That's a good question.ozij wrote: ↑Wed Nov 16, 2022 2:16 amYou're so thorough that I dare ask you about the chronology of the score card.robysue1 wrote: ↑Wed Nov 16, 2022 12:43 amHere is the score card through Night 11:
Aerophagia: 3 nights worse than usual compared to the DreamStation; 8 night about the same (or better) as the DreamStation
Wakes & Arousals: 3 nights worse than usual compared to the DreamStation; 9 night about the same (or better) as the DreamStation
Feeling on Wake: 2 nights worse than usual compared to the DreamStation; 9 nights about the same (or better) as the DreamStation
Is there an indication that it's also a process, in which the first nights were more likely to be worse, and you figured out the settings and perhaps got more used to some things?
The short answer to your question is that the first two nights with the AirCurve were the nights that were clearly worse than the DreamStation. And that yes, it took a few nights to figure out the settings and to get used to some things that Resmed does differently than PR.
Here's the long answer to your question:
In my Resmed AirCurve 10 experiment, the the basic question to be answered was: "Should I just get a new AirCurve 10 with my insurance benefits now instead of waiting indefinitely for PR to replace my DreamStation 1 BiPAP Auto with another potentially rehabbed DreamStation 1 BiPAP Auto of the same age?"
My husband is an applied mathematician (I'm a "pure mathematician"), and he's the one who suggested doing a Bayesian hypothesis testing experiment. In order to do this you set up two competing hypotheses, and gather data to see which hypothesis "fits" each data point best and collectively the data points to which hypothesis is most likely to be valid. So I had to recraft my basic question of whether I should get a new AirCurve or wait for my DreamStation to be replaced, as a pair of competing hypotheses that I could actually "test" and quantify.
The basic competing Bayesian hypotheses are:
- H1: I will sleep worse on average with the Resmed AirCurve 10 VAuto than with the PR DreamStation BiPAP Auto.
- H2: I will sleep about the same or better on average with the Resmed AirCurve 10 VAuto than with the PR DreamStation BiPAP Auto.
And part of why I'm updating the score card each day is that I can, in fact, see the historical trend on which nights are "worse" and which nights are "better or about the same" as well as simply keeping a tally. But the data is clearly pointing to H2 as being the more likely true hypothesis. The evidence is so strongly pointing to H2 that I am now working with a DME to try to get an AirCurve 10 Vauto as a replacement machine with my insurance paying their 50% of the cost of the machine.
Here are some factors that made those first few nights worse, even though I've only made one modest change in the clinical settings.
1: Since a DreamStation has no Cycle, Trigger, Ti min, and Ti max settings, I had to make an intelligent guess (based on some information give to me by palerider) about those settings. And while breathing felt reasonably "ok" with my initial settings, something still felt "off" those first two nights. Changing the Trigger setting for the third night helped quite a bit. I'm not yet sure I have Cycle, Trigger, Ti min, and Ti max set in the best way for me, but my current settings are pretty good and I'm reluctant to change them when there are some other things that I want to make sure of first. (In other words, this is now a situation of "If it ain't broke, don't fix it.")
2. The fact that my nasal pillows were already problematic when I swapped the machine was an issue on the first couple of nights. On the DreamStation, which I was used to, the leaky, worn out pillows had not yet gotten to the point of genuinely interfering with my sleep. But the combo of "leaky, worn out pillows" with "brand new machine" meant that leaks that were trivial for me to fix without really waking up on the DreamStation suddenly were a big issue with the AirCurve. The fix for that, of course, was to change the pillows, which I also did for night 3.
3. Darth Vader breathing has not been a noticeable problem on my DreamStation with my Swift FX mask recently, but it was an immediate problem with the AirCurve. So back to the fix that I used on the PR System One BiPAP Auto way back when the jet exhaust from the FX was bothering me intensely: A homemade diffuser for the exhaust vents. That eliminated the Darth Vader noises and their contributions to extending the lengths of wakes because it was difficult to get back to sleep listening to them.
4. A major breakthrough also occurred when I found the answer to "How do I turn off the blower completely?" buried in the Clinical manual. Knowing that holding the power button down for 3 seconds will turn the blower off has made it much easier to deal with my expected, usual short middle of the night wakes when I want to just pull the pillows off the nose to wipe my nose or to cough or just reset them because there's been a small leak. The blower continuing to blow after the machine is turned off was really, really irritating me (because it was extending the wakes) before I learned the trick about Power Saver mode.
5. At this point, I've got the ClimateLine hose on the machine, but it's set so low (64F = 18C) that the air essentially feels like its not heated. (That's intentional.) The elbow on the ClimateLine has fixed the problem of the hose being too easy to pull off the back of the machine. The fact that I still have to orient the machine away from my face is not an issue for me, but I do still think where Resmed chooses to put the hose outlet is not a good design feature. (There's a reason that all the Resmed pictures seem to show the machine sitting on a nightstand without the hose attached.) Experimenting with the hose temp is probably the next set of changes I plan on making.
6. The dryness of my nose is still a bit problematic. I've got the humidifier set to 8 (its max setting). (On the DreamStation I used "Classic 5", which was a non-smart mode with the humidifier set as high as possible.) Rainout has not been a big issue for me on the AirCurve, although it was a minor one on the DreamStation: My nose was happiest on the nights where I would wake up to gurgling noises and have to raise the hose to get the water to run back to the humidifier. So far the nasal dryness is not a deal breaker, but long term I may need to pay more attention to nasal hygiene with the AirCurve than I've had to do in the last several years of using the DreamStation.
So, yes, in retrospect it doesn't surprise me that the worst nights were at the beginning of my experiment. Truth be told, I was hoping that whatever difficulties I had would tease themselves out and that the data would get better with time. But it's also why I didn't just dismiss those first two nights outright: Dirty data is worth something, even if it is dirty. And had the aerophagia or wakes continued to be issues after the few basic things I changed on night 3, that dirty data would have been more data building a case supporting H1.