First Couple of Nights - ResMed AirSense 10 AutoSet

DavidY wrote: ↑

Sat Apr 07, 2018 7:06 pm

A chin strap is cheap to try. As cheap as $10 on Amazon Canada.
Are you still able to trial test FFM? I am thinking about a FFM in case of colds and such. I have a nasal Pico mask on order....in my search for a near perfect nasal mask.
Dave

Dave, I have seen those chin straps on Amazon and eBay. It is actually quite an interesting look into how marketing of items of low value actually occurs. Those same chin straps in different colors with the holes for the ears are everywhere. They can be priced from $10 to $12 on Amazon, and for delivery from Canada on eBay about $7. But if you will accept free delivery from China the price is as low as $1.27 each. Obviously people are buying them from China and then reselling them on Amazon and from Canada on eBay.

In any case I made one using 3" Tensor bandage and it worked quite well. I also used paper medical tape to ensure there were no mouth leaks. The combination was uncomfortable but worked. I don't think I have any opportunity to trial a FFM as I have kind of cut ties with the local sleep clinic that gave me the free trial of the F&P SleepStyle, that they wanted me to pay $2400 for. Probably won't be too interested in giving me a trial of a mask, only to have me buy it on line. I need to do some research on FFM options. My quick look seems to suggest the ResMed Mirage Quattro is one of the older but still most popular models. Sure a lot more bulky than the P10, but at the end of the day, function is most important.

facemir wrote: ↑

Sun Apr 08, 2018 12:11 am

Ron AKA wrote: ↑

Sat Apr 07, 2018 11:00 am

Tried setup #2 last night, and it was a fail. I suspect I am opening at least my lips and letting air out especially at the higher pressures.

Try taping your mouth shut with some surgical tape. I tapemine shut every night.

Did that last night using paper medical tape. Yes, it works, but I often have to get up to take some Tums for heartburn, and it is a bit of a pain to retape again. I think I am going to have to look at full face options.

palerider wrote: ↑

Sat Apr 07, 2018 7:47 pm

Cpaps DO NOT "try ... to force the obstruction open"... never have, never will. There are modalities of obstructive apnea where more pressure from above will just block the airway harder, like pushing on a door that opens towards you.... therefore, *NO* cpap raises pressure *during* an apnea, they *all* raise pressure AFTER an obstructive apnea is over.
It is easy enough to mistake the cause/response behavior unless you've zoomed in on a breath by breath basis on the charts.

I think we are both essentially saying the same thing in a different way. I take my understanding of how the A10 works from the ResMed Clinical Manual, as I suspect their engineers are the only ones that really know the detail. Some quotes:

"The AutoSet algorithm adjusts treatment pressure as a function of three parameters: inspiratory flow limitation, snore, and apnea... Minimum pressure (Min. Pressure) that adjusts according to the frequency of apneas: If two apneas occur within a minute, the pressure reached in response to the second apnea will become the new minimum treatment pressure until the next treatment session."

While the machine will not respond to central apneas, it does respond to flow limitations which are often associated with them and tries to predict future apneas from the apnea frequency. The bottom line is that it is responding, and now based on my latest results without all the major leak noise, it looks like I could benefit from more pressure. This is new, but easy to fix. That said I suspect from looking at the detailed wave forms that it may just cause the machine to classify the events as CA's instead of OA's.

ajack wrote: ↑

Sun Apr 08, 2018 2:14 am

Please don't take post count as credibility, the two aren't the same. If someone needs to say how clever they are, they aren't.
If it were me. Turn off EPR if the CA scare you. min 10 max 20 and get a full face mask(f20?) I found it's easier to get use to, than playing with stuff that is a part fix. review in a month.
you may need to set the F&P a bit different to the resmed for your wife. the min on the F&P may need a bit more. both are good machines and I'd put it above the dreamstation on comparative test results.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005142/

Thank you for the link to the very interesting article. Do you think the A1 and A2 ResMed machines correspond to the Standard, and For Her versions of the machines respectively?

For clarity, I am no longer using the F&P machine, as it was just a trial. I used my wife's S9 for one night and actually got better results than I am getting now, AHI of 2.9. I am sticking with the EPR for now as I think there is some possibility it has the ability to somewhat reduce the CA induced waxing and waning cycle that I see. However, whether or not it does may be somewhat dependent on the method the machine uses to trigger the EPR. I noted that the study you provided the link to was done with EPR turned off. There are also differences between the way manufacturers do that, and in particular between ResMed and Respironics. ResMed triggers on actual flow reversal with the EPR, while Respironics Flex triggers on predictive timing. It tries to anticipate when your will switch from inhale to exhale. That method can be detrimental to the comfort aspect, but possibly better in supporting CA event reductions. Here is a link to an article that talks about the differences. The F&P machine is not included, but I suspect it triggers on prediction like the Respironics. At least that is what it felt like to me. I could feel it trying to force me to breath, sometimes before I wanted to. Don't feel that at all on the ResMed. I have not researched it a lot, but I think that is part of the difference between the AirSense models and the AirCurve models in ResMed. The AirCurve ones may trigger on prediction... Not a lot of data to compare, but so far the AHI's I got averaged low than what I am not getting with the A10. Perhaps EPR switching may be part of that.

The resmed that doesn't pressure spike as much is the for her mode one. It's slower and gentler.
Generally the CA or clear airway apnea are new user, pressure induced and settle down for most people within 12 weeks. You only have 2.6 and I'd ignore them for now. See what happens when you raise the max pressure. You would need to zoom in to see what is going on. Some just follow a big breath. Some just happen, it is thought it is the o2/co2 balance and waiting for the co2 to build back up again to trigger a breath. Generally EPR increases them. I'd keep the comfort of the EPR. It's only if they last a long time, over 20-30 seconds and you get an o2 drop from a real Central Apnea, that I would think they are an issue. If they continue and you are concerned, you can get a recording spo2 meter off ebay or such for $32 or less
https://www.amazon.com/Blue-Finger-Puls ... B00B8L8ZXE

Ron AKA wrote: ↑

Sun Apr 08, 2018 9:46 am

palerider wrote: ↑

Sat Apr 07, 2018 7:47 pm

Cpaps DO NOT "try ... to force the obstruction open"... never have, never will. There are modalities of obstructive apnea where more pressure from above will just block the airway harder, like pushing on a door that opens towards you.... therefore, *NO* cpap raises pressure *during* an apnea, they *all* raise pressure AFTER an obstructive apnea is over.
It is easy enough to mistake the cause/response behavior unless you've zoomed in on a breath by breath basis on the charts.

I think we are both essentially saying the same thing in a different way. I take my understanding of how the A10 works from the ResMed Clinical Manual, as I suspect their engineers are the only ones that really know the detail. Some quotes:

"The AutoSet algorithm adjusts treatment pressure as a function of three parameters: inspiratory flow limitation, snore, and apnea... Minimum pressure (Min. Pressure) that adjusts according to the frequency of apneas: If two apneas occur within a minute, the pressure reached in response to the second apnea will become the new minimum treatment pressure until the next treatment session."

Unless you're using the AutoSet For Her algorithm, (and have the wrong machine in your profile), then you're reading the wrong part of the manual.

And no, we're not saying the same thing in a different way, You implied that auto machines raise pressure to "try ... to force the obstruction open", while the fact is that they raise pressure *after the apnea event has ended, and you're breathing again on your own*

ajack wrote: ↑

Sun Apr 08, 2018 11:11 am

The resmed that doesn't pressure spike as much is the for her mode one. It's slower and gentler.
Generally the CA or clear airway apnea are new user, pressure induced and settle down for most people within 12 weeks. You only have 2.6 and I'd ignore them for now. See what happens when you raise the max pressure. You would need to zoom in to see what is going on. Some just follow a big breath. Some just happen, it is thought it is the o2/co2 balance and waiting for the co2 to build back up again to trigger a breath. Generally EPR increases them. I'd keep the comfort of the EPR. It's only if they last a long time, over 20-30 seconds and you get an o2 drop from a real Central Apnea, that I would think they are an issue. If they continue and you are concerned, you can get a recording spo2 meter off ebay or such for $32 or less
https://www.amazon.com/Blue-Finger-Puls ... B00B8L8ZXE

Thanks for the suggestions. I noticed I forgot to include the link I promised on the different methods for EPR. Here it is:

Comparing Expiry Relief in Different CPAP Machines

Yes, I am aware of the issue with centrals and new CPAP users. I recall the statistics are that about 6% of new users increase their incidence of centrals. And of those about 1.5% still have the issue after about 6-8 weeks of treatment. I'm into my 3rd week, so still hoping I will not be in the 1.5% category. Fisher&Paykel have a document that sums it up well.

The True Prevalence of Central Apnea in CPAP Patients

For now I am focusing on getting the obstructive events down. Then I will reevaluate at the 8 week mark.

Thanks for that, I've only used resmed and an old resmart, as a first machine. I don't know what the other pressure relief systems feel like.

It sounds a good plan. I'd also focus on the OA and H, the H can be tricky and worth looking at zoomed. Machines tend to over count apnea, when compared to a lab.
https://www.youtube.com/watch?v=FMkBatUVu7s
Some other videos here are worth watching on it too.
https://www.youtube.com/user/TheLankyLefty27/videos

So last night is finally showing some potential with an AHI of 2.2. That is the best I have achieved with the AirSense 10 machine. And it matches the best I achieved with the F&P SleepStyle. It may represent about the limit of what I can do in the short term given the high component of centrals that I have. The hope would be that my body adapts and does a better job of maintaining breathing rate as it adjusts to the higher O2 and lower CO2 levels.

My chin strap and medical tape over the mouth solution to the mouth leaks does not seem to be a permanent one, although it is effective. I think I will try the chin strap only tonight and see how much of a difference that makes. It may be a tolerable long term solution. From there I will go on to try the option of a lower minimum pressure and no EPR.