Experimenting with a Resmed AirCurve 10

[robysue1]

The companies have different criteria:

Resmed:
Glossary of Sleep Apnea Terms
Hypopnea is a partial blockage of the airway (shallow breathing). During a hypopnea, breathing is reduced by 50% for 10 seconds or longer.

Philips
https://www.philips.com/c-dam/b2c/ko_KR ... report.pdf
Hypopnea(H): defined by a 40% reduction in airflow for at least 10 seconds.

I might just use Oscar/SleepyHead's "custom flagging" to see what might have been flagged by a PR machine under that definition that is not getting flagged by the Resmed machine.

But truth to tell: Even though my diagnostic sleep test showed that my untreated OSA consisted almost entirely of "hypopneas with arousal", all of the machines I've used in all modes score more OAs than Hs on a typical night. And that list of machines & modes is pretty extensive: Resmed S9 AutoSet in both CPAP and APAP modes, two PR System One BiPAP Autos in both fixed and auto BiPAP modes, a PR DreamStation BiPAP Auto in auto mode, and now a Resmed AirCurve 10 Vauto in auto mode. They all have scored more OAs than Hs for me. But on all of them, once the pressure was dialed in, the AHIs were low enough for effective treatment. I've gone back and checked the data going all the way back to 2010: On the Resmeds, a typical AHI has been between 0.5 and 1.5. On the PRs, a typical AHI has been between 1.0 and 2.5.

We know that Respironics flags more flow limitations than does Philips and responds to them rather aggressively.

I think you mean to say: We know that Resmed flags more flow limitations than does Philips and responds to them rather aggressively. And I agree with that corrected statement.

The Resmed's aggressive response to increasing pressure in response to flow limitations was one of the reasons I was worried about switching to an AirCurve. I've experimented with increasing the max pressure setting on my PR DreamStation in the past since I often have a median IPAP = 9 on that machine (while the EPAP is often still at 4 cm). Every time I've opened the Max IPAP setting up to something higher than 9, the PR Search algorithm together with flow limitations that the PR machine does score leads to me using pretty close to the max IPAP setting for long periods of the night, but there is no reduction in my AHI (sometimes there is an increase in the AHI) and there is a noticeable deterioration in how I feel when I wake up and function during the daytime when I allow IPAP to get above 9cm. A lot of that deterioration in "how do I feel" is due to increased aerophagia when I increase the Max IPAP setting.

In other words, for me there seems to be a point of diminishing returns when it comes to increasing IPAP pressure in an effort to eliminate flow reductions. If the IPAP is allowed to go to 10cm or above, it doesn't really eliminate many more flow reductions and it does cause more overall problems due to waking up with aerophagia. And it can, bizarrely, increase the number of OAs that get scored in my data.

[naturalctx]

I am about to start BiPAP therapy after failing CPAP many years ago, and this is the machine my doctor has ordered and insists works best (Aircurve 10 Vauto). Just in the long waiting period to try to get the DME I picked to confirm they have one or not. I'm hoping I have good results and really want it to work this time. CPAP showed not effective for me in my titration study, which explains why therapy failed for me 15 or so years ago. Thanks for the detailed rundown of the quirks and features of this machine. It was helpful to flag things to look for once I (finally) get to start using mine!

[ozij]

I think you mean to say: We know that Resmed flags more flow limitations than does Philips and responds to them rather taggressively. And I agree with that corrected statement.

You're right of course, that's what I meant to say.

[lazarus]

If I were given the choice between calculus and water torture, I would need some time to deliberate before choosing.

But thank you, RobySue for dignifying this forum with the documentation of your AirCurve 10 experimentation.

[robysue1]

Night 8
Last night was a pretty good night, although it was a short sleep night because I got to bed late and had to get up early for an Open House at work that I thought was today, but in reality it's next week. Here's the data (as shown in Oscar) for the night:

On paper this is a really good night for me.

So how did I feel? I felt pretty good when I woke up. And there was no aerophagia. I've felt pretty good most of the day.

I do remember two of the wakes last night. The first was when I had to fiddle with something, but I don't recall what the heck I had to fiddle with. It could be the covers. Or the hose. Or the mask. Or perhaps a bit of rainout. Or a very small leak (although there is no leaking reported on the graph). Whatever it was, I must have fixed it reasonably quickly and then got back to sleep. I'm pretty sure that the wake I remember is the one around 4:15 am.

The second wake I remember is the one at 6:32. Because I thought I had to be at Open House, I set my alarm clock last night. But because my alarm clock is still on daylight time (long story that I won't get into here), the alarm went off at 6:30 instead of 7:30 like it was supposed to. The alarm sounds like chirping birds and it starts off super quiet and gets louder and louder the longer you ignore it typically takes me about 2 or 3 minutes to respond to the alarm because it really does sound just like birds chirping outside the window. At any rate, when I realized that it was only 6:30 (because it was way too dark to be 7:30), I turned the alarm off and then went back to sleep for one more hour.

Once again, Oscar is messing up the Session information: I turned the machine on a total of 4 times last night, but Oscar has run the second and third sessions together as a 2:13 long session.

As for the two events that got recorded: When I zoom in on the one hypopnea, it looks like this might be a real event or it might be a post arousal event. The breaths immediately preceding the event are ambiguous:


The OA scored later in the night is some kind of post arousal event. (The FitBit data also indicates a short wake at this time.) My guess is that I may have turned over in bed and held my breath while doing so:


Here is the score card through Night 8:
Aerophagia: 3 nights worse than usual compared to the DreamStation; 5 night about the same (or better) as the DreamStation
Wakes & Arousals: 3 nights worse than usual compared to the DreamStation; 5 night about the same (or better) as the DreamStation
Feeling on Wake: 2 nights worse than usual compared to the DreamStation; 6 nights about the same (or better) as the DreamStation

[robysue1]

Night 9
Here's the Night 9 data:

Again, on paper this is a really great night. So how did I feel? Pretty good actually.

I did put the ClimateLine (heated hose) on the machine last night. The right angle elbow that clicks into the machine's pivot at the back makes a big difference for me in terms of being able to turn over. I've ordered one from cpap.com since I do want to be able to use unheated hoses with the AirCurve 10 Vauto I've ordered from a local DME that takes my insurance.

I had the ClimateLine hose set to something like 64F (I think), which is maybe a couple of degrees warmer than we keep the bedroom during cold weather. And it has finally gotten cold here in Buffalo: We're having our first frost/freeze of the season tonight and there were flurries coming off the lake today. I also kept the humidifier set at 8. The nose is already close to being too dried out so I don't really want to turn the humidifier down.

I also put the ClimateLine in a hoze cozy. I know this is not needed for rainout protection. But I hug the hose at night and hugging a plastic hose does not have the same appeal as hugging a fleece covered hose. The hose cozy makes the hose feel like a stuffed toy snake; hence hubby and I refer to any xPAPs as a "Kaa".

With the hose set at 64F (virtually unheated) and the humidifier set to 8, there was a bit of rainout, but not enough to make the hose start gurgling. My nose was reasonably happy. (The nose is always happier on a night where I get a bit of rainout---it seems to want to sleep in a dense, cool fog.)

I'm going to leave the hose temp the same for a night or two. I may then cautiously raise the temp a bit more in an effort to see whether the nose would like some additional actual heat or not.

Well it's time to slather the lips (which are slightly chapped) with whatever kind of petroleum-free chapstick-type lip balm I've got by my bedside. I've been out of Badger Balm for a while, but with winter fast approaching, it may be time to bite the bullet and order some.

Here is the score card through Night 9:
Aerophagia: 3 nights worse than usual compared to the DreamStation; 6 night about the same (or better) as the DreamStation
Wakes & Arousals: 3 nights worse than usual compared to the DreamStation; 6 night about the same (or better) as the DreamStation
Feeling on Wake: 2 nights worse than usual compared to the DreamStation; 7 nights about the same (or better) as the DreamStation

[robysue1]

Night 10
The machine scored AHI was higher last night---as in all the way up to 0.68:


Oscar is still not showing the session data correctly for my current AirCurve: There were 3 times that I turned the machine OFF and back ON during the night. The session lengths are roughly 90 minutes, 40 minutes, 190 minutes (i.e. 3+ hours), and 15 minutes.

There was a grand total of four OAs scored, but of those four OAs that were scored, two were pretty clearly in the middle of an arousal of some sort---I suspect it was to turn over in bed. Here's one of those OAs close up:



The other two OAs occur kind of close together in the final "session" of the night. I had to set the alarm for 7:00 AM this morning because I had a routine physical exam with my PCP scheduled at 8:00. But I woke up a bit too early---as in I woke up at 6:40 and I really didn't want to get out of bed---our bedroom is chilly now that the weather has decided to be much more seasonal up here in Buffalo. (Our current forecast includes the words "Lake Effect snow" on Thursday night right now.) So I decided to lie back down and try to get a few more winks.

In scrolling through the flow rate graph zoomed in to where I can see individual breaths, it looks like I probably got back to sleep by 6:44 or 6:45. A few minutes later, what looks like a real OA happened. Four minutes later, the second likely real OA happened. And clearly I aroused after that second OA. Here's what the breathing looks like zoomed in enough to see a bit of sleep breathing before the first OA in the image as well as the recovery breaths/arousal after the second one:


I felt pretty decent when I woke up and got out of bed at 7:00 am. No aerophagia and rested enough that even though I was getting up 60-90 minutes earlier than I usually get up (without the alarm). The day has been pretty decent except that the pizza I ate at lunch has been talking back to me ever since I got done teaching my Calculus class at 3:00pm. The stomach is feeling bloated right now, but I think it's just the pizza. (However, I do hate going to bed with a stomach that is already feeling bloated. So it won't be a surprise if I wake up tonight (or tomorrow morning) with some significant aerophagia.

My nose has been pretty happy today. I did get some rainout last night, but nothing serious enough to pose a problem. However, I also noticed that after the machine finished its cool-down cycle where it continues blowing air through the hose for 20 minutes, there was still a noticeable amount of water in or right by the elbow in the ClimateLine hose. And when I disconnected the hose, I got a small puddle to clean up on the nightstand and the sheets on my side of the bed. In other words, I still think the overall design for how the hose attaches to the machine is flawed. In some ways it reminds me of some bad decisions Steve Jobs & Apple made way back when a desktop Mac was translucent (which was cool) and the mouse was circular---that circular mouse may have looked really cool, but it was a horrible anti-ergonomic design that caused a lot of people's hands to cramp while using that mouse. I hated that mouse and thought of it as "design over function". I feel the same way about Resmed's choice of how to have the hose attach to the AirCurve 10: It makes the machine's triangular prism shape look cool and sleek, but it's not really the best design in terms of function. The old PR System Ones are ugly as anything with that hose attachment coming right off the top of the humidifier. But putting the hose attachment there on a full 360-degree pivot was a wonderful design from a functional point of view: There were no right angle kinks in the hose and you could easily orient the machine in whatever direction you needed to in terms of the space available on your bedside table. (The PR DreamStation 1 pivot is not as nice as the System One's and the machine is almost as ugly as the System One.)

Because my stomach is already feeling bloated from the pizza I ate, I don't intend to fiddle with the heated hose temperature tonight. And since I'm not getting rainout that is bothering me, I'm not fiddling with the humidity setting either.

Here is the score card through Night 10:
Aerophagia: 3 nights worse than usual compared to the DreamStation; 7 night about the same (or better) as the DreamStation
Wakes & Arousals: 3 nights worse than usual compared to the DreamStation; 7 night about the same (or better) as the DreamStation
Feeling on Wake: 2 nights worse than usual compared to the DreamStation; 8 nights about the same (or better) as the DreamStation

[lynninnj]

Robysue- I empathize. Calculus makes my tummy hurt too. Jk (not really)

Have you tried comparing the data to sleephq? I have done so in the past, cross checking, but some small differences can be seen from time to time.

I have the AS11 and I know they’re different machines but does yours have a swivel at thoe jnx of the two hoses? I can’t spin the heated hose but there’s a swivel where I hook in hose to hose.

just wondering and hth

[robysue1]

Robysue- I empathize. Calculus makes my tummy hurt too. Jk (not really)

The stomach was feeling much better this morning. I think it really was the tomato sauce on the pizza at lunch time.

Have you tried comparing the data to sleephq? I have done so in the past, cross checking, but some small differences can be seen from time to time.

I played around with it some when I was still using the PR DreamStation. There were problems uploading my data, but with a bit of help from the folks who run the site, the problem was figured out and addressed.

I have not gone onto SleepHQ since starting to use the AirCurve on loan from Pugsy. My impression is that SleepHQ only allows one machine per user profile, and that's a big drawback for me right now. I've got data from 5 different xPAP machines loaded into my profile for Oscar (and also for SleepyHead), namely one Resmed S9 Autoset, two different PR System One BiPAP Autos, my PR DreamStation BiPAP Auto, and the borrowed AirCurve 10 Vauto. When I get set up with my own AirCurve 10 Vauto, I may create another user profile for that machine.

I can’t spin the heated hose but there’s a swivel where I hook in hose to hose.

The backs of the AS 11 and the AS/AC 10 are of different designs. Yes, in both series of machines, the humidifier is on the left side of the front of the machine and the hose does come out from the back of the machine.

Here's the back of the AS 11:


An AS 11 ClimateLine hose plugs into that top slot. And every hose just attaches to the round thing in the middle.

Here's the back of the AS 10:


Now my AC 10 doesn't have the "orange stuff" on that outside "ring", but whole thing is a a socket-cuff that rotates. The AS/AC 10 ClimateLine hose ends with a rigid 90-degree "elbow" that plugs into the rotating socket on the back of the machine. This elbow prevents the hose from getting a 90-degree bend when you try to route the hose either around the side of the machine or over the top of the machine if you place the machine so the LCD is not facing directly away from you. Because the ClimateLine hose "clicks" into the rotating cuff, this set up also makes it harder (probably impossible) to just pull the hose off the back of the machine. If you are using an unheated hose on an AS/AC 10 and you don't have an "elbow adapter", then you just have to push the unheated hose onto that inner ring in the center of the rotating cuff as best you can. But it's pretty easy to pull the hose off accidentally is what I've found. I've ordered a replacement hose elbow from cpap.com that I hope will allow my large collection of SlimLine hoses to attach more securely and possibly rotate. (It was a cheap enough thing to not worry if it doesn't do the job.)

Overall, it sounds to me like the design of the hose attachment in the AirSense 11 is a backward step from that of the AirSense 10.

I have the AS11 and I know they’re different machines but does yours have a swivel at thoe jnx of the two hoses? ...
but there’s a swivel where I hook in hose to hose

The mask end of the AS/AC 10 ClimateLine hose is just an ordinary coupler. But both the Swift FX and the P10 nasal masks that I use have a rotating swivel that connects the short hose to the main hose. The Swift FX also has another rotating swivel that attaches the nasal pillows to the short hose to the main hose. (And I miss that swivel when I'm using the P10 mask.) In other words, using the ClimateLine on the AirCurve with my FX mask gives me three places where the hose(s) can rotate:

• Back of the machine. This keeps the main hose from being stressed by a 90-degree turn to route the hose towards the bed.
• Between the small hose and the main hose. Supposedly this should increase freedom of movement at the hose end. But this is also trapped under a hose cozy so I don't know how much extra movement I actually get from this swivel point.
• Between the small hose and the pillows themselves. This helps prevent the weight of the hose from pulling the pillows off my nose when I move my head around.

Hubby's F&P Simplex FFM has a swivel attachment at the front that attaches to the main hose; it doesn't have a small hose at all. The swivel on the top of his System One Series 60 Auto BiPAP lets him toss the hose overhead or route it under the blankets depending on his mood and the air temperature in the bedroom. And regardless of what we decide to do in terms of replacing his machine (which is also still under recall), I'm pretty sure he's going to miss that full pivot on top of the System One Series 60.

[lynninnj]

Robysue- I empathize. Calculus makes my tummy hurt too. Jk (not really)

The stomach was feeling much better this morning. I think it really was the tomato sauce on the pizza at lunch time.

-smiles as my goofy calculus joke seemingly puts Robysue into the area under the curve-

I imagine I would be where you are if I had to transition away from my machine. Hopefully the positives will outweigh the negatives wherever you land. I definitely appreciate the swivels at the end of the mask hoses. I guess I’m just used to it.

[lynninnj]

By the way, when I popped the sd card into sleep hq it created a new profile for mine. There’s a bar with date and then to the right will be a oull down menu then further right the three dots for creating link etc.

My primary machine is listed as Airsense11autoset and secondary was Airsense 11 autoset. I can only view backup data by using that pull down menu.

hth

Edit: sleephq did this all by itself

[robysue1]

By the way, when I popped the sd card into sleep hq it created a new profile for mine. There’s a bar with date and then to the right will be a oull down menu then further right the three dots for creating link etc.

My primary machine is listed as Airsense11autoset and secondary was Airsense 11 autoset. I can only view backup data by using that pull down menu.

hth

Edit: sleephq did this all by itself

Yep. I finally got brave enough to do it. It's a pain that I can't seamlessly go from November 3 (last day on the DreamStation) to November 4 (first day with the AirCurve) without going through choosing the machine data that I want to look at.

[robysue1]

Night 11
The data from Night 11 doesn't look as "great" as the last several nights have:


But that cluster of stuff at the end of the night, including the activity in the snore graph is most likely SWJ as I was waking up for the morning. And since I felt fine waking up this morning and have felt pretty good all day long, there's clearly no need to fret about it.

One thing I was extremely happy about this morning was the lack of a stomach ache. I went to bed with a bad stomach ache and lots of bloating caused by eating pizza for lunch. Going to bed bloated always increases the chances of my waking up with aerophagia both during the night and the next morning. But the stomach felt totally normal this morning and the wake or two I vaguely remember were not tied to aerophagia. The median EPAP was still below 4.5, and I think that may be part of why I was so lucky that PAPing didn't trigger a battle with aerophagia last night.

The humidifier used more water last night than it's been using. I think it's probably just because the ambient relative humidity may have been a bit lower last night. Nothing else has changed: The bedroom is still cool (our thermostat is set at 58F = 14.5C), the hose is still set at 64F = 18C, and the humidifier is still set at 8. You'd think that combo of room temp, hose temp, and humidifier setting would guarantee a huge amount of rainout, but truth be told, my nose was comfy this morning rather than feeling somewhat dried out. I don't actually remember waking up to rainout gurgling in the hose at any point during the night, but when I disconnected the hose, I was careful not to let it dribble all over like it did yesterday. This time, I poured the accumulated water in the ClimateLine's elbow into a mug. Just out of curiosity I brought the mug downstairs before dumping it out. And I measured the water that came out of the hose: It was 1 1/2 teaspoons. (1 US teaspoon is about 5ml for those of you living in the civilized world.)

It's now close to my usual bedtime and I'm getting sleepy. So I'm posting this and signing off for the night.


Here is the score card through Night 11:
Aerophagia: 3 nights worse than usual compared to the DreamStation; 8 night about the same (or better) as the DreamStation
Wakes & Arousals: 3 nights worse than usual compared to the DreamStation; 9 night about the same (or better) as the DreamStation
Feeling on Wake: 2 nights worse than usual compared to the DreamStation; 9 nights about the same (or better) as the DreamStation

[ozij]

Here is the score card through Night 11:
Aerophagia: 3 nights worse than usual compared to the DreamStation; 8 night about the same (or better) as the DreamStation
Wakes & Arousals: 3 nights worse than usual compared to the DreamStation; 9 night about the same (or better) as the DreamStation
Feeling on Wake: 2 nights worse than usual compared to the DreamStation; 9 nights about the same (or better) as the DreamStation

You're so thorough that I dare ask you about the chronology of the score card.
Is there an indication that it's also a process, in which the first nights were more likely to be worse, and you figured out the settings and perhaps got more used to some things?

[lynninnj]

Here is the score card through Night 11:
Aerophagia: 3 nights worse than usual compared to the DreamStation; 8 night about the same (or better) as the DreamStation
Wakes & Arousals: 3 nights worse than usual compared to the DreamStation; 9 night about the same (or better) as the DreamStation
Feeling on Wake: 2 nights worse than usual compared to the DreamStation; 9 nights about the same (or better) as the DreamStation

You're so thorough that I dare ask you about the chronology of the score card.
Is there an indication that it's also a process, in which the first nights were more likely to be worse, and you figured out the settings and perhaps got more used to some things?

I was wondering the exact same thing.