5 years I have been waking up mornings with severe migraines, muscle aches, extremely tired, and just plain feeling awful. During this same 4 to 5 year period I also began frequenting the restroom more and more often during the night (up to 3 or 4 times) and thought that it was the reason for my tiredness and poor sleeping experience. The doc put me on prostrate meds which did not help any.

Fast-forward to a month ago and per my request, my doc referred me to a sleep clinic where I underwent a one-night sleep study. They discovered that I had an AHI of 102 (mostly apneas) and classified me as a sever case of OSA. I was provided a one-month rental of a CPAP system (per requirement of my health insurance) that they used on me at the sleep lab. The system consists of the ResMed Elite (S8 model w/heated humidifier) and the Swift nasal pillows. Currently the CPAP machine is set with EPR on a setting of 3 and the pressure is set at 10 ramping from 4 over a specified time (20 minutes) according to my comfort level.

I did however request the Breeze nasal pillows on the day of my CPAP fitting last Tuesday since I had not tried it on the night of my sleep study. On the first night I had dreams all night long which I had not done for in years. I just assumed that as one got older, the brain slowed down and dreams occurred much less frequent as a consequence. For the first time in years I also woke up without a headache, my muscle aches were much less severe and I was fairly rested. I did not have to get up to use the restroom a single time that night. The only problem was that I had a painful rash on the tip of my nose and what felt like bruising on the back of my scalp from the triangular plate on the Breeze headset. So I called up the lab tech and they told me I could switch out the Breeze for the Swift nasal pillows -- which I did that same day. I suppose I did not give the Breeze enough time for a fair evaluation.

During the last five nights with the Swift, I am beginning to develop the rash on the tip of my nose again but still not as bad as with the first night on the Breeze. On the other hand, I have not slept as well with the Swift as I did that first night with the Breeze but still a lot better than with no CPAP at all. I have noticed that on occasion my mouth opens during my sleep and the rush of air coming out wakes me. In addition, I became concerned over what I was to do if and when my sinuses became clogged due to sinus cold or allergies. About that time I began researching here on this message board and read about the Hybrid mask. I called up the sleep lab and told them about my concern and about the Hybrid mask. They actually Googled it while I was still on the phone and told me they would talk to the sleep doc and call me back. Thirty minutes later they called and said they too were very interested in the new Hybrid mask and said they would order it and let me try it out.

As I have continued to read more here, I have realized that finding the perfect CPAP interface is the most challenging part of the CPAP lifestyle. It seems that the best solution is to collect and try several and then modify the best one based on the experience of all the others. I am grateful to have become a member of this message board. For the postings by all those here not only provide numerous engineering strategies for a CPAP interface but they also provide the all important support to newbies not give up to the effects of OSA because of the difficult challenge of finding a comfortable and effective CPAP interface.

I apologize for the long and winded post but do have one question of the more experienced group members here. In a few weeks I will have to decide whether to keep and buy the current ResMed Elite CPAP machine or ask the sleep doc for a different one. I am aware of the old saying “if it works don’t fix it”. However, is there any reason for me to ask my sleep doc to prescribe me an “Auto” CPAP machine rather than the one I currently have and if so, how do I rationalize it to my sleep doc? I have read some of the negative postings here regarding ResMed but at this point, my health is more important than corporate/marketing policies or practices and besides my health insurance covers most of my costs. I do not mean to offend or make light of others wanting to send a message to ResMed and fully respect their prerogative to do so … just not at the expense of my personal health.

Thanks and may you all sleep well,

The DreamStalker

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, resmed, breeze, humidifier, swift, CPAP, AHI, Nasal Pillows

[Goofproof]

If you can get them to go APAP by all means that's the thing to do. As far as brands, the main three will do the job good, My Fav in listed below in my Sig info, I prefer it because it allow me pressure exhale relief, and I like the software system. The Resmed APAP, besides there colaberation to rip off consumers, doesn't provide exhale relif in the Auto mode.

A auto machine allows you to use the least pressure you need to keep the airway open, the less pressure the less leaks and other problems with your treatment, and if you truly care about your treatment, the software is a must although the INS won't cover it. With it you can fine tune your treatment to get yourself the best results. Also if they won't go APAP the Remstar Pro 2 has most of the same data and is a fine machine too. I have both. Jim

[krousseau]

My preference for the Auto is based on the simple fact that it can be used in the CPAP mode or the APAP mode. Of course there are other features so you can experiment to find out what works best for you. You can do that based on how you feel if you keep a good sleep journal. Or you can base it on how you feel along with the help of the cardreader & software. You cannot base the success of treatment solely on numbers though-you have to also feel better-have less daytime fatigue-be more energetic. (If you have any other health problems you have to take care of them too.)

[inacpapfog]

Can't go wrong with selecting an auto for the exact reason krousseau points out....apap can be used in cpap or apap mode!
Also.......
The Respironic auto provides exhalation relief in either cpap or apap mode.
The Resmed auto does not. (EPR works on cpap mode only.)

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, CPAP, auto, APAP

[Ms Piggy]

interesting you have a rash on your nose since starting cpap, I have been getting from 2 to 4 red spots on the end of my nose, they come and go, but couldn't see how cpap would be the cause.

[SleepyHibiscus]

Welcome... you have come to a good place. The people posting here speak from experience and you will learn lots of interesting things. From what I've read you cannot go wrong with an auto machine. Best of luck.

[snoregirl]

While I have not been Xpap as long as the others (I am approaching 4 months) I will throw in a vote for APAP for the reasons mentioned above AND the likelihood that you can avoid another sleep study (titration) for longer since nothing is constant in life. AND we all know how lovely, comfortable and cheap sleep studies are.

[DreamStalker]

[quote="Ms Piggy"]interesting you have a rash on your nose since starting cpap, I have been getting from 2 to 4 red spots on the end of my nose, they come and go, but couldn't see how cpap would be the cause.

[rested gal]

Can't go wrong with selecting an auto for the exact reason krousseau points out....apap can be used in cpap or apap mode!
Also.......
The Respironic auto provides exhalation relief in either cpap or apap mode.
The Resmed auto does not. (EPR works on cpap mode only.)

That last "Also..." is the main reason I would choose the Respironics REMstar Auto with C-flex.

The ResMed S8 Vantage with EPR is not able to give any exhalation relief at all when being used as an autopap. Their EPR cannot be enabled in auto mode.

The Respironics REMstar Auto with C-flex can use C-Flex for exhalation pressure relief in any mode. A much more versatile machine, imho. It's an excellent machine in either the regular size or the new M series smaller size.

If a person plans to get software to see more detailed data about their treatment, on their own computer, the Encore Pro software used by Respironics machines is far better, imho, than the Autoscan software used by ResMed.

[Snoredog]

Can't go wrong with selecting an auto for the exact reason krousseau points out....apap can be used in cpap or apap mode!
Also.......
The Respironic auto provides exhalation relief in either cpap or apap mode.
The Resmed auto does not. (EPR works on cpap mode only.)

That last "Also..." is the main reason I would choose the Respironics REMstar Auto with C-flex.

The ResMed S8 Vantage with EPR is not able to give any exhalation relief at all when being used as an autopap. Their EPR cannot be enabled in auto mode.

The Respironics REMstar Auto with C-flex can use C-Flex for exhalation pressure relief in any mode. A much more versatile machine, imho. It's an excellent machine in either the regular size or the new M series smaller size.

If a person plans to get software to see more detailed data about their treatment, on their own computer, the Encore Pro software used by Respironics machines is far better, imho, than the Autoscan software used by ResMed.

ditto to that... and I'd add getting some Ayr Saline Gel for the nares, sold in the nasal spray section of the druggist store.

[NightHawkeye]

I suppose it is a reaction to the nasal pillows rubbing on my nares.

Dreamstalker, here are a couple of solutions to this problem you might want to consider, especially since the hybrid also has nasal pillows and may continue to cause this same problem for you.

1) If you find the hybrid treats your apnea well, but you still have trouble with sores on your nares, then consider a full-face mask, like the Ultra-Mirage FFM. You might have more congestion with a regular FFM, but that can be mitigated with Breathe-Rite strips which hold your nostrils open. (In my experience, the Breathe-Rite strips are about as effective holding the nostrils open as nasal pillows are.) Also, many of find that nightly nasal irrigations are effective at resolving congestion.

2) The Comfort Curve is an unconventional nasal mask which works about as effectively as nasal pillows holding the nostrils open, but does not go inside the nares. In the month I've been using my Comfort Curve mask, the sores at the tips of my nares have almost entirely healed. It's a difficult mask to get adjusted properly, and some folks don't get the mask to work for them, but for some of us it is a very good mask. The Comfort Curve forces air up the nostrils keeping them open in the same manner as nasal pillows do, something which regular nasal masks cannot do.

Hope this helps, and welcome to the wonderful world of CPAP.

Regards,
Bill

[DreamStalker]

Bill -
Thanks for the suggestions. Indeed I have already planned to collect several different types of interfaces over the next year ... hopefully by sometime next year I will have narrowed my choices to just two or three that will take care of all my needs ... a FF mask for backup is inevitable and the ideal nasal mask/pillow system is what I am shooting for.

Snoredog -
I'll try the gel but my gut feeling is that I won't like it ... but I will try it ... thanks!

Rested Gal -
I noticed that you are one of the more experienced here and also noticed that you are using BiPAP auto. Could you please explain what factors would direct someone to use BiPAP over CPAP?

Thanks again to all and may you find your dream world ...

- roberto

[Captain Nemo]

Go with the auto, by all means. My last sleep study said I needed 15 whatevers of pressure, but that led to major mask leaks and discomfort because it was too much pressure for most of the night and for most of my sleep positions. Just switched to an auto, and I have been sleeping MUCH better, dreaming much more. Pressure when I am having no apnea stays at 4 or 5, settles at 8 to 10 most of the time, and has hit 14 only once so far.