Newly diagnosed - about to buy machine, but have questions!

Hi all!

I live in Australia, and I was diagnosed with severe pain obstructive sleep apnoea about a month ago. I’ve been using a rented machine for almost a couple of weeks now; it’s a Philips DreamStation Auto and I have to say that it seems to be doing the job. The machine was rented to me by the sleep clinic, along with a mask. The Australian system is different to the US, by the way, so the clinic I’ve been to is based at a hospital and doesn’t sell machines, it just rents them at a nominal price whilst people test the pressure and get used to using it.

On my original sleep test, my AHI was scored at 106.7. Since using the machine, the Philips Dreammapper app (and OSCAR) tell me that my AHI has been no higher than 2.1, and on most nights it has been 1 or lower (on 4 different nights it was as low as 0.3!). Also, according to the app, my mask fit is 100% every night; I certainly don’t feel any air escaping. I’m using the DreamWear Wisp nasal mask and a chin strap, which has taken some getting used to, but it allows me to sleep on my back again and my wife tells me that I no longer snore at all. I don’t wake up with a dry mouth either – double bonus.

I wasn’t actually informed of the pressure I’ve been prescribed, but it appears (from the machine, which was already set when I brought it home) to be 10cmH20. To be honest, I don’t even use the ramp feature as I feel more comfortable breathing through my nose at the correct pressure as soon as I turn the machine on at night.

I go back to the clinic this Thursday morning, so they can pull the data from my SD card and see how I’m going, I guess. Then I go back again another two weeks after that for the same reason, as well as seeing my specialist around the same time.

I do have a few queries though, and it’d be awesome if people could provide advice based on their experiences!

1. I have the money to buy the Philips DreamStation APAP or the Philips DreamStation CPAP. Normally, the DreamStation APAP is $500 more expensive than the straight CPAP machine, but I can buy it from a reputable supplier as part of a package (including mask, heated tube and 5-year warranty) for the same price as the CPAP before 30 September. Is there any disadvantage to buying the APAP rather than the CPAP model, if I’m only using it at a fixed pressure?

2. Even if I can’t take advantage of the offer, would it still be better to buy the APAP rather than the CPAP? I have the money to buy either, but if the APAP gives me more flexibility in the future (even if I don’t use that flexibility straight away) I’d be willing to “future-proof” myself in that way.

3. To take advantage of the discount, I would need to buy the machine before I go back to the clinic for the second time or return to my specialist. Are there any pitfalls in buying now? I mean, it seems unlikely that they’re suddenly going to say “Oh, wait, you don’t have severe OSA after all”.  My guess is that these last appointments will be about checking my progress and settling on the final pressure that I should be using – is that a reasonable assumption? If the pressure changes then I can just change the settings on the machine, right? Or is there something I haven’t considered which could mean I buy a machine that is useless for me?

4. In the last few days, I’ve felt tired and like I could nod off in the afternoon, which is usually fairly rare for me, even though I have severe OSA. Should I be concerned? To be fair I’ve had alcohol on the evening before a few of those days, so last night was the first night in a few that I slept for over 7 hours – the other nights I was asleep for between 5.5 and 6.5 hours. Is this something that should improve?

I know this is a lot of questions but I’m really just trying to adapt to what is a very new situation for me.

Thanks in advance for any help you can provide!

Welcome to the forum.

First of all....less than 6 hours of sleep will guarantee that I need a nap the next afternoon. Simply not enough sleep.
And I have been on cpap for over 10 years.
To be honest anything less than 7 hours is sub optimal for me to feel my best.

Secondly....read this about how alcohol messes with our sleep.
https://thesleepdoctor.com/2017/11/15/t ... hol-sleep/
Anything (not just alcohol) that messes with our sleep quality (no matter how many hours we get) is going to leave us feeling crappy the next day.

Thirdly....get the apap/auto adjusting capable machine if at all possible. You never know what the future will hold and you might be like me and have much higher pressure needs during REM stage sleep (quite common to need more pressure in REM where you just spend 20% of the night) and while I suppose I could use 15 cm pressure all night long to cover REM.....I much prefer to use around 9 cm for the other 80% of the night and let the machine only go higher when it really needs to. Much more comfortable.
The same can be said of supine sleeping...some people need much higher when on their back and maybe they spend a lot of time on their back or just part of the night.

The DreamStation CPAP machine...model DSX200xxx fixed pressure only machine doesn't collect full data either. If you run into problems you have nothing to evaluate to help you figure out what the problem might be.
The DreamStation Auto CPAP....model DSX500xxx...is a full data machine and there is easy to obtain and use software available to help you out in terms of evaluating effectiveness.
OSCAR is based on SleepyHead so any SleepyHead information will work with OSCAR
https://www.sleepfiles.com/OSCAR/
some examples of what you can see
viewtopic/t158560/How-to-post-images-for-review.html
wiki/index.php/Sleepyhead:Organize

model examples and whether they are full data or not.
wiki/index.php/CPAP_models

Apap, by all means.
The difference is well worth the money.
Think of how much people will spend for a good mattress.
Just for the best sleep they can get.
Breathing is priceless.

APAP for sure. If you want to use straight cpap pressure, an apap machine can be set to provide that as well.

The Dreamstation Auto can do anything the Dreamstation Pro can do (Pro is CPAP with data). For the small difference in price, it doesn’t make any sense at all to buy the fixed pressure version.

Unfortunately, I had no luck with convincing my DME and doc of this. For the moment, I’m renting the Dreamstation Pro they want me to have, but I bought a Dreamstation Go Auto.

Actually, I suspect the Dreamstation Pro is just a Dreamstation Auto that is crippled by the firmware.

The Go is functionally very similar too, except it is downsized for travel. The main trade off is a smaller and louder fan. It does arguably make sense to have a regular machine for daily use, and I seem to get along best with a fairly narrow pressure range anyway, but the ONLY reason for having a fixed pressure machine is that the doc doesn’t like auto.

ragtopcircus wrote: ↑

Tue Sep 24, 2019 6:10 pm

Actually, I suspect the Dreamstation Pro is just a Dreamstation Auto that is crippled by the firmware.

The Go is functionally very similar too, except it is downsized for travel. The main trade off is a smaller and louder fan. It does arguably make sense to have a regular machine for daily use, and I seem to get along best with a fairly narrow pressure range anyway, but the ONLY reason for having a fixed pressure machine is that the doc doesn’t like auto.

I usually get what I want and what I like...not what my doctor likes. The Auto machines can be used as variable pressure OR fixed pressure. That give you flexibility if the fixed doesn't work for you. Obviously your doctor can't figure that out.

I’m going to jump on the Auto version at the reduced price, then - thanks everyone for your advice!

I’m also intrigued by the DreamStation Go, though. I love to travel and am originally from the UK, so any time I visit family there I’m on a plane for 24 hours in each direction. It’s not a priority for me at the moment, but I’m intending to go back in just over two years from now. Would you recommend using a DreamStation Go? I’m willing to spend the extra cash to have a second machine to use solely when I’m travelling.

I’m not sure I’m qualified to recommend the Go or not. I’ll just tell you why I picked it.

I read multiple complaints that people felt starved for air with the Z1/Z2. Their “integration” with their battery seemed pretty clunky too. However, their Heat Moisture Exchanger, though no match for a real humidifier, does work with other machines if you have a suitable mask.

The ResMed Air Mini is only compatible with a few masks. Oscar doesn’t currently support it (I don’t know if that will change or what it’s data capabilities are). It also requires an external brick, and has no integrated battery option.

The Go has an integrated universal power supply, so you only need to bring a slim cord instead of a brick. By itself, it’s not much bigger than the Air Mini plus brick. It has integrated humidifier and battery options that snap on (though you can’t run the humidifier from the battery). The machine plus either the battery or humidifier is pretty small. You could carry the machine and battery on the plane and pack the humidifier, or just get by with the HME while traveling. As I mentioned it is louder (directly related to your inhalation flow rate). It reminds me of sleeping with the wind blowing outside the window. I don’t mind it, but putting it on the floor helps a lot if it bothers you.

Btw, the Go and I think the mini come with 12mm hoses. I find that to be a little too restrictive. The Go is compatible with any standard hose. The actual outlet size is 15mm ID, and it accepts standard 22mm hose ends. I use a Respironics 15mm slimline hose with both the home and travel machines. The Respironics is a little lighter than ResMed’s 15mm thinline. Per the specs, the Go’s pressure regulation is a little more accurate with 15mm also.

Of course, even home machines have gotten smaller and lighter. Some choose to travel with them.

My father was an early CPAP patient. The big noisy boat anchor he was chained to was a big factor in putting off CPAP myself for so long - especially as a widower dating again. The availability of decent travel machines was a factor in deciding it was finally time. I’m not saying that waiting was the smart thing to do ... it clearly wasn’t.

Btw, a few drops of purified water on the HME help jumpstart it. You still wouldn’t want to use it every day though. Each one is good for about a week. You can buy them in packs of ten from Amazon. I’ve only tested them at home so far, but they seem like a great option for use in planes, trains, and automobiles. Whether to use them in the hotel is a personal choice.

Correction: the AirMini uses a 15mm hose that is proprietary at both ends.

As I said earlier, I use a 15mm hose with the Go instead of the 12 it comes with.