Sleep Study Results - Basics

PhotoCrusader · Post by **PhotoCrusader** » Fri Dec 08, 2017 2:28 am

ChicagoGranny wrote:
PhotoCrusader wrote:You can see my study at https://imgur.com/a/2xc2u.
Oh, I meant to mention, while you are in the process of getting a machine, you may find significant relief by avoiding backsleeping. Obstructive sleep apnea is often more severe on the back where gravity is directly pulling the tongue and soft palate toward the airway. On the sides or stomach, the effect of gravity is moderated.

During your study, while sleeping on your sides, you got no REM sleep. So, it can't be sure that you will get relief by avoiding backsleeping. (OSA is usually most severe in REM.)

To avoid backsleeping, some pile up pillows against the back and others have worn something like a small backpack.

Thank you for sharing your knowledge with me. It is very helpful. I normally do not sleep on my back. I am a side or stomach sleeper. Many nights right now I sleep in a recliner. Then I do sleep on my back.

PhotoCrusader · Post by **PhotoCrusader** » Fri Dec 08, 2017 1:06 pm

ChicagoGranny wrote:I recommend a gently used AirSense 10 AutoSet or S9 AutoSet from http://www.secondwindcpap.com/Used_CPAP.html

These come with one-year seller's warranty. I bought an S9 from them earlier this year. They are good to work with.

PhotoCrusader wrote:Is the "For Her" really better for woman?
Above 10 cm pressure, the For-Her algorithm is disabled. It's value below 10 cm is doubtful.

So, this model is not a good idea. Thanks.

PhotoCrusader wrote:Is heated tubing better or not necessary?
What climate do you live in? What is your bedroom temperature in heating and cooling seasons?

Our room tends to be cold since my husband gives off lots of body heat to keeps us warm. He can't stand sleeping in heat, so during the summer it can get a little cold as well.

PhotoCrusader wrote:Where can one find rentals?
At local DMEs (durable medical equipment suppliers). Usually very high rental prices.

I will pass on them

PhotoCrusader wrote:What else should I be asking?
Masks. Here is a generic guide to selecting your first one -

How to Choose an Initial CPAP Mask for Newbies

1. If you had a sleep lab titration and liked the mask that was used, and that mask was recommended by your medical team, then go for it.

2. If not 1., then did your medical team recommend a nasal mask or a full face mask (FFM)? For many people, nasal masks are easier to use assuming they don't mouthbreathe, leak air out the mouth or get air inflating the cheeks while using CPAP during sleep. If you have any of these problems, you may need to use a FFM. (Despite what you may see in the forum, there are many of us that find FFMs are easy to use, do not leak and are not uncomfortable.)

For comfort and less leakage I prefer the nasal mask. It felt the most comfortable. The issue I had was that the air was coming in at such a rate that I couldn't exhale against the force of the air. Reading some of the machine features. This could be helped by a machine that gives me time to exhale or reduces the air coming in so I can exhale.

3. Once you have decided whether you need to start with a nasal mask or a FFM mask, begin looking at the mask descriptions and images at https://www.cpap.com/cpap-masks.php . This is the website of this forum's host.

4. For a newbie, you should select a popular mask that gets high rankings from the reviews. Some people in this forum get excellent usage out of masks that are not popular and do not get good reviews. They might rave about the mask to you. But for a newbie, you want to start with a popular mask with high rankings. After you get some experience, you can experiment with masks that pique your fancy but are not so popular.

5. Once you have a category (nasal or FFM) of masks selected, you can go to that category on CPAP dot com's web page and sort by Biggest Sellers and then by Rating. You can check the ratings and read reviews.

6. When you receive your mask and machine, you should watch the mask manufacturer's videos (On CPAP dot com's web page) for instructions on use and adjustments.

7. If you have any problems using the mask, please start a new thread here and ask for help.

8. It's not unusual to try different masks before settling on one that works well for you. If you find yourself buying a fourth or fifth different mask, the problem may be with the way you are trying to use the masks, instead of the mask itself. Please get help from the experienced forum members.

- ChicagoGranny

Pugsy · Post by **Pugsy** » Fri Dec 08, 2017 1:54 pm

So, this model is not a good idea. Thanks.

You were talking about the ResMed AirSense 10 AutoSet for Her model and Chicago Granny was thinking it worked like the old A10 ResMed algorithm when she made her comments. That's not the case I have since explained it better to CG and I think she has a better understanding of that special apap algorithm.

So...The ResMed AirSense 10 AutoSet would actually be a really good choice of models to try.is the
Even if you didn't do well with the special "for Her" algorithm....you could always switch over to the regular apap mode algorithm.

You get the best of both worlds with the For Her Autoset because it is essentially 3 machines in one instead of 2 machines in one like the regular AutoSet is.

AirSense 10 AutoSet..2 modes of operation...cpap fixed pressure and the regular apap (auto adjusting pressure mode).

AirSense 10 AutoSet for Her..3 modes of operation
the cpap fixed pressure mode
the regular apap auto ajusting pressure mode
and the 3 rd one is the special for her algorithm.

So you lose nothing by getting the For Her model and gain a 3 rd mode of operation. Now will you need or want or like that 3rd mode.....dunno but it's there to try if someone wants to. I am using it. I like it. It works nothing at all like the old A10 algorithm that the ResMed S8 and older machines did.

See the manual for a little bit of information on the new algorithm. Most of it you probably won't understand right now but later you might.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

tedtomato · Post by **tedtomato** » Mon Dec 11, 2017 12:34 am

ChicagoGranny wrote: Above 10 cm pressure, the For-Her algorithm is disabled. Its value below 10 cm is doubtful.

What do you mean by that?

I am using a "for her" machine with a starting pressure above 10, and with the "for her" algorithm selected.

I have never read anywhere else that the "for her" algorithm couldn't be used for pressure about 10. My understanding of the "for her" algorithm is that it reacts to flow limitations quicker than the standard algorithm.

Muse-Inc · Post by **Muse-Inc** » Mon Dec 11, 2017 12:53 am

If they recommend a full face mask (FFM), you might checkout the mask I wear Universal Hybrid by Innomed/RespCare. Click on it in my signature to see it. Works well with low or high pressures. Comes with 3 sizes of nose pillows and 3 sizes of oral cushions (covers mouth). Nothing on the nose & minimal touching on face. Comes with a DVD for fitting and care.

There are 2 other hybrid-style FFMs: Liberty and Amara View.

Pugsy · Post by **Pugsy** » Mon Dec 11, 2017 9:21 am

tedtomato wrote:What do you mean by that?

I am using a "for her" machine with a starting pressure above 10, and with the "for her" algorithm selected.

I have never read anywhere else that the "for her" algorithm couldn't be used for pressure about 10. My understanding of the "for her" algorithm is that it reacts to flow limitations quicker than the standard algorithm.

CG was thinking the "for Her" algorithm worked like the old algorithm that was used with the S8 machines and older and it did have some limitations in how it responded if pressure needs went above 10 in auto adjusting mode.
The new algorithm (either with the regular apap algorithm or the for her algorithm) doesn't do anything like the old A10 algorithm did with the pressure increases when pressures went over 10 in auto mode.
I have since explained to CG that the new algorithm doesn't work like the old algorithm (we called that old algorithm the A10 algorithm oddly enough but it had nothing to do with the AirSense).

So just disregard what CG said...she was using the wrong fact base for algorithms when she said that.

Now that are some situations where the for her algorithm and how it responds allows too many OAs to happen. Long story on why it does that and I don't have time to go into it but I have only seen one person that needed the regular algorithm because of the for her algorithm not getting the job done. It's rare. You would know it if you had that problem. Large dense clusters of OAs and the machine not doing a damn thing about it.

Jay Aitchsee · Post by **Jay Aitchsee** » Mon Dec 11, 2017 6:36 pm

Pugsy wrote:CG was thinking the "for Her" algorithm worked like the old algorithm that was used with the S8 machines and older

Is this no longer true?

ResMed Clinical Guide, AirSense 10 AutoSet for Her Mode wrote:Treats apneas up to 12 cm H2O and continues to respond to flow limitation and snore up to
20 cm H2O.

Pugsy · Post by **Pugsy** » Mon Dec 11, 2017 7:13 pm

Jay Aitchsee wrote:
Pugsy wrote:CG was thinking the "for Her" algorithm worked like the old algorithm that was used with the S8 machines and older
Is this no longer true?

ResMed Clinical Guide, AirSense 10 AutoSet for Her Mode wrote:Treats apneas up to 12 cm H2O and continues to respond to flow limitation and snore up to
20 cm H2O.

It was never true that the new for Her algorithm was the old A10 algorithm by a different name.
That's what CG was referring to with the 10 cm comment. She thought the new for her algorithm was just like the old A10 algorithm and it isn't.
The new for Her algorithm will indeed respond above 12 cm if the other warning signs of an impending OA is apparent. It gets complicated and people (back when the A10 on the S8 and older machines) read it they didn't understand it and instead thought the machine wouldn't respond above 10 cm which wasn't true. It just wouldn't respond to an OA unless FLs or snores were also present.

I am using the new for her algorithm...it often goes to 15 or 16 and I don't have many OAs...so it is responding to probably FLs and maybe a few snores. I never see much activity of either on my reports but there is a little. It's very rare that a person would have an OA and not have some sort of FL or snore go along with it. Not impossible but sure not common.

I only know of one person who had ugly OA clusters at 14 cm and the machine didn't do what we needed it to do (go higher) and I assume because there weren't any FLs or snores to drive the pressure. I have only seen it with one person and it wasn't a common occurrence with that person. It's not a reason to not get this model machine. If that should happen with someone all they have to do is switch over to the regular APAP mode. Easy fix. That's what she did.

Here's an example...note the pressure graph (the single pressure line and not mask pressure) is EPAP value...add 3 to what you see for IPAP since I am using EPR at 3.
It went to 16.5 and you can see that it increased substantially. Also side note....look at that leak line..OMG mine are rarely that good.

I rather like the new for her mode...it will automatically increase my minimum pressure if I have 2 OAs within 2 minutes I think for that night only.
You can see it in this example. At 5:18 I had 2 OAs (so close together they look like one flag) and at 5:20 when the machine went back down it only went to around 10 cm and wouldn't go any lower. If it had needed to go higher again it would have. I just ran out of sleep before it needed to increase again.

Does this help you understand how it works and potential limitations of this mode? It is not nearly as limited as the old A10 algorithm was.

Jay Aitchsee · Post by **Jay Aitchsee** » Tue Dec 12, 2017 6:10 am

Pugsy wrote:Does this help you understand how it works and potential limitations of this mode? It is not nearly as limited as the old [S8] A10 algorithm was.

Yes, the For Her Mode doesn't respond to OA events at pressures of 12cm/H20 and higher, but will respond to Flow Limitations and Snores to 20cm/H20 as stated in the manual.

ResMed Clinical Guide, AirSense 10 AutoSet for Her Mode wrote:Treats apneas up to 12 cm H2O and continues to respond to flow limitation and snore up to20 cm H2O.

Also, the For Her Mode is able to distinguish between Central and Obstructive Apneas using a FOT, while the S8 could not, which was the primary reason the S8 did not respond to Apneas above 10cm/H2O. But the S8, like the For Her Mode, would respond to flow limitations and snores to 20cm/H2O as well.

tedtomato · Post by **tedtomato** » Mon Dec 25, 2017 3:07 am

Actually, I found some more details regarding the "for her" algorithm:

"In comparison, ResMed AutoSet for Her evaluates the flow for every breath looking for apneas, snore, and flow limitation, and delivers a proportional increase in pressure depending on the degree of deviation of the event from normal, modulated by the current pressure setting and leak rates. If pressure is >10, then the response to flow limitation reduces and a louder snore is required to produce a response. Both AutoSet for Her and AutoSet respond less as leak gets higher."

Extract from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629962/

I don't think this was written for the A10 version, but I can see that, when I use the "for her" algorithm with my Airsense 10 Autoset for her device with a pressure above 10, the device hardly changes its pressure despite many events (like flow limitations). Pressure graph is pretty much flat. Below 10cm, the device does change the pressure a lot more.

Sleep Study Results - Basics

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