AHI Went Up After Switching to New Machine - Help?

[palerider]

Thanks so much for your kind words, Zonker!

Since my last post, I went a second night at the higher levels but my AHI went up again. So I called the DME and am very happy to say that they agreed to give me a ResMed and to take back the Dreamstation. I'll be making the switch on Friday, but in the meantime I went back to my old machine (which is aging but still functional) and my AHI dropped immediately to 0.2.

I've been happy with my AHI on the ResMed but since this latest episode and finding this forum, I think it would do me some good to stick around and learn a little more so I can hopefully avoid something like this happening again.

Capnloki wants to talk to you about how dreamstations are JUST AS GOOD as Resmeds.

tsk, tsk. not to mention tut, tut.

to each their own, as the saying goes.

Ack! I've been tutted at.

[zonker]

Ack! I've been tutted at.

don't push it, young man. i may follow up with a stern look and a finger wag.

you have been warned.

[palerider]

Ack! I've been tutted at.

don't push it, young man. i may follow up with a stern look and a finger wag.

you have been warned.

*cower*

[Pugsy]

Ack! I've been tutted at.

don't push it, young man. i may follow up with a stern look and a finger wag.

you have been warned.

*cower*

finger wag better than the ruler across the knuckles thing

[CapnLoki]

Thanks so much for your kind words, Zonker!

Since my last post, I went a second night at the higher levels but my AHI went up again. So I called the DME and am very happy to say that they agreed to give me a ResMed and to take back the Dreamstation. I'll be making the switch on Friday, but in the meantime I went back to my old machine (which is aging but still functional) and my AHI dropped immediately to 0.2.

I've been happy with my AHI on the ResMed but since this latest episode and finding this forum, I think it would do me some good to stick around and learn a little more so I can hopefully avoid something like this happening again.

Capnloki wants to talk to you about how dreamstations are JUST AS GOOD as Resmeds.

Tuts, Tsk's, wags and raps notwithstanding, I never said Dreamstation were "just as good" as ResMed (actually I may have but I'm far too lazy to look) but its been said here numerous times here. What I said, and is backed up by a study financed by ResMed, is that the aggressive Resmed algorithm overshoots the target pressure while the Dreamstation more gradually approaches it. I believe that for most people, the preferred strategy is to have the initial pressure a bit below the target pressure so that minimal pressure increases are needed during the night. While the ResMed strategy may work for some. especially if the initial setting is too low (e.g a wide open 5-20), I speculated that for others the overshoot may cause leak problems. I would now add that a setting that appears to work with ResMed may not be properly tuned for a DreamStation.

My own experience is that once I set the initial pressure to just under the 90% point, my AHI went down under 1.0 and as I learned to practice better sleep hygiene its gone down to 0.1. I've had trouble seeing how I could get better therapy.

[palerider]

I never said Dreamstation were "just as good" as ResMed (actually I may have but I'm far too lazy to look) but its been said here numerous times here. What I said, and is backed up by a study financed by ResMed, is that the aggressive Resmed algorithm overshoots the target pressure while the Dreamstation more gradually approaches it.

You persist in pandering your misinterpretation of multiple tests.

Resmed achieves *stable breathing* much faster than Respironics, and that's the entire purpose of cpap.

While the ResMed strategy may work for some.

Like the OP who has much worse sleep on a dreamstation, so much worse, they're ditching it.

, I speculated that for others the overshoot may cause leak problems.

Poorly fitted masks cause leak problems.

My own experience is that once I set the initial pressure to just under the 90% point,

Only the ignorant use the 90% point in trying to set auto pressures.

Pugsy's 90% point is in the high teens, but she does well with her minimum in the 7-8 range, and a Responsive Resmed.

[CapnLoki]

Sorry PR, your bullying tactics may work with the newbies, but not with me. You're clearly wrong here and your rudeness just shows your ignorance.

I never said Dreamstation were "just as good" as ResMed (actually I may have but I'm far too lazy to look) but its been said here numerous times here. What I said, and is backed up by a study financed by ResMed, is that the aggressive Resmed algorithm overshoots the target pressure while the Dreamstation more gradually approaches it.

You persist in pandering your misinterpretation of multiple tests.

The specific test I referenced is this:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005142/
I know its tough reading but its quite clear: for the sample the would require pressure 12 to "normalize breathing" the ResMed jumps the pressure up as high as 17.9. Its considerably higher than any other machine in the test - the next highest was 13.9, all other were much lower.

Resmed achieves *stable breathing* much faster than Respironics, and that's the entire purpose of cpap.

While the ResMed strategy may work for some.

Like the OP who has much worse sleep on a dreamstation, so much worse, they're ditching it.

, I speculated that for others the overshoot may cause leak problems.

Poorly fitted masks cause leak problems.

High pressure causes leaks. A mask must be fitted for the pressure a pump generates. If the pump goes to 17.9 when a pressure of 12 would work, there can obviously be a problem.

My own experience is that once I set the initial pressure to just under the 90% point,

Only the ignorant use the 90% point in trying to set auto pressures.

Pugsy's 90% point is in the high teens, but she does well with her minimum in the 7-8 range, and a Responsive Resmed.

I can't argue with this anecdotal evidence - just as you can't argue with my example that the DreamStation works fine for me. I completely agree that the fast response of the ResMed may help some people. I'm just saying it might cause problems with others. You never seem to actually refute any of my arguments so I can only assume that reading a scientific paper is beyond your abilities.

[palerider]

Sorry PR, your bullying tactics may work with the newbies, but not with me.

"WAAAAAAAAHHHH, I have no idea what I'm blubbering about, so I'll call the other person a 'bully'"

Spot on, capn, spot on.

You're clearly wrong here and your rudeness just shows your ignorance.

See below

I never said Dreamstation were "just as good" as ResMed (actually I may have but I'm far too lazy to look) but its been said here numerous times here. What I said, and is backed up by a study financed by ResMed, is that the aggressive Resmed algorithm overshoots the target pressure while the Dreamstation more gradually approaches it.

You persist in pandering your misinterpretation of multiple tests.

The specific test I referenced is this:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005142/
I know its tough reading but its quite clear: for the sample the would require pressure 12 to "normalize breathing" the ResMed jumps the pressure up as high as 17.9. Its considerably higher than any other machine in the test - the next highest was 13.9, all other were much lower.

Let's actually READ from that...AGAIN.

Device A1(Airsense 10 standard setting) responded to obstructive events with a step-wise increase in pressure sufficient to overcome obstruction (mean maximum pressure 17.9 cmH2O). A2(Airsense 10 [soft] response setting) increases in pressure were more gradual but the pressures reached (mean maximum 15.5 cmH2O) were sufficient to normalise breathing.

More than five residual obstructive events per hour were observed with devices B, D, F(System One) and G. Breathing normalisation (defined as the avoidance of any obstructive event: apnoea, hypopnoea or flow limitation) was only achieved with the A1(Airsense 10 Autoset, A2(Airsense 10 Autoset) and C(Icon) devices.

So, by the very study that you like to wave around to bash the Resmeds...

The Resmeds SUCCEEDED and the Philips Respironics *FAILED*.

Maybe someone else can explain it in words you can understand.
PLEASE stick to batteries, where you actually KNOW something *VERY* helpful.... and leave the suggestion of what apap to select to people who know what they're talking about.

You're clearly trying to put your own 'special' twist on the results... *desperately* trying to find something to be critical of.

Please stop.

[Pugsy]

You know it's funny (in an odd way I suppose) but when I was using the Respironics machines I ended up with a higher overall 90/95% pressure averages AND that was with a higher minimum than I use now with the ResMed machine.
Makes me wonder which machine really wants to overshoot things in the long run.

[zoocrewphoto]

Dreamstation more gradually approaches it. I believe that for most people, the preferred strategy is to have the initial pressure a bit below the target pressure so that minimal pressure increases are needed during the night. While the ResMed strategy may work for some. especially if the initial setting is too low (e.g a wide open 5-20), I speculated that for others the overshoot may cause leak problems. I would now add that a setting that appears to work with ResMed may not be properly tuned for a DreamStation.

My goal is to set my minimum for the pressure that prevents most problems. And the auto can handle when I roll onto my back.

I want a mostly boring pressure line with a limited number of spikes. Not a bunch of ups and downs. I never look at the 90% number. I look at the pressure line. If it goes up and down a lot, then I move the minimum to a level that will get rid of the roller coaster ride.

[Dog Slobber]

My goal is to set my minimum for the pressure that prevents most problems. And the auto can handle when I roll onto my back.

I want a mostly boring pressure line with a limited number of spikes. Not a bunch of ups and downs. I never look at the 90% number. I look at the pressure line. If it goes up and down a lot, then I move the minimum to a level that will get rid of the roller coaster ride.

This is exactly the philosophy I used, except replace "roll onto my back" with REM sleep.

I kept increasing my minimum, and with it my graph flattened out, the peaks dropped. Now, my trace is flat, but for a few blips. Almost always when you see the blips and look down you'll see an active Flow Limitation and the increased respiratory rate associated with REM.

[CapnLoki]

sorry for the delay - I was busy moving this weekend ...

Sorry PR, your bullying tactics may work with the newbies, but not with me.

"WAAAAAAAAHHHH, I have no idea what I'm blubbering about, so I'll call the other person a 'bully'"

Spot on, capn, spot on.

You're clearly wrong here and your rudeness just shows your ignorance.

See below

I never said Dreamstation were "just as good" as ResMed (actually I may have but I'm far too lazy to look) but its been said here numerous times here. What I said, and is backed up by a study financed by ResMed, is that the aggressive Resmed algorithm overshoots the target pressure while the Dreamstation more gradually approaches it.

You persist in pandering your misinterpretation of multiple tests.

The specific test I referenced is this:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005142/
I know its tough reading but its quite clear: for the sample the would require pressure 12 to "normalize breathing" the ResMed jumps the pressure up as high as 17.9. Its considerably higher than any other machine in the test - the next highest was 13.9, all other were much lower.

Let's actually READ from that...AGAIN.

Device A1(Airsense 10 standard setting) responded to obstructive events with a step-wise increase in pressure sufficient to overcome obstruction (mean maximum pressure 17.9 cmH2O). A2(Airsense 10 [soft] response setting) increases in pressure were more gradual but the pressures reached (mean maximum 15.5 cmH2O) were sufficient to normalise breathing.

More than five residual obstructive events per hour were observed with devices B, D, F(System One) and G. Breathing normalisation (defined as the avoidance of any obstructive event: apnoea, hypopnoea or flow limitation) was only achieved with the A1(Airsense 10 Autoset, A2(Airsense 10 Autoset) and C(Icon) devices.

So, by the very study that you like to wave around to bash the Resmeds...

The Resmeds SUCCEEDED and the Philips Respironics *FAILED*.

Your SHOUTING just proves my point about bullying! Also I've never "bashed" ResMed - this false claim is another aspect of your noxious bullying. I've merely pointed out a well documented aspect of the ResMed algorithm that should be taken into account. Your claim that ResMed is vastly superior to Philips for all users is clearly an over-reach given that Philips works fine for many users, and is lighter, cheaper, uses less power, etc.

If you think running the pressure up to almost 18 when 12 is appropriate is success, then you have an odd view of success. I call this a complete failure because it would blow the mask off my face! I fit my mask to about pressure 12-13 because 11 is the pressure I need to fully control my obstructive events. Fitting a mask to 18 when I only need 12 would be a major problem for me.

I don't know how well ResMed would work if the initial pressure were set to closer to the target, i.e if it were set to 10 instead of 5, but I know that in this case the Philips responds quickly enough that I generally have few if any events with no "overshoots." I will admit that when I started with a pressure of 5 my I would have several events before the pressure came up enough to stop them, leaving me with an AHI of 2-3. Bringing the initial pressure up to 9 means that the pressure stays from 9 to 11 and I have virtually no events and no leaks.

[palerider]

Interesting, how you refuse to see how the very study you cite says the respironics failed to achieve adequate treatment.

I give up, some heads are just too hard.

[CapnLoki]

Interesting, how you refuse to see how the very study you cite says the respironics failed to achieve adequate treatment.

I give up, some heads are just too hard.

The paper pretty clearly says that this is a model and doesn't necessarily reproduce "human" results. And I freely admitted the if the initial pressure is set to 5 when the target pressure is 12 the DreamStation will take a long time to achieve that pressure, and this study only looked at a limited time frame. On the other hand, blowing the the mask off and causing major leaks can hardly be considered a "success." The study is quite clear: the ResMed achieves its "adequate treatment" by greatly overshooting the target pressure while other pumps gradually raise pressure and will take more time. For all your ranting, you've never actually addressed this issue.

[palerider]

On the other hand, blowing the the mask off and causing major leaks can hardly be considered a "success."

People who have pressures in the high teens, and indeed into the twenties would laugh at your hyperbole of "blowing the mask off".