Interested in difference I noticed DreamStation v. Airsense

[svh]

I've been on CPAP for years and years, and switched to an auto machine (S9) maybe 7 years ago, when my second sleep study found that my apnea was highly positional. I've been very happy with the S9. But I've also suffered terribly from insomnia, even with 100% CPAP compliance. I went to a new doctor (pulmonary/sleep medicine specialist) over the holidays, and he's resolved the insomnia (pretty miraculously). I'm sleeping well now, for the first time in years, which is awesome. Life altering. That said, he wanted me to have a new machine. Really, he wanted me to have a DreamStation, because that's the one for which he can access detailed data from afar. So, I got that machine and tried it for two nights. I HATED it. It was louder than my S9 (mostly on the inhale), but more importantly, set at the same range and EPR, it felt completely different. My chest ached, as though I was getting too much air, and it seemed like it decreased the pressure (exhalation relief) too soon, which made me feel like I couldn't get a full breath without fighting the machine. I used it for two nights, and had much higher AHIs than usual (10-12 instead of 0-2).

I told the doctor, and I now have a ResMed Airsense 10 Autoset, which feels much more comfortable for me. I just find the whole experience curious, and wonder what it means. I'm seeing the sleep doctor for a follow up on Wednesday, so I'm just idly speculating, because I'm curious/interested, and I know from past experience that there are a lot of really well informed people on this board.

Thanks for any insight.

[ChicagoGranny]

It was louder than my S9 (mostly on the inhale), but more importantly, set at the same range and EPR, it felt completely different. My chest ached, as though I was getting too much air, and it seemed like it decreased the pressure (exhalation relief) too soon, which made me feel like I couldn't get a full breath without fighting the machine. I used it for two nights, and had much higher AHIs than usual (10-12 instead of 0-2).

You probably know they have different algorithms that drive how the machine responds to your breathing. But, I am surprised there was that much difference. Others have reported here switching from one machine to the other and finding a preference of one over the other. But, I don't remember any that saw that dramatic a difference. In any case, I'm glad you are back to a new ResMed machine.

he's resolved the insomnia (pretty miraculously). I'm sleeping well now, for the first time in years, which is awesome. Life altering.

Plenty of people here have suffered and still are suffering with insomnia. Maybe you want to share what the doctor did for you?

[svh]

Thank you. Yes, I'd read that the algorithms for the machines were different, but I was genuinely surprised that they FELT so different for me.

As to the insomnia, all my life, I've suffered with it on and off. I'd not sleep at all, practically, some nights, then take Ambien or clonopin to get myself back on track. This was more or less workable for years, but it got worse last summer, and I needed the meds too often; my body got used to them and they stopped working. As I was already on the highest dose I was comfortable with, I needed an alternative. I was pretty desperate, as it was really hard to carry on with life getting only maybe a couple of semi-decent nights sleep each week and basically worrying about sleep all the time.

I was fortunate to get a referral, through a friend, to a doctor who specializes in complex sleep apnea and other sleep disorders. He's a Harvard researcher, and is at the early stages of a study on what he calls Cyclic Sleep Disorder. Basically, I was desperate, and willing to do anything, so I let him experiment on me. His idea is that, in people who present with my history, he noticed a similarity to the sleep aspects of bipolar (not the emotional ones). The difference being that people suffering from actual bipolar tend to get into sleepless phases (manic) when they don't sleep at night, but also don't feel sleepy the next day. I felt terrible after not sleeping, which helped me fit into the profile he was looking for. Long story short, I'm taking a super low dose of lithium (150mg), and it has changed everything. I have no side effects. I get into bed and I fall asleep. I stay asleep ALL NIGHT. It's stunning. I'm happy to talk to anyone who is interested. This solution isn't for everyone, obviously, but for me it's been just amazing.

[ChicagoGranny]

Long story short, I'm taking a super low dose of lithium (150mg), and it has changed everything. I have no side effects. I get into bed and I fall asleep. I stay asleep ALL NIGHT. It's stunning. I'm happy to talk to anyone who is interested. This solution isn't for everyone, obviously, but for me it's been just amazing.

Excellent! Thanks for sharing.

[Pugsy]

I have used both brands of machines.
I always felt the Respironics was a bit noisier on inhale and sometimes (not all the time) the ResMed was a bit noisier on exhale.
Neither was a deal breaker for me as I tend to adapt to any change fairly easily. I am lucky in that regard...not everyone can adapt easily to change.

The exhale relief offered by each brand...again they are different in how they go about achieving that relief and not the same and what you describe with the Resprionics I also noticed. It's more of a timing issue than amount of relief. Timing of when the reduction happens and when the inhalation starts again. Pretty much what you described. It might have been able to overcome that discomfort with a bit of experimenting with the various Flex/relief settings available. Still wouldn't have addressed the inhale noise though.

So it doesn't surprise me that the change to the Resprionics caused a problem especially since you also have a history of insomnia. Your body doesn't like change and it will do anything to avoid dealing with it and the first defense is "not sleep".
I would bet that the bulk of the higher AHI on the Respironics was probably SWJ Sleep/Wake/Junk or falsely reported apnea events flagged while awake.
Some of it might have been a bit higher because of the less aggressive response of the Respironics algorithm but I would bet my last dollar that the bulk of it was SWJ since you report not sleeping well with it due to comfort from exhale issues and the noise bugging you.

The chest wall discomfort that was new....again most likely the difference in the pressures during exhale. The Respironics exhale relief made you "work" a little harder at the pressures you were using than you would have "worked" at on the ResMed machine due to the way ResMed drops the pressure during exhale and the timing or transition of that drop. There's also a chance that you ended up using more pressure with the Respironics overall due to that "less aggressive" response of the Respironics algorithm.

I have used both...and with ResMed's algorithm I find I can get by with less pressure minimums and still get the job done than I had to use with the Respironics.

It's funny...I have had a chance to talk a lot of Respironics users into trying the ResMed...I think only one person wanted to go back to Respironics.
All the rest (and there's a lot of them) preferred ResMed's way of doing things.
And almost all ResMed users (long term like yourself) who tried Respironics way of doing things said they preferred the ResMed.

I think a lot of it depends on what we initially start out with but once we use one way of doing things for a long time the body is used to that way of doing things and some people's bodies just don't like change. Now some people like myself can adapt easily to any change but others not so much.
Those people probably shouldn't be playing around changing stuff all the time.
The Respironics is a fine machine..make no mistake about it and I think that when first starting out on cpap therapy and having no prior history for the body to want to draw upon...I think most people would do well on either brand. Heck, I started my cpap therapy with a Respironics M Series Auto and didn't change to ResMed until some years later. I was quite happy with how things were going.

So there are some subtle differences though and for some people those differences end up being deal breakers or makers. It's just the way the cpap world goes.

As for figuring out a med that helps the insomnia...goes to what I have always said. Sometimes there is a time and place for all meds for any reason.
After just recently being engaged in my own insomnia battle (not cpap or sleep apnea related) I thoroughly understand. We just have to get some sleep and if that means a medication of some sort then so be it.
So congratulations on finding what works for you and for finding a doctor that can think outside the box and is willing to try different things until something works.

[svh]

Thank you so much for the detailed reply. I think you've hit the nail on the head--my problem with the DreamStation was a timing issue more than anything. Plus, I've always been a super light sleeper....I'm just glad I was able to swap the machine and get something that feels right for me. Hopefully new machine will give me years of good service. Plus, I have the s9 as a backup/travel machine. Excellent outcome. Thank you again.

[jnk...]

. . . I think a lot of it depends on what we initially start out with but once we use one way of doing things for a long time the body is used to that way of doing things . . .

That was my experience in my early days with bilevel. I was given the opportunity by a board member to try the other brand's version, so I did. I believe I could have adapted to it, but my brain was already adapted to the brand I had started out with.

. . . what he calls Cyclic Sleep Disorder. . . . similarity to the sleep aspects of bipolar (not the emotional ones). . . . Long story short, I'm taking a super low dose of lithium (150mg), and it has changed everything. I have no side effects. I get into bed and I fall asleep. I stay asleep ALL NIGHT. It's stunning. I'm happy to talk to anyone who is interested. This solution isn't for everyone, obviously, but for me it's been just amazing.

Thanks for sharing your experience!

Supporting material:

A relatively unique syndrome of recurrent insomnia . . . with cycling reminiscent of bipolar disorder but with stable mood; there are some similarities to KLS [Kleine-Levin syndrome]. So far the disorder has proven to be sensitive to low dose lithium, (serum levels between 0.2 to 0.3mg/dl) which is considered sub-therapeutic for bipolar disorder. KLS can respond to lithium. Recurrent insomnia may reside within a spectrum of “cycling” disorders which include bipolar disease and KLS. -- https://academic.oup.com/sleep/article- ... 09/3781527

[svh]

Thank you so much for the reference! One of the authors is my doctor—this is exactly what he’s treating me for. I'm glad to have a reference I can share when people ask.

[jnk...]

You are welcome, Sarah.

Interesting stuff!

And that picture made me do a double take: Could pass for a younger version of my little sister, who lives in Florida, of whom I am very proud because of her struggles and successes with her diagnosed actual bipolar condition.

[ShinRyoku]

It's funny...I have had a chance to talk a lot of Respironics users into trying the ResMed...I think only one person wanted to go back to Respironics.

I'm one of those people. To be honest though, I don't really notice much difference. The ResMed has a nicer screen, and sometimes I have to push the Respironics button twice for it to start. So I use the ResMed. But in terms of sound, comfort, algorithm, efficacy, there is little difference between them for my purposes.

[Janknitz]

I did not have a Dream Station, but a Philips Respironics System1 for 6 years. Then I switched to a ResMed AutoSet latest model. They are like night and day! The PRS1 WAS noisier, and I always felt as if I had to match my breathing to its rhythm, It was not natural for me. My husband, who has very poor hearing, could always hear "Darth Vader breathing" and my kids complained if we had to share a hotel room (though they admitted it was way better than me snoring!).

When I switched to the ResMed, it was like suddenly going to sleep on a cloud. I can't hear this machine, even when I try. I always have to check the exhaust to make sure it's on. And my breathing doesn't feel forced at all. It feels very natural. I thought I'd have a hard time adjusting, but it was easy and comfortable from the first night.

One other big difference is that the PRS1 never warmed the air from the machine. About 3 years in the heater on the humidifier died, but it didn't make any difference. While I keep the temperature down on my ResMed humidifier, it's never ice cold in the winter as the PRS1 always was.

I'm surprised at how much variation there is between the brands, and very grateful to have a ResMed.

[JimW159]

Thank you so much for the reference! One of the authors is my doctor—this is exactly what he’s treating me for. I'm glad to have a reference I can share when people ask.

One additional point of reference: https://sleep.med.harvard.edu/people/fa ... +Thomas+MD

[svh]

Thank you. I really appreciate everyone's interest and willingness to help.

[Holden4th]

I'm another who has gone back to Resmed (without Pugsy's recommendation though I'm sure she would have made it if I'd asked). My first successful machine was an S9 APAP loaner from the DME. I loved it. When I came to purchase (no insurance deals like the US in Australia) economics saw me get a Respironics PRS1 560 Auto. It worked quite well but not as well as I liked. I suppose my subconscious mind was referring back to the S9. I then decided to go BiPAP and bought the PRS1 760 Auto. It made significant improvements in my sleep comfort but some of the data I saw on SH just didn't add up.

I now own the S9 VPAP Auto and all those comfortable feelings have returned. My 760 will be my travel machine. I'm sure I can find a new home for a 560 with only 1000 hours on it.

[JimW159]

I'm sure I can find a new home for a 560 with only 1000 hours on it.

No doubt - from what I have seen on Australian eBay, the market seems quite active (and compared to the US, with vigorous pricing)
https://www.ebay.com.au/sch/i.html?_fro ... 5573.m1684