Followed Board Advice - Please Compare 2 Days

[Pugsy]

I don't know that the new machine would have you get a better night. This is where I have to say "maybe" a lot.
You aren't having the rather large swings in pressure needs that I have. Not everyone does and those that do may not have it happen every night. That's what makes figuring out the "best way to do anything with whatever" so difficult. We simply don't sleep the same each night. What we have to be happy with is finding something that works well most of the time and accept that things are rarely perfect all the time.

We have to learn to accept that not all our bad sleep is sleep apnea related and we can't always fix all the problems we want to fix with the machine.

We can get you nice clean reports with the DreamStation and last night is an example.

Actually my recommendation for now is hold off on spending the money and work with what you have and see how you sleep and feel and lets see if you ever have much of a pressure change. The main advantage to the ResMed is the more rapid/aggressive response to the when the machine wants/needs to go higher and if you aren't going to have that need then there may not be much to be gained in that area.

Now as for the noise level difference...for me the difference was ever so slight.
My husband never could tell any difference.
Palerider noticed a significant difference in the whine but that was long ago and with the 50 series machine I think and Respironics has improved on the noise reduction thing...and also there seems to always be individual machines that are noisier than others.
Again I have NOT had a chance to use a DreamStation to compare the motor noise or inhale/exhale noise with the ResMed.
It's an expensive experiment for sure.

What I did with all my experiments was buy used at killer deal prices. I never could afford to pay full retail for these machines.
Now if a person isn't comfortable with a used machine for some reason then they have to buy new but for a 50 to 75% reduction in cost I was okay with used.

As far as wake ups during the night. It's normal to have a few like after a REM cycle. Normally we don't wake up enough to form a memory of the wake up and we just roll over and go right back to sleep. When we remember several wake ups it's a pretty safe bet that there were a few others we don't remember. For me a night with a half a dozen wake ups is a good night. I have a bad back and the pain messes with my sleep. Like you I prefer to sleep on my side but seem to navigate to my back and when I am on my back it causes more back/pelvic pain and I wake up. But then I also will wake up on my side and in pain. It sucks being old with arthritis and your pain meds cause insomnia. Damned if you do and damned if you don't.

I still don't wake up rearing to go run a marathon but at least I don't wake up feeling like I just ran one and got run over by a bus at the end. I have addressed the sleep apnea stuff the best I can and I will always have to work on the other stuff that the machine can't really improve on. As much as I wish the machine could fix all my sleep problems...it just can't fix problems unrelated to sleep apnea.

[MurrayNevada]

Good advice Pugsy. I will hold off on ordering the new machine. OK if I continue posting reports until I become more educated in interpreting the SleepyHead data? Your feedback is a tremendous help to me.

[Pugsy]

By all means, continue posting and even continue experimenting if you wish.
Do give your changes a reasonable trial length though once you get some consistent decent results.

Here's a brief history of what I did.
Started with an in lab titration pressure recommendation of 8 cm. Got myself an apap because that was what I wanted and I got it privately. Ended up costing me about what I would have paid using my insurance and my co pays.
Very quickly I discovered that 8 cm (started with 8 min and 10 max just to get started) minimum wasn't going to work because I spent the bulk of the night maxed out at 10 cm. Once I got my sleep study reports it was easy to see why 8 cm didn't work. My OSA is worse in REM and during the in lab titration I only got 6 minutes of REM. It was a bad night...didn't sleep well at all for a number of reasons.

Anyway I opened up the max just to see where it wanted to go and started raising the minimum in 0.5 cm increments until I had the AHI below 2.0. This ended up being at 10 cm minimum. Spent about 3 months there and things got all settled in and I was consistently seeing the AHI between 1 and 2 with rare below 1.0 and equally rare above 4.0. Then I decided to try more minimum to see if anything changed in terms of AHI or my sleep quality (remember I also have the back issues that complicate things). So I increased the minimum in 0.5 cm increments staying a week at each setting until I got to 13 cm minimum for a week. Took about 6 weeks to get it all done.

At the end of the 6 weeks I looked at the data and examined how I felt in general and realized that the AHI never really changed that much...still between 1 and 2 now that I look back on it I was probably having some sleep wake junk stuff get flagged like we have now (and you are having) that isn't real apnea events but back then we didn't have machines that gave us flow rate to examine like we can now. Also realized that I wasn't sleeping any better or feeling any better than I did with the 10 cm minimum.
So essentially no change in the data or how I felt. But I did answer a nagging question in my head which was "would more pressure make a significant improvement in anything" and it didn't.
This was with Respironics equipment. I chose it over ResMed at the time because back then Respironics machines offered more data than ResMed machines.

Fast forward a few years and I got a chance to try a ResMed machine because a forum member loaned one to me....and the rest was history in terms of experimenting with bilevels and ASV and whatever I could get my hands on until I ended up with the AirSense 10 for Her AutoSet (again a low hour used machine) mainly because I just wanted to test out the for Her mode and see what it really did.
I could get great therapy with any of the machines I tried at whatever pressures I ended up having to use with whatever model I happened to be using. I do better with auto adjusting because of the sometimes big changes during REM but I can do a fixed mode only machine. I just don't like it quite as well because I have to use a lot more fixed.

Moral of my story....give yourself a lot of time and try to find yourself a good inventory of patience so that you can learn more about yourself and your machine.
It took me at least 3 months to quit waking up often just because my brain wanted to tell me that there was an alien stuck on my face.

Get yourself dialed in on a pressure that seems good fairly consistently and then give yourself some time for the body and your brain to come to accept this new reality in your life. The brain likes things to be predictable and not change all the time so that it never knows what to expect. There is a lot of truth to the "give it time thing". When I was experimenting with bilevel to find optimal pressures I picked a set that gave me half way decent results and then didn't change anything for 6 weeks. At the end of the 6 weeks the AHI was averaging 50% less than when I started and I never changed anything.
It's hard to not want to change something but we all have rare fluke nights where things just go haywire and the knee jerk reaction is to change something to fix it but you can't fix what happened last night. It's done and over with and unless you make a habit of it...not much sense in worrying about a fluke night.

Having patience was my biggest challenge. It's not something I have an abundance of.

[MurrayNevada]

Good morning Pugsy,
Woke up a few times during the night. At one of my first wake-ups I found my mask ridiculously tight and seemed to be leaking. I loosened it and all was well and comfortable. Attached is last nights data in this post along with screen shots of expanded flow in this and the next post for possible interpretation.
Thank you,
Mike

[MurrayNevada]

Last 2 expanded flow:

[Pugsy]

Short on time today as it is my mom's chemo day so I have to take her to the big city.
Still looks loosely like REM clusters especially those in the first part of the night before the break in therapy.

I would increase the minimum another 0.5 cm if it were me. The machine isn't doing it for whatever reason so you will have to just start higher.

[Pugsy]

Well actually it did try to go higher for that second cluster but couldn't because of the 15 max. Might also think about opening the max to 20 and let the machine sort it out in addition to the increase in minimum.

[MurrayNevada]

The max was already set at 20cm. I will raise the minimum by .5cm as you suggest. The REM you mention probably accounts for the dream that woke me up at that time. Hope all goes well at the doctor visit.
Mike

[MurrayNevada]

Good morning Pugsy,
Hope all went well for you yesterday. Below is my screenshot from last night. I increased the minimum pressure by .5 to 10.5 and max remains at 20. Had a bit of trouble falling asleep at first. After that all seemed to go well. Question: If I am using a 10.5 minimum pressure on my current Respironics machine, what minimum pressure (guestimate would be good) do you think I could get away with using the RESMED "For Her" machine? I know you said it should be lower but I'm trying to learn just how much lower. It may be a comfort issue that would help me. Also, with the quicker to take action RESMED machine do you see this as a possible advantage in my case?
Thank you,
Mike

[Pugsy]

I knew you were going to ask me how much lower minimum maybe with the ResMed and I was so hoping you wouldn't do that.
I don't know.
Until Bruce in Canada made the switch and it looks like his minimum is going to be the same I would have said probably 2 cm at least.
Everybody is different in terms of pressure needs. Bruce's issue is mainly positional...with a little bit of probable REM component.
I thought he could get by with less but from his reports so far it's only maybe 1 cm less...on some nights.

Me...I can get by with 3 cm less.
But then like I said before my main issue is REM where I happen to need 6 to 8 cm more. You aren't having the same issue as I have in terms of pressure needs or at least I haven't seen it happen very often.
You are only going to maybe 14 or 15 max and it's rare and not for very long. I was seeing sometimes 18 cm max.

I hate to see you spend the money on the ResMed with so many "maybes".

Where in Nevada are you located?

[MurrayNevada]

I knew you were going to ask me how much lower minimum maybe with the ResMed and I was so hoping you wouldn't do that.

And I figured you knew that I was going to ask. Liked your answer as I will stay with my Respironics machine and not wonder forever if I could have done better with the other. I live in Las Vegas (not the city, but Clark County). I'm only about 15 minutes (northwest) from the Strip yet my neighbors have large properties and many horses. Much different than most folk's perception of Las Vegas. Some think we all live in the casino's and attended Bugsy Siegel High School. You mentioned you spent some years in Las Vegas. Where were you?

[Pugsy]

I was in Henderson. Black Mountain Cove area as the towers were on the mountain behind our sub division.
Not far off of Stephanie.
When we move out there (to be full time grandma to the grandson when he was born in 2002) we looked in your area because of the horse property (I have 2) but it was too pricey so we opted for Henderson and board the horses in Boulder City.
Moved back here when he started kindergarden...hated the city.
I live on 40 acres here in SW Missouri...still hate the city.
Now he comes here for a couple weeks in the summer and I spend Christmas out there.

Let me think on your situation a bit. I got a bunch of crap going on here right now.

[MurrayNevada]

When I flew a single engine Piper (PA-180) here years ago those Black Mountain towers were a good landmark for me and the airport tower. I moved here a long time ago and things were much less pricey when I bought here. We rarely get to the city and have only gone there a few times this year because of Vegas Golden Knights hockey games. This town is absolutely crazy over this NHL hockey team. All of my daughters and grandchildren live within a mile of me and my wife. Other than the sleeping, life is good. And even that is getting better due to your help. So generous of you.

[Pugsy]

Check your private message box. I have an idea I want to run by you.

[MurrayNevada]

Good morning Pugsy,
I woke up every hour for the first 2 or 3 hours and then things settled down. The big gap shows where my mask came apart and I had a bit of difficulty putting it back together. Looking at the mask in the light of day I should have had it back together in 30 seconds. I took off the ramp feature before bed last night and think I like it better without the ramp. It started off at my 10.5 minimum pressure and I didn't have to worry about how the mask would fit after it ramped up. For the first time last night, in the middle of the night, I placed a small piece of 3M Micropore surgical tape lightly over my lips. It worked well and I seemed more comfortable with no dry mouth. Will try that again tonight.
Thank you,
Mike