PR to Resmed Transition - Need Help

[BP]

Nasal congestion may be playing a role. As I noted it has been bad the last few weeks, however last night I felt pretty clear going to bed using Astepro. I could have clogged up during the night, but I didn't notice.

[robysue1]

First, thanks so much to everyone who jumped on board, I very much appreciate it.

Ok, let me try to answer all the questions before posting any images.

1. I have been at 11-15 on my System One for about 4 years, and 10-15 for the 13 years before that.

Then in all honesty, I would set the AS11 at 11-15 for at least a few days.

2. I tried A-Flex initially but didn't like the in and out feeling, plus never had an issue exhaling against pressures up to 15.

EPR = off would best mimic the settings you were comfortable sleeping with on the old PR machine.

3. So, because of that I haven't tried EPR assuming it was the same kind of thing. Although never had pressures of 20 to deal with.

It could be that you really don't need pressures of up to 20 and that your AHI will settle back down to a more normal range once you are more used to the way the AS11 increases the pressures.

4. Also, I have never used a humidifier. The last time I tried I didn't like the warm air, felt suffocating to me (this was during my first year on APAP, 14 years ago, however). I actually enjoy the cool apap air.

Are you still using no humdifier?

5. And, along that line, while I do take antihistamines regularly, the congestion did not start with the AS11. I am trying a new spray called Astepro, which seems to be helping a lot. Sometime I do mouth breath as well.

How did you deal with the mouth breathing when using the PR System One? A similar approach should work for the Resmed machine.

6. The insomnia, but not the congestion, started with the AS11. It hasn't been every night, but it most likely due to my worry especially after I looked at how rapidly the AS11 increases pressure, and waking me up with the pressure a few times. My main issue is falling asleep rather than staying asleep. Sometimes I take some Ambien or Melatonin to help.

First, you say that your main problem is falling asleep. Is that at the beginning of the night or is that after you wake up because of the pressure?

Next, quit worrying about why the AS11 increases the pressure so rapidly. It's just a difference in the auto algorithm. It doesn't mean that something has somehow deteriorated in your OSA and that the AS11 is somehow doing a better job of responding. Rather it's that the AS11 is programmed to respond aggressively and your old PR System One was not. Both algorithms can deliver good quality treatment of OSA.

Since the rapid pressure increases are waking you up, that is a problem. It's possible that with more wakes, there is more SWJ breathing mixed into your data. And it's also possible that if your breathing becomes ragged when you wake up (wake breathing is often ragged compared to sleep breathing), the Resmed may be more prone to mistaking your normal wake and sleep transition breathing as sleep disordered breathing and raising the pressure even more. Which in turn can trigger more wakes/arousals and more SWJ stuff.

One thing that you can do when you wake up and realize you are having trouble breathing against a super high pressure is to turn the machine off and then back on. That will reset the pressure to your minimum pressure setting and that may let you get back to sleep much more quickly. If SWJ is tied up with some of the clusters of events, then that may make your data "look" better. But just as important, if turning the machine off and back on lets you get back to sleep more quickly after the pressure wakes you up, you might just get better quality sleep all around.

7. I did try Soft a couple of nights, I really didn't notice much difference. It still hit the same pressures, keeping in mind that I have been adjusting the ranges quite a bit, and I have only had 8 nights using the AS11.

Have you used the same settings on the AS11 for more than 1 or 2 nights in a row?

[qupte]8. My 95% pressure level is consistently around 12.5 on my System One, it is higher with my AS11. I don't have a lot of nights of data yet to determine a pattern, but I see 13.5, 16.5, 14.96, 16.66, and then a couple in the 12s.[/quote]Well, yes, if you allow your new machine to go to 20cm and the old one was limited to a max of 15, then it's not a surprise that your 95% is higher on the new machine. Particularly when the new machine is known to respond aggressively to anything it thinks might be a precursor to obstructive hyponeas and apneas.

[BP]

Then in all honesty, I would set the AS11 at 11-15 for at least a few days.

I agree with one small caveat. A pressure of 11 in System One seems greater than 11 on the AS11. Not sure why but I kind of felt starved for air at 11, a minimum pressure of 12 on the AS11 feels much more like what I am used to.

EPR = off would best mimic the settings you were comfortable sleeping with on the old PR machine.

Yes, I agree.

It could be that you really don't need pressures of up to 20 and that your AHI will settle back down to a more normal range once you are more used to the way the AS11 increases the pressures.

That would be great, I couldn't see in the numbers that the high pressures were helping that much.

Are you still using no humdifier?

I am not using the humidifier right now. I thought I would keep things the same as I am used to. Although I have heard it can help with congestion, my guess is the warm air will still not agree with me. But if things don't calm down maybe I will try.

How did you deal with the mouth breathing when using the PR System One? A similar approach should work for the Resmed machine.

Usually I might mouth breathe if slightly congested and the air flow will generally help. If I fall asleep mouth breathing I usually wake up very dry, uncomfortable but not a problem.

First, you say that your main problem is falling asleep. Is that at the beginning of the night or is that after you wake up because of the pressure?

For the most part it is at the beginning of the night, had this problem ever since I was a child. I go long stretches with no issues, but it does creep up regularly. If I wake up in the middle of the night, I usually go right back to sleep unless I start worrying about something, which does happen.

turn the machine off and then back on

Funny you should say that, I just started doing that the last few nights.

Have you used the same settings on the AS11 for more than 1 or 2 nights in a row?

No I really haven't and I get the point. I was going to wait to post until I had more data, but I thought the group may be able to give me some good advice to help circumvent some of the issues.

if you allow your new machine to go to 20cm and the old one was limited to a max of 15, then it's not a surprise that your 95% is higher on the new machine.

Yeah, seems like a no brainer doesn't it.

I guess my biggest hurdle is my total unfamiliarity with the Resmed algorithm. I'm still learning and hopefully will get things back on track. Thanks...