Is my new machine damaged?

[PEF]

This is really strange. I have used my new Dreamstation now for 3 nights. (I guess I should point out that, for the last 6 weeks or so, I have had increasingly bad nasal congestion that does not respond to anything. Usually worse at night than during the day. I have not had this problem for about 2 years). I am also not using the humidifier on the Dreamstation because it is so humid here. My sinuses seem to better with less humidity. I am also using a nasal mask most of the time, so far all my efforts to fall asleep and stay asleep with my Amara View FFM have failed. I know I need to get more used to it.

Anyway, the Sleepyhead data is totally different on the 2 different machines. My Resmed almost always reported AHI less than 1. By contrast, the Dreamstation is reporting AHI between 5 and 8. One night, I saw some periodic breathing. I will wait a little while to post contrast data, just in case I had a few unusual nights.

Does anyone know why the data can vary so much from machine to machine?

I also have to say that although the Resmed reported good data, I never felt the reality of that. The Dreamstation seems to be reporting the way I actually feel - not all that good.

[Pugsy]

You may need to alter the pressure a bit on the DreamStation.
The Respironics algorithm is not as aggressive as the ResMed algorithm. I have found that with ResMed machines I can use a little bit less minimum pressure to get the same job done as with the Respironics machine.

Is much of that AHI you are seeing now ClearAirway Index...or is it OA and hyponea?
If it is mostly ClearAirway it could just be reflective of poor sleep in general due to the congestion.

[PEF]

Hi Pugsy,

The vast majority of increase in events was hypoapneas, comprising slightly over 50% of the pie chart for all 3 nights. The smallest increase was CA´s. The rest is divided about equally between obstructive and flow limitation. Even on the Resmed, hypoapnea was always the largest category of events.

How right you are about the pressure. I discovered that the pressure at the same settings is noticeably lower on the PR. I did seem to be experiencing more air hunger when I used the PR, but thought it might have just been my imagination. I don´t know for sure, but instead of 5 min and 7 max, I am going to need at least 8 and perhaps 9 for my min. pressure. I also discovered a very small leak on a new hose I was using, so that could help to account for the pressure difference. I have to admit that I am disappointed that the PR machine did not complain more loudly about that than it did.

For now, I want to go back to my Resmed to get a week of baseline data for comparison before using the PR machine again. I am really impressed how well the Resmed handles my nasal congestion.

[Pugsy]

I discovered that the pressure at the same settings is noticeably lower on the PR.

Pressures are the same no matter which machine unless there is a problem with delivery and I doubt that there would be a problem. Now they can "seem" to be different because of how they go about things....like if you are using Flex relief or EPR relief. They are different and won't feel the same.

The algorithm itself is different in terms of how quickly the machine goes about lower or raising the pressure depending on what it may be sensing is going on in terms of flow reduction or other warning signs that the airway is collapsing.
But 5 cm on one machine is going to be 5 cm on another machine (unless there is a delivery problem) but that same 5 cm can "feel" different.

Also the definition may be a little different which will affect the scoring somewhat.
Like the definition for hyponea is at least 40% reduction in air flow for one brand (I forget which) and it's 50% for the other brand. If a person happens to have more flow reductions in the 40 to 50% range then that brand will score more hyponeas than the other brand simply because the other brand won't flag them because they didn't meet criteria.

It's one of the reasons that comparing AHI by itself between the 2 brands doesn't give us an apples to apples comparison. Definitions are different....response time is different...how they react or respond is different.

[Wulfman...]

Hi Pugsy,

The vast majority of increase in events was hypoapneas, comprising slightly over 50% of the pie chart for all 3 nights. The smallest increase was CA´s. The rest is divided about equally between obstructive and flow limitation. Even on the Resmed, hypoapnea was always the largest category of events.

How right you are about the pressure. I discovered that the pressure at the same settings is noticeably lower on the PR. I did seem to be experiencing more air hunger when I used the PR, but thought it might have just been my imagination. I don´t know for sure, but instead of 5 min and 7 max, I am going to need at least 8 and perhaps 9 for my min. pressure. I also discovered a very small leak on a new hose I was using, so that could help to account for the pressure difference. I have to admit that I am disappointed that the PR machine did not complain more loudly about that than it did.

For now, I want to go back to my Resmed to get a week of baseline data for comparison before using the PR machine again. I am really impressed how well the Resmed handles my nasal congestion.

You can do a quick check of it with this method.

viewtopic.php?f=1&t=4506&p=37259&hilit= ... ter#p37259

It was recently discussed in another thread, too.

Edit to add:
I would recommend setting the machine to a fixed pressure when testing the output with the container of water.
You may also want to try a couple of different pressures
And, as was mentioned in the link, be sure to put the hose far enough into the water before turning the machine on. If you don't, it could blow water all over the place.


Den

.

[PEF]

Wulfman, thanks so much for the link! I will do it just to see what the pressure really is.

Thanks, Pugsy for the explanation. I understand. I went through the menu options on the PR again and turned off Flex since I don´t need any type of exhale relief. I have a question about the ¨mask type¨option on the PR. It wants a number between 1X and 5X. I checked the docs on all my PR masks and the correct option for these is X1. When I looked at the doc for my Resmed P10, it said to use pillows, swift or marage. So what option do I use (if any) for the P10?, maybe just set it to none? Does this even matter?

So do you suggest I raise the pressure settings on the PR? Would this improve my AHI number? It looks so ugly compared to the Resmed. Which machine should I believe?

[Pugsy]

The mask resistance setting when using a ResMed product is really unavailable. The only masks with a Resistance setting are the Respironics masks. It's not a critical issue though and won't explain the difference in results. I just turned it off on my PR S1 machine.

So do you suggest I raise the pressure settings on the PR? Would this improve my AHI number? It looks so ugly compared to the Resmed. Which machine should I believe?

You believe both machines because both machines are reporting what they sense. They if they sense different things because of different response times or algorithms or definition...it doesn't necessarily mean one is right and the other is wrong...it just means they are different in both how they do their jobs and the definitions on what they sense that triggers the response.

If the bulk of your elevated AHI on the PR machine is OA or hyponea then yes...probably a little more pressure is needed and if mainly hyponea you may not need as much as you think.
So I would start with maybe just a little 0.5 cm increase in the minimum if you are using auto mode.
There's probably no reason to increase the maximum unless you are seeing the machine pegged out at the maximum for prolonged periods of time.

What about the other stuff shown on the events graph that don't count in the AHI?
Are you seeing many RERAs, FLs or snores?

[PEF]

I am seeing some RERA´s. 2 or 3 per night, not a lot. But a lot of FL´s. The FL´s agree with the Resmed machine. I always had moderate activity on my FL chart when using the Resmed, so I was prepared to see quite a lot of FL´s reported on the PR machine. My issues for the Resmed were always FL´s and leaks, but both were not really bad, but perhaps could use some improvement.

I DO have a couple of vibratory snore events per night on the PR.

I will try bumping up my min pressure to 5.5 and leave my max pressure where it is for now at 7. I have been very, very slowly raising my max pressure on the Resmed because I do see a lot of hugging the max pressure on my graphs. Like you said, that slight pressure increase may be enough to take care of the elevated hypoapneas.

last night, I switched back to using my Resmed and my AHI was .23 or something like that. 1 hypoapnea and 1 obstructive. I usually don´t see obstructives on the Resmed, but there will be 1 or 2 CA´s.

I had initially thought that I did have UARS, but probably not OSA. That is the main reason I never bothered with s sleep test. Robysue disagreed. She thought I perhaps did have mild OSA. I think she is right. So when I can get to the US for a longer period of time, I think I will try to get one done.

[PEF]

The first image represents a typical night on my Dreamstation.

The second represents a typical night on my Resmed.

Same mask and pressure, Swift FX for her and min 5, max 7.

Can anyone figure out why these are consistently so different?

I know about the Hypoapnea issues - Resmed threshold at 50% and Dreamstation at 40% - so maybe that explains those. But what about the increase in OA's on the Dreamstation? I very seldom saw any OA's on the Resmed.

Any idea why the Dreamstation is not able, under the current configuration, to give me better therapy??

I am really confused. Am I doing anything wrong?

After 2 weeks on the Dreamstation, my therapy has really deteriorated. I have started to experience choking episodes at night that I have not experienced since before I started CPAP.

[Julie]

There's no such thing as a hypoapnea!

[PEF]

OK, then what does the "H" mean then??

My version of Sleepyhead does not allow me to get rid of the pie chart - Sorry!

[Julie]

There are apneas and there are hypopneas (wannabe apneas, not completely obstructive apneas), but no hypoapneas - spelling, but nothing to do with the 'h'.

[Pugsy]

The 2 algorithms are different meaning they respond differently to apnea events or apnea event warning signs.
The ResMed is a bit more "aggressive" and will respond faster.

You can't expect exact duplication of the results with same pressures since they have different methods for doing their jobs.

So it's more than just the definition of hyponea...it's how each machine responds and while there's not a huge difference in the response, it is enough in your situation to get significantly different results.
To get equivalent results with the Respironics machine you are likely going to need to use a little more pressure...probably both minimum and maximum.

Some people find they do better with one machine's algorithm over the other brand. We don't know why but it happens.

I can't enlarge your images to see the details like the numbers and stuff. Everything is a bit too small to read easily but for me there is no need to redo them. I can see enough to get an idea.
Wouldn't change my above comments.
You are trying to compare apples and oranges and expect them to taste the same and they can't.

[PEF]

Hi Pugsy, thanks for the response. I guess it is finally sinking in.

I guess I just sometimes worry that something is really wrong with my therapy. But I am reassured by your comments.

One night on the Dreamstation, I did manage to sleep all night with my FFM, the Amara View, with the min pressure set to 5.5 and max set to 7.5. I was disappointed to find that the AHI did not improve much, so maybe the pressure needs to be even higher. However, the Dreamstation pressure increments are .5 (a feature I don't like). I cannot go up .5 using my nasal masks because that is too much pressure increase for me all at once. The mouth leaks, while not dramatic, wake me up all night. On my Resmed, I go up .2 and then wait for a several weeks before going up .2 again. So I will have to use the Resmed to get used to higher pressure and then try the higher pressure on the Dreamstation.

For now, I am going to use only the Resmed because I feel somewhat better using that machine.

[Pugsy]

Should you wish to try the DreamStation again how about just increasing the maximum and letting the machine go there (wherever there is) after you are asleep.
It might be enough to get you a little better therapy just to have it maybe go a little higher each night.
Since it wouldn't do it until you are asleep then it wouldn't be so initially uncomfortable.
It's very possible that just allowing a little more leeway with that maximum might be enough to reduce those hyponeas, etc.