New apap higher AHI & apap doesn't seem to be trying :(

[frapilu]

Hi all,

After almost 5 years, my beloved but ancient M series Respironics machine started squeeking and hissing and generally sounding like it was getting ready to die. I brought it to the DME here (I had gotten it from cpcp.com but there is a DME here where I buy my Quattro masks since ResMed refuses to allow cpap.com to deliver to Canada) to see what was going on. The RT agreed that it sounded like it was going to die but said it would probably be over $500 to get it repaired so I should consider getting a new machine (although because the 5 years isn't passed, it won't be covered).

I checked out cpap.com's comparisons and decided on the DeVilbiss IntelliPAP with the SmartLink software for various reasons but I'm still feeling crappy and I don't understand what's going on. My AHI with the Repironics M Series shown by EncoreViewer was usually under 1.0; occasionally I might be a little above 1.0 but never above 2.0. The DeVilbiss is set (like the Respironics was) at 15 - 20 and I'm getting AHIs of between 3-7 with the lowest I've seen being 2.28. I understand that AHI isn't necessarily a perfect measure but I feel very tired so I'm inclined to wonder if the DeVilbiss is doing the trick.

I installed SleepyHead to see if it made any more sense to me than the SmartLink but it doesn't.

With the Respironics, my 90% pressure was 16.5 with my my average pressure being 15.4 although sometimes it did go up higher to 17 or 18 and I've seen 20.
With the DeVilbiss, my 95% pressure for the past 25 days is 16 with my average pressure being 15.2.

OK, put that way, they seem similar except that I seem to be having lots of apneas, hypopneas and non-responsive events that DeVilbiss doesn't seem to be making any effort to deal with and I'm having AHIs like I've never had, like 4.48 in this screen shot (I've never put a report in a post and I'm trying to follow Pugsy's instructions so I hope this will work). I don't think I've ever had a non-responsive event with the Respironics (I had to go look up in Pugsy's glossary to figure out what it was).

[img][IMG]http://i1334.photobucket.com/albums/w64 ... 7ede29.jpg[/img][/img]
[img][IMG]http://i1334.photobucket.com/albums/w64 ... 7148e0.jpg[/img][/img]

I hope it works. Any comments?
France

[frapilu]

Well, that didn't give me the picture I expected so no idea what I did wrong. Sigh. I'm feeling very stupid.

France

[frapilu]

How's this?

[frapilu]

Another thing I forgot to mention was that a few times, I've waken up gasping for breath and feeling suffocated. I haven't had that happen since before cpap so I'm just worried.

France

[Pugsy]

Your machine's pressure line doesn't appear to be moving off of 15 cm on this report. It shows ramp starting at 14 and then goes to 15 and stays flat.
Do you have the Devilbiss software to compare the pressure line to?
If it is staying at 15 and not increasing or responding optimally to those hyponeas then maybe the settings aren't quite optimal.

Your report isn't the first report that I have seen the Devilbiss Auto not seeming to move off of the minimum pressure and I have wondered if it is a SH problem or just the machine not wanting to increase the pressure????

Totally different algorithm between the Devilbiss and the Respironics machine so same settings aren't necessarily going to work.
If the machine doesn't want to respond to those hyponeas with more pressure...maybe use a little more minimum pressure????

[frapilu]

Yes, there's all kinds of stuff that is bugging me with this. First is I don't use a ramp and if I did, it wouldn't be at 14 so no idea why it's starting at 14. Then my settings clearly show 15-20 and it did do a few above 15 so that the chart showed higher than 15 but many, many days are like that, looking stuck at 15.

Here is the DeVilbiss info:





Thanks
France

[Pugsy]

Hmm...it says no delay but is shows it starting at 14 on SH...so I guess it's a SH issue.
Support for Devilbiss was a last minute thing so it may not be polished.

The machine doesn't want to respond to the hyponeas...that's pretty evident. As to why not? I guess there weren't any warning signs that Devilbiss uses. Maybe something else is needed to trigger the pressure increases that isn't showing up.
I will be honest...I don't understand much about the way the Devilbiss wants to do things.

All I know to do is if the machine won't increase on it's own then perhaps do the increasing for it.

The Non Responsives...well there were several hyponeas happening no where near the NRs.

Are there enough hyponeas going along to impact how you feel? I don't know. On paper they shouldn't be in enough numbers to impact things all that much but often on paper doesn't match real life.

[BobHale]

Frence,

This is a link to the Intellipap Autoadjust Clinical Overview which explains how events are detected.
http://www.devilbisshealthcare.com/file ... T-2089.pdf
My unit does respond to hypopneas. You may want to check the firmware version on your unit or have it checked out.

I use the Intellipap for travel and a Resmed S9 Auto at home. The AHI numbers are significantly different between the machines but I seem to sleep as well using either one.

Bob

[mollete]

Well, the first question that one needs to ask is "Do one really need to club the hypopneas to death if there's only 25 of them?"

While the DeVilbiss hypopnea algorithm is very aggressive if there's concomitant snoring, it's a slug if there ain't:

http://www.sleepreviewmag.com/all-news/ ... y-pressure

[frapilu]

Hmm...it says no delay but is shows it starting at 14 on SH...so I guess it's a SH issue.
Support for Devilbiss was a last minute thing so it may not be polished.

The machine doesn't want to respond to the hyponeas...that's pretty evident. As to why not? I guess there weren't any warning signs that Devilbiss uses. Maybe something else is needed to trigger the pressure increases that isn't showing up.
I will be honest...I don't understand much about the way the Devilbiss wants to do things.

All I know to do is if the machine won't increase on it's own then perhaps do the increasing for it.

The Non Responsives...well there were several hyponeas happening no where near the NRs.

Are there enough hyponeas going along to impact how you feel? I don't know. On paper they shouldn't be in enough numbers to impact things all that much but often on paper doesn't match real life.

It helps that you're validating my impression that the DeVilbiss is not reacting to the hypopneas so I might give cpap.com or DeVilbiss a call to ask about it. It's a brand-new machine so seems to me it should work. I'm super tired so I'm assuming that it's due to the hypopneas but who knows. I had been tired before getting this machine I figure that was because the noise of my dying M series kept waking me (and hubby) up. Sigh, why can't anything be easy

Thanks.
France

[frapilu]

Frence,

This is a link to the Intellipap Autoadjust Clinical Overview which explains how events are detected.
http://www.devilbisshealthcare.com/file ... T-2089.pdf
My unit does respond to hypopneas. You may want to check the firmware version on your unit or have it checked out.

I use the Intellipap for travel and a Resmed S9 Auto at home. The AHI numbers are significantly different between the machines but I seem to sleep as well using either one.

Bob

Thanks Bob. I'll check this out. I'll probably also check with cpap.com and DeVilbiss to see about the firmware. In any case, I believe there's some sort of firmware fix I need to have done because when I press on the machine to get the quick numbers, if I go right, it tells me I have 31.5+ AHI but if I go left, it makes more sense. I've read some threads about that and it said something about getting a firmware update so perhaps my hypopneas are another one?

Thanks again
France

[frapilu]

Well, the first question that one needs to ask is "Do one really need to club the hypopneas to death if there's only 25 of them?"

While the DeVilbiss hypopnea algorithm is very aggressive if there's concomitant snoring, it's a slug if there ain't:

http://www.sleepreviewmag.com/all-news/ ... y-pressure

Thanks mollete. I'll read that article. Very interesting.

I agree that if I was feeling ok, I wouldn't feel the need to beat those hypopneas to death but I'm so tired. I drag myself out of bed every morning to go to work. On the weekends, I'm sleeping about 9-10 hours and still not waking up refreshed. Something's wrong. I kept being tired when my old, dying M Series Respironics kept waking me up with the noise so I was so hopeful that a new quiet machine would improve my sleep. It hasn't so I'm blaming the hypopneas. Mind you, I know it could possibly be something else but right now all I can think of is seeing if there's anything I can do about them.

By the way, I'm not sure why the DeVilbiss is pretending that I don't snore when my Encore Viewer reports from Respironics used to show lots of snoring. Good thing hubby sleeps like a rock but he has ocassionally mentioned the snoring so I seriously doubt that the DeVilbiss has magically "fixed" my snoring. By your comment, I'd think that it would behave aggressively because I do really have lots of snoring but it's like it's going to sleep with me

Thanks again.
France

[Pugsy]

Thank you mollete. I remember now...snores. That along with the criteria difference for hyponea count is going to let a person end up with a few more hyponeas than maybe the other machines with a little more % reduction needed to make criteria seems to explain the seemingly extra number of hyponeas.
I was thinking of "clubbing" them to death maybe to see if their presence explains the the general not so great feeling.
Going out on the proverbial limb trying to find maybe an answer.
Hyponea count is not horrible but maybe related to poor quality of sleep....of course there is that long list of other stuff that might also be a factor in poor quality sleep as well as feeling less than optimal the next day.

[herefishy]

Could you try your old machine for a while and nail it down the the new one?

[Dreamrobot]

I use th intellipap, and find it true it's not aggressive in cranking up the pressures. That is actually the reason I found useful when I tried the auto as it does not run away for me like the older remstar resp I have ( i suffer terribly with increased pressures). Even just half a point will make the difference between my machines on straight pap. Hope you find the right pressure to get relief of your symptoms,
Dreamrobot