Trialing the Dreamstation after 3 weeks of Resmed Auto 10. Higher AHI? My thoughts.

[ethereal]

I've been posting new threads here a fair bit, but it's because this forum is so helpful Plus, the people at the sales clinic know next to nothing useful.

So I am coming close to the end of my CPAP trial, and I thought I would be wise to at least try another machine for my own sanity. So for the last 3 weeks or so, I am using the Philips Respironics Dreamstation APAP. That's after about a month with the Resmed Autoset 10.

Settings are currently the same for both:
Mask = Philips Dreamware Full Face
Pressure = 7 - 10 cmH20
EPR (Resmed) = 2, A-Flex (DS) = 2
Tube heating / Humidifier = Auto (Resmed) / Adaptive (DS)

Differences I've noticed from the Resmed Autoset 10 to the Respironics Dreamstation:

• The Resmed is quieter, while the Dreamstation isn't loud by any means, I can hear a distinct type of whine on inhale/exhale. No biggie, I am adaptable. Once I'm asleep I'm good.

• Prefer the user interface of the Dreamstation

• Prefer the humidifier on the dreamstation, the way it detatches, and the fact you don't need it clipped in to use the machine. It's really much of a muchness though, the Resmed has a larger volume.

• Think I prefer A-Flex way more than EPR (haven't been able to try C-Flex) but I feel like breathing is so much smoother and more natural with the dreamstation, if that makes sense?

• My Resmed AHI was much better than the Dreamstation on the same settings.

• Looking at the graphs for pressure, the Resmed seems way more proactive in it's approach (more frequent and higher pressure changes during the night)

• Way more event flagging going on with the Dreamstation - I even have Snoring? Wth? My sleep study never recorded that.

• Still way too early (only 2 nights with it) but I feel really well rested.

Should I worry about the increase in AHI with the Dreamstation? What can I do to get it down under 1.0? Why does it seem worse than the Resmed Autoset 10?

It would seem that this machine suits me a little better, as I really like how smooth the breathing feels. However the whine really annoys me before I fall asleep, the Resmed was dead quiet.

Also looking at all the almost radical variance in the flagging, it makes me not trust either of the machine's reporting capabilities. Is the Resmed lying to me when it consistently says I am under <1 or even 0.0 AHI? Is the Philips just over-recording? What is it?!

I've attached my final night with the Resmed (0.0AHI Wooh!) and then my Last two nights with the Dreamstation. The machines work totally differently to each other.

Keen to hear from those that have used both, although doubt there's many people around.

[Pugsy]

Read this about the VS2 snores.
It probably won't help much except to tell you we don't know a whole lot about why Respironics does the VS2 snores since they won't do anything about them anyway. For the number you are having which actually small...if it wasn't for the AHI (which isn't horribly horrible)...I probably would ignore them. Scroll back up to the top and very first post from RobySue.
viewtopic.php?f=1&t=155478&p=1182872#p1182872

You can still get good results with the DreamStation but you will need to use higher minimum pressure in auto mode than you need with ResMed to get similar AHI numbers.
This is because of different auto adjusting algorithms. You have discovered that ResMed is more aggressive with their algorithm.
It is just the way it is. They both do a good job but they respond differently and the Respironics is slower and less aggressive with either the increases or decreases in pressure...just doesn't move as fast. For this reason pressure settings have to have some adjustments to get comparable results.

I started cpap therapy on a Respironics machine and did quite well for years...settings were 10 min and 20 max (sometimes in REM I need 16 to 18).....to get nice low AHI numbers.
On a ResMed apap I only need 7 minimum to get the same numbers. 10 cm was doable though and quite comfortable and I did well with it for many years. I still see the need to go higher when in REM (where my OSA is worse) and sometimes up to 16 to 18 again but with the ResMed going up faster I can get by with a lower starting point the rest of the night. I did prefer AFlex over CFlex....and while there is a slight difference between EPR and AFlex...I was actually okay with either. I liked the more difference available with EPR better though...I can get 3 cm difference with EPR and with AFlex (or CFlex) the most difference a person can get is 2 cm and even that is based on how forcefully they breathe.
Again...just different ways of getting a job done..
So different ways of accomplishing exhale relief along with a different way to lower AHI. Different...not necessarily bad different unless a person has a problem using slightly higher pressures all night in the form of a higher minimum.

So try 8 cm minimum or even 9 and see how it things go if you want to try to get the AHI numbers down to more what you got with the ResMed.
AFlex is an improved CFlex...the newer of the 2 reliefs...smoother. You can try both if you wish but you may not like CFlex as much as AFlex.

[palerider]

• My Resmed AHI was much better than the Dreamstation on the same settings.

• Looking at the graphs for pressure, the Resmed seems way more proactive in it's approach (more frequent and higher pressure changes during the night)

• Way more event flagging going on with the Dreamstation - I even have Snoring? Wth? My sleep study never recorded that.

...
Should I worry about the increase in AHI with the Dreamstation? What can I do to get it down under 1.0? Why does it seem worse than the Resmed Autoset 10?

It would seem that this machine suits me a little better, as I really like how smooth the breathing feels. However the whine really annoys me before I fall asleep, the Resmed was dead quiet.

Also looking at all the almost radical variance in the flagging, it makes me not trust either of the machine's reporting capabilities. Is the Resmed lying to me when it consistently says I am under <1 or even 0.0 AHI? Is the Philips just over-recording? What is it?!

You answered your own question... Why are you having a higher AHI with the Dreamstation? because the Resmed is "way more proactive"

https://www.youtube.com/watch?v=lzCCgNLya_g

[ethereal]

Alrighty so I swapped back to the Resmed just for my own sanity and I definitely think I am one of those people who just prefer the Dreamstation.

I feel like I am suffocating with the Resmed, the breathing for me just feels unnatural where as the Dreamstation felt fluid, natural and seemed like it was breathing with me. I feel like I am fighting the Resmed.

I just wish the bloody Dreamstation was as quiet as the Resmed (man that thing is SILENT).

It's a weird observation, but I FEEL better with the Dreamstation - even with a slightly higher AHI. Ended up purchasing a Dreamstation last night and I hope it comes fast because I couldn't even sleep with the Resmed last night, I sleep bare and I definitely feel it today.

Hope these type of posts help people in the future as I myself was looking around for lots of Resmed Airsense 10 v Dreamstation discussions.

[Pugsy]

You are one of the lucky ones who actually got a chance to trial different machines so that you could decide which one suits your overall needs the best.
Most people don’t get a choice.

Everything about any Cpap equipment or sleep apnea therapy comes with a big YMMV sticker.

For me it’s always been more about my sleep and how I feel than just numbers. I know some people say the notice a big difference in how they feel with just relatively small differences (at least in my eyes) but I have never really experienced all that much difference in how I feel vs AHI of sub 2.0 vs 3 to 5 AHI.
In fact one of my very best days in terms of how I felt during the day followed a night with AHI of 10.2. Go figure that one.
And it was with a Respironics machine some 9 years ago.

The slight difference in the noise from the machine......the brain can help you out a bit in that regard if you will let it. Try not to think about it or try not to dwell on it and eventually the brain can learn to tune it out for the most part.

If you do feel the need to lower the OA or hyponea numbers...just a little more minimum pressure can usually accomplish that goal. It’s not the end of the world to need to use just a little more pressure to get the same job done.
Or you may end up being like me and not really notice any real differences between an AHI of 1 and an AHI of 3.
My primary goals have always been good sleep and feel good during the day. Not a great math score or pretty graphs.
Just another one of those YMMV things.

[Arlene1963]

I know some people say the notice a big difference in how they feel with just relatively small differences (at least in my eyes) but I have never really experienced all that much difference in how I feel vs AHI of sub 2.0 vs 3 to 5 AHI.
....
My primary goals have always been good sleep and feel good during the day.

Just want to add that I am in this camp as well. I'm always amazed at folks who can feel the impact of such small differences, I honestly can't.

To me this just shows how each of us responds very differently to sleep disordered breathing if for some folks, even a few breathing events or arousals per hour can be very significant and yet for others, several events per hour will have no impact at all. It's definitely not the same for all of us.

[jnk...]

. . . looking at all the almost radical variance in the flagging, it makes me not trust either of the machine's reporting capabilities. Is the Resmed lying to me when it consistently says I am under <1 or even 0.0 AHI? Is the Philips just over-recording? What is it?! . . .

Both machines have excellent recording capabilities. However, the definitions used by home machines differ from the definitions used for lab/clinic sleep studies, and the definitions differ among manufacturers of home machines (for proprietary reasons involving patents, I believe). So, it isn't so much that either machine is "over-recording" or "lying." The reported AHIs on home-use machines are given primarily for trending purposes--to see if a change in pressure or comfort feature makes the reported data change for the better or for the worse.

AHI numbers are never really an exact science, especially when it comes to hypopneas. And that is even the case for lab/clinic NPSGs that have differing equipment, differing sensors, differing scoring programs, different settings, and differing human scorers who may adapt to preferences of sleep docs according to what each doc considers the most pertinent data. There is sufficient standardization all in all, but much as is the case with medical labs that assess and report on drawn blood, there is an acceptable range of variation that comes into play, so it is good to use the same sleep lab for comparison purposes for trending and especially for comparing the diagnostic testing with the titration testing. And it is likewise best to use the same manufacturing brand and same model machine for direct AHI to AHI comparison.

Lab to lab differs. Manufacturer to manufacturer differs. But those limitations in data comparison across brands and across labs do not negate the value of the data collected when it is understood for what it is and when it is then used properly.

[D.H.]

I'm not sure that you're really experiencing more episodes. I don't really know how accurate or how sensitive these machine are when taking measurements.

[jnk...]

. . . I don't really know how accurate or how sensitive these machine are when taking measurements.

In my opinion: They are excellent for reporting apneas. They are OK for reporting hypopneas according to their various disclosed proprietary definitions. They are only so-so in differentiating obstructives from centrals based solely on whether the airway is somewhat open for some or all of the event in question.

[palerider]

I'm not sure that you're really experiencing more episodes. I don't really know how accurate or how sensitive these machine are when taking measurements.

Said someone who's never learned how to read sleepyhead charts.

[ethereal]

You are one of the lucky ones who actually got a chance to trial different machines so that you could decide which one suits your overall needs the best.
Most people don’t get a choice.

Yep, here in Australia we are able to pay $250 for a CPAP trial once we have the prescription from the sleep specialist, and that allows 6-8 weeks of unlimited machine and mask testing.

Now that I've had a couple months of experience I can firmly say that Mask is absolutely your NUMBER 1 consideration, then machine second. But the machine can certainly have a positive/negative effect. Makes me wonder how many people could do better with a more suited machine, everyone seems to be getting Resmed Airsenses by default.

For me it’s always been more about my sleep and how I feel than just numbers. I know some people say the notice a big difference in how they feel with just relatively small differences (at least in my eyes) but I have never really experienced all that much difference in how I feel vs AHI of sub 2.0 vs 3 to 5 AHI.
In fact one of my very best days in terms of how I felt during the day followed a night with AHI of 10.2. Go figure that one.
And it was with a Respironics machine some 9 years ago.

Absolutely. For a person like me it's hard to decouple the numbers from experience as I am a highly data driven and factual individual. Therefore if I felt good on 10.2 AHI like you I would totally discount the machine .

Another thing I believe in heavily and watch out for myself is placebo effect. It's extremely powerful and that's why I've swapped to the Resmed and Dreamstation twice, I needed to make sure.

The slight difference in the noise from the machine......the brain can help you out a bit in that regard if you will let it. Try not to think about it or try not to dwell on it and eventually the brain can learn to tune it out for the most part.

I reckon this is an older machine. My mate has a dreamstation from 1800CPAP refurbished and confirmed he hears no whining on inhale / exhale. So I hope my brand new device coming from sistemmacpap.com is the same (great price btw - $599 brand new with heated hose)

Both machines have excellent recording capabilities. However, the definitions used by home machines differ from the definitions used for lab/clinic sleep studies, and the definitions differ among manufacturers of home machines (for proprietary reasons involving patents, I believe). So, it isn't so much that either machine is "over-recording" or "lying." The reported AHIs on home-use machines are given primarily for trending purposes--to see if a change in pressure or comfort feature makes the reported data change for the better or for the worse.

AHI numbers are never really an exact science, especially when it comes to hypopneas. And that is even the case for lab/clinic NPSGs that have differing equipment, differing sensors, differing scoring programs, different settings, and differing human scorers who may adapt to preferences of sleep docs according to what each doc considers the most pertinent data. There is sufficient standardization all in all, but much as is the case with medical labs that assess and report on drawn blood, there is an acceptable range of variation that comes into play, so it is good to use the same sleep lab for comparison purposes for trending and especially for comparing the diagnostic testing with the titration testing. And it is likewise best to use the same manufacturing brand and same model machine for direct AHI to AHI comparison.

Lab to lab differs. Manufacturer to manufacturer differs. But those limitations in data comparison across brands and across labs do not negate the value of the data collected when it is understood for what it is and when it is then used properly.

And this is what sucks. There should be an authorizing body with standard(s) to which these events are prescribed, specified and communicated... then the machines, labs etc should be based of those specifications and adhere to them. They way they do it can be the patent, as long as the criterion is the same.

Ah well, I think we can all say that in this CPAP game, end of the day control your numbers to as optimal as you can with maximum compliance, then from there completely go by how you feel rather than focusing on the numbers.