New APAP user without sleep study looking for advice

Pugsy · Post by **Pugsy** » Thu May 06, 2021 7:54 am

Pressure pulses are just little teeny tiny puffs of air that the machine uses to help distinguish what kind of event might be trying to happen. Doesn't always mean some sort of event materialized and lasted long enough to meet criteria for some sort of apnea event flag.
The puffs are used to help the machine figure out obstructive kind of event from central kind of event.
With obstructive event the airway is closed or trying to close and with CA/central event the airway is open. More pressure is usually what is given when obstructive in nature events are seen. More pressure won't help with centrals so the machine has to just sit back and ignore centrals.

So that's the function of pressure pulses and most people won't find them problematic....and they won't disrupt sleep.

Remember OAs, CAs and hyponeas all have to last at least 10 seconds to earn a flag. If the airway tries to close off and there's a pressure pulse during the air flow reduction and the airway opens back up after only 9 seconds....no flag will happen but it isn't impossible for that 9 second air flow reduction to have disturbed sleep.

Also....remember awake breathing irregularities themselves can cause the machine to do the pressure pulses because of the machine not knowing if you are awake or not. Those false positives I have already talked about. These machines are good but not perfect. They don't know if we are asleep or not and they would rather err on the side of caution than ignore a real sleep apnea event so they won't ignore awake breathing irregularities. Awake breathing air flow that might be irregular gets the same treatment and response as asleep breathing air flow because that's all the machine measures.....air flow.

gadgetmaniah · Post by **gadgetmaniah** » Thu May 06, 2021 8:24 pm

Pugsy wrote: ↑
Thu May 06, 2021 7:54 am
Pressure pulses are just little teeny tiny puffs of air that the machine uses to help distinguish what kind of event might be trying to happen. Doesn't always mean some sort of event materialized and lasted long enough to meet criteria for some sort of apnea event flag.
The puffs are used to help the machine figure out obstructive kind of event from central kind of event.
With obstructive event the airway is closed or trying to close and with CA/central event the airway is open. More pressure is usually what is given when obstructive in nature events are seen. More pressure won't help with centrals so the machine has to just sit back and ignore centrals.

So that's the function of pressure pulses and most people won't find them problematic....and they won't disrupt sleep.

Remember OAs, CAs and hyponeas all have to last at least 10 seconds to earn a flag. If the airway tries to close off and there's a pressure pulse during the air flow reduction and the airway opens back up after only 9 seconds....no flag will happen but it isn't impossible for that 9 second air flow reduction to have disturbed sleep.

Also....remember awake breathing irregularities themselves can cause the machine to do the pressure pulses because of the machine not knowing if you are awake or not. Those false positives I have already talked about. These machines are good but not perfect. They don't know if we are asleep or not and they would rather err on the side of caution than ignore a real sleep apnea event so they won't ignore awake breathing irregularities. Awake breathing air flow that might be irregular gets the same treatment and response as asleep breathing air flow because that's all the machine measures.....air flow.

Ah, I understand now. Thank you.

gadgetmaniah · Post by **gadgetmaniah** » Sat May 08, 2021 7:40 am

Bad sleep third day in a row. I think I know what could be causing the issue - there's a medicine that I recently started that has 'difficulty sleeping' as one of its side effects. I'll try stopping that for a few days and see if it makes any difference.

Pugsy · Post by **Pugsy** » Sat May 08, 2021 8:34 am

gadgetmaniah wrote: ↑
Sat May 08, 2021 7:40 am
Bad sleep third day in a row. I think I know what could be causing the issue - there's a medicine that I recently started that has 'difficulty sleeping' as one of its side effects. I'll try stopping that for a few days and see if it makes any difference.

I take one of those meds myself. Most people it causes drowsiness but not me....I am in the very small percentage of people that it causes insomnia.

If it does work out that your crappy sleep is indeed medication side effect related you need to talk to your doctor abut maybe dosage times or even changing meds.
Unfortunately lots of medications come with the extra baggage of screwing with our sleep quality.

gadgetmaniah · Post by **gadgetmaniah** » Sat May 08, 2021 8:47 am

Pugsy wrote: ↑
Sat May 08, 2021 8:34 am

gadgetmaniah wrote: ↑
Sat May 08, 2021 7:40 am
Bad sleep third day in a row. I think I know what could be causing the issue - there's a medicine that I recently started that has 'difficulty sleeping' as one of its side effects. I'll try stopping that for a few days and see if it makes any difference.
I take one of those meds myself. Most people it causes drowsiness but not me....I am in the very small percentage of people that it causes insomnia.

If it does work out that your crappy sleep is indeed medication side effect related you need to talk to your doctor abut maybe dosage times or even changing meds.
Unfortunately lots of medications come with the extra baggage of screwing with our sleep quality.

Ok, thanks. I actually did not take the medicine on the prescription of a doctor. I took it for my constipation issues but it isn't working anyways so there wouldn't be any problem in leaving the medicine if my sleep does get better.

gadgetmaniah · Post by **gadgetmaniah** » Sun May 09, 2021 5:45 am

Ok, I had a better sleep today. I did initially not feel very good when I woke up, but gradually about an hour after waking up I felt much more refreshed. Still feel there is some residual sleep in my head though (is that a thing?).

I had the min pressure at 5 cm and max pressure at 12 cm. The median pressure was 6 cm.

I am thinking of the purchasing the machine now and will contact the seller to ask for the price.

gadgetmaniah · Post by **gadgetmaniah** » Mon May 10, 2021 5:32 am

A very bad sleep again today. I don't know what's wrong...woke up feeling very tired and unrefreshed just like I would without using a CPAP. My stats look alright. Should I try increasing the minimum pressure anyways?

zonker · Post by **zonker** » Mon May 10, 2021 10:34 am

gadgetmaniah wrote: ↑
Mon May 10, 2021 5:32 am
A very bad sleep again today. I don't know what's wrong...woke up feeling very tired and unrefreshed just like I would without using a CPAP. My stats look alright. Should I try increasing the minimum pressure anyways?

i wouldn't, no. we don't sleep the same way every night. this is true whether you are new to cpap or have almost six years at it, like me.

give it some time. what you are looking for are trends, not something that happens on what night of data collection shows.

it's hard to do, i know. but slow and steady wins the race.

good luck

Pugsy · Post by **Pugsy** » Mon May 10, 2021 10:46 am

Why do you think that more pressure is the answer?

I know people want to blame all their sleep problems on the airway and fix it with more pressure from the cpap machine but the cold hard fact of life is that all our sleep problems aren't always caused by airway issues.

Now increasing the pressure isn't going to harm you but it may not be the ticket to better sleep that you are looking for.
As long as you understand that and accept it...won't hurt to try it. There are people who say they sleep better at pressures above what the machine wants to give or the data might not point to actually needing it...and it doesn't hurt anything but we don't really know why.

While you are renting the machine...probably wouldn't hurt to experiment a bit and see if more pressure does anything for your sleep quality or not. It might...and it might not. I did a similar experiment back when I first started therapy. Didn't change sleep quality or the data that I saw and I ended up 3 cm higher than my minimum....so I backed off an went back to my minimum after a 6 week experiment with more pressure and more pressure didn't do a damn thing for anything for me.

More pressure isn't always going to give us great sleep. It only helps IF (big IF) the problem is in the airway somehow. Most of the time poor sleep isn't from the airway once someone is on cpap and the data isn't all that exciting.

gadgetmaniah · Post by **gadgetmaniah** » Mon May 10, 2021 2:26 pm

zonker wrote: ↑
Mon May 10, 2021 10:34 am
wouldn't, no. we don't sleep the same way every night. this is true whether you are new to cpap or have almost six years at it, like me.

give it some time. what you are looking for are trends, not something that happens on what night of data collection shows.

it's hard to do, i know. but slow and steady wins the race.

Pugsy wrote: ↑
Mon May 10, 2021 10:46 am
Why do you think that more pressure is the answer?

I know people want to blame all their sleep problems on the airway and fix it with more pressure from the cpap machine but the cold hard fact of life is that all our sleep problems aren't always caused by airway issues.

Now increasing the pressure isn't going to harm you but it may not be the ticket to better sleep that you are looking for.
As long as you understand that and accept it...won't hurt to try it. There are people who say they sleep better at pressures above what the machine wants to give or the data might not point to actually needing it...and it doesn't hurt anything but we don't really know why.

While you are renting the machine...probably wouldn't hurt to experiment a bit and see if more pressure does anything for your sleep quality or not. It might...and it might not. I did a similar experiment back when I first started therapy. Didn't change sleep quality or the data that I saw and I ended up 3 cm higher than my minimum....so I backed off an went back to my minimum after a 6 week experiment with more pressure and more pressure didn't do a damn thing for anything for me.

More pressure isn't always going to give us great sleep. It only helps IF (big IF) the problem is in the airway somehow. Most of the time poor sleep isn't from the airway once someone is on cpap and the data isn't all that exciting.

Thank you both for the reply. I realized I'm just being impatient and not looking at it realistically. Sorry! Just going to try to be more patient now.

gadgetmaniah · Post by **gadgetmaniah** » Wed May 12, 2021 7:48 am

Pugsy wrote: ↑
Mon May 10, 2021 10:46 am
Why do you think that more pressure is the answer?

I know people want to blame all their sleep problems on the airway and fix it with more pressure from the cpap machine but the cold hard fact of life is that all our sleep problems aren't always caused by airway issues.

Now increasing the pressure isn't going to harm you but it may not be the ticket to better sleep that you are looking for.
As long as you understand that and accept it...won't hurt to try it. There are people who say they sleep better at pressures above what the machine wants to give or the data might not point to actually needing it...and it doesn't hurt anything but we don't really know why.

While you are renting the machine...probably wouldn't hurt to experiment a bit and see if more pressure does anything for your sleep quality or not. It might...and it might not. I did a similar experiment back when I first started therapy. Didn't change sleep quality or the data that I saw and I ended up 3 cm higher than my minimum....so I backed off an went back to my minimum after a 6 week experiment with more pressure and more pressure didn't do a damn thing for anything for me.

More pressure isn't always going to give us great sleep. It only helps IF (big IF) the problem is in the airway somehow. Most of the time poor sleep isn't from the airway once someone is on cpap and the data isn't all that exciting.

Hi, so I contacted the seller and he's selling the machine for too expensive a price - he's asking around $400 for it and it has about 1400 hours on it. I found another seller who is selling refurbished machines and he has a Resmed S10 available for about $350. Do you think I should go for that, since it is newer and I have read that Resmed machines are better? And, are there any details that I should ask the seller about the machine before purchasing it? Thank you.

Edit: He also has the machine that I am renting right now (Philips Respironics REMStar) for about $200 refurbished.

Pugsy · Post by **Pugsy** » Wed May 12, 2021 8:21 am

gadgetmaniah wrote: ↑
Wed May 12, 2021 7:48 am
he has a Resmed S10 available for about $350. Do you think I should go for that

Depends on the exact model...
Which model??? If the CPAP model...absolutely not worth it. Avoid it totally no matter how inexpensive it might be.

CPAP
Elite
AutoSet
AutoSet for Her

gadgetmaniah wrote: ↑
Wed May 12, 2021 7:48 am
(Philips Respironics REMStar)

Remstar tells us nothing than it is an older than DreamStation model machine. Respironics used "Remstar" in ALL their machines from the dawn of time until they changed to the DreamStation model name.
Again....value is tied to exact model because not all models will do what you need done to monitor your own therapy.

As to which brand is "better" depends on what a person needs and I personally prefer the ResMed but I have used Respironics in the past and got along well with it. It's quieter for one thing and I do think that the different algorithm is "better" for most people but that doesn't mean the Respironics is a crap machine at all.

$400 for the System One 550 model....way too much money even if it was zero hour.

It was replaced by the 560 in 2011 I think it was.

gadgetmaniah · Post by **gadgetmaniah** » Wed May 12, 2021 8:28 am

Pugsy wrote: ↑
Wed May 12, 2021 8:21 am

gadgetmaniah wrote: ↑
Wed May 12, 2021 7:48 am
he has a Resmed S10 available for about $350. Do you think I should go for that
Depends on the exact model...
Which model??? If the CPAP model...absolutely not worth it. Avoid it totally no matter how inexpensive it might be.

CPAP
Elite
AutoSet
AutoSet for Her

gadgetmaniah wrote: ↑
Wed May 12, 2021 7:48 am
(Philips Respironics REMStar)
Remstar tells us nothing than it is an older than DreamStation model machine. Respironics used "Remstar" in ALL their machines from the dawn of time until they changed to the DreamStation model name.
Again....value is tied to exact model because not all models will do what you need done to monitor your own therapy.

As to which brand is "better" depends on what a person needs and I personally prefer the ResMed but I have used Respironics in the past and got along well with it. It's quieter for one thing and I do think that the different algorithm is "better" for most people but that doesn't mean the Respironics is a crap machine at all.

$400 for the System One 550 model....way too much money even if it was zero hour. It was replaced by the 560 in 2011 I think it was.

Thanks for the reply! Ah, I forgot to ask the exact model for the Resmed. If it's an Autoset then it should be a good deal?

Yeah, the REMStar is the 550P Auto A-Flex. I thought that that $400 was too much especially since the latest Dreamstation is for the same price.

Pugsy · Post by **Pugsy** » Wed May 12, 2021 8:53 am

Yes, if the AirSense 10 is the AutoSet then a good deal.
We seen slightly used models in the US for $400 and they sell quickly.
Now we do expect a newer AirSense 11 model to be released fairly soon but so far it's not available but the online market seems to be discounting new AirSense 10 models now and historically that is an indication of a newer model release coming in the future.
We never know when though. ResMed is real tight lipped about new model release dates.

gadgetmaniah · Post by **gadgetmaniah** » Wed May 12, 2021 8:56 am

Ok, I see. So, I've asked him and he's saying that the AutoSet S10 refurbished is for $400. I'll ask him about the hours though and try to buy a one with lower hours.

New APAP user without sleep study looking for advice

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