LOVE my new ResMed AutoSet 10 !!!

After reaching my 10th year using the Respironics Remstar M-series (which was a great auto-CPAP for it's time & gave me excellent results), I decided it was time for an up-to-date APAP --"out-of-pocket" to avoid the hassles -- and decided to try ResMed this time because so many cpap-users love it here (besides the "for Her" is very pretty!

I didn't do a Sleep Lab this time (thought it was a waste since I couldn't get more than an hour or two of sleep even with sleeping pills back in 2009, trying twice!). Back in 2009, with my Respironics APAP & software, and help on this forum, I ultimately set my machine to 12-17 with my 90% pressure reading 14 with great results for ten years.

This time around, I've set my AutoSet 10 to a pressure range of 6-20 (after reading posts about pressure on this forum). Other settings: 15 min of Ramp (i like the super-quiet) - EPR 2 is ON, but only during Ramp (I've read that EPR can increase CI, so I opted out of "full night").

I currently don't have a computer that will work with Oscar or ResScan, only a Amazon Fire Tablet . . . so I am limited to the data on my AutoSet using Clinician Settings. My 4th night in and my readings are: Pressure=11.5, AHI=2.1, AI=1.4, [HI=0.7], CI=0.8, Leaks=34.

So how am I doing with my numbers so far? Any suggestions for improving are welcome!

Thx, Joy

JoyD. wrote: ↑

Sat Nov 09, 2019 9:35 am

EPR 2 is ON, but only during Ramp (I've read that EPR can increase CI, so I opted out of "full night").

It can have that effect in somewhere between 1 in 7 and one in 15 people, it's not that common.

You could try all night epr and see how it feels, and how you react, even with the people that are affected, it's usually minimal.

The pressure and leak numbers on the screen in auto mode are 95% numbers which means at OR BELOW that number for 95% of the night.

Large leak territory is 24 L/min so the 35 L/min means you spent some time in large leak territory (over 24) but it doesn't necessarily mean that leaks were horrible for most of the night.
The machine will still be able to do a decent enough job of responding and recording up to around 35 L/min mark. The higher it goes the iffier it gets. When the machine starts having trouble preventing events you would likely see some UA flagging...unknown apnea...something happened but the machine couldn't quite figure out exactly what it was.

95% numbers are easily skewed by a relatively small period at the higher numbers so I don't worry too much about 95% numbers all by themselves. I prefer to see the detailed data to evaluate exactly how much time was spent at the higher numbers.
Mr Frowny face won't show up for leak management or mask fit until a person spends at least 30% of the night above 24 L/min...so on the LCD screen that is really the only guideline and it takes a LOT of big leak to add up to 30% or more.

Here's a good example of a big 95% number but the actual time overall spent in large leak really wasn't that horrible.
viewtopic.php?f=1&t=108724&p=1036669&hi ... t#p1036669

Once you get to where you can see the details by using the software all you have to go on is the numbers on the screen....I wouldn't worry about the 35% number. I am betting the bulk of the night your leaks weren't all that excessive.
If you slept through them...ignore for now.

As to EPR causing centrals....very small minority of people will have that happen. Give EPR a try...you might really like it and the chances of it causing a problem are very small.

OK, Pugsy, thanks, I won't worry about the 34L/min leak report right now. BTW, my Zest Nasal Mask seems to fit well, and while I'm awake I don't notice any air escaping.

As long as my AHI readings are around 2 or under & AI readings 1.5 or under, can I be assured that I'm doing fine with my therapy? Would you suggest any setting adjustments to improve the numbers (w/o help from software)?

Even though I'd LOVE to be able to use Oscar or ResScan, I'm not sure having access to it would make that much difference to my current therapy with the data that is being reported, my APAP history & the fact that I am feeling fine . . . considering having access to software would mean "for me" purchasing a Mac . . . my Amazon Fire works for me with everything else!

ALSO . . . forgot to mention this:

During my 10 years on Auto-CPAP therapy with my old Respironics RemStar & using software . . . CENTRALS were never reported. NOW, using AutoSet 10 for Her, I see numbers each of the four nights I've used it so far: CI = 1.5, 0.9, 1.3, 0.8.

What's up with that? What should those numbers mean to me?

JoyD. wrote: ↑

Sat Nov 09, 2019 10:50 am

ALSO . . . forgot to mention this:

During my 10 years on Auto-CPAP therapy with my old Respironics RemStar & using software . . . CENTRALS were never reported. NOW, using AutoSet 10 for Her, I see numbers each of the four nights I've used it so far: CI = 1.5, 0.9, 1.3, 0.8.

What's up with that? What should those numbers mean to me?

They weren't reported because your old machine wasn't smart enough to recognize them.

Are CIs always significant when reported? Centrals didn't show up on my 2009 Sleep Study that I know of (but I only got a couple hours sleep!). What should these AutoSet reports of CI up to 1.5 mean to me?

I understand an Apnea, and a Hypopnea, but not a Central.

Continuing thanks for all your kind responses!!

JoyD. wrote: ↑

Sat Nov 09, 2019 11:01 am

Are CIs always significant when reported? What should it mean to me?

I understand an Apnea, and a Hypopnea, but not a Central.

Hold your breath for 10 seconds.

THAT is a central, that's it. Nothing. No effort, no stress, nothing.

Now, pinch your nose, keep your mouth closed, and try really hard to breathe for 10 seconds.... THAT is an obstructive.

Feel the difference?

A few centrals are totally insignificant, ignore them.

They're only an issue if they happen in clusters, because they can cause your oxygen levels to drop.

Actually per a discussion I had with a Respironics software tech back in the dark ages when the M series was the latest and greatest...while it didn't flag central apneas separately it would flag them but they got dumped in the OA basket. You could very well have had a few but they got dumped in the OA basket.

You aren't having enough centrals to worry about even if every single one of them was a real asleep central. I am betting at least a few of them are related to awake/semi awake breathing false positive flagging.
Real or false positive centrals...can't do much about them and if they aren't numerous to cause a problem we just ignore them since we really can't do much about them.

I wouldn't do anything with the settings for a couple of weeks. Give yourself time to adjust to the new machine and the new algorithm and just concentrate on being comfortable and sleep quality in general.
There is no urgent need to go changing things and there is a lot of truth to the "give things some time" adage.

Like you, I have a pretty low AHI with a sizable component of centrals. When I look at them using Oscar, I can see that they almost always come after some arousal-type breathing, meaning that I may not even really be asleep when they happen. During a polysomnographic sleep study, these would probably not be scored as sleep apneas (though they would represent little arousals).

Try noticing your breathing during the day: you'll probably see that you stop breathing when you're concentrating on something or exerting yourself in some way. Awake breathing is a lot less regular than asleep breathing, so if your centrals are like mine, and happening when you're somewhat awake, that's really nothing to worry about. And as others have said, even if they are occurring while you're asleep, they are so infrequent that you shouldn't worry anyhow.

Thanks everyone!! You are the BEST!!

Pugsy wrote: ↑

Sat Nov 09, 2019 11:29 am

Actually per a discussion I had with a Respironics software tech back in the dark ages when the M series was the latest and greatest...while it didn't flag central apneas separately it would flag them but they got dumped in the OA basket. You could very well have had a few but they got dumped in the OA basket.

Now, wait a minute...

I had to read this a couple times...

What I think you're saying is that older machines, before "System One" in respironics, or "S9" in Resmed would flag an apnea, central or obstructive, because all they could do is tell you're not breathing... But they couldn't differentiate between the two types of apneas, so all they'd report is "apnea"... Like the UA flags on Resmed... The "I don't know what it was" bucket.

To piggyback on what Miss Emerita says, I find I get CA's flagged when I turn over and have to wrestle with and reposition my hose. Turns out I hold my breath when I do that! At least long enough for my machine to flag it as a CA. I guess it thinks it's smarter than I am!

palerider wrote: ↑

Sat Nov 09, 2019 1:04 pm

Pugsy wrote: ↑

Sat Nov 09, 2019 11:29 am

Actually per a discussion I had with a Respironics software tech back in the dark ages when the M series was the latest and greatest...while it didn't flag central apneas separately it would flag them but they got dumped in the OA basket. You could very well have had a few but they got dumped in the OA basket.

Now, wait a minute...

I had to read this a couple times...

What I think you're saying is that older machines, before "System One" in respironics, or "S9" in Resmed would flag an apnea, central or obstructive, because all they could do is tell you're not breathing... But they couldn't differentiate between the two types of apneas, so all they'd report is "apnea"... Like the UA flags on Resmed... The "I don't know what it was" bucket.

Just reporting what the Respironics software tech (who helped write the software (encore pro and basic) told me.
We used to think that centrals were totally ignored by those M series machines and simply not counted at all.. We thought that someone could have a low AHI and still have central apnea problems. What he told me was that if a central apnea happened the machine still reported an apnea or hyponea (was where it usually got dumped). Explained why we used to see people with high hyponeas or OAs and more pressure didn't fix them like we thought it should.

So the central apnea wasn't totally ignored like we thought....maybe it couldn't classify the apnea as officially "central" but it was still flagged and not hidden away to be a problem that there wasn't some sort of indication of being a problem.
So when someone tells me that they had nice low AHI numbers on a M series machine....I can assume that they didn't have a problem with central apnea numbers or else the AHI wouldn't have been nice and low.

M series machines (and I assume those earlier legacy series full data) didn't have a "I don't know what it is" category.
They did have the "non responsive" category that we thought might be where centrals were dumped but that really wasn't what the non responsive category was meant for. Most of the time they went to the hyponea category for some reason but could also be in the OA basket.

All this is what I gleaned from a direct discussion with a software tech employed by Respironics when I asked him directly about central apneas and were they ignored or just flagged something else lack of a better category.

Pugsy wrote: ↑

Sat Nov 09, 2019 1:18 pm

palerider wrote: ↑

Sat Nov 09, 2019 1:04 pm

Pugsy wrote: ↑

Sat Nov 09, 2019 11:29 am

Actually per a discussion I had with a Respironics software tech back in the dark ages when the M series was the latest and greatest...while it didn't flag central apneas separately it would flag them but they got dumped in the OA basket. You could very well have had a few but they got dumped in the OA basket.

Now, wait a minute...

I had to read this a couple times...

What I think you're saying is that older machines, before "System One" in respironics, or "S9" in Resmed would flag an apnea, central or obstructive, because all they could do is tell you're not breathing... But they couldn't differentiate between the two types of apneas, so all they'd report is "apnea"... Like the UA flags on Resmed... The "I don't know what it was" bucket.

Just reporting what the Respironics software tech (who helped write the software (encore pro and basic) told me.
We used to think that centrals were totally ignored by those M series machines and simply not counted at all.. We thought that someone could have a low AHI and still have central apnea problems. What he told me was that if a central apnea happened the machine still reported an apnea or hyponea (was where it usually got dumped). Explained why we used to see people with high hyponeas or OAs and more pressure didn't fix them like we thought it should.

So the central apnea wasn't totally ignored like we thought....maybe it couldn't classify the apnea as officially "central" but it was still flagged and not hidden away to be a problem that there wasn't some sort of indication of being a problem.
So when someone tells me that they had nice low AHI numbers on a M series machine....I can assume that they didn't have a problem with central apnea numbers or else the AHI wouldn't have been nice and low.

Well, logically, the machine would *have* to report the central as an apnea, since you weren't breathing... to be able to ignore them, it would have to have some determination routine, which hadn't been invented yet

Pugsy wrote: ↑

Sat Nov 09, 2019 1:18 pm

All this is what I gleaned from a direct discussion with a software tech employed by Respironics when I asked him directly about central apneas and were they ignored or just flagged something else lack of a better category.

Well, that does make perfect sense.