Ready for a new CPAP Machine...maybe

Quick history: I've been a CPAP user for probably around 20 years (can't remember when I started). Compliance has never been a problem...I simply can't sleep without it. I recently switched from a Swift FX to the Airfit P10, and actually like them both. I have been using a ResMed S8 for about 10 years (again, can't remember exactly how long), which still blows air, so I guess it's still OK. About 2 years ago I lost 40 lbs., and decided to "self-treat" my apnea by taking my fixed pressure level from 10 down to 8, and all was well. I don't have software to check my therapy. I've just gone by how I feel during the day, and if my wife (the world's lightest sleeper) tells me if she heard any episodes of odd-sounding breathing, air leaks, etc. (which she hasn't)...I know, not very scientific.

About a two or so years ago, I started getting awakened by air escaping from my mouth. I always sleep with my mouth closed, and had no idea why after so many years of therapy without this issue it just started happening out of nowhere. It feels like some air entering my nose would not go into my lungs, and instead ended up in my mouth, gently forcing my lips apart so the air could escape. The solution? Full Face Mask or chin strap...no contest...although I wish I didn't have to use it every night, the chin strap is doing the job.

I have not had a sleep study in at least 10 years, and since I have been feeling a little "sleepy" at times during the day (could be caused by any number of factors), I figured it's time to see the sleep doc, which I did last week. I thought he'd order a new sleep study, but when he saw that my insurance should allow me to get a new CPAP machine, he told me he would check with the insurance company, and would submit a script for an Auto CPAP machine with a therapy range of 5 to 15. And with a new machine he would be able to track my therapy, and decide if a new sleep study would be necessary at our next appointment in three months.

I was just contacted by the medical equipment supplier to bring in my S8 for evaluation (I guess so they can determine if it needs replacement), and to choose a new Auto CPAP machine. I asked them if they had the ResMed Airsense 10 and the Respironics Dreamstation, and they do. So I guess I have a few questions regarding the CPAP machine choice and the new Auto therapy.

From my brief research, both machines seem to be very good, with pretty much the same features, but very different form factors. I won't ask the standard "which is best" question, but I was wondering if there may be an item (feature/function) or two that differentiates one machine from the other. One example would be that I believe the Dreamstation has built in Bluetooth and an iPhone app, which the Airsense doesn't (maybe a bad example because I really don't know if those things are important at all).

Another question about these two machines...I believe that the Dreamstation is relatively new, and the Airsense 10 has been around for a couple of years. Based on the size/form factor alone, I would prefer the Airsense 10, but since my old S8 appears to still be working, would it make any sense to hold off, perhaps until ResMed comes out with a new model? The next CPAP machine I get will probably have to last me a long time (our excellent health insurance coverage will be ending in a couple of years).

Lastly, regarding the change in therapy from a constant pressure (8) to an Auto pressure (5 to 15 range), can anyone share their experience going through something like this? Is there an adjustment period? I'm someone who does not like ramping at all, so every night my therapy starts on "full blast", and I like it that way. I realize that "ramping" and "Autoset therapy" are two different things, but am I wrong to be concerned that when the Autoset pressure drops, that I will be gasping for air?

Thanks for your help and guidance.

Just set your therapy to be 8-15. There are clinician manuals on line for just about every machine.

The resmed has the advantage in that the sleepyhead software has not yet been written for the PR dream thing.

Resmed Airsense 10 is only the make and year designation.
Insist on an Autoset or an Autoset for Her; the "cpap" will leave you without the data you need.

bcab17 wrote:Quick history: I've been a CPAP user for probably around 20 years (can't remember when I started). Compliance has never been a problem...I simply can't sleep without it. I recently switched from a Swift FX to the Airfit P10, and actually like them both. I have been using a ResMed S8 for about 10 years (again, can't remember exactly how long), which still blows air, so I guess it's still OK. About 2 years ago I lost 40 lbs., and decided to "self-treat" my apnea by taking my fixed pressure level from 10 down to 8, and all was well. I don't have software to check my therapy. I've just gone by how I feel during the day, and if my wife (the world's lightest sleeper) tells me if she heard any episodes of odd-sounding breathing, air leaks, etc. (which she hasn't)...I know, not very scientific.

About a two or so years ago, I started getting awakened by air escaping from my mouth. I always sleep with my mouth closed, and had no idea why after so many years of therapy without this issue it just started happening out of nowhere. It feels like some air entering my nose would not go into my lungs, and instead ended up in my mouth, gently forcing my lips apart so the air could escape. The solution? Full Face Mask or chin strap...no contest...although I wish I didn't have to use it every night, the chin strap is doing the job.

I have not had a sleep study in at least 10 years, and since I have been feeling a little "sleepy" at times during the day (could be caused by any number of factors), I figured it's time to see the sleep doc, which I did last week. I thought he'd order a new sleep study, but when he saw that my insurance should allow me to get a new CPAP machine, he told me he would check with the insurance company, and would submit a script for an Auto CPAP machine with a therapy range of 5 to 15. And with a new machine he would be able to track my therapy, and decide if a new sleep study would be necessary at our next appointment in three months.

I was just contacted by the medical equipment supplier to bring in my S8 for evaluation (I guess so they can determine if it needs replacement), and to choose a new Auto CPAP machine. I asked them if they had the ResMed Airsense 10 and the Respironics Dreamstation, and they do. So I guess I have a few questions regarding the CPAP machine choice and the new Auto therapy.

From my brief research, both machines seem to be very good, with pretty much the same features, but very different form factors. I won't ask the standard "which is best" question, but I was wondering if there may be an item (feature/function) or two that differentiates one machine from the other. One example would be that I believe the Dreamstation has built in Bluetooth and an iPhone app, which the Airsense doesn't (maybe a bad example because I really don't know if those things are important at all).

Another question about these two machines...I believe that the Dreamstation is relatively new, and the Airsense 10 has been around for a couple of years. Based on the size/form factor alone, I would prefer the Airsense 10, but since my old S8 appears to still be working, would it make any sense to hold off, perhaps until ResMed comes out with a new model? The next CPAP machine I get will probably have to last me a long time (our excellent health insurance coverage will be ending in a couple of years).

Lastly, regarding the change in therapy from a constant pressure (8) to an Auto pressure (5 to 15 range), can anyone share their experience going through something like this? Is there an adjustment period? I'm someone who does not like ramping at all, so every night my therapy starts on "full blast", and I like it that way. I realize that "ramping" and "Autoset therapy" are two different things, but am I wrong to be concerned that when the Autoset pressure drops, that I will be gasping for air?

Thanks for your help and guidance.

I didn't see this thread until after I had replied to your other one.
However, you haven't stated which model of the S8 Series you've been using, or if you've been monitoring your therapy with software or from the info in the LCD.


Den

.

Thanks for the reply Den.

From my original post: "I don't have software to check my therapy. I've just gone by how I feel during the day, and if my wife (the world's lightest sleeper) tells me if she heard any episodes of odd-sounding breathing, air leaks, etc. (which she hasn't)...I know, not very scientific."

My S8 is an AutoSet. As I mentioned in the OP, I'm a long-time CPAP user, but I have never gotten into checking the therapy data (I probably should, but I don't know that I would actually understand what the data means). I've just simply been going by if I'm feeling rested during the day, and since I have felt tired lately I went to see the sleep doc.

I would like to try out the 5 to 15 auto setting that the doc prescribed, but I don't remember how to change the therapy (pressure) settings on the S8.

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1. Accessing the Clinical Menu

Turn on the device and wait until the standby (RAMP/SETTLING) screen appears on the LCD.
At this stage you can adjust the ramp/settling time.

Press the DOWN and RIGHT keys simultaneously for 3 seconds to access the clinical menu.


2. Changing Options and Settings.

Press the LEFT (menu) key to access the SETTINGS menu screen.

Use the UP and DOWN keys to scroll through the RESULTS, OPTIONS and SERVICING menu screens.

From a menu screen, use the LEFT (enter) key to access the parameters in that menu.

Use the UP and DOWN keys to scroll through menu parameters.

Use the LEFT key to view or change each parameter setting as required.

Press the RIGHT (exit) key until you return to the standby (RAMP/SETTLING) screen.

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ResMed S8 Series:
To get into the provider setup mode in a ResMed S8 CPAP machine - such as the S8 Compact, S8 Elite or S8 AutoSet Vantage - follow these steps:

1. press the right and down arrows simultaneously for about 3 seconds until the word "clinical" appears
2. select Menu

Use the left and right arrows to cycle through the settings and use the up and down arrows to make adjustments. Below is a list of settings you can cycle through on an S8 AutoSet Vantage automatic CPAP machine. There are four groups of settings which have adjustments and data within them.

* Settings
o CPAP Mode
o Minimum CPAP Pressure
o Maximum CPAP Pressure
o Maximum Settling / Ramp
o Mask Type
o Tube Length
o Humidifier
o Smart Start
o Leak Alert
* Results
o Efficacy Data
o Usage Data
* Options
o Smart Data
o Reminders
o Factory Defaults
o Erase Data
o Date
o Time
o Menu Type
o Language
* Servicing
o Run Hours
o Serial Number
o PCV Number
o SW Number
o BR Number

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Operating Information
Principles of Operation
The S8 AutoSet II system is designed for clinical use and home treatment of
adult patients with obstructive sleep apnea (OSA). The system has two therapy
modes for treating OSA: CPAP mode and AutoSet mode.
CPAP mode
In CPAP mode, the S8 AutoSet II device provides fixed-positive-pressure room
air via tubing to the mask worn by your patient. The continuous air stream
“splints” open the upper airway, preventing airway collapse.
The S8 AutoSet II delivers pressure within the range 4 to 20 cm H2O, depending
on the patency of the upper airway. To make the beginning of treatment more
comfortable, you may set a ramp so the pressure starts low and gradually
increases to full treatment pressure over the ramp time.
AutoSet mode
The treatment pressure required by your patient may vary through the night, and
from night to night, due to changes in sleep state, body position, and airway
resistance. In AutoSet mode S8 AutoSet II provides only that amount of pressure
required to maintain upper airway patency.
You can set the minimum and maximum allowable treatment pressures. The
device analyzes the state of the patient’s upper airway on a breath-by-breath
basis, and delivers pressure within the allowed range according to the degree of
obstruction. The AutoSet algorithm adjusts treatment pressure as a function of
three parameters: inspiratory flow limitation, snore, and apnea.
The flow sensor, located in the S8 AutoSet II device, enables detection of
inspiratory flow limitation and apneas. The pressure sensor, also located in the
device, enables measurement of pressure and snore.
Inspiratory flow limitation indicates silent partial obstruction. When your
patient is breathing normally, the inspiratory flow measured by the device as a
function of time shows a typically rounded curve for each breath.
As the upper airway begins to collapse, the shape of the inspiratory flow-time
curve changes and the central section flattens.
The AutoSet algorithm analyzes the shape of the central part of the curve for
each breath. If the inspiratory flow-time curve falls below a certain threshhold,
the pressure is increased.
Inspiratory flow limitation, or partial airway closure, usually precedes snoring and
obstruction. Detection of this flow limitation enables the device to increase the
pressure before obstruction occurs, making treatment pre-emptive. If no further
flow limitation is detected, therapy is reduced towards the minimum pressure
with a 20-minute time constant.
Flattening is a measure of silent inspiratory airflow limitation. Flow limitation with
loud snoring is handled by the snore detector. When a patient snores, sound is
generated and the inspiratory flow/time curve is distorted by the frequency of the
sound.
The AutoSet algorithm assigns an arbitrary value between 0.0 and 2.0 to the
average amplitude of the snoring detected for the past 5 breaths. A value of 1.0
is equivalent to approximately 75 dBA measured 10 cm from the nares.
Treatment pressure increases by up to 0.2 cm H2O per second (proportional to
the severity of the snore) for snore above 0.2 snore units. When snore is less
than 0.2 snore units, therapy is reduced towards the minimum pressure with a
20-minute time constant.
An apnea is defined as a greater than 75% decrease in ventilation. The AutoSet
algorithm scores an apnea if the 2-second moving average ventilation drops
below 25% of the recent time average (time constant 100 seconds) for at least
10 consecutive seconds. Treatment pressure increases based on the duration of
the apnea. The pressure will not rise above 10 cm H2O when an apnea is
detected, to prevent an inappropriate response to central apneas. Initial pressure
increases are rapid, but the rate of increase diminishes as the pressure
approaches 10 cm H2O. When no further apneas are detected, therapy is
reduced towards the minimum pressure with a 20-minute time constant.
A hypopnea is defined as a 50 to 75% drop in ventilation. A hypopnea is scored
if the 8-second moving average ventilation drops below 50%, but not below
25%, of the recent average for 10 consecutive seconds. In order to avoid falsely
responding to central hypopneas, the AutoSet algorithm does not respond to
hypopneas but rather to the associated snore or flow limitation.
Expiratory Pressure Relief (EPR)
In either CPAP or AutoSet mode you can select expiratory pressure relief (EPR).
EPR is designed to maintain optimal treatment for the patient during inhalation
and reduce the delivered mask pressure during exhalation. The desired result of
EPR is to decrease the pressure the patient must breathe out against, making
the overall therapy more comfortable.
The features of EPR are:
• EPR is disabled automatically in the event of an apnea.
• EPR resumes automatically when the apnea event has passed.
• You can select an EPR pressure drop of OFF, 1, 2, or 3 cm H2O.
• You can set EPR to be off, delivered only during ramping (CPAP mode) or
settling (AutoSet mode), or delivered throughout therapy.
• Pressure drop is limited, to avoid sub-optimal treatment (maximum drop is
3 cm H2O).
• When EPR is enabled, the delivered pressure will not drop below a minimum
pressure of 4 cm H2O, regardless of the settings.
• Either the clinician alone, or both the clinician and the patient can access the
EPR level. You can enable or disable patient access to the EPR level setting.

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The S8 mask selections are:
Mirage
Mirage Full
Swift
Activa
Ultra
Standard


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See if any of that helps.

Den

.

Great stuff, Den. Thank you!