Standard vs Soft Response for people having trouble adapting to PAP

[JOinPA]

I don't typically respond to any threads for folks having trouble adapting to PAP simply because I don't feel qualified. I'm one of those apparently unusual creatures who adapted to it on the first night with my current setting (pretty much), machine and mask and haven't changed a thing in years. I probably will never post in those threads because so many of you had to overcome adaptation issues and you are much more qualified to help people over difficulties.

However, I was curious about the Standard vs Soft response in an AirSense 10 machine, and searching here and at the other board there is not a lot of discussion about it, and I rarely see a recommendation to change that particular setting. For what it's worth, I thought I'd post my experience with fiddling with it on my machine. My average pressures dropped across the board and my AHI numbers were not meaningfully different, IMO. I feel great whatever I do, but for those having trouble adapting to PAP therapy, my understanding is the lowest pressure needed to overcome their apneas and hypopneas is the target. No less than necessary, but too high can contribute to adaptation issues.

So, with the understanding I don't seem to be particularly sensitive to any minor settings tweaks, and the understanding this is certainly anecdotal, not scientific, over 4 nights with Standard and 4 nights with Soft Response here were my numbers:

...............Median....95%....99.5%....AHI
Std............11.52....12.56...12.83....0.59
Soft...........10.43....11.09...11.45....0.74

I don't know if that's meaningful enough to make the Response setting something you coaches want to use more in your toolkit or not, and everyone's response to PAP therapy is unique. But I thought I'd post it here in case any of you want to start using it. I still won't post in adaptation threads much simply because I don't feel experienced enough, but I wanted to put this out there. Response is not someting I see talked about very much.

[Pugsy]

The slight statistical difference isn't really something that we could for sure attribute to soft or standard because we can have more of a difference than what you had and not have changed anything. We just don't sleep the same each night so we can't expect the same readings each night.

This past Thursday night my AHI was 0.53 and the next two nights it was double that and I didn't change anything.
Not to mention I have seen AHI greater than 3 on occasion and again never change any settings. I expect it to vary and in fact when it doesn't ever vary that is more of a concern to me.

Soft vs standard probably is one of those things we have to evaluate subjectively and that's hard for numbers oriented people to do.

[JOinPA]

It wasn’t about my AHI, Pugsy, that I agree was not meaningfully different. It was because I seemed to be getting good result at lower pressures. My thought was the soft setting might result in more comfortable sleep for people have trouble adapting.

I don’t feel qualified to coach, but thought coaches may want to experiment with this setting. If it results in good numbers/comfort by lowering pressures I thought it might be useful. I don’t see this posted about much.

I was surprised it dropped my pressures almost 10% with no loss of efficacy.

[Pugsy]

I don’t see this posted about much.

Not everyone even has the option to try the soft response. My current machine doesn't offer it and the AirSense 10 AutoSet I had years ago didn't have it either. The "soft" thing was added to the later AirSense 10 models and I guess full time on the AirSense 11 AutoSets.

You would likely need to keep a really detailed log about how your subjective feelings measure up with using the soft response for like maybe a couple of weeks to really see if it makes any difference in how you feel.....if it even changes anything.

So no...it hasn't been talked about a lot for various reasons. It's only available on select models in the ResMed line for one thing. Other brands won't even have it in any model.

And as for you...you took to cpap like a duck to water so you didn't really have any problem that needed fixing.
Since I have never had a chance to try it myself...I can't really offer any past experience with it and to be honest...I forget that option is available to some people.

[chunkyfrog]

I tried the soft, but went back to the more aggressive operation.
Just me.

[JOinPA]

Well, I went back to Standard, however you all know by now, I am not particularly sensitive to settings changes and have always been comfortable with PAP therapy.

I'm posting this however, because I was surprised to find out when I got my new AS10 replacement machine that the factory default shipping setting for Response is Soft not standard. I was surprised by that. Brand new machine, factory default settings are APAP 4-20, no EPR and Response = soft.

I'm still not going to wade into threads where folks are asking for help adapting to therapy because I have no experience with not adapting to therapy. But I still think you more experienced folks who did have to work at this might consider adding playing with the Response setting on ResMed machines when coaching folks having problems. I mean why not do that?

I keep coming back to Pugsy's rule ... there are no rules. It's a setting. Why not play with it? You play with all the other settings. Just sayin.

[lazarus]

the factory default shipping setting for Response is Soft not standard.

I believe mine arrived set to standard, so it may depend on who ships it. I don't know.

It is cool that customization is available for comfort for "patients who are sensitive to faster changes in pressure during therapy."--https://www.resmed.com.au/healthcare-pr ... technology

Personally I have always admired the fast rise in pressure in ResMed Autosets, but I have no doubt a few patients could be bothered by it, especially at first, before adapting to it.

In my opinion, setting the min to within 1 or 2 cm of what is needed to prevent apneas all night is likely to make the difference between standard response and soft response less of a meaningful factor for comfort, anyway. Shooting up from 4 cm may be a different thing.

I do great on standard response, but your thread has motivated me to try soft response tonight for the first time, just for the heck of it.

After all, my therapy ain't at all broke, so, hey, why not try to fix it anyway!

[JOinPA]

Hmmm. I assumed it was factory default, I don't think the box had been opened since it left ResMed, but if yours was standard, Lazarus, maybe it's randomly left with whatever settings a factory tester left.

Anyway, I'm with you and Chunkyfrog, I went back to standard, but played with it along with other settings getting familiar with what the machine will do, and thought it might be a tool in the toolkit for you coaches.

Funny, after all my fiddling, I ended up back where I started 6 years ago. Took ramp off and set EPR to 2, but otherwise I'm back to the settings I started with and feel great. It was fun to play around a bit though. I'm so sad so many people have such trouble with it.

[LSAT]

If you go in and reset the machine to factory defaults it will go to standard. The Soft is similar to the "For Her" setting.

[lazarus]

similar to the "For Her" setting.

To one small aspect of it, at least.

[Pugsy]

The for Her setting in terms of mode is an algorithm change which affects just about everything the machine does in response to what it senses is going on.

Soft mode does NOT make a mode of operation or algorithm change to the "for Her" algorithm.

You guys and gals with the AirSense 11 AutoSets...it has both soft and standard response????? And it has the 3 modes of operation which are cpap, regular Autoset, and the for Her modes...
Don't you think that if "soft" was the same as the "for Her" thing that maybe have those 2 different choices available wouldn't be needed?

Soft response does NOT equal for Her algorithm.

[lazarus]

My one night using soft response on my AS10 has earned a one-week trial.

My treatment-machine-reported AHI was slightly higher than usual for the night, but I slept longer and without waking up as often. If the week goes well, I'll give it another.

I have done well on autobilevel, on the For Her algorithm (even though I am a large male), and on APAP. But I never thought to try soft response, for some reason.

Thanks for the thread, JOinPA. It made me think. And that doesn't happen very often.

[JOinPA]

You're welcome. I ended up liking standard, but frankly I could not tell much difference. But I did note that my median, 95% and 99.5% pressures were down by about 1cm. So I thought you expert coaches might want to play with it a bit. I'd never coach, don't feel qualified. But since pressure, and rate of pressure increase could be a factor, I'm glad you're playing with it, too. Who knows? Could be helpful?

[LSAT]

The for Her setting in terms of mode is an algorithm change which affects just about everything the machine does in response to what it senses is going on.

Soft mode does NOT make a mode of operation or algorithm change to the "for Her" algorithm.

You guys and gals with the AirSense 11 AutoSets...it has both soft and standard response????? And it has the 3 modes of operation which are cpap, regular Autoset, and the for Her modes...
Don't you think that if "soft" was the same as the "for Her" thing that maybe have those 2 different choices available wouldn't be needed?

Soft response does NOT equal for Her algorithm.

I did not say it was the same as....I said it was "similar to".

[ChicagoGranny]

For people that enjoyed those statistics, the median pressure went down by 10% and the AHI went up by 25%.