Question from a Newbie

Brentcom003 · Post by **Brentcom003** » Tue Mar 21, 2017 8:02 am

Hello All,

Two weeks ago I got a Dreamstation APAP machine (loaner) through a pharmacy with a F&P Simplus (Size Small) Mask, and a 22 non-heated hose. I used it for 6 nights before I decided to switch pharmacy's . The reason for the switch is a much longer story... Anyway, My AHI's were averaging 4. After my switch I was given a Dreamstation CPAP Pro (On 30 day auto mode), a F&P Simplus (Size Medium), and a 15 heated hose. The problem is that now my AHI's are over 8 for the past 4 nights. Why is this happening? Settings were the same on both machines: C-FLex 3, Mask Type Off, Humidity 3, Heated Hose 1 (On new). Oh and 100% mask fit on both machines every night.

Any chance that the mask size change is causing issues? Is it the Dreamstation CPAP Pro (in Auto Mode) vs Dreamstation APAP? Is it Hose size 15 vs 22? Looking for some experienced opinions.

Thank you!!

Pugsy · Post by **Pugsy** » Tue Mar 21, 2017 8:20 am

The one variable you can't see in the AHI when just going by the AHI on the LCD screen is the event category make up of that AHI.

3 categories make up the AHI.
Clear Airway/Central Apnea
Obstructive Apnea
Hyponea

Those are all variables that can happen even if you don't change a thing in your setup.

You need to use available software to see what that AHI is made up of.
https://sleep.tnet.com/equipment

You didn't by chance use the software with the first machine to compare the results to the results from the second machine did you?
How is the sleep quality...spend much time awake when using the mask and machine?
Of the items you changed...mask size maybe but that's only if there is a problem with fit and leak and maybe it causing some awake/semi awake events getting flagged by mistake.

Hose size wouldn't as long as you made the appropriate hose size selection in the setup menu.
Neither would changing from full time apap mode to the trial apap mode on the Pro...they are both apap modes with identical algorithms. So if the settings were the same...shouldn't change anything in terms of therapy.

D.H. · Post by **D.H.** » Tue Mar 21, 2017 8:33 am

I get the impression that you're in a country other than the U.S. Is that correct?

You did not say what you're pressure settings are or even if they're the same as on the previous machine. If you were doing better with a different mask, you may want to go back to it.

Also, how was your SDB diagnosed, and how were you titrted?

tooter · Post by **tooter** » Tue Mar 21, 2017 8:40 am

D.H. wrote:I get the impression that you're in a country other than the U.S. Is that correct?

You did not say what you're pressure settings are or even if they're the same as on the previous machine. If you were doing better with a different mask, you may want to go back to it.

Also, how was your SDB diagnosed, and how were you titrted?

He said..."Settings were the same on both machines:"

Brentcom003 · Post by **Brentcom003** » Tue Mar 21, 2017 8:42 am

Pugsy wrote:The one variable you can't see in the AHI when just going by the AHI on the LCD screen is the event category make up of that AHI.

3 categories make up the AHI.
Clear Airway/Central Apnea
Obstructive Apnea
Hyponea

Those are all variables that can happen even if you don't change a thing in your setup.

You need to use available software to see what that AHI is made up of.
https://sleep.tnet.com/equipment

You didn't by chance use the software with the first machine to compare the results to the results from the second machine did you? - Just the Dream Mapper App for my iPhone.

CAs- Before 5 Avg. After 10 Avg.
OAs- Befroe 5 Avg. After 10.5 Avg
Hypopneas- Before 25 Avg. After 40 Avg

How is the sleep quality...spend much time awake when using the mask and machine? - Sleep quality isn't too bad. About the same on both. Still trying to get used to the mask.

Of the items you changed...mask size maybe but that's only if there is a problem with fit and leak and maybe it causing some awake/semi awake events getting flagged by mistake.

Hose size wouldn't as long as you made the appropriate hose size selection in the setup menu.
Neither would changing from full time apap mode to the trial apap mode on the Pro...they are both apap modes with identical algorithms. So if the settings were the same...shouldn't change anything in terms of therapy.

Thank you for your response. Please see my answers above.

Brentcom003 · Post by **Brentcom003** » Tue Mar 21, 2017 8:47 am

tooter wrote:
D.H. wrote:I get the impression that you're in a country other than the U.S. Is that correct?

You did not say what you're pressure settings are or even if they're the same as on the previous machine. If you were doing better with a different mask, you may want to go back to it.

Also, how was your SDB diagnosed, and how were you titrted?
He said..."Settings were the same on both machines:"

Correct. Also, yes. I'm in Canada. I had a "Sleep test" and was diagnosed. My AHI was 45. I don't have the full details yet. I was told to get a free loaner machine from a select few pharmacy's to start my auto trial before my second sleep test. The second test is to determine my ideal CPAP pressure I believe.

Pugsy · Post by **Pugsy** » Tue Mar 21, 2017 8:59 am

All I know to do is work with whatever you have now and go from there with whatever results you are having.
Even with the software details from the first machine there's no guarantee that we could have spotted anything when comparing it to the new software details that are available. Without the software we are just guessing.

There's a lot more available than what the very limited DreamMapper shows.
Like when did the events get flagged...what it close to a known awake time so that maybe they are just SWJ (Sleep/Wake/Junk) flags.

Things can vary a lot and we never change anything. We don't sleep the same way each night. Maybe you are getting more REM lately (where OSA can be worse and maybe need more pressure) or maybe you are on your back more for some reason and it's also common for OSA to be worse and/or maybe need more pressure.

Brentcom003 · Post by **Brentcom003** » Tue Mar 21, 2017 9:04 am

Pugsy wrote:All I know to do is work with whatever you have now and go from there with whatever results you are having.
Even with the software details from the first machine there's no guarantee that we could have spotted anything when comparing it to the new software details that are available. Without the software we are just guessing.

There's a lot more available than what the very limited DreamMapper shows.
Like when did the events get flagged...what it close to a known awake time so that maybe they are just SWJ (Sleep/Wake/Junk) flags.

Things can vary a lot and we never change anything. We don't sleep the same way each night. Maybe you are getting more REM lately (where OSA can be worse and maybe need more pressure) or maybe you are on your back more for some reason and it's also common for OSA to be worse and/or maybe need more pressure.

Thank you for your feedback. I will continue to try to find out what's changed. I've downloaded the Sleephead software. I'll take a look at that tonight.

palerider · Post by **palerider** » Tue Mar 21, 2017 12:38 pm

tooter wrote:
. wrote:I get the impression that you're in a country other than the U.S. Is that correct?

You did not say what you're pressure settings are or even if they're the same as on the previous machine. If you were doing better with a different mask, you may want to go back to it.

Also, how was your SDB diagnosed, and how were you titrted?
He said..."Settings were the same on both machines:"

he may not know what the PRESSURE settings are, since they weren't listed. most new users don't.

Brentcom003 · Post by **Brentcom003** » Tue Mar 21, 2017 2:29 pm

palerider wrote:
tooter wrote:
. wrote:I get the impression that you're in a country other than the U.S. Is that correct?

You did not say what you're pressure settings are or even if they're the same as on the previous machine. If you were doing better with a different mask, you may want to go back to it.

Also, how was your SDB diagnosed, and how were you titrted?
He said..."Settings were the same on both machines:"
he may not know what the PRESSURE settings are, since they weren't listed. most new users don't.

I do. I'm S-M-R-T
Pressure settings are Low 5 High 20. It's in Auto mode

palerider · Post by **palerider** » Tue Mar 21, 2017 6:07 pm

Brentcom003 wrote:
palerider wrote:
tooter wrote:
. wrote:I get the impression that you're in a country other than the U.S. Is that correct?

You did not say what you're pressure settings are or even if they're the same as on the previous machine. If you were doing better with a different mask, you may want to go back to it.

Also, how was your SDB diagnosed, and how were you titrted?
He said..."Settings were the same on both machines:"
he may not know what the PRESSURE settings are, since they weren't listed. most new users don't.
I do. I'm S-M-R-T
Pressure settings are Low 5 High 20. It's in Auto mode

and you've verified this, by checking the data from the SD card?

D.H. · Post by **D.H.** » Wed Mar 22, 2017 10:32 am

Brentcom003 wrote:
palerider wrote:
tooter wrote:
. wrote:I get the impression that you're in a country other than the U.S. Is that correct?

You did not say what you're pressure settings are or even if they're the same as on the previous machine. If you were doing better with a different mask, you may want to go back to it.

Also, how was your SDB diagnosed, and how were you titrted?
He said..."Settings were the same on both machines:"
he may not know what the PRESSURE settings are, since they weren't listed. most new users don't.
I do. I'm S-M-R-T
Pressure settings are Low 5 High 20. It's in Auto mode

If you're not having Central or Clear Airway events and the pressure is not bothering you, the high end of 20 is probably fine (whether you ever hit 20 or not). If you find you spend a lot of time above a given number (let's say 10), try setting the low to that number. That number will kind of present itself (don't look specifically for 10, that was arbitrary on my part).

BTW, I knew that you were not in the U.S. since one does not get a CPAP machine at a pharmacy here.

Brentcom003 · Post by **Brentcom003** » Wed Mar 22, 2017 1:14 pm

D.H. wrote:
BTW, I knew that you were not in the U.S. since one does not get a CPAP machine at a pharmacy here.

That's correct, I'm in Ontario Canada. It's a home health care built into a pharmacy. By the sounds of it we are very lucky here in Ontario Canada as our government pays 75% for the machine and equipment. My work health benefits cover the rest. Because of that I will be making sure I get exactly what I'm most comfortable with.

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Machine	Mask

Additional Comments: Auto PAP; 13.5 cmH2O min - 20 cmH2O max