Followed Board Advice - Please Compare 2 Days

[OkyDoky]

To resize your graphs go to the line between the graphs click on it and move the line. To turn off the graph go to the graphs setting in the bottom right corner and find the snore graph click on it and it will turn red which means it is off.

[Pugsy]

You can just resize the graphs above the snore graph.
Hover your mouse cursor on the line at the bottom of the graph until you see a little short double line thing then click and drag downward to make the graph itself larger.
Making the other graphs larger will move the snore graph downward out of view.

So that the graphs are about this size.

[MurrayNevada]

Good Morning Pugsy,
Las night was a bit different. I awoke to snores at least a couple of times and a few times I felt the mask was momentarily leaking. Below is last nights screen shot. I also expanded the events I thought may help.
Thank you,
mike

[MurrayNevada]

Another expanded graph.

[Pugsy]

That first cluster at 23:00 is spot on for time of the first REM sleep stage.
REM comes in cycles and the first one is usually around 90 minutes after sleep onset and as the night goes on REM starts coming a little more frequently and lasting long until the wee hours of the morning where we have the most REM.
Google "sleep stages" and look at the various hypnograms and get a feel for the pattern for when REM happens and compare it to yours.
It's common for OSA to worsen and/or need more pressures in REM. I myself have it. Confirmed by the diagnostic sleep study with 5 times more events during REM than in non REM.

Same with the 4:22 cluster. Probably REM until 4:30.

Sleeping position can also play a factor sometimes. Like on our backs. Sometimes OSA worsens when we are on our backs.
Sometimes people have a double whammy....worse on their backs and in REM.

Whatever the reason...REM or supine sleeping or a combination you have a situation where the machine can't get to where it needs fast enough to prevent the airway collapse and while it tries to it just can't do it. These machines don't respond during an event either. They wait until after the event and then they think about what is and has happened and then decide what to do.
In your situation I wish you had the ResMed apap machine because I think it's a little more aggressive response works better with clusters like this no matter what the cause. It would mean that you wouldn't have to use higher minimums as much.

So how is your sleep quality in general? How are you feeling during the day in general?

[MurrayNevada]

I am feeling much better when I awake and throughout the day. Before last week I would wake up feeling miserable. Last night I had dreams I remembered for the first time since starting the APAP. Looking at the sleep steps you mentioned I think REM might be responsible for that. What is the RESMED machine that would be the best one?

[Pugsy]

Remembering dreams isn't necessarily a good thing because for us to remember a dream we have to wake up during it. So remembering dreams means wakes ups and wake ups aren't good.

The ResMed machine that I am using is probably the best one that I can think of and I am using that special for her algorithm but there's no reason that a guy wouldn't benefit from it either.
But it does have the other regular auto algorithm available as well as cpap mode so it's like 3 machines in one.

My first machines were Respironics apaps...I had to end up using 10 minimum and 20 max to break up my REM clusters and get my AHI consistently below 2.
With the ResMed auto I get to use 7 minimum (with 3 exhale relief) to consistently get below 1.0 AHI.

Here's the manual...read up on it.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

If there was anyway you could try one I would really like to see how it worked for you.

[MurrayNevada]

Dreams are never a good thing for me. They are usually more like nightmares. I was a Marine infantryman in Vietnam 50 years ago and many of my dreams bring me back there. I don't want to dream at all. Would that top of the line RESMED machine make me much less likely to dream? I would make the investment if it might.

[Pugsy]

Here's the deal about dreams. We really don't have any control over having them or not. It's just that you won't remember them if you don't wake up during them. A person has to wake up enough during or right at the end of a dream to form a memory of the dream.
So how to not remember dreams...don't wake up.
And I know, easier said than done especially when the dreams are bad.
And even more so when dreams are related to the stresses of war. My husband is a Vietnam vet and he still has those dreams sometimes too. He doesn't have sleep apnea causing the wake ups...it's the unpleasantness of the dream that the brain finally says "hey dude, enough is enough, wake up and quit dreaming this crap". Not much we can do about that.

But you can lessen your chances of waking up during dreams by better preventing the chances of an apnea event causing you to have an arousal or wake up.

Now there are medications that inhibit REM sleep stage but that doesn't necessarily prevent all dreaming because we can dream in any sleep stage...doesn't have to be REM and you wouldn't want to not have REM because it's the nice normal progression of all the sleep stages in the needed percentages to give the restorative powers of sleep the best chance to work their magic. Those meds are nasty in terms of other side effects and there's no guarantee that those bad dreams wouldn't happen in some other sleep stage anyway.

So what do we do now with what we have? More minimum pressure and break up the clusters even more so that we can maybe lessen the chances of the apnea events causing a wake up. How much more? Don't know. Everybody is different.
When I was seeing reports like yours with the AHI in the 4 ish range on my Respironics machine I was using 8 cm minimum.
It wasn't until I used 10 cm minimum that the reduction was significant consistently. Doesn't necessarily mean than you would need 2 cm more minimum though. It's funny but I saw a significant change in results between 9.5 and 10.0 minimum which is why I usually advise go up slow because we never know when that last 0.5 cm increase will end up making a huge difference.

If you are sleeping on your back it may or may not be a factor in your pressure needs. It can be a factor for a lot of people but not for others so much. It wasn't for me. I once did an experiment where I built a wall that wouldn't move and I use it and a real wall to keep me for sure on my side all night and I still saw the same pressure fluctuations in probable REM sleep when I was for sure on my side. But I know people who need 9 cm pressure on their side and 18 when on their back. So there is a wide variation in how supine sleep can effect pressure needs. I still saw 18 cm in REM on my side.

There's no real harm in using more minimum with the Respironics than what a person might use with a ResMed machine unless there are some comfort related issues due to the differences in minimum pressure. I slept quite well with my Respironics doing its job at the 10 cm minimum. I don't necessarily sleep better or feel any better with the ResMed but it sure is more comfort to be using 7 inhale and 4 exhale when I first go to bed than it was with the 10 inhale and 2 exhale that I was using with the Respironics.
The ResMed machine still goes up to where the Respironics machine went during REM which was between 15 and 18...it just gets there a little faster so I don't have to give it as much of a head start. I still have a Respironics machine which I use when I travel and it's my back up in case my ResMed craps out.

I wish I had a magic solution to your war dreams but I don't. The best chance is to reduce the chances of apnea events causing wake ups and that's doable with either machine.

If you want to make a big leap instead up small leap and see what happens you can try it. No harm in it and you can always back down if you want to. It's just I found it easier to adjust to small increases than big increases and easier adjustment to me meant falling asleep easier. Other people have made big jumps without batting an eye.

So you can make a big jump if you are up to it...to say maybe 12 minimum or continue with the 0.5 cm increases.
And of course consider the ResMed apap but I can't guarantee that you will have the same significant difference in minimums that I had. I have known a handful of people who end up needing about what they were needing on a Respironics but most people need a bit less. I will tell you this though....the ResMed is a bit less noisy and the inhale/exhale when using EPR is so smooth that it feels like normal breathing. I barely notice any pressure at all. Most people that I know who have had a chance to try both brands have preferred the ResMed but there have been a few who preferred Respironics. Huge YMMV sticker between the brands.

Now if the higher minimum on the Respironics ends up causing aerophagia issues...for sure need to try ResMed because the exhale relief with it and the chance of less pressure minimum being needed greatly increases the chances of the aerophagia issues not happening.

[MurrayNevada]

If I purchase the RESMED machine what settings would you suggest based on the info on me you have? If I order it on Tuesday I can have them set it to your recommendations and later fine tune it. The RESMED AirSense 10 AutoSet would provide the same benefits as the "For Her" model you use?

Minimum Pressure: ?
Maximum Pressure: ?
Ramp: Auto ?
Start Pressure: ? (I currently use a 10 minute ramp starting at 6cm)
Humidity Level: Humidifier off currently and it's comfortable
Mask Type: Full Face Mask
EPR: Off : ? (I don't know what this is exactly but if it is exhale pressure I would like one lighter than my current Respironics machine)
SmartStart: Off ?
Tube Type: Slimline ?

[Pugsy]

The regular AutoSet model doesn't have the 3rd mode which is a special apap mode. It responds differently and is more sensitive to flow limitations and if you have 2 OAs within a minute it will automatically change the minimum pressure for the rest of that sleep session and won't lower the minimum even if nothing happens unless the machine gets turned off and back on again.

If price is the same...get the for Her model because that 3rd mode might come in handy and it's always better to have something and not need it than need it and not have it.
I don't understand why ResMed targeted women for this mode because what it does could just as easily work for a man.
It is the mode I use and I like that it is smart enough to change the minimum for me if it thinks it needs it. If I was a guy I would still like it. What happens with my OSA events can just as easily happen to a guy.

Is it the end of the world to not have that special mode...of course not and with your machine not wanting to make huge changes during REM (assuming that is what we are seeing with those clusters) it might not be as useful for you as for me because I always saw big changes in REM and you aren't really having nearly as big as I did.

Minimum Pressure: ? 8
Maximum Pressure: ? 20
Ramp: Auto ?...no not auto, as that pertains to the machine sensing when you are asleep...I would instead keep it like you are using now at 10 minutes and change the starting pressure for ramp to 6 cm which is of course easy to do.
Start Pressure: ? (I currently use a 10 minute ramp starting at 6cm)...if it allows comfort for you and you like it...keep it like it is. Less changes the better.
Humidity Level: Humidifier off currently and it's comfortable...you can do the same with the ResMed..just turn it off
Mask Type: Full Face Mask...whatever type you use. You don't have mask type on the Respironics but instead you have Resistance setting and it doesn't do exactly the same thing as mask type on ResMed does
EPR: Off : ? (I don't know what this is exactly but if it is exhale pressure I would like one lighter than my current Respironics machine)
I don't understand "lighter"...what Flex setting are you using now? EPR is a straight drop in pressure during exhale and a per cm drop to whatever setting. Setting of 1 is a 1 cm drop...setting of 3 is a 3 cm drop. Flex does its drop based on the force of your own breathing and the most you can get is a 2 cm drop. If you are a shallow breather you won't even get that at the setting of 3.
My advice always with using any exhale relief...try all settings including off and pick the one you like the best in terms of comfort and use it no matter the number.
SmartStart: Off ? This just lets the machine start once you take a couple of breaths and you don't have to push the button to turn it on. It will also turn the machine off rather quickly if you remove the mask and don't push the off button. If you lose power during the night briefly if you have Smart Start set to ON the machine will start right back up once power gets back on.
I like the feature myself even though with my mask and my pressure the auto off part doesn't work so great. Auto on part is wonderful.
Tube Type: Slimline ?....this just for hose diameter if not using a heated hose. If using a heated hose the machine automatically recognizes the hose and makes appropriate diameter choice. Slim line is 15 mm I think and regular diameter is 22 mm.
Hose diameter choice needs to be correct and is critical to machine functioning properly. I don't know what diameter hose you are currently using...I know it is a non heated hose but Respironics has both 15 mm and 22 mm non heated hoses. It should have some numbers somewhere on the hose to tell you.

[MurrayNevada]

Pugsy,
Thank you so much for taking so much of your time to help me. I want to purchase the "For Her" model but the only thing stopping me is my need for an 8' hose. All I see online are 6' hoses for it. Are there 8' hoses for this machine? Can it use the more common sized hises?

[Pugsy]

I don't think it matters about the 8 ft hose because the 8 ft hose is non heated and probably 22 mm.

I use the heated hose but I also use a mask that has an almost 2 ft long short hose so in total I am close to 8 ft.
Since I use the heated hose (which is 15 mm) and that's what the machine gives me and it's for 6 ft but there's no reason I couldn't use a 6 ft non heated hose if I wanted to.

Let me go see for sure what the options for hose length are. I think you will be fine with the 8 ft non heated hose.
No need to use a heated hose or slimline hose if you don't want to.

I will report back shortly.

[Pugsy]

Hose choices when no hose is attached for the for Her model
slimline
standard
and that refers to diameter.
No where is there a mention about hose length.

I dug out a spare that I have...a regular AirSense 10 Autoset (the not for her model) and the choices for hose/tube
slimline
standard
and no mention anywhere about hose length.

You don't have to use a heated hose if you don't want to. They come in handy in the winter if you like the bedroom cold or you are getting condensation somewhere but you don't have to use one if you don't want to.
I could hook up an 8 ft 22 mm standard hose to my for Her machine and be good to go without doing anything but changing the tube to "standard".

Slimline is 15 mm
Standard is 22 mm
Now there are some non heated hoses that are 19 mm but those aren't common. Should a person happen to have one of those then I would think the standard 22 mm would be the better choice.

[MurrayNevada]

Very glad to hear about the hose. Most importantly: Can I continue using my Simplus Full Face CPAP Mask or must I use a RESMED mask for the "For Her" machine? I see something about a connection to the Internet. Is this in addition to being able to continue use of the SleepyHead software?