Better APAP Machine - Airsense 10 Autoset or Dreamstation

[jweiner]

Which is your preference between these two popular APAP machines, and why?

[Pugsy]

You do realize that most people don't get a chance to use both brands/models and make an actual in use comparison.
Most people are going to have to rely on what they read about in the marketing material as to the minor differences. They won't have first hand experience to report because all they have ever used is the one machine brand or model.

The biggest difference between the 2 brands and in auto (apap) mode is the algorithm that each brand uses to determine whatever pressure adjustments are needed.
And if you have never tried the other algorithm you can't say that one is better (for you) than the other.

[LSAT]

The people using the Airsense will say theirs is best even though they haven't tried the Dreamstation and visa versa. Very few people have been able to try both. They are both good machines.

[Hannibal 2]

Which is your preference between these two popular APAP machines, and why?

If you're used to the Dreamstation algorithm and have had a good experience with it, then maybe better to stick with what you know.

[chunkyfrog]

You can go to the cpap.com site, and compare features and reviews.
Each has its advantages and disadvantages.
As a rule, Resmed are more expensive, but Respironics machines are easier to use off the grid.
Take your pick.

[jweiner]

Excellent points - thank you! Right now, I am not sure that I am happy with my Dreamstation. Despite 100% mask fit and adjusting the minimum pressure up to 7cm H20 (my typical maintenance pressure is about 10cm H20), It says that I still have "residual" AHIs in the 5-7 range.

[jds2001]

and adjusting the minimum pressure up to 7cm H20 (my typical maintenance pressure is about 10cm H20), It says that I still have "residual" AHIs in the 5-7 range.

Herein lies the problem. If the machine is adjusting to a much higher pressure, the Respironics algorithm is going to be less aggressive than the ResMed (from what I've read). My suggestion would be to adjust the minimum to 10, and see where that leads. Obviously, a little at a time - 7 to 10 is quite a jump!

I had a residual AHI of around 2 or so when I was at my titrated pressure of 8. Saw that it was jumping up to 9ish fairly often, so I adjusted the minimum to 9 (just a change of 1). My AHI is now less than 1, zero on some nights. Adjusting to a correct therapeutic pressure is essential.

[jweiner]

and adjusting the minimum pressure up to 7cm H20 (my typical maintenance pressure is about 10cm H20), It says that I still have "residual" AHIs in the 5-7 range.

Herein lies the problem. If the machine is adjusting to a much higher pressure, the Respironics algorithm is going to be less aggressive than the ResMed (from what I've read). My suggestion would be to adjust the minimum to 10, and see where that leads. Obviously, a little at a time - 7 to 10 is quite a jump!

I had a residual AHI of around 2 or so when I was at my titrated pressure of 8. Saw that it was jumping up to 9ish fairly often, so I adjusted the minimum to 9 (just a change of 1). My AHI is now less than 1, zero on some nights. Adjusting to a correct therapeutic pressure is essential.

But is it okay to adjust the minimum to 10 even if my average requirements are sometimes <10? Are you suggesting that the minimum pressure setting on the machine should be equal to my 90% pressure value?

[Pugsy]

It says that I still have "residual" AHIs in the 5-7 range.

What is the breakdown into each event category of that AHI....this is really important when you are evaluating pressure results.

When making evaluations to determine pressure needs...you have to make sure that what you are wanting to reduce/fix/eliminate is even fixable with more pressure from your machine.

Neither of the Respironics or the ResMed apap models will do anything at all for centrals/clear airway events. When the airway is open and no air is moving neither of these machines will do anything except twiddle their thumbs.

Now for obstructive apneas and hyponeas...ResMed is a teeny tiny bit faster in its response...so a bit more aggressive. Would that be better for you...dunno. You would need to try the other brand to see for sure.
There are very minor pros and cons with either brand. None are deal breakers or deal makers for that matter. They go about their jobs in slightly different directions (the difference in the algorithms) but they both end up at the same finish line when all said and done.

If your AHI is still predominately obstructive in nature then you probably need a little more than that 7 cm minimum.

[palerider]

But is it okay to adjust the minimum to 10 even if my average requirements are sometimes <10? Are you suggesting that the minimum pressure setting on the machine should be equal to my 90% pressure value?

wasn't that what was just suggested?

[Pugsy]

But is it okay to adjust the minimum to 10 even if my average requirements are sometimes <10? Are you suggesting that the minimum pressure setting on the machine should be equal to my 90% pressure value?

I wouldn't do it. Probably won't hurt you but you don't need it and I don't see any sense in using a lot more pressure than is really needed unless there are some special circumstances going on.

I don't agree with the idea of setting the minimum to 10 because there's a lot we don't know and nothing to justify it. It's a wild ass guess and I don't do wild ass guesses when data documentation is available via software reports.
If that AHI is primarily central/clear airway....no amount of pressure increase is going to fix them. If it's half central....no amount of pressure increase is going to fix it but it might reduce the obstructive stuff.

I would never suggest going from 7 minimum to 10 minimum without documentation that it was really needed...like AHI in the teens and primarily obstructive in nature.

90% numbers....these are numbers where you were AT OR BELOW for 90% of the night...they are NOT and overall average and they are NOT where you spent 90% of the night.
They are easily skewed upwards and they are not the holy grail of numbers where anything just has to be.
Especially with someone new to therapy where things tend to go all over the place...

[jweiner]

But is it okay to adjust the minimum to 10 even if my average requirements are sometimes <10? Are you suggesting that the minimum pressure setting on the machine should be equal to my 90% pressure value?

I wouldn't do it. Probably won't hurt you but you don't need it and I don't see any sense in using a lot more pressure than is really needed unless there are some special circumstances going on.

I don't agree with the idea of setting the minimum to 10 because there's a lot we don't know and nothing to justify it. It's a wild ass guess and I don't do wild ass guesses when data documentation is available via software reports.
If that AHI is primarily central/clear airway....no amount of pressure increase is going to fix them. If it's half central....no amount of pressure increase is going to fix it but it might reduce the obstructive stuff.

I would never suggest going from 7 minimum to 10 minimum without documentation that it was really needed...like AHI in the teens and primarily obstructive in nature.

90% numbers....these are numbers where you were AT OR BELOW for 90% of the night...they are NOT and overall average and they are NOT where you spent 90% of the night.
They are easily skewed upwards and they are not the holy grail of numbers where anything just has to be.
Especially with someone new to therapy where things tend to go all over the place...

Thanks Pugsy - I'll upload my data from SH tonight for your review. I've been at the 7cm H20 (per your recommendation) for the last few nights and the residual AHI really hasn't changed much (still 5-6).

[Pugsy]

Read my lips....

When you tell me AHI numbers...always, always, always give me the event category breakdown of that AHI.

The overall AHI is worthless without knowing the categories involved.

How much was the hourly index for each of the 3 categories that make up that AHI...it's really, really important to know because if it is primarily central/clear airway...more pressure won't fix it at all and might make things worse.

[JimW159]

But is it okay to adjust the minimum to 10 even if my average requirements are sometimes <10? Are you suggesting that the minimum pressure setting on the machine should be equal to my 90% pressure value?

90% numbers....these are numbers where you were AT OR BELOW for 90% of the night...they are NOT and overall average and they are NOT where you spent 90% of the night.
They are easily skewed upwards and they are not the holy grail of numbers where anything just has to be.
Especially with someone new to therapy where things tend to go all over the place...

+1
Indeed, if you are using SleepyHead to assess performance, the MEDIAN pressure number may give you a truer statement of where things are throughout the night.

[aspen]

I'm currently trialling both those machines. My CPAP company has lent me both and for my situation, I certainly have an opinion on which is better.

The ResMed machine increases much more quickly for events. I require this. The Dream Station isn't cutting it in this area.

However the way the pressure increase is triffered at the end of exhalation relief is markedly different. In this way the ResMed didn't work at all for me. The ResMed pressure increase is triggered by you taking a next breath. Sometimes I don't, then the lack of pressure collapses my airway. The Dream Station uses a time based increase to boost pressure.

I need a hybrid lol. Overall the Dreamstation is better for me.