Sleep quality vs algorithm?

7 weeks into CPAP. 1 month with my own unit, Airsense 10 Autoset. For the past month, my AHI was 2.4, AI 1.7 and centrals at 0.4. 95 percentile pressure was 14.3 for the past month. My median pressure was around 10 during the trial. Sleep quality is better than the very beginning, but poorer than pre-CPAP. I have severe OSA (77 per hour while on my back). Would trying a Dreamstation Auto (or A10 for her) be worth considering due to its different algorithms? Here in Canada, the Dreamstation Auto is a bit cheaper than the A10 Autoset. A new unit would either be my backup or main.

Dave

The vast majority of issues are due to machine settings and mask comfort/leaking - not machine brand.
Use your data to help you understand what is working, and not working. See the three links below.

A couple nights ago...

Added left menu...

DavidY wrote: ↑

Sat Mar 24, 2018 9:16 am

Sleep quality is better than the very beginning, but poorer than pre-CPAP.

That's simply not possible. You can't have 77 sleep disturbances *per hour* and have "good sleep". you were *passed out from exhaustion", which isn't the same as "good sleep". You were just so exhausted, you don't remember having terrible sleep... (which is common).

DavidY wrote: ↑

Sat Mar 24, 2018 9:16 am

the Dreamstation Auto is a bit cheaper than the A10 Autoset.

Cheaper, but less capable.

Raise your minimum pressure a couple of cm.

palerider wrote: ↑

Sat Mar 24, 2018 11:54 am

DavidY wrote: ↑

Sat Mar 24, 2018 9:16 am

Sleep quality is better than the very beginning, but poorer than pre-CPAP.

That's simply not possible. You can't have 77 sleep disturbances *per hour* and have "good sleep". you were *passed out from exhaustion", which isn't the same as "good sleep". You were just so exhausted, you don't remember having terrible sleep... (which is common).

DavidY wrote: ↑

Sat Mar 24, 2018 9:16 am

the Dreamstation Auto is a bit cheaper than the A10 Autoset.

Cheaper, but less capable.

Raise your minimum pressure a couple of cm.

Last week, my sleep tech raised the min and max pressures to 12 and 18, respectively. Triggered my dormant vertigo with dizziness and headache symptoms like the very beginning of my CPAP trial. After a couple nights of this and seeing increases in AHI and centrals, I adjusted to minimum pressure back down to 10....that was last Sunday.

Maybe sleep quality isn't exact words...however, I feel somewhat tired each CPAP morning. I did not feel like this (unrested) pre-CPAP. With CPAP, I wake up several times during each night. pre-CPAP, I didn't usually wake up during each night...no naps during the day too. I do "sleep" longer now..about 1-1.5 hours per night.

Dave

I don't read the charts well and will leave that for others. I'm one of those people who was affected by the algorithm. The different brands all work to reduce your AHI. The biggest difference is how they do it and whether that wakes you up.

Resmed standard algorithm responds sharply. After event is handled, it also drops somewhat more sharply. Resmed for Her responds earlier and more gently, holds longer and drops slower (I'm told it is the same algorithm as an older Resmed model, S7 or S8). Respironics responds slower, maintains and reduces slower. There might be a slight variation between AHI results between the 3 algorithms, but properly adjusted, they will all work very well. The biggest difference is whether any of them wake you up. I absolutely could not sleep with the Respironics machine. I'd wake up repeatedly. After 3 days, I switched from auto to straight pressure. I have the For Her model now and comparing the two, the For Her works better for me except during the part of Spring when grass first comes out - then I switch to the regular algorithm for a month or so.

SewTired wrote: ↑

Sun Mar 25, 2018 7:41 pm

I don't read the charts well and will leave that for others. I'm one of those people who was affected by the algorithm. The different brands all work to reduce your AHI. The biggest difference is how they do it and whether that wakes you up.

Resmed standard algorithm responds sharply. After event is handled, it also drops somewhat more sharply. Resmed for Her responds earlier and more gently, holds longer and drops slower (I'm told it is the same algorithm as an older Resmed model, S7 or S8). Respironics responds slower, maintains and reduces slower. There might be a slight variation between AHI results between the 3 algorithms, but properly adjusted, they will all work very well. The biggest difference is whether any of them wake you up. I absolutely could not sleep with the Respironics machine. I'd wake up repeatedly. After 3 days, I switched from auto to straight pressure. I have the For Her model now and comparing the two, the For Her works better for me except during the part of Spring when grass first comes out - then I switch to the regular algorithm for a month or so.

Do you know if the For Her model is worth considering if the min pressure is 10-12 and the 95% pressure is 14-15?

Dave

DavidY wrote: ↑

Sun Mar 25, 2018 8:57 pm

Do you know if the For Her model is worth considering if the min pressure is 10-12 and the 95% pressure is 14-15?

The For Her model has the regular auto algorithm as well as the special new For Her algorithm so if someone doesn't like or do well with the For algorithm they can always use the regular auto algorithm.

The For Her algorithm isn't really like the old S8 algorithm. If it was we would see a lot more hyponeas with it and that old algorithm didn't flag centrals or use FOT at all. And while the response is sort of similar at pressures over 12...not really exactly that old S8 algorithm which slowed down a lot at pressures over 10 if only OAs were sensed.
I am using the for Her algorithm right now and I also tried the regular algorithm at the exact same settings and the only real difference that I have seen is that if I have 2 OAs within a certain time frame the machine creates a new minimum pressure for the rest of the night or I turn the machine off.

I have only seen one person who had issues with the different for Her algorithm not responding well or as needed with pressures in the mid teens. That person ended up doing better on the regular algrithm.

You aren't giving up anything by getting the For Her model. Actually you are gaining 2 auto algorithms instead of 1 in addition to the regular cpap mode available.

If cost is the same......you can get the for Her model with 3 modes of operation or the regular apap that has 2 modes.
Seems like a no brainer to me.
People seem to think that they just HAVE to use that new algorithm and it simply isn't the case...they can try either one and decide which works best for them.

APAP is nice but for some it causes more issues. Perhaps you should titrate yourself using CPAP so you understand what your pressure needs are.

TedVPAP wrote: ↑

Sun Mar 25, 2018 9:18 pm

APAP is nice but for some it causes more issues. Perhaps you should titrate yourself using CPAP so you understand what your pressure needs are.

*facepalm*

I agree...isn't this a forum where we try to help each other regarding sleep apnea treatment?

Dave

Pugsy wrote: ↑

Sun Mar 25, 2018 9:12 pm

DavidY wrote: ↑

Sun Mar 25, 2018 8:57 pm

Do you know if the For Her model is worth considering if the min pressure is 10-12 and the 95% pressure is 14-15?

The For Her algorithm isn't really like the old S8 algorithm. If it was we would see a lot more hyponeas with it and that old algorithm didn't flag centrals or use FOT at all. And while the response is sort of similar at pressures over 12...not really exactly that old S8 algorithm which slowed down a lot at pressures over 10 if only OAs were sensed.
I am using the for Her algorithm right now and I also tried the regular algorithm at the exact same settings and the only real difference that I have seen is that if I have 2 OAs within a certain time frame the machine creates a new minimum pressure for the rest of the night or I turn the machine off.

Thanks Pugsy. I bow to your greater knowledge, especially since you had those older machines!!

SewTired wrote: ↑

Mon Mar 26, 2018 10:33 am

Thanks Pugsy. I bow to your greater knowledge, especially since you had those older machines!!

To be fair I first thought that the "for Her" algorithm was pretty much the old S8 Auto Algorithm initially but I was wrong.
While the For Her algorithm did seem to take a couple of maybe the "finer" points of that old S8 (to confuse things even more we referred to it as the A10 algorithm back in the day since people use A10 for machine as well as algorithm) it's pretty much a different animal.
That old A10 algorithm caused a lot of confusion when people didn't understand how it was designed to work and why.
ResMed made the change in auto adjusting algorithms with the S9 models so I guess the powers that be decided it was time to update things.

With the old A10 the machine wouldn't go above 10 cm to fight OAs UNLESS there was some of the other signs of the airway collapse happening that met the criteria needs to increase the pressure. People were thinking that it wouldn't go over 10 and if you needed more than 10 then you were screwed but that really wasn't the case. It just wouldn't go over 10 cm unless it had something else to fight besides a random OA. Lot of unhappy people thinking they had a machine that wouldn't do what was needed and that wasn't the case. They saw "won't go past 10 in auto mode" and stopped reading and didn't see or understand the UNLESS so and so is happening part.

When the For Her mode on the AirSense 10 (back to that old A10 confusing thing again) was first released I think I saw that it wouldn't increase past 12 UNLESS those other criteria or met. So I thought it was a revamped A10 algorithm from the old S8 machines but it really doesn't perform like that old dinosaur algorithm.
I never understood why so many hyponeas for some people (not all people) with the S8 unless it had to do with the algorithm but since it was happening with the fixed mode too...just something we never really knew why it did that unless hyponea definition itself changed and I don't know that I remember the definition of hyponea way back then. Doesn't matter now anyway.

With every other apap machine I have ever tried I sometimes see the need for 18 cm or more pressure. I assume in REM seems it seems to cycle like REM cycles and my OSA is worse in REM.
With the the for Her mode that I am using now....I still will see the machine go up near that 18 cm mark. Doesn't happen every night but it didn't happen every night with all those other apap machines either. Not sure if supine was involved because I once did a month long experiment where I built a wall and stayed in one position all night long and the pressure changes still happened.

So for me and whatever is triggering my machine in the for Her mode to increase to 18...it does as designed.
Like I said above....I only know of one person where the way it was designed to work doesn't fulfill that one person's needs.
Exactly why it doesn't we haven't been able to figure out but it was painfully obvious it wasn't working some nights (some nights it worked perfectly) but the best choice for that person was just go to the regular auto adjusting mode.