Adaptive Behavior For Dreamstation Auto

Greetings everyone. I'm brand new to this forum. I stumbled upon this place in search of information regarding my new Dreamstation. For the last 12 years I've been using a ResMed Elite II. I had it set to 12 for pressure. Anyway, the on/off button was becoming more and more problematic so I decided to buy a new machine. I received my new Dreamstation yesterday and spent some time getting it all set up, programmed, and paired to the DreamMapper app on my phone. Even though I had my last machine set at 12, I decided to set my new machine up on auto with 4 being the lowest and 20 being the highest which is actually the way it came to me out of the box. My theory was that it would adapt to my breathing and end up at the ideal pressure for me. I actually slept pretty well other than having to get up in the middle of the night urinate. I was excited to look at the overnight data from the app when I woke up this morning but was surprised to see that the average pressure was 4.7. I was also surprised to see that my AHI was 24.3. Was I wrong to set my minimum and maximum pressure that far apart? If I leave my new machine set up as is, will it slowly adapt towards perfection or do I need to set my minimum up higher?

Set your minimum pressure at 6. Then download the Oscar software so you can see the actual data from your nights sleep. Keep messages
on this post so we can follow what is happening. https://www.verywellhealth.com/how-init ... ap-3015039

Fuzrock wrote: ↑

Fri Sep 25, 2020 11:19 am

I decided to set my new machine up on auto with 4 being the lowest and 20 being the highest which is actually the way it came to me out of the box. My theory was that it would adapt to my breathing and end up at the ideal pressure for me.

This is one of the worse things you can do.

These machines don't adapt and zero in on your optimum pressure. They float down to the minimum pressure and will increase pressure based on potential obstruction indicators (apneas, hypopnea, flow limitations and snores). They respond by increasing the pressure, hoping to prevent apneas.

The problem with have to low a minimum pressure is the machine may not respond quick enough enough to prevent the apnea.

One approach is to set you minimum to a reasonable value, then look at your charts and then keep inching up your minimum until it starts approach an optimal value. You can tell your getting close to optimal when your pressure chart starts to flatten and AHI lowers.

People here can help dial-in your settings.

Fuzrock wrote: ↑

Fri Sep 25, 2020 11:19 am

Was I wrong to set my minimum and maximum pressure that far apart?

No, the problem was setting the minimum too low. Dog Slobber is pointing you in the right direction to find your optimal setting.

Note 1. The machines are not adaptive.
Note 2. Many of us, even those with low minimum pressure requirements, set the max pressure at 20.0. The machine won't go any higher than needed.

Something isn't adding up here. With that many OAs I would think the machine would have tried harder than a 90% pressure of 5.0 cm.
Is EZStart turned on by chance???? If so...turn it off.

Fuzrock wrote: ↑

Fri Sep 25, 2020 11:19 am

My theory was that it would adapt to my breathing and end up at the ideal pressure for me.

If only it could work that way, but it can't.

The machine is slow and stupid and spends all night trying to get the pressure down to 4, because, like a faithful dog, it *trusted you to tell it the right thing*... and 4 is almost *never* the right thing.

palerider wrote: ↑

Sat Sep 26, 2020 6:20 am

like a faithful dog

Add a humidifier, and you have a Slobber Dog.

ChicagoGranny wrote: ↑

Sat Sep 26, 2020 7:42 am

palerider wrote: ↑

Sat Sep 26, 2020 6:20 am

like a faithful dog

Add a humidifier, and you have a Slobber Dog.

So I took LSAT's suggestion and set my minimum to 6 on the second night which lowered my AHI to 16.8.
For the next night I raised the minimum pressure to a 7 and got my AHI down to 7.1.
Last night I bumped the minimum up to a 7.5 which lowered my AHI to 3.2.
Do you suppose I should try setting my minimum at 8 tonight to see if I can do better? I've read that under 5 is good. Anyone here consistently do less than 1 AHI?

Pugsy wrote: ↑

Fri Sep 25, 2020 3:22 pm

Something isn't adding up here. With that many OAs I would think the machine would have tried harder than a 90% pressure of 5.0 cm.
Is EZStart turned on by chance???? If so...turn it off.

I'm pretty sure I have easy start turned on. My numbers are looking a lot better so I'm unsure that turning it off at this point would be more beneficial. What are your reasons for not liking it?

Fuzrock wrote: ↑

Mon Sep 28, 2020 7:50 am

Pugsy wrote: ↑

Fri Sep 25, 2020 3:22 pm

Something isn't adding up here. With that many OAs I would think the machine would have tried harder than a 90% pressure of 5.0 cm.
Is EZStart turned on by chance???? If so...turn it off.

I'm pretty sure I have easy start turned on. My numbers are looking a lot better so I'm unsure that turning it off at this point would be more beneficial. What are your reasons for not liking it?

Because EZStart keeps the machine from auto adjusting the pressures upwards in response to apnea events for a period of time which I think is 30 days
It keeps the max pressure artificially low to "help you during the adjustment period" which means the machine can't do what it is designed to do...auto adjust the pressure upwards in response to airway collapses. Read what it does in auto mode. It's not doing you any favors.

If you were to use OSCAR software you would see the machine didn't increase the pressure in response to the apnea events that were happening because it couldn't. The max might have been 20 but when at the lower starting points like 5 or 6 minimum...the machine never went above 1 cm above the minimum. It's no wonder it wasn't effective. With EZStart turned on and a setting of 6 cm minimum the most the machine will go to is 7 cm and that's going to allow apnea events to happen. When you have changed the minimum it still is limiting the machine and will always limit the machine. You are making the machine function with a 1 cm auto adjusting range. Might as well be in cpap fixed mode.

Suit yourself on using it but realize what it is doing...and it's not helping you at these settings. It might be useful if you needed a 12 cm minimum and 12 cm was too much to start with but with the way you are using it now....you are artificially restricting it and it won't ever auto adjust to its full ability. It is one of the stupidest ideas Respironics ever came up with. Using the ramp feature is a better way to ease into a higher pressure or manually start lower and work up.

If you continue with the minimum of 7.5 and EZStart turned on...even though your max is officially set to 20 it won't ever go above 8.5 cm. Might as well be in fixed mode with that tiny of a range.

EZ-Start is a "feature" intended for absolute newbies starting out CPAP therapy.

As Pugsy pointed it, it is artificially limiting your machines ability to increase pressure, should it need to.

Judging by your machine's consistent AHI drop relative to your increase in minimum pressure, we can be reasonably certain that that was part of the problem. But without detail graphs, we don't know how much of a problem the artificial cap played.

This is why you, and all members are encouraged to download OSCAR and post charts.

Fuzrock wrote: ↑

Mon Sep 28, 2020 7:47 am

Anyone here consistently do less than 1 AHI?

A lot of us do. And we've done so with the help of OSCAR, and then fine-tuning according to the charts produced by OSCAR.

My Sleep study put my AHI at 59, and that was without achieving REM. My AHI is worse in REM, I don't know how much higher it would be, but considerable.

With the help of OSCAR, the fine people on this forum and Zonker, my AHI for the last year has been 0.15, and 0.09 for the last month.

Dog Slobber wrote: ↑

Mon Sep 28, 2020 8:47 am

With the help of OSCAR, the fine people on this forum and Zonker,

Now just a minute.
I think Zonker is a fine people too.

JPB

jimbud wrote: ↑

Mon Sep 28, 2020 9:03 am

Now just a minute.
I think Zonker is a fine people too.

Do you mean "fine" such as in a satisfactory or pleasing manner; very well, or "fine" such as in small, thin, insignificant? I hope you menat the former, and not the later.

Okie bipap wrote: ↑

Mon Sep 28, 2020 12:00 pm

small, thin, insignificant