1y CPAP user in Netherlands with some questions

[dannyteh]

I stumbled upon this website recent, and i must say there is so much info. Thanks guys!
I wonder if you can help me with some long-standing questions/decisions

1. I was tested for sleep apnea last year, and i think i suspect i have been having it since 20s (34 now). They can't seem to figure out the reason. my weight is 75kg, 5'8", workout and my nose,throat, mouth anatomy is correct. However, the doctor checked that i wake up 40 times an hour (normal is 5?). I am now down to 6 with CPAP. The physicians can't seem to figure out whats the problem but just treat it. What other reasons are there?

2. i was given devilbliss sleepcube (DV54SE). i think i sleep better after, seems better. Recent months however i can't sleep without my CPAP anymore. i will just wake up a lot until early mornings. but even with the machine i am starting to feel occassionally tired in noons and sleepy again. This forum give high praise to Resmed S9 and PR System one 60. Is it a big gap in effectiveness compared to the sleep cube i am using? Also if any of you are in netherlands, are you using one of these two too?

Thanks for the wealth of knowledge here and keep up the good work!

Danny

[ChicagoGranny]

Danny, Most important for you is to get the CPAP software and look at the details of how effective your CPAP therapy is. Do you know whether the manufacturer's software or SleepyHead is compatible with your machine? I am not familiar with your current machine and don't know if it has full data capability.

Please consider registering here.

[demetheus]

Oh hi, I am the thread starter. I was registered but i guess i didn't log in. I wasnt' ever introduced to a sleepyhead/or any software by the. There are some codes which i would read out to the manufacturer for the first few months and it translates to some data. I will check more about this

[tmr]

Not all people are candidate for sleep apnea surgery, it is not that reliable anyway. It should be a last resort.

For the machine I don't think it will make a difference in terms of treating capability. But it is very important to have a machine that record full data to know whether you are being treated effectively or not.

[jedimark]

Not from the Netherlands, but I am half Dutch.. does that count?

I've used the DV54 personally, along with the PRS1 550P, and ResMed S9 VPAP Auto and Adapt models..

I can tell you some stuff that you mostly know already:

• As a straight CPAP machine, the Intellipap does it's job quite well. Provided you have been titrated correctly.
• As an auto machine, the DV54 ramps pressure up too quickly in response to events, and can become quite uncomfortable to use.
• The DV54 has no mechanism to detect Central apneas, nor does it provide a flow waveform (outside of an impractical serial interface), or adequate enough resolution event data for exploring how well your treatment is going.

Both PRS1 and ResMed S9 are genuinely good machines. The PRS1 has stronger data availability, the ResMed has slightly better detection of Central Apneas thanks to it's pressure ripple (FOT) algorithm. ResMed machines generally cost more.

I found both PRS1 and ResMed S9 machines were much smoother to breath on compared to Intellipap, my ResMed's are quieter than my PRS1, both are quiter than the Intellipap.

There are some interesting alternatives that might be available in your area.. Weinmann from over the border from you makes a promising series of machines (SOMNOsoft and SOMNObalance), I'm impressed with the data format, seems to have all the important stuff available. I'm currently working on adding support for these in SleepyHead.

Anyway, as for Intellipap software support...

Up till now, the SmartLink Desktop software has been making incorrect AHI calculations in their daily reports (not sure if it's on all machines, or just all the ones I've seen). I've reported this to DeVilbiss and it is currently being investigated. :/

And up till recently SleepyHead had some pretty yucky bugs in it's Intellipap AHI calculations too, because I made the mistake of trying to match DeVilbiss's figures, before realising their calculations were faulty. The next release (0.9.7) which will be out soon will have much better Intellipap support.

[chunkyfrog]

Mark, it is my understanding that the firmware can be updated on the Intellipap machine itself.
Is that true? I wonder if the European version will update too,
and if some of the problems may be solvable in this manner.
I realize there are limits due to the hardware, and availability of Devilbiss upgrades.

[Slartybartfast]

Hi Danny,

I have both the ResMed S9 Autoset and DeVilbiss Intellipap, which is called SleepCube Auto Plus in Europe. Both machines are excellent and have reduced my events from 73 to nearly 0. As long as your sleep study was done correctly, the difference between the effectiveness of an automatic (APAP) and constant pressure (CPAP) machine is very little. Many doctors will not prescribe an automatic machine because they don't believe the difference is worthwhile.

My sleep study indicated that I required 10.9 cm pressure. My ResMed Autoset with full data capability indicates that I average about 10.5 cm. The difference is very small, and my pressure requirement has not changed during the 5 years that I have been using APAP. The fact that your AHI has been reduced from 40 to 6 each hour indicates your machine is working well, but there is still some room for improvement. I don't think 6 awakening/hour are enough to make you feel tired during the day.

Sleep quality is not a simple matter. There are many things that can cause awakenings that are unrelated to sleep apnea. For example, five days each week I awaken every morning at around 0300 and have difficulty sleeping any longer. But when the weekend comes, or when I am on vacation, I sleep through the night with no problem. I know my problem is stress from my job, which I have grown to dislike, but there is nothing I can do about that until my kids are finished with university. So the best advice I can offer to you is to keep working with your doctor.

Welcome to the forum. Keep reading and I'm sure you will find something that will help you.

[library lady]

Sleep Apnea is a condition that doesn't "go away"; you are being treated with cpap because it is the best way to treat it in the long run (like for the rest of your life)... if your anatomy is correct, surgery can't correct it; a dental appliance might help, but I personally don't recommend it. Others may disagree with me on that. Successful treatment goals are for AHI of 5 or less.

[jedimark]

Mark, it is my understanding that the firmware can be updated on the Intellipap machine itself.
Is that true? I wonder if the European version will update too,
and if some of the problems may be solvable in this manner.
I realize there are limits due to the hardware, and availability of Devilbiss upgrades.

Yeah, that firmware upgradability thing is one of the few neat things about them.

The hardware itself is reasonable, apart from the glaringly bad Flow Waveform deficiency in the SmartLink module.
(For this reason alone, I would never recommend them to anyone looking for a starting machine.)

They do have some pretty cool features.. like definable Apnea flagging thresholds and stuff like that.

But they should have used the firmware upgrade to change the way it logged to SD card.. No excuse for that kind of design mistake.
Where there is a will, there is a way, even on the most limited CPU, memory and IO bandwidth budget...

[sc0ttt]

Aangenaam kennis met je temaken!

You post doesn't indicate if your apnea events are obstructive or central - that could make a big difference in choosing a different machine if you're having problems.

Do you have a copy of your sleep test results?

[Slartybartfast]

The firmware upgradability is a nice concept, but I wonder how upgrading the firmware actually pans out with a FDA Class II Medical Device. I think that once the device has left the manufacturer's custody, upgrading it would not be allowed for the usual reasons.

[demetheus]

Wow! Thanks so much for all the insightful response esp jedimark and slartybartfast.

I think i am too cowardly to go for surgery, but i am just curious about the cause of my sleep apnea, the doctors in sleep clinic here aren't even sure why

@jedimark, any % of dutch is welcome! the immediate high pressure is ok for me unless i have been drinking, i really can't wear it then. Your comparisons are impressive! You are not holding back on trying all the machines . I am gonna read up on how to gather any data from the machine. it used to come with a sd card attachment which the clinic have taken back. does it mean i have no more data history for the past year? . Checked the Weinmann website, gonna speak with my doc this friday on how to proceed to see what's best

@slartbartfast 73 events is scary! I am at level 5 of my machine. the lowest setting, it has been a year. probably time to recheck. i will speak to the doc. the 6 waking events is from last year. i haven't spoken to the sleep clinic guys for almost a year. i should check with them again to see where i am at. Your comparisons were very useful, esp since i was thinking of investing on the ResMed s9 option going ahead, probably i don't need it after all

i will look for the document i have on if it's obstructive or central. my problem is when i sleep...i stop breathing. then i breathe really hard 2-3 seconds later to recoup. then it starts again in a bit. friends who sleep over (when i dont wear mask) tell me it scares them that suddenly no sound. when i ask how often..all of them say..very often