Questions about ResMed AirSense 10

Hi, I was diagnosed in 1996 and am on my third CPAP machine. I have recently moved to southern CA where there is a huge medical industry, but no "health care" services that I've been able to find. You act like a sheep and do what you are told even if it kills you because the patient does not count down here as far as I can tell. I think it is time for a new CPAP machine and the doctor and DME supplier are completely uninterested in whether I have a good solution or not. The way the tech put it: the doctor issues a prescription for the pressures and the DME supplier issues me a machine based on what the insurance company will pay for. He said I have no input in the selection. I really miss Westside Sleep Center in Oregon... Anyway, they want to issue me a ResMed AirSense 10 auto CPAP machine. I have always used Respironics, so I know nothing about ResMed machines. So I have a few questions to ask of you all.

(Edit: I guess question zero would be "are these decent machines?")

First, it seems that my current machine is effective most of the time, but a few times a week it cannot sense an apnea and then raise the pressure high enough and fast enough to get me breathing again before I wake up with pounding heart and adrenaline. This seems to usually happen in the middle of the night when I am at the starting pressure and I enter deep sleep and need a large increase in pressure. The doctor said that a different machine might react more quickly, but he knows nothing about actual individual makes and models. I asked the technician how the ResMed compares to my old Respironics and he said nobody has ever asked him before and he doesn't have time to research it. I'm supposed to take what I'm offered. He says it's newer than my old one, so it "should" be better. But that means nothing. I want to know it's going to be better, not just guess. The manufacturers won't talk to me, so does anyone out there know this?

Second, it appears that I am not likely to get good service (and forget about "care" entirely) from these humongous California medical businesses, so I want to be able to setup/adjust my own machine if necessary. As I said, I've been sleeping with a CPAP every night since 1996. My early experiences were with a large and well respected hospital in Oregon. They were so bad that I looked over the tech's shoulder and saw how he entered the programming mode and then took over management of my own sleep apnea for about 12 years. I did very well until I moved and started seeing a really good independent sleep doctor. But even since then I have occasionally had to adjust my own machine from time to time. For example, I tried a new sleep doctor shortly after moving down here and she set my machine to a pressure range of 5 to 20, when I had been using it successfully at a range of 12-20. I could not even get to sleep before having an apnea and I do not use the ramp-up feature. I had to adjust my pressure up to 8-20 in order to get to sleep that night! And I fired her and went looking for another doctor.
Also, if I am losing weight, sometimes I'll need to increase the pressure a little as the tissues in my throat become loose. Then as I lose more, I have to lower it down and down to keep air from blowing out of my mouth. There's no point in going to a sleep doctor as long as my weight is changing because all he can do is the same as me: guess at an adjustment with the intention of finalizing it when my weight is stable. So I fiddle with my pressures until my weight is stable and then go in to get the doctor to read the card and recommend a good pressure range. (Unfortunately, then I eventually gain the weight back and have to reverse the process. ) So my very important question #2 is: how do I put the machine into programming mode? On the Respironics, it's a matter of holding down one or two buttons for a few seconds until it beeps into the programming mode. How do you do it with the ResMed AirSense 10? I've heard rumors of passwords than only the Dr. or tech knows. That would rule this model out entirely. And question #3: these things come with all sorts of "modes". The Respironics has C-flex and A-flex and who knows what other flexes now. And they have ramps and all sorts of comfort features and so on. I want to put on the mask, push a button, and have my full starting pressure right from the beginning - no ramp-up. And I want to be able to breathe at my own pace without the machine trying to anticipate when I am going to breathe and raising or lowering the pressure based on its guess. That is very distracting. With my current machine in the legacy mode (C-flex, I think) I lay down and go to sleep almost instantly. With all of these lame "comfort modes", I cannot get to sleep at all until I am just exhausted from fighting the machine. I'm sure some people need them and I'm not putting anyone down for using them. We're all different and I just want to know if the ResMed AirSense 10 can work in a simple auto-cpap mode without ramping up and without comfort modes that anticipate my inhales and exhales.
Thanks to anyone with the tenacity to read this far. :-)

Wow! I wish I could answer your questions. I am using an AirSense10 since Feb. 2015, and really like it. I have used a CPAP machine since March of 2005 and this is the best one so far. Initially, my target pressure was 7 with a range above and below that. I don't mind the ramp up as it is only seconds usually. I log my scores from each night to see how I am doing and to watch for changes that might indicate an adjustment is necessary. When I saw my average number of sleep interruptions per night going up, the store I get my supplies from checked my records and saw I needed a higher average pressure. I had to go to the sleep clinic and they adjusted my machine for me. My average sleep interruptions dropped back to what is a normal range for me. I asked why the interruptions went up and was told it is because my throat tissue sag more as I get older. I asked if there were any exercises I could do to strengthen them and was told there weren't any.

When I log my scores, I enter all the data for each night, then log the number of sleep interruptions and the score on different sheets. My most frequent score is 100, followed by 99, 98, 97 etc. My most frequent interruptions per hour is .5 followed by .2 I have gotten 0 14 times. so far. I recently noted that when I got through with a big project, my sleep quality improved--fewer interruptions and higher scores--like 100 seven nights in a row and two nights with 0 sleep interruptions. I didn't realize there might be a correlation between stress and sleep quality.

I fall asleep easily, often within seconds, and am never fighting the machine. I pull the sheet and blanket over my head to keep all the machine air from bothering my wife. But, my weight is stable, so my issues are very different from yours. I easily sleep 7 or more hours/night without having to get up.

My current nose mask is an AIRFIT N20 Med sys - Amer and is the most comfortable mask I have had. No strap marks, no nose creases or skin breaking down.

I hope someone else with more specific knowledge on adjustments, etc. can answer your questions.

I do other things to stay healthy overall. Due to arthritis "everywhere", I take a water aerobics class at least twice a week, followed by light weight lifting to maintain strength. I weigh myself each time I am at the fitness club and maintain a fairly healthy weight. I never get down to my target weight, but am never more than 10 lbs over it either. The only thing that changes as it fluctuates is my stomach size. I have had 4 serious medical situations, each of which was correctable and a one-time operation or treatment as the answer, so I don't take good health for granted and do what I can to take care of myself. So far, it seems to be working. That doesn't mean I am home-free, but I do what I can and research shows to be effective in contributing to good health.

Good luck to you!

I will attempt to answer your questions in under 500 words.

question 0: They are fine. Some of the adjustments are in an on screen menu, which is a problem if you are not a native English speaker or you are technophobic (most of my patients are one or the other), but from your history you should be fine. The humidifier is one of the better ones. The AirSense 10 is usually a bit more expensive that either a Respironics or a Fisher & Paykel and no better than either of these. If you can get a Respironics DreamStation for less I would probably go that way. The main issue with the Fisher & Paykel is that the humidifier is fiddly and hard to empty, but if you use a humidifier it is also cheaper because you don't have to pay extra for it (it is integrated).

question 1: That is a very technical question. The reps for each company will tell you that their machine adjusts itself faster than everyone else's, but they are all pretty similar. The simple truth is that there is no way of telling if a new machine will fix your sudden waking problem until you give it a try. The AirSense 10 is almost certainly no worse than your old Respironics machine, but whether or not it is better will only be revealed by giving it a try.

question 2: It is easy to put the AirSense into clinical mode. I don't feel comfortable disclosing how it is done here, but I don't think I'm giving away any secrets when I say that Mr Google will help you find and answer to your question in under 60 seconds. I totally understand why you wish t oadjust your own machine and, as you are using an auto, the lower pressure is really only for your comfort and there is little harm in you adjusting it. However, I feel I must add that, in general, I do not encourage people to adjust their own machines. Sorry, just had to get that in.\

question 3: The AirSense has it's own version of C-Flex called EPR. It's exactly the same thing. If you don't like it just turn it off. I personally hate C-Flex, EPR and all other similar forms of pressure relief. In 99.9% of cases they are unnecessary and in some cases can cause serious problems, but I don't want to break into a rant now (even if that's what internet fora are for). You can also turn the ramp off if you like.

Any further questions, I'm happy to help.