Switched from PR System1 to ResMed AirSense 11 Autoset

[ChrisD]

Good Evening to the Collective.

After 10 years and 29,000+ hours on a Phillips Respironics System One (DS550HS), I've made the switch last Saturday to the ResMed AirSense 11 Autoset w/climate line hose. Still getting settled in with the new machine and mask. I've gone from the Phillips Respironics TrueBlue nasal mask to the ResMed AirFit N20 nasal mask. Total switchover to ResMed. I'm really enjoying the leap in technology with the heated hose, quietness, touch screen, and myAir app that shows my nightly numbers.

From OSCAR:
Last weeks average AHI on the PRS1 was .31, Average Leak Rate 3.28, 95% leak Rate 11.00, % time above leak rate threshold 1.76%, Sleep study doc recommended pressure set to 11-14 range. This is the pressure I used for 10 years.
Last weeks average AHI on the AirSense was .25, Average Leak Rate 13.26, 95% leak Rate 36.00, % time above leak rate threshold 15.18%, New sleep doc (no sleep study) recommended pressure set to 4-20. I reset the pressure to 10-15 during the first night.

AHI looks good but I'm feeling like the mask may need to be adjusted more or it's the wrong mask for me. I'm a side/stomach sleeper using a regular pillow. The myAir mask scores for last week are 13/20, 7/20, 10/20, 8/20, 16/20, 9/20, 12/20

So for my fellow ResMed AirSense users:
1. Any need to know info/tweaks for the AirSense 11 that helped you?
2. Any suggestions on getting leaks using the AirFit N20 under control? I'm using the correct cushion size according to the included guide. I've watched the ResMed fitting video.
3. Does ResMed have a "Master Catalog" that show all their offerings and part numbers? Phillips Respironics has https://images.philips.com/is/content/P ... pitals.pdf I've found the ResMed Product manual library https://www.resmed.com/en-us/sleep-apne ... t-manuals/ but I'm hoping for an all in one offering.

Thanks in advance for any and all replies.
Chris

[LSAT]

Mouth breathing?

[palerider]

Average Leak Rate 3.28, 95% leak Rate 11.00, % time above leak rate threshold 1.76%,
Average Leak Rate 13.26, 95% leak Rate 36.00, % time above leak rate threshold 15.18%,

Respironics and Resmed calculate the leak rates *totally* differently, there's no comparison.

However, your leaks with the new mask are higher than the machine likes. Why don't you try your old mask?

Sleep study doc recommended pressure set to 11-14 range. This is the pressure I used for 10 years.

Needs do change over time.

New sleep doc (no sleep study) recommended pressure set to 4-20. I reset the pressure to 10-15 during the first night.

However, they will never change in such a way that leaving the machine at the default setting is appropriate.

That's a stupid recommendation, be wary of the new doctor.

[dataq1]

That's a stupid recommendation, be wary of the new doctor.

Please explain why that is a stupid recommendation.
In order to understand your reasoning people need to hear your explanation.

[Tec5]

I get why ChrisD set his minimum pressure at 10 (he's been using that for years) but why is setting his maximum to 20 "stupid"?
(apparently ChrisD already knows that he needs at least 10 cm all night long)

If the new apap senses conditions that warrant increasing the pressure above 14 cm, is there some reason that the machine should arbitrarily be prevented from increasing the pressure ?

[palerider]

I get why ChrisD set his minimum pressure at 10 (he's been using that for years) but why is setting his maximum to 20 "stupid"?

It's not, I never said, or implied that it was, in fact if you read any of my posts recommending settings, I always recommend people set the max to 20 (or 25 depending on the machine capabilities).

it's the "4-20" over all setting that's stupid.

And Chris changed away from that stupid setting.

If the new apap senses conditions that warrant increasing the pressure above 14 cm, is there some reason that the machine should arbitrarily be prevented from increasing the pressure ?

Which is why I tell people to set their max to 20.

[chunkyfrog]

20 is a realistic maximum pressure for most people.
I am one of the rare frogs whose breathing is easily misinterpreted
by the machine; so a maximum of 14 works better for me.
(20 wakes me repeatedly--just makes me cuss out loud.)
My numbers are as good as I can get, and still sleep.
My advice is to be flexible, and consider advice relative to experience of the giver.
There is no better coach than an old player.

[Tec5]

Scenerio:
ChrisD: "Doc, Palerider says that your prescription / recommendation of 4-20 is stupid and that I should be wary of you"
Doc: "Why is it "stupid""
ChrisD: "I don't know"
Doc" "WTF"

So why is it a stupid ?

[Pugsy]

The default settings of 4 - 20 are just factory preset settings. Not and actual prescription setting unless the doctor doesn't understand how auto adjusting pressure settings work and often a potential cause for someone bailing on cpap therapy because "it didn't help".

Sure the machine will try to auto adjust upwards in terms of pressure if it senses the criteria that it has programmed in it's algorithm to respond to....BUT....even if it senses whatever and wants to increase the pressure it can't/won't do it in the blink of an eye. Since these machines won't do ANYTHING at all but twiddle its little thumbs when some sort of apnea event is happening there is the potential for delayed optimal responses to obstructive events.

If someone happens to need pressures above 10 cm to optimally hold the airway open there is a good chance that the machine won't get there fast enough what with the do nothing during the event and the fact it goes up in stages rather slowly the patient could have a truckload of events happen between 4 cm and the above 10 cm that someone might need.

So the setting of 4 cm minimum starting point might work out okay if someone only needs 7 or 8 cm to hold the airway open optimally....it's going to fail miserably if there happens to be a need for 14 cm pressure to hold the airway open and prevent the collapses.

Also at the setting of 4 cm starting point the majority of people will say they are suffocating at that pressure and they can't exhale against it....another "can't do" excuse for bailing on cpap therapy.
When actually they aren't suffocating at all but it feels like it because there is simply not much air movement.
Plus if EPR is turned on and used...at the setting of 4 cm the patient won't get a drop during exhale to help with comfort when moving air. The machine can't go below 4 cm at all....so even with EPR at 3 the machine can't drop at all when the setting is 4 cm.
Not to mention that often DMEs will also leave the default ramp setting turned on....and during ramp the machine doesn't sense events, doesn't flag events and doesn't respond to any events.

Default settings are okay to start with during the initial beginning of therapy when no one knows what pressure is needed to optimally hold the airway open but after a short period of time the settings should be re-evaluated to see if a higher minimum is needed to better hold the airway open and prevent the airway collapses.

Better settings in terms of comfort and therapy would be maybe a minimum of 7 cm...EPR set to 3 and maximum 20 cm (usually no need to limit the maximum unless higher pressures cause a problem like aerophagia or centrals) .
Having a higher maximum doesn't affect the overall algorithm at all. The machine won't go anywhere up there without a good reason.

To give a machine to an established cpap user like the OP here at the factory defaults is a recipe for disaster. He's already proven he needs a much higher minimum pressure on the old machine.
He's going to feel like he is suffocating for sure because 4 cm simply isn't no where near what he is used to having....plus it's going to take too long for the machine to get to where it needs to go to best prevent the apnea events.

There several reasons 4 to 20 aren't the best option...and only a couple of reasons why it might be helpful but the person needs to be monitored closely if 4 minimum is what is being used.

So is it always "stupid" to be using the factory defaults??? Maybe not but the chances of it being stupid are much higher than the chances of it working out okay for someone.

Settings of 4 to 20 and no follow up planned....that's not a prescription. That's just factory defaults and lazy DME and/or doctor.

The minimum pressure is going to be the most critical setting. It needs to be high enough to prevent the collapse of the airway in general and it needs a range where it can go there if something unusual happens beyond the normal.
Like...supine sleeping or REM or whatever.

[Tec5]

Sure the machine will try to auto adjust upwards in terms of pressure if it senses the criteria that it has programmed in it's algorithm to respond to....BUT....even if it senses whatever and wants to increase the pressure it can't/won't do it in the blink of an eye. Since these machines won't do ANYTHING at all but twiddle its little thumbs when some sort of apnea event is happening there is the potential for delayed optimal responses to obstructive events.

So it sounds like your reasoning (mainly) is a perceived delay between and event or flow limitation and the response (by the machine) in increasing the pressure.

Have these delays been quantified?
Are the reaction delays different as a function of the current pressure. (that is, is the reaction delay greater at, say 5 cm than at 10cm)?

(On my Airsense 11 Autoset the reaction time for a flow limitation change from 0,00 to 0.13 is about 1.5 sec) YMMV

As to comfort, I can't speak for the majority, but will say that in my close family members (about 5) all find that starting the sleep session at the pressure of 4 and allowing the machine to do what it was designed to do (increase as called for) is more comfortable than arbitrarily stating at a higher pressure (say 75% of one's highest pressure), again YMMV.

Interesting technical discussion, but my main revulsion is to precipitously calling the Dr's recommendation "stupid" without qualification or explanation.

[Dog Slobber]

The default settings of 4 - 20 are just factory preset settings. Not and actual prescription setting unless the doctor doesn't understand how auto adjusting pressure settings work and often a potential cause for someone bailing on cpap therapy because "it didn't help".

Sure the machine will try to auto adjust upwards in terms of pressure if it senses the criteria that it has programmed in it's algorithm to respond to....BUT....even if it senses whatever and wants to increase the pressure it can't/won't do it in the blink of an eye. Since these machines won't do ANYTHING at all but twiddle its little thumbs when some sort of apnea event is happening there is the potential for delayed optimal responses to obstructive events.

If someone happens to need pressures above 10 cm to optimally hold the airway open there is a good chance that the machine won't get there fast enough what with the do nothing during the event and the fact it goes up in stages rather slowly the patient could have a truckload of events happen between 4 cm and the above 10 cm that someone might need.

So the setting of 4 cm minimum starting point might work out okay if someone only needs 7 or 8 cm to hold the airway open optimally....it's going to fail miserably if there happens to be a need for 14 cm pressure to hold the airway open and prevent the collapses.

Also at the setting of 4 cm starting point the majority of people will say they are suffocating at that pressure and they can't exhale against it....another "can't do" excuse for bailing on cpap therapy.
When actually they aren't suffocating at all but it feels like it because there is simply not much air movement.
Plus if EPR is turned on and used...at the setting of 4 cm the patient won't get a drop during exhale to help with comfort when moving air. The machine can't go below 4 cm at all....so even with EPR at 3 the machine can't drop at all when the setting is 4 cm.
Not to mention that often DMEs will also leave the default ramp setting turned on....and during ramp the machine doesn't sense events, doesn't flag events and doesn't respond to any events.

Default settings are okay to start with during the initial beginning of therapy when no one knows what pressure is needed to optimally hold the airway open but after a short period of time the settings should be re-evaluated to see if a higher minimum is needed to better hold the airway open and prevent the airway collapses.

Better settings in terms of comfort and therapy would be maybe a minimum of 7 cm...EPR set to 3 and maximum 20 cm (usually no need to limit the maximum unless higher pressures cause a problem like aerophagia or centrals) .
Having a higher maximum doesn't affect the overall algorithm at all. The machine won't go anywhere up there without a good reason.

To give a machine to an established cpap user like the OP here at the factory defaults is a recipe for disaster. He's already proven he needs a much higher minimum pressure on the old machine.
He's going to feel like he is suffocating for sure because 4 cm simply isn't no where near what he is used to having....plus it's going to take too long for the machine to get to where it needs to go to best prevent the apnea events.

There several reasons 4 to 20 aren't the best option...and only a couple of reasons why it might be helpful but the person needs to be monitored closely if 4 minimum is what is being used.

So is it always "stupid" to be using the factory defaults??? Maybe not but the chances of it being stupid are much higher than the chances of it working out okay for someone.

Settings of 4 to 20 and no follow up planned....that's not a prescription. That's just factory defaults and lazy DME and/or doctor.

The minimum pressure is going to be the most critical setting. It needs to be high enough to prevent the collapse of the airway in general and it needs a range where it can go there if something unusual happens beyond the normal.
Like...supine sleeping or REM or whatever.

So it sounds like your reasoning (mainly) is a perceived delay between and event or flow limitation and the response (by the machine) in increasing the pressure.

Have these delays been quantified?
Are the reaction delays different as a function of the current pressure. (that is, is the reaction delay greater at, say 5 cm than at 10cm)?

(On my Airsense 11 Autoset the reaction time for a flow limitation change from 0,00 to 0.13 is about 1.5 sec) YMMV

As to comfort, I can't speak for the majority, but will say that in my close family members (about 5) all find that starting the sleep session at the pressure of 4 and allowing the machine to do what it was designed to do (increase as called for) is more comfortable than arbitrarily stating at a higher pressure (say 75% of one's highest pressure), again YMMV.

Interesting technical discussion, but my main revulsion is to precipitously calling the Dr's recommendation "stupid" without qualification or explanation.

You ask why the change to 4-20 was stupid.

Pugsy takes her time to write a thoughtful significant explanation, and this is how you respond?

I'm guessing you're too much of an ignorant, argumentative f@%&, to even understand how rude you are.

[ChrisD]

[ChrisD]

Mouth breathing?

Could be. I've noticed I've been waking up with a dry mouth some mornings lately. I'll look into a chin strap and see it that helps.

Thanks,
Chris

[dataq1]

Interesting technical discussion, but my main revulsion is to precipitously calling the Dr's recommendation "stupid" without qualification or explanation.

yep

[chunkyfrog]

I would FIRE any doctor insisting my cpap be left at factory defaults.
His JOB is helping me find an effective range for TREATMENT;
not promoting my failure at using cpap.
I fired one doctor because he was senile, another because she ignored
a debilitating, but correctable disorder.
They were not necessarily "stupid",
but unable or unwilling to be the doctors I needed.
Factory defaults exist for some reason or other,
but I doubt they are appropriate for ANYONE but a very few.