How Important is the Sleep Study? Self-treat user looking for opinions

[LSAT]

I think going for it. Just got a response that the unit is under 20 blower hours and comes with six month warranty.

Ask to see a picture of the run hours screen...I wouldn't believe the 20 hours.

[Fetou]

I think going for it. Just got a response that the unit is under 20 blower hours and comes with six month warranty.

Ask to see a picture of the run hours screen...I wouldn't believe the 20 hours.

I actually bought it from the Amazon seller that you posted last night, "thecpapco" and they appear to be a legitimate DME provider. They have really good reviews on Amazon, including other people who have bought their refurb CPAPs. With Amazon's guarantee extending to third party sellers, I pretty much have a no-risk 30 day period, so hopefully the seller is being honest with me, but I should be covered if not.

Apparently it comes with a new hose, new filters, etc as well, but no SD Card. I'm looking to buy one of those SD cards that I can leave in the machine and download the data with WiFi.

I found their retail website here: http://monitormedical.com/

[bonum.noctem]

Went through probably at least a half a dozen various bilevel models and now back to an apap. Rest assured if/when I can get my grubby little paws on an AirCurve 10 VAuto bilevel at some stupid cheap price...I will get one.

I'm slightly confused, I thought a BILEVEL machine is destined for patients with high pressure levels (above 15) and/or special needs. If you have a lower Auto CPAP pressure range, do you really feel a difference between 3 vs. 4 cm on exhale?

I didn't know that the DreamStation can only reduce exhale pressure by 2 cm, so going from a DreamStation Auto-CPAP to a ResMed AirSense 10 AutoSet should already make a difference, if 1 cm difference matters.

Now I'm unsure about my own plans because I don't know my pressure range yet. I assume it's not possible to conclude the expected max pressure from data found in the home screening report, is it? Because that's the only data I have so far.

What's your idea of a stupid cheap price? Secondwind CPAP currently has "gently used" VAuto machines with humidifier, heated tube and 1-year warranty available at $799.

I actually bought it from the Amazon seller that you posted last night, "thecpapco" and they appear to be a legitimate DME provider ... I found their retail website here: http://monitormedical.com

Just had a quick look at Amazon, but was unable to find a seller called "thecpapco" and their website does not list any used devices. Do you have a direct link to an offering from that seller on Amazon?

Anyway, since you already bought that machine, I am very interested in reading your experience with it and comparison to your DreamStation. When will you get your ResMed machine?

[Fetou]

I actually bought it from the Amazon seller that you posted last night, "thecpapco" and they appear to be a legitimate DME provider ... I found their retail website here: http://monitormedical.com

Just had a quick look at Amazon, but was unable to find a seller called "thecpapco" and their website does not list any used devices. Do you have a direct link to an offering from that seller on Amazon?

Anyway, since you already bought that machine, I am very interested in reading your experience with it and comparison to your DreamStation. When will you get your ResMed machine?

I will PM the link.

I will have the machine between Tuesday and Friday and will be sure to give a comparison.

[Pugsy]

I thought a BILEVEL machine is destined for patients with high pressure levels (above 15) and/or special needs. If you have a lower Auto CPAP pressure range, do you really feel a difference between 3 vs. 4 cm on exhale?

Anyone can use a bilevel machine...now whether they really need it or not can be another matter.
Forum member RobySue needed bilevel because of bad aerophagia even at her very low prescribed pressure of 8.
You don't have to be having pressures in the teens to appreciate the comfort or really need it.
memberlist.php?mode=viewprofile&u=52030
I am sorry but I don't have time to go find her BiPap personal experience stuff...but she uses
Minimum EPAP 4
PS range of 3 to 4 I think
Max IPAP 10...anything more than that the aerophagia monster comes to live.
When you have some time go poking around in her old posts...she's one smart lady.
Also she has a good blog
memberlist.php?mode=viewprofile&u=52030

Do I "need" it...probably not technically that doesn't stop me from liking to use it and sleeping better with it.

And yes...I can tell a difference between 3cm and 4 cm exhale relief or PS. You haven't had a chance to use these machines yet..sometimes 1 cm difference can be a deal maker or breaker for some people.

What's your idea of a stupid cheap price?

So cheap I can't pass it up..
Like I once bought this machine...AirCurve 10 ST for $100 plus 20 for mailing. Now it was used at 2200 hours but that didn't bother me. The woman selling it...it was her husband's machine...he had passed away.
At secondwindcpap....used is around $1379 US dollars...they didn't want the machine because they have a 2000 hour limit.
She offered it on the forum for $100...no one wanted it because it isn't auto anything. So I bought it.
That's a stupid cheap price. She got it out of the house and I got to try and AirCurve machine because back when I got that machine I hadn't tried any of the new model lines..AirSense or Air Curve.
She wanted it out of the house. I bought it and used it in fixed pressure S mode. It actually did a lot more than what I need and eventually I found someone who actually needed what the machine could do for central apnea. So it found a new home.

Secondwindcpap.com prices aren't stupid cheap...they are fair market retail price for what they offer. You get some sort of warranty and they have gone through the machine and made sure it works as expected. When I buy from a private person...I am on my own with it but if I get it cheap enough I don't care.

From a Respironics manual that most people haven't seen confirming what I said about 2 cm max even at setting of 3.

[palerider]

For me, I've got my eye on the VAuto. I sent an email inquiry last night on a refurb selling for $700 to get more details. The idea of having control of the ipap/epap rise timing is very attractive. I want breathing to feel as natural as humanly possible.

For me, the 'EasyBreathe" mode on the vauto (which is also on the airsense10 elite and autosets) is so smooth that it doesn't even feel like anything's happening, it just flows up to the higher pressure.

Here's what the pressure changes look like with a 3cm difference, on an autoset, vauto with EasyBreathe on, and a vauto with EasyBreathe off.

[SewTired]

I self treated before I had a sleep study because of the long time period between diagnosis and sleep study. If I had not already discovered through a fluke (hospitalized for IV antibiotics), I would not have discovered that I had a slow heart beat without the sleep study. So, if you aren't getting a sleep study, I do recommend at least borrowing something that shows O2 and heart rate while you are sleeping. After the actual sleep study, my lower setting was raised from 6 to 8. The doc simply said my minimum must always be at least 8 to get my oxygen level as high as possible. People here can help you interpret your results using Sleepyhead.

[Fetou]

I self treated before I had a sleep study because of the long time period between diagnosis and sleep study. If I had not already discovered through a fluke (hospitalized for IV antibiotics), I would not have discovered that I had a slow heart beat without the sleep study. So, if you aren't getting a sleep study, I do recommend at least borrowing something that shows O2 and heart rate while you are sleeping. After the actual sleep study, my lower setting was raised from 6 to 8. The doc simply said my minimum must always be at least 8 to get my oxygen level as high as possible. People here can help you interpret your results using Sleepyhead.

I will keep my eye on craigslist for cheap oximeters and get a data point on that in the future just to be informed. I've now spent all of the money I was considering spending on a sleep study in my initial post on equipment

[Fetou]

For me, I've got my eye on the VAuto. I sent an email inquiry last night on a refurb selling for $700 to get more details. The idea of having control of the ipap/epap rise timing is very attractive. I want breathing to feel as natural as humanly possible.

For me, the 'EasyBreathe" mode on the vauto (which is also on the airsense10 elite and autosets) is so smooth that it doesn't even feel like anything's happening, it just flows up to the higher pressure.

Here's what the pressure changes look like with a 3cm difference, on an autoset, vauto with EasyBreathe on, and a vauto with EasyBreathe off.
(img snip)

I was thumbing through the clinician manual on the Aircurve 10 VAuto that I just bought, and it appears that the EasyBreathe functionality is available in "S" mode, but not in the VAuto mode?

PDF Page 17/44 @ this link: https://www.oxystore.it/Brochures/37826 ... ow_eng.pdf

Perhaps it's more that EasyBreathe can't be turned off in VAuto instead of it can't be turned on? If so, I'm also curious how the EasyBreathe algorithm works in conjunction with the manual TiMax/TiMin and Trigger/Cycle settings.

Would it be accurate to say that "Rise Time" is the variable that EasyBreathe replaces, and all of the other variable settings I referenced above are completely independent of EasyBreathe?

Based on the charts in the manual, this is my understanding of the whole process:

1) Machine detects inhalation, which is the "Trigger" or start of one full breathing cycle.

2) Pressure increases to the sum of the EPAP Pressure + the fixed Pressure Support setting. The Trigger setting determines how aggressively/quickly this pressurization occurs.

3) Pressure will not decrease to EPAP for at least TiMin. TiMin makes sure that you don't take half-assed breaths before decreasing pressure?

4) Pressure may decrease to EPAP level if machine detects inhalation has ended prior to TiMax. This is called a "Cycle", and the cycle setting determines how aggressively/quickly depressurization occurs.

5) If the machine detects inhalation is still going on at TiMax, it will decrease to EPAP pressure before the exhale even begins. I don't really understand why anyone would want this time limit.

[palerider]

I was thumbing through the clinician manual on the Aircurve 10 VAuto that I just bought, and it appears that the EasyBreathe functionality is available in "S" mode, but not in the VAuto mode?
Perhaps it's more that EasyBreathe can't be turned off in VAuto instead of it can't be turned on?

That's correct, EasyBreathe is always on in vauto mode. It can be turned off in S mode and then you get a manual rise time setting instead.

If so, I'm also curious how the EasyBreathe algorithm works in conjunction with the manual TiMax/TiMin and Trigger/Cycle settings.

Doesn't have anything to do with it, really. all those are just timing of when the pressure change happens. Easybreath is how the pressure change is delivered, after it kicks off

Would it be accurate to say that "Rise Time" is the variable that EasyBreathe replaces, and all of the other variable settings I referenced above are completely independent of EasyBreathe?

DIdn't I just say that?

2) The Trigger setting determines how aggressively/quickly this pressurization occurs.

you mean Risetime/EasyBreathe. Trigger just determines how sensitive the machine is to your beginning inhalation... or perhaps, how much of a inhalation has to happen before it switches to ipap... tiny normal, or more...

4) Pressure may decrease to EPAP level if machine detects inhalation has ended prior to TiMax. This is called a "Cycle", and the cycle setting determines how aggressively/quickly depressurization occurs.

No, the Cycle setting determines exactly *when* the pressure drops back.. how sensitive it is to the beginning of exhalation.

5) If the machine detects inhalation is still going on at TiMax, it will decrease to EPAP pressure before the exhale even begins. I don't really understand why anyone would want this time limit.

Lung diseases. Some people have problems exhaling, so if their inhalation isn't limited properly, they end up with too much air in their lungs.

[Fetou]

(snip)

Thanks, that solved all of my confusion, and hopefully anyone else's who googles this topic in the future. "When" vs. "How" really clears it up. It looks like the most important part (the how/EasyBreathe) is automatic and I don't have to worry about it, so that's a plus. Maybe I tinker a bit with the Cycle setting to make sure there's no feeling of lag before the exhale relief kicks in, depending on how the default settings feel, but overall it seems like there is way less need for obsession with these settings than I originally imagined. Would I be correct in saying that an otherwise healthy person with OSA and no other pulmonary abnormalities is unlikely to be affected by TiMin/TiMax at all when set at the defaults?

When it comes to pressure support, is that something that should be eased into given that my current APAP's max relief is 2cm, or is it OK to just set it to 5cm PS right from the start? Ideally I want as much exhalation relief as possible without inducing centrals, as I have pretty much no centrals whatsoever to date except the brief unavoidable ones in the transition to sleep.

[Pugsy]

I would suggest PS of 4 to start with...don't go over 5 right now ...too much PS can trigger centrals in some people.
It's relatively rare but it's there.

Had a friend who was using a bilevel ..sent me a note all in a panic because she had a truckload of centrals where she never had centrals that amounted to much. Wondered what the hell was going on until I saw the report...she had decided to try PS of 10.

[Fetou]

Aircurve 10 Vauto has arrived. 16 hours as advertised, still has the plastic seals on the knob and screen. Sealed Climateline and new humidifier. Will report back on differences from the Dreamstation Auto.

Also have a few new CPAP oriented pillows and some new masks from Pugsy that got in today. Will give some feedback on everything after some testing. Thanks!

[Fetou]

I'm in love with the pressure support already. I almost lose focus on my breathing pattern and the fact that I have a mask on at all pretty quickly. The responsiveness between the pressure switches is amazing. I really enjoy how the screen will show the pressure bar going up on the inhale, and then dissipating immediately as you switch to exhale.

While neither machine was particularly noisy, the Resmed is definitely quieter.

I used the Brevida Pillows last night and definitely still don't have the fit down, which unfortunately sullied my sleepyhead data with large leaks for 35% of the night. The leaks are a shame, because without the data I wouldn't have thought I had any issue. The pillows are very comfortable and soft. Nothing of note was recorded during the non-leak periods.

I'm wondering if this machine will have less false flags for SWJ, as there seems to be noticeably less flags on my pre-sleep period than before. No practical difference in outcome, but would definitely prefer to have less crap datapoints to sort through.

Also look forward to more experimentation with this CPAPFit buckwheat pillow. I can add/remove fill and play around with digging cavities for the mask etc, and I need to get used to it. But right out of the box, it is way more comfortable than I expected. It's not hard like a brick or anything, but it doesn't give at all. The support is actually extremely pleasant. I thought I would be tearing out half the buckwheat before I could stand it.

Overall, I kind of feel bad about the idea of giving the Dreamstation to my mom now. As much as it is a great machine that will do the job, the comfort difference with the bi-level seems like it would be a large improvement for someone who may be difficult to get to comply with treatment if it is too unpleasant. I may keep the Dreamstation as my backup (or sell it and get a cheaper backup), and look into getting an S9 VPAP Auto for her to use. I think the prices should be more reasonable on the older models, and from what I've read there's not a terribly significant difference between the S9 and S10 VPAP Autos/VAutos.

[Pugsy]

Now you know why I say that most people once they go to bilevel they don't want to go back to single pressures.

For your mom...have her at least try the DreamStation APAP and see how she does and keep an eye out for a ResMed AutoSet for cheap..S9 or AirSense.
The AutoSet with EPR at 3 is so much like your VAuto if you use 3 PS that it's hard to feel the difference. I know because I have experimented with both. There's a reason that I call the AutoSet with EPR at 3 a poor man's bilevel because it is essentially a bilevel but limited to 3 PS.

Any yes...it can take a few nights to get the tension dialed in on any new mask to get the mask movement leaks down.
Even for me I always allow 3 nights of big leaks before I start really worrying when I am trying a brand new mask.
You had a new mask, new bed pillow and a new machine all in one night. Finding the right tension is really to be expected. Don't beat yourself up over it. As long as you don't spend much time with the leak over 35 L/min...the ResMed machine is going to be fairly accurate and not miss much. The first sign it might be missing something is very many unknown apnea flags. Those mean that something is going on but the machine can't quite figure it out because the leaks are making it difficult.

As for the DreamStation maybe flagging more SWJ...I have never used a DreamStation model so I don't know. The hyponea definition is only very slightly different between the 2 brands but the FL definition we don't have any way to know the criteria for it.
I don't spend much time or energy worrying about stuff that I know I can't ever really know the answer to or fix. I work on the stuff that is within my control.
Also there is the simple fact that sometimes a person just sleeps better for some reason with one brand/model over another.
And if you sleep better there's less chance of SWJ even happening.

I sleep good enough with Respironics (I used that brand for at least 3 years) but I sleep slightly better with ResMed. Since my sleep is already fragile from the arthritis pain issues...I take any improvements I can get and count my blessings.