Sierra

It may be possible that the therapist has software that gives her better detail from the DreamStation. They typically use proprietary software from the manufacturer that is not legally available to us as users. SleepyHead is legal and free. In my experience looking at the SleepyHead reports from each, there is actually more information from the ResMed. The ResMed displays both set pressure and mask pressure. The set pressure is what the machine is being asked to deliver, and the mask pressure is what the machine actually does. The DreamStation only seems to give access to the set pressure. ResMed also gives a continuous flow limitation signal which can be graphed. DreamStation on the other hand seems to treat a flow limitation as an event rather than a continuous variable.

What I don't like about the DreamStation is how it automatically set the pressure. Some describe it as a "hunt and peck" strategy like a chicken pecking at the dirt on a repeated basis and mainly only finding dirt, but every once in a while finds something to eat. DreamStation apparently uses this technique to periodically increase pressure to see if anything gets better. If nothing gets better, then it then lower the pressure again. It does this all night. To the user having this pressure fluctuating up and down all night has to be annoying, and the machine is usually accomplishing nothing by doing it. The other difference is that the DreamStation seems to be slow to increase pressure, and needs more events to get the pressure up to an effective level.

And on the ramp feature I like the ability the ResMed has to only apply the EPR during the ramp and then turn it off when it detects you are asleep.

Those are some of the reasons I would choose a ResMed over the Respironics Dreamstation.

Here is an example of what the DreamStation does during the night. Take note of the red inhale pressure trace. You can almost set your watch by the ramp up in pressure every 10 minutes or so, while from the events flagging area, nothing is happening. It just does it. If you load your data into SleepyHead you probably will see something similar. For sure you will be able to see that the maximum pressures are. Below that is one of my ResMed reports when I had a wider pressure range set and you can see how it responds differently. In comparison the ResMed leaves things alone when there are no events, raises the pressure quickly when they occur, and then ramps down slowly after they occur in anticipation of more events.

DreamStation

ResMed AirSense 10

My wife has been into the CPAP for nearly 4 years now. I'm only 6 months into it. None of it has been covered by insurance other than the initial at home sleep study.

Costs in Canadian dollars. Prices seem to be higher in the US so these probably translate pretty closely to $US.

Auto machine: ResMed AirSense 10 Auto including mask and heated hose: $900 - probably needs to be replaced every 5 years or so. My wife's S9 ResMed is 4 years old and is running fine. She averages about 9 hours a night.

Hose: A heated hose is the Cadillac way to go and they cost about $30-40. My wife is on the original, and has the standard hose as a spare. Perhaps every 5 years for replacement? You do not want a smaller hose as it increases pressure drop and air velocity and likely will be more noisy and disturb your sleep.

Mask: They run from about $100 to $150 depending on the type and model. The replaceable inserts on my wife's original mask lasted about 18 months each and cost about $35 to replace. I'm still using my original after 6 months.

Filters: Not sure what they cost. Those that were included in my original package will last me a long time. I made the first replacement after 6 months.

Cleaning Machine: My opinion is that these are not at all necessary -- a solution in search of a problem. Yes, I'm sure they do a good job of sterilizing your machine. However after you take two or three breaths through it, the mask and hose is just as contaminated as it ever will be. Exhaled air does not go back through the machine. It exits from a vent in the mask. The machine only ever sees clean filtered air from your room. All you need to do is rinse out the mask and hose with household vinegar, follow that with a wash with water and a little bit of dish washing liquid soap, and then rinse with clean water and hang up to dry. Probably not necessary any more than once ever two or three weeks.

Yes, you can buy smaller machines for travel, but my opinion is that they are not necessary. Our son who is a bit younger than you, got both an AirSense 10 machine and a travel Z-1 Auto machine. He gave away the Z-1 to us to keep as a spare. He found it too noisy. We don't use it either. ResMed makes an AirMini travel machine, but it is a bit of a pain. First it needs a special mask or adapter to fit it. It does not use a water humidifier, but instead a replaceable gizmo that I gather sucks water in from the air. And, I don't think it talks to SleepyHead which is the common software used to monitor results. The standard ResMed AirSense 10 AutoSet with the ClimateLine heated hose is very portable, uses a standard water humidifier which is built in, and talks to SleepyHead. I just went on a 4 day trip and packed the whole travel case inside my carry on luggage. You can also carry it separately and it has velcro straps to secure it to a wheeled travel bag. You are allowed to carry it on at no cost as required medical equipment. In short I see no reason to get a travel sized CPAP. The ResMed standard machine travels very well.

Masks are a problem. However, you would appear to have a mild apnea at most based on your reported sleep study results. Most likely you will not be using a very high pressure. The pressure is what drives you to tighten the straps to keep the mask from leaking. In general the nasal pillow masks are the most comfortable and least claustrophobic, standard nasal next, and the full face masks the least comfortable. For that reason most try the nasal pillow like the ResMed P10 first and only move to the other ones if the nasal pillow is not tolerable.

On machines I think there are two good ones; the ResMed AirSense 10 AutoSet, and the Phillips Respironics DreamStation Auto. The DreamStation is typically a little cheaper but in my opinion not as good as the ResMed. They both will share data with the SleepyHead software application, which in my view is a necessity to monitor your treatment.

The way things work in this part of Canada is that a positive diagnosis of sleep apnea is followed by a free trial of a CPAP. If that is available to you, I would go that way. It will give you a chance to see what mask works for you, whether or not the treatment works, and if you like the machine they give you. Both my wife and I did that. We did not buy the machine they gave us to try, and just bought our machine on line at 1/3 of what they were going to charge us. But that all depends on your health coverage as to what works for you.

Hope that helps some,

Some comments:

The DreamStation is a good machine, but if you have any choice in the matter, I believe the ResMed AirSense 10 AutoSet is a better machine. I like the way it automatically adjusts pressure better, and it has some ramp and EPR features the DreamStation does not have. But, it can do the job and many use it quite successfully. What I like on the ResMed is the Auto Ramp feature and the ability to use the EPR during the ramp hold period and then shut it off automatically when you go to sleep. I don't believe the DreamStation has the ability to do that. These features make it more comfortable to go to sleep and more effective in the treatment after you go to sleep. DreamStation use something called Flex which is similar to EPR but not as effective in my opinion.

I'm not clear what you mean with your pressures. There should be a minimum and maximum treatment pressure, and a ramp start pressure. Your ramp start is 4 cm? Minimum 5 cm? and Maximum ?? These are very low, and have the potential to be uncomfortable and feel somewhat suffocating.

There should be no functional difference between a nasal pillow mask and a plain nasal mask. They both feed air through your nose, and require you to keep your mouth closed while sleeping. I prefer the nasal pillow as it lets me scratch my nose during the night if it feels itchy, feels less confining, and has less contact on my face.

I think the issue on dreaming/nightmares is that if you wake up during them, you will remember it. If you do not wake up you will still have them, but will not remember them. So if anything it is an indication of how frequently you wake up.

I'm diabetic and if I have a hot flash during the night is is most often a sign of low blood sugar. Other than that, I have not experienced them. I do find sleep quality is affected negatively by a higher room temperature and/or too many covers.

If you want to stay with a nasal or nasal pillow mask, you will have to address the mouth leakage issue. You will wake up with a sore throat, and treatment may be compromised. Some learn to do it. Some report that it helps to keep your tongue on the top of your mouth and pressed up against the the back of your top teeth. The issue is still doing it when you are sleeping. I have resorted to using a Breathewear Halo chin strap. Sleep Yeti in Calgary have them for $25 plus $7 shipping. I have also found it necessary to use a 1" Nexcare Paper Medical Tape (from Walmart) to keep my mouth closed. Sounds awful, but it isn't really that bad.

Swallowing air can be an issue, but I think it is more of a problem with a full face mask. Suspect it may go away when you can learn or stop the mouth opening.

If you use a ramp start and wake up during the night, you will likely notice the higher pressure during the night. I find higher pressure only really wakes me up when the mask is leaking and for example blowing air into my eyes. Suspect it is not just the pressure that wakes you up. Do you know what pressure the machine is going up to?

I'm sure they will not know if you have taken the SD card out and copied the data to SleepyHead. It will transmit data briefly when you shut the machine off in the morning. If you change settings on the machine they may or may not notice. When I did my sleep test with a F&P SleepStyle machine it was not compatible with SleepyHead, so I switched it with my wife's ResMed S9 machine so I could see my data in SleepyHead. I then changed some settings in the F&P machine and started using it again. They never noticed that my wife used it one night, or that I changed settings. Or, at least did not mention it.

Is this just a trial machine, or have you (or your insurance company) bought it? At some point when you do own it, it is important to remember that it is your machine and your treatment, not theirs. It is good to involve the sleep specialist if they are cooperative. The more common issue is that they are not nearly as interested in your treatment as you are.

I would highly recommend loading your data into SleepyHead. That way you will see what the machine is really doing, and how effective it is.

Hope that helps some. Any questions, just ask. Regardless it takes some time to get used to sleeping with a mask on. But I'm sure you can do it with some perseverance.

It looks like they are about $31 on Amazon.com

ClimateLine for AirSense 10

Just as an update I stopped the fixed pressure trial after 22 days. The AHI average after 22 days was the same 2.4 as I reported after the initial 12 days. So the 25% reduction in AHI using a fixed pressure compared to running in Auto held in the longer term.

I am now 6 days into my next test. I rationalized that if I put the machine back in Auto and set the minimum pressure at what appeared to be the optimum single fixed CPAP pressure of 12.2 cm, and then the maximum pressure a bit above that at 13 cm, then I might get even better results. That setup would get the pressure up to an effective level early in the sleep, and then still be able to respond a bit higher to abnormal events which may occur later on. I can report that so far my average is now 2.0 or about another 17% reduction. But, I know from past experience that it takes a lot longer than 6 days to set a true average. So we will see if this method holds up in the longer term.

I think a CPAP would have to be set up a bit differently to address the issue of apnea just as you are going to sleep. Typically the pressure is either held low or ramped up slowly to make it more comfortable to go to sleep. However, to stop an apnea that happens right when you are going to sleep would require higher pressure earlier. I think one would want not use a pressure ramp at all and start at the full treatment pressure, or use a very short 5 minute ramp so it would be at full treatment pressure BEFORE you go to sleep. And the other issue is that a CPAP cannot prevent a clear airway or central apnea event at all. Pressure does not help when the airway is already open. The CPAP would only help if the sleep onset apnea was of the obstructive type.

My solution to the mouth leaks has been the Breathewear Halo chin strap AND using 1" paper medical tape over my mouth. Sounds much worse than it really is. If find the nasal pillow masks to be the most comfortable, but mouth leaks are the weak point of them.

There are a couple of sleep dentists that check in here and I'm sure will have some good information for you. But if it were me, I would not even think for one second about getting one from Mexico. There are boil and bite options from the pharmacy stores that I would be tempted to try before I would risk anything from Mexico. One issue to consider with these devices is that unless you get a sleep study done with them in place you don't really know if they are working or not. A CPAP gives you daily feedback on how well they are working for you. The $900 cost of an Auto CPAP is also much less than the typical $2000+ for a dentist fitted device. But if the insurance company is paying then perhaps that is not a factor.

Hi Bill. Welcome to the forum. It is good to hear that you are giving CPAP treatment a second chance.

The DreamStation Auto BiPAP is a very good machine, but is fairly complex to set up properly. Do you have a manual for it? If not here is one you can download from this link:

DreamStation Manual

I would recommend as a next step if you have not already done so to download SleepyHead so you can view your detailed sleep reports. The software is free, but you need a PC or Mac and a SD card reader to use it. A couple of links:

SleepyHead Download

SleepyHead Basic Manual

If you want some help with getting the machine working for you, it probably would be best to start a new thread as posts tend to get lost in this Introductory thread. But, if you give some details on how your machine is set up, what pressures you are running, and what the breakdown of your AHI is. The key part at this point is the ratio of obstructive apneas to central apneas. A good way to communicate this is by posting screen shots of your Daily Report in SleepyHead.

When they rate apnea they just count the events and do not consider the length of each event, or how close together they are. If your events were short and spread out, that would likely have less impact on the O2 levels.

During a sleep study they do not treat you for apnea. They just monitor your apnea events. In a titration study you are being treated for apnea with pressure. They try each pressure level for an hour or so to see what impact it has on obstructive apnea and whether or not it increases central apnea events. The purpose is to determine what pressure your CPAP should be set at. If you have an automatic CPAP it is not really necessary to do a titration study. If they were to give you an Auto CPAP like the ResMed AirSense 10 AutoSet to try for a couple of weeks it would collect all this data automatically. You would find out whether or not there is any benefit to using one.