Upgraded my machine now I'm in misery

[gregnga]

Earlier this week I received a new Resmed Airsense 10 Autoset. I had been using a Resperonics Remstar Auto Cflex machine for about the last 10 years. I had a good experience with the Remstar machine but I was having problems with rainout, so that, along with the fact that my insurance will pay for most of it, led me to try a new machine. I went the traditional DME route because my insurance requires I follow proper protocol in order for them to pay for it. Anyway, it has been a week of misery for me since using the new Airsense 10 machine. My AHI was 20 and 15, respectively, the last 2 nights. I have felt like 10 miles of bad road every morning when I got up. I think this is because the DME set the pressure on the A/10 to a range of 5-15 per the doctors prescription. I had been using a straight pressure of 11 (no range) on my Remstar machine and I felt a lot better in the am with that. The kicker is that part of the compliance agreement is that I make a return visit to the sleep doctor no sooner than 30 days but no later than 90 days. Well, I can't wait 30 days to wait and see what adjustments the doctor wants to make so I will sleep better. Since I know how to get into the clinical menu and change the adjustments, I thought about changing the pressure on the A/10 to 11 for a couple of days like I had on the Remstar and see if that helps. I'm concerned, however, it will through the readings off for the doctor when I go visit him, or worse, he'll figure out I've been tinkering it with the settings.

I'm in a quandary and I am in misery, any suggestions?

[LSAT]

IT takes about 30 seconds to change pressures on that machine...Here is the clinical menu that will show you how. You need to change it from AUTO to CPAP and set the pressure to 11. It's your machine and your therapy...the doctor will realize that...(or should).
https://sleep.tnet.com/home/files/resme ... -guide.pdf

[gregnga]

IT takes about 30 seconds to change pressures on that machine...Here is the clinical menu that will show you how. You need to change it from AUTO to CPAP and set the pressure to 11. It's your machine and your therapy...the doctor will realize that...(or should).
https://sleep.tnet.com/home/files/resme ... -guide.pdf

My biggest concern is that if the doctor figures out I went around his prescribed settings and fiddled with the settings on my own it could affect whether or not I have been compliant and hence have an impact on my insurance co's willingness to pay for it.

[Pugsy]

Make the change and see how it goes.

The face to face requirement for insurance (sounds like Medicare) is just to document you are using the machine and it is working.
Insurance doesn't care if you change the settings or not...all they want is to know you are using it the required number of hours.
Now will your doctor care??? Probably not especially if you end up doing better on fixed at 11 cm.

In terms of current settings...most likely the 5 minimum is too low since you were doing well on fixed 11 cm. Without seeing the reports it's hard to say for sure what is going on. Contrary to what some people believe these apap machines sometimes need a little help with a better more optimal baseline (minimum) pressure because it takes a bit of time to increase the pressure to where you need to be to hold the airway open and if it takes too long to get there the airway closes and opens back up while the machine is trying to get to where it needs to be.
If you want to learn more about what your machine shows besides the AHI on the screen you can get the software.
https://sleep.tnet.com/equipment

Someone using fixed pressures for years like you have been doing very likely will find the auto adjusting mode quite a change and made worse if the settings aren't optimal. Some people prefer fixed mode and that's just fine. Some people prefer auto mode and that's fine too. It's all in what you feel works best for you.
It's probably easily fixed to either keep it in auto mode or you can try fixed at 11 cm and see how it goes. If you still have problems at fixed then we could do a little more detective work and figure out the next plan of action.

Oh...do you know what the AHI event category breakdown is? If going to fixed mode doesn't bring it down then we for sure need to figure out the event category breakdown
Like how much is the Central Index and the Obstructive Apnea index and the Hyponea index. If you are seeing predominately central index that is high then we need to have a different discussion.

Start with easy first though...just change it over to what you used to use and see what happens.
Insurance won't care at all and I would be real surprised if your doctor cared or was upset.

[gregnga]

i would make the change

how did the first machine get a different setting ?
did you change that one ? Yes, I changed it

how did the setting on the new one get changed if the doctor had it at 11 on the first one ?
This was a different doctor than the one I used for my 1st machine that was at 11, although I told the doctor that prescribed my new machine that I had been using 11. I guess he based it on what he saw on the sleep study or maybe he wanted to start low and then raise it as needed

[gregnga]

Someone using fixed pressures for years like you have been doing very likely will find the auto adjusting mode quite a change and made worse if the settings aren't optimal. Some people prefer fixed mode and that's just fine. Some people prefer auto mode and that's fine too. It's all in what you feel works best for you.
It's probably easily fixed to either keep it in auto mode or you can try fixed at 11 cm and see how it goes.

You may be on to something regarding the AUTO setting. Now that I think back, my Remstar machine was originally set to AUTO and I changed it to a fixed 11cm and liked it better that way. Think I'll try fixed 11cm.

BTW, my AHI for last night was 15.7, central was .2

Thanks for the advice,

[ajack]

I don't think min 5 works for anyone. I would stay on auto and use a pressure just under your old pressure as a minimum. I'd use minimum 10 and max 15, to see where the machine wants to lands.
I would download sleepyhead, so you can see what your median and the 95% of the time pressure is. I'd also post the charts for opinions

[klv329]

Another inexperienced physician, imagine that.

Make the change as others have suggested, don't hurt yourself for no good reason.

Good luck!!

[Gryphon]

If it was me - You were feeling good at 11 - I would set it to 10-16 to start... That gives you just a tiny bit of pressure relief from the 11 but keeps you close to what was working. The 16 gives it somewhere to go if it needs to with out giving it the full 20.

I'd then get Sleepy Head on your computer and look at the data from your machine and see how things were looking.

It's easy to change settings on that system and I wouldn't wait ages for your doctor to do it for you. Especially if your going to be changing it to behave more like the system you had.

[RogerSC]

If fixed pressure was working with the previous cpap, that's where I would start. Changing too many things at one time doesn't give you much insight about what's causing problems. If you go fixed at 11cm H2O, and that works for you, that's great. If it doesn't, then you can figure out where to go from there...you're already making a major change by upgrading your cpap machine, that's enough to change at one time.

You're getting conflicting advice. My experience tells me that it would be a good idea to just stabilize things, and try something that worked for you before (the 11 fixed pressure)...and then move on from there if you need to.

[Gryphon]

If you really really want to rule out variables then you can set it to 11 and then see how you feel after two days.

If your still not feeling better. You may want to look at exhalation relief. You could turn that off or make changes to it as well just to see.

I can say that the ResMed vs. Resperonics does have a different feel between the two. 5 years or so ago I preferred the Resperonics but after having had a chance to use the ResMed I actually like the way breathing feels on it better. It's very subtle nit picky thing but it can feel different.

Reason I was recommending the 10 to 16 before was based on the 5-15 the doc prescribed. I think 5 to start is silly - doesn't work for most people. 5-15 is more conservative version of 4-20 so basically putting all your faith in the machine and letting it do what ever. Maybe the doc wanted to let the machine do a little self titrating. I'm not 100% sure. More information would help.

If you wanted to take advantage of the auto function of the machine then 10-16 I think would be a good start. You still need to get sleepy head and download your data and look it over. Maybe post it to the forum so we could take a look.

[jds2001]

Also, when I had this happen (absolutely horrible first couple of nights) I emailed the doctor (he's EXTREMELY responsive) along with reports from EncorePro (I have a Respironics machine). He basically siad "looks like this needs to change, let me know if you know how to do it. If not, we'll have your DME do it". So I immediately changed it. No one from the DME said a word, nor did anyone from the doctor's office (though he might have documented the change). I also did it with EncorePro, and unchecked the box that erases the prescription from the SD card after it's successfully applied to the machine so even if the DME decided to change it back somehow, it would revert to my settings.

This is on a machine with a cellular connection, and based on data I later changed it again myself (without the doctor's input) to 9-14 which I'm at now. Again, not a peep from a soul.

[Pugsy]

The 5 to 15 range (or the 4 to 20 default) for settings can work for some people but not all people.
Once a person starts needing 10 or more pressure that time it can take for the machine to make the journey from 5 (or 4) to 10 can simply take too long for the machine to get to where it needs to be to prevent the airway from collapsing. And remember the machine won't do anything when an obstructive apnea or hyponea is actually happening...it waits until the airway opens back up and then will continue it's journey upwards if it thinks it needs to go higher (snores and Flow limitations are a factor also).

So sometimes we have to help the machine out with a more optimal starting point for that pressure to start from and make the journey to the higher pressure needs time.

I had this happen to me. My RX from my titation sleep study was for 8 cm but bear in mind my OSA is worse in REM and I got very little REM during the titration sleep study. I started therapy with apap set to 8 min and 10 max and quickly found that there were times where I was maxing that 10 cm and the timing of the maxing pretty much coincided with probable REM sleep stage...and other parts of the night the 8 cm did a great job but during REM things were really ugly with very dense clustering of OAs. So I opened up the 10 to 20 just to see where it would go and I found it helped the REM clustering but still left me with some not quite so ugly clustering during REM. I ended up needing a 10 minimum starting point to better clean up the REM related OAs.
Because at times my pressure went to 16-18 cm and going from 8 to 16 just simply took too long. Just having that extra 2 cm starting point head start was enough to take care of the REM stuff. The other parts of the night when not in REM my pressure would be around the 10 to 11 range and only go higher when needed.

Now I don't know that is what is going on with the OP in this thread and I mention it only as an example of how using a higher minimum can dramatically affect the results.

4 or 5 minimum works fine for those lucky people you end up only needing 8 or 9 cm pressure to keep that airway open but not so great if you need 11 or higher.

[gregnga]

I noticed that if I start the machine up without putting the mask on (I'm holding the mask in my hand) it seems like there air pressure coming through the mask is extremely high, my wife even commented that the it was like a whirlwind of air coming through the pillows, mush higher than my old Remstar machine then when I put the mask on, the air pressure doesn't seem so great. It doesn't seem to matter if the pressure is set to 5-15cm or 10cm, the pressure coming through the pillows is extremely high until I put the mask on. Is it something normal about the Airsense 10 to produce high air velocity when the mask is not on or could their be something wrong with the machine.

I've emailed the DME about this and am waiting for a response.

[Pugsy]

It's normal to feel that way. The pressure part doesn't come into play until you have a sealed circuit with the mask to establish a pressure and then keep it stable.
There's nothing wrong with the machine.