Switching from DS2 to Airsense 11 - Struggling

I've been on CPAP for about 13 years. I started with a Remstar System One that was replaced during the recall with a Dreamstation 2. As my Dreamstation 2 was having issues with the humidifier, I was issued an Airsense 11 as a replacement by my new sleep specialist/DME.

I was originally diagnosed with severe OSA with AHI 72. My original prescribed pressure was 12cm and that crept up over the years to 14.5cm. Using the Remstar and Dreamstation, my AHI was reduced to 4 or less.

About 18 months ago I began a lifestyle change and have dropped over 100lb. I noticed that I was waking up with a dry mouth. When I discussed it with my previous specialist they agreed that I might try auto to how my treatment needs changed. I set the Dreamstation to 5-15 Auto with flex setting at 2. My 95% pressure hovered around 7 and my AHI was typically about 1.
I have used a Respironics Nasal Cushion mask for the last several years without issue.

Now that I've switched over to the Airsense, I haven't had nearly the quality of sleep that I was getting with the Dreamstation. I set the Airsense 11 to Autoset 5-15 EPR 3 No Ramp. I have a heated tube and both the tube and humidifier are set to Auto and am using the same Respironics Nasal cushion mask.

I have tried switching to CPAP at 9cm instead of Autoset. I've tried Austoset for Her. I've made many adjustments, but almost every night, especially with Autoset, my pressure increases and it blows the mask off my face or causes a mouth leak. In OSCAR, I can see episodes where my pressure builds to 10-12 cm while the leak rate is above the large leak threshold. This of course causes fragmentation of my sleep.

Anatomically, I have noticed that my right nostril stays congested and feels like there is some flow restriction. I'm trying to use a nasal steroid to open up that passage, but I do wonder it that flow restriction is part of the issue.

All that being said, my AHI numbers are very low (usually 1 or less) and there are very few incidences of snoring, yet I don't feel great in the morning.

I wanted to call on the hive mind here to see if anyone else has transitioned from DS2 to Airsense 11 successfully and what made it work for you. The only other item I have on the table is to add a chin strap or mouth tape, but I've never needed that with the previous Phillips devices.

Thanks in advance.

T

Resmed's automatic algorithm is different form the Respironics algorithm.

tyler.durden wrote: ↑

Tue Aug 06, 2024 9:42 pm

My 95% pressure hovered around 7 and my AHI was typically about 1.

The Resmed machine had you spending 95% of the night a pressure of 7 or less.

For some people, ResMed machines' algorithm causes runaway pressure.

Set your Resmed at a maximum of 7, or 7.4 at most, no EPR, and see how you feel after about a week of that.

Check how your mask is fitting, too. When I lost weight, I lost it in my face, and needed a lot of adjustment to the mask.

Why is your minimum so low?
5 is only 1 cm higher than the absolute lowest possible,
without shutting the machine off.
My low is over 9-- can't breathe comfortably with less.

I appreciate the responses.

I am a long time CPAP user and have extensive experience with masks and leaks, so I had already spent a good deal of time adjusting the mask, so that was not the culprit.

My new DME provider literally programmed the equivalent settings on the Airsense 11 as I was using on my Dreamstation 2: auto, 5-15 flex 3, no ramp.

After starting therapy with the Airsense 11, I had performed many trials making adjustments to pressures, Auto/CPAP, and pretty much every logical setting I could think of to see if I could find a trend toward even being close to the benefit of the Dreamstation 2.

Finally, just after starting this thread, and counter to what I would have at first expected, I disabled the Autoset and selected a constant pressure of 8cm. My sleep results in OSCAR showed the best night I'd had since switching to the Airsense 11. AHI = 0.33, Total Time in Apnea = 00:00:29, and Time Over Leak Redline 0.000%. My suspicion was that the Airsense 11 Algorithm was escalating too much and causing runaway pressure. The next night I lowered my constant pressure to 7cm with similar results. I'm sticking with that for now.

I would assume that many of us have made or will make the transition from Phillips machines to other brands. I will say that the Auto Algorithm for Resmed is completely different and difficult to tolerate. Whether I had grown accustomed to the Phillips system over the years and Airsense is just different I am unsure. I do hope that this thread will help others who are struggling find some hope.

T

tyler.durden wrote: ↑

Sun Aug 11, 2024 10:44 am

I appreciate the responses.

I am a long time CPAP user and have extensive experience with masks and leaks, so I had already spent a good deal of time adjusting the mask, so that was not the culprit.

My new DME provider literally programmed the equivalent settings on the Airsense 11 as I was using on my Dreamstation 2: auto, 5-15 flex 3, no ramp.

Resmed's EPR and PR's Flex are not the same. If you had Flex set to 3 on the DreamStation 2, you might do better with EPR = 2 rather than 3. On a PR machine, Flex provides a variable amount of exhalation relief based on the forcefulness of the exhalation. On a Resmed, the exhalation relief is always the same and EPR = 3 means that the pressure goes down by 3cm every time you exhale. With Flex = 3, the exhalation relief is typically anywhere between 1.5cm and 2.5 cm, but it seldom is as much as 3 cm on any individual breath.

After starting therapy with the Airsense 11, I had performed many trials making adjustments to pressures, Auto/CPAP, and pretty much every logical setting I could think of to see if I could find a trend toward even being close to the benefit of the Dreamstation 2.

Finally, just after starting this thread, and counter to what I would have at first expected, I disabled the Autoset and selected a constant pressure of 8cm. My sleep results in OSCAR showed the best night I'd had since switching to the Airsense 11. AHI = 0.33, Total Time in Apnea = 00:00:29, and Time Over Leak Redline 0.000%. My suspicion was that the Airsense 11 Algorithm was escalating too much and causing runaway pressure. The next night I lowered my constant pressure to 7cm with similar results. I'm sticking with that for now.

There are people who do find the Resmed AutoSet's Auto algorithm more aggressive than the PR algorithm. The Resmed Auto algorithm seems to be much quicker to increase pressure rapidly when it detects obstructive events. The PR algorithm does a more gentle increase followed by a "wait and see" if things get better. There is also a difference in how the two algorithms choose when and how to decrease the pressure after the machine is happy with the breathing.

You may be in the minority of folks who simply do better with the PR algorithm.

I would assume that many of us have made or will make the transition from Phillips machines to other brands. I will say that the Auto Algorithm for Resmed is completely different and difficult to tolerate. Whether I had grown accustomed to the Phillips system over the years and Airsense is just different I am unsure. I do hope that this thread will help others who are struggling find some hope.

As a long time PR BiPAP System One and DreamStation 1 user who had a bad initial response to a Resmed S9 AutoSet when I was first starting out, I was not eager to switch to a Resmed AirCurve VAuto, but between the length of time I was waiting for a replacement machine combined with the fact that I was due for a new machine anyway, I bit the bullet and went with a new Resmed VAuto when the black fiber stuff started showing up in my DS's humidifier tank.

I have found that I need to cap the Resmed AirCurve VAuto's max IPAP lower than I needed to cap the PR DS 1 BiPAP Auto's max IPAP. I was worried that I would miss the PR's variable pressure support, but that has not been as big of an issue as I was worried about.

If you choose to experiment again with the Resmed AirSense 11's Auto mode, I would suggest that you consider changing the EPR setting to 2 and the max pressure setting to something around 9 (plus or minus 1 cm). And if you wind up spending most of the night at your max pressure, but your AHI is low and you are feeling good, then don't worry about how much time you are spending at max pressure each night.

Agree with robysue, and would like to add:
ResMed's EPR is a one to one drop in cm of pressure. Respironics is more like a low-medium-high setting.

Other considerations:
If you have any OSCAR graphs of your therapy while using the DS2, post them so we can see the typical range it was typically delivering. We can then see the Air11 is typically delivering.

A frequent observation from many who switched from DS/DS2 to ResMed was the ResMed was more responsive and that translated to faster and higher pressure increases. Depending on how one welcomed the change in responsiveness some referred to it as aggressive.

Even though the DS2 was set to a max of 15, perhaps it never got close and your typical high on the ResMed is higher than the DS2 ever got to.

A consideration is to:
- Set your Response to Soft, so the pressure increases/decreases will not be as quick
- cap the max pressure. 9's a good place to start.
- post some OSCAR graphs and see if there is optimization room.