New Insurance - New Machine?

was that on the 8.1 or the win 10 computer?

Those results look pretty good. It looks to me like you have all your history. For future posts, I would just do that first one -- the Daily Detail. The format looks pretty good except I would ditch the pie chart as it covers up more important detail on the left and is somewhat redundant. To hide the pie chart use File, Preferences, Appearance, and then uncheck the box that says something like "Show event breakdown pie chart".

I started to post to your "whats going on" thread, and this one came back from the dead. Without repeating too much, your results look very good. About the only thing I notice a bit out of line is the RERA number. It seems high, and is not counted in your AHI. What you might want to do is zoom in on some of those RERA events to see what the flow rate wave form looks like. You can do that with the Events tab and then click on the RERA events individually. Or what I do is just left click on the event of interest in the Events Flags area and repeatedly left click to get the level of detail I want. The up arrow also zooms in more, and the down arrow back out. Left and right move along the time scale. What you are looking for is some flattening out of the top side of the inhale cycle. A RERA event usually ends with some kind of flow disturbance indicating you are be aroused but not wakened by the event. This data indicates you may have been a good candidate for the ResMed AirSense 10 AutoSet For Her machine. It has been designed to respond quicker to flow limitations which tend to initiate the RERA events. But, I gather that ship has sailed.

There are some potential ways you may want to consider to minimize the RERA. I see most (but not all) of these events are occurring at lower pressures. You may want to ask about increasing the minimum pressure on your new machine to 8-9 cm. It may address some of these flow restrictions before they become RERA events and disturb your sleep. It appears you have Flex set at 2. I normally suggest that there can be benefits to turning that off to reduce maximum pressures and CA events. But your maximum pressure is not that high and your CA events are low, so it may not make sense in your case.

I believe you new machine is a DreamStation Auto? If so I believe it has a SmartRamp feature you may want to consider using. It holds the pressure at a selected ramp start pressure and only ramps pressure up to your minimum when it detects you are asleep. If you end up with a higher minimum I would suggest you also get the SmartRamp turned on with a start pressure of 7 cm. That should let you get to sleep comfortably.

Other than that, it looks to me that you had a very well set up machine that has been working well for you.

The starting pressure for the ramp is really a personal preference. You can't set it higher than your minimum pressure though. I like to have it where it feels like it requires no effort at all to breathe when I am awake. I recall originally it was about 6-7 cm for me, but now it is at 9 cm. I can have it that high as I am now using a fixed pressure of about 11 cm.

On your minimum pressure I think you would likely see some reduction in your RERA and flow limitations with it in the 8-9 cm range instead of the 6 cm on your old machine. Your machine is going up to the 10-10.5 range automatically, so I doubt that having the minimum higher is going to feel much different from a maximum pressure point of view, especially if you use the Smart Ramp feature. The Respironics machine like your old one and the new DreamStation like to bump up the pressure periodically (the red spikes on the pressure chart), and then almost as quickly bring the pressure back down again. Having a higher minimum can take some of that irregular changing pressure behaviour out of the machine. It can result in a more comfortable ride over the night. Your maximum pressure of 12 looks fine.

Another more conservative option would be to set your new machine exactly the same as your old and use it for a few nights to see if the new machine is behaving any different. Then when you have a baseline with the new machine, you will be able to see what difference the new settings may make.

Strange that you are hearing noise from the DreamStation. It is rated slightly quieter than the ResMed. Should be hard to hear...

There is nothing wrong with any mask that doesn't leak too much and is comfortable. That is all you need. I tried the Mirage Quattro and the F20, but couldn't make friends with either one of them. The F20 was a bit better than the Mirage Quattro, but they both leaked, blew air in my eyes, and kept me awake.

Your results look very good for a first setup with a new machine. I can't quite see your full Leak Rate graph but if the lower of the two green traces stays below 24 L/min then it is good.

If it were my machine I would ask about setting the minimum pressure higher in the 8-9 cm range. That could prevent some of the hypopnea and flow limitations you are seeing. And I would use the Auto Ramp with a start pressure of 7 cm. That should feel more comfortable going to sleep. The 12 cm max looks good. There were a few flow limitations when the pressure is maxed out, but that is not too bad.

Yes, if you want to take the responsibility for changing pressures it is not that hard. Just press and hold the round set button on the front, and the ramp button on the top at the same time for about 5 seconds. That will put it into the clinical mode. Go to the Therapy section and it will give you the option to set minimum and maximum pressures. Here is a link to a full manual which also explains it.

DreamStation Technical Manual

I find it best to only change one thing at a time, and then give it a few days to determine if you got the improvement you were expecting. The results change from night to night with no changes in the setting, so you can kind of fall into a trap by thinking that all the change for the next day was due to the change. You really need an average of nights from before the change to after the change to see the real impact of it.

What I did with the ramp start pressure is just try it at each pressure while lying on the bed. I take a deeper than normal breaths and see if it feels like there is any kind of flow restriction when I breath in. It should feel like you are not wearing a mask at all. You will know pretty much right away what you prefer. I would encourage using the SmartRamp feature. I think it is better to have a fixed pressure while awake and going to sleep than a pressure that is creeping up. And with a timed ramp you can fall asleep before the ramp is over, and have apnea events while the pressure is not up to minimum.

The pressure your ramp starts at is all about comfort, so if it is comfortable then it is right. It's that simple.

Looks very good. If it were me, I would turn the Flex off and see if that reduces the Median pressure any. It may. After you see what that does, then you may want to try a higher minimum pressure at say 9 cm, and perhaps even as high as 10. Your max pressure could probably be reduced to 12, but for now it is not doing any harm leaving it at 14.

Drop by and do a bit of stirring from time to time jifjifjif.

They deserve it! :P

You might want to check on how much data your DreamStation will hold on the SD card before it overwrites. On my wife's ResMed S9 it starts overwriting the detailed data after only a couple of weeks. If you don't transfer to SH before it overwrites the data is gone gone. My ResMed A10 keeps the detailed data much longer, perhaps up to a year. Not sure about the DreamStation...