- Gidday mates.
(upbeat music)
Welcome to another super fun and educational
SleepHQ case study.
David is a valued member
on the CPAP Reviews Facebook community.
Gidday, Davo,
and like many CPAP users who frequently travel,
he has two machines.
For therapy at home, he uses a ResMed AirSense 10 Autoset,
but he also has recently recalled
Phillips Respironics DreamStation Go Auto
that he bought a couple of weeks prior to the recall.
Poor old Dave.
Now, let's compare David's results on both devices,
and spoiler alert,
if you're currently using a Phillips device,
and wish to continue, perhaps skip to the next video.
All right, let's do it.
(graphic whooshing)
(graphic clicking)
(text beeping)
Here we are on the Dashboard at SleepHQ,
and for those tuning in for the very first time,
warm welcome to the channel.
My name's Nick but everyone just calls me uncle Nicko.
Don't ask me why.
I know it's a little creepy but the shoe definitely fits.
Now, SleepHQ
is my CPAP data reporting and analysis platform.
You can upload your CPAP data directly to the SleepHQ cloud,
and then you can monitor your therapy,
and make changes if required, and it's free,
so go check it out, sleephq.com,
and here we are on David's profile,
and thanks to David for sharing his profile with us today.
Dave, I'll send you a little hat just to say thanks.
So you can see here, David's got an AirSense 10 Autoset,
like I showed you before,
and the DreamStation Go Auto,
two automatic devices,
but as you're about to find out,
just because they're both automatic
doesn't mean the performance and the results are the same.
So on the DreamStation, David's Apnea Hypopnea Index,
up here in green, is 39.1.
Ouch.
39 times an hour he's having breathing difficulty,
and on the AHI donut, here,
we can see the majority of events
are obstructive apneas, 32.87,
which is also bad news for Dave
because obstructive events
are the most severe classification of apnea.
They're the most dangerous,
and here's his machine settings,
currently in mode automatic.
He's got a pressure min of five and a pressure max of 20,
so the automatic machine will vary the pressure
automatically within that pressure range.
It won't go below five and it can't go above 20.
20's is the max on most CPAP machines, anyway.
So what's going on?
(laughing)
Why is that AHI so damn high?
As it currently stands, old mate Dave,
he's still classified
as having severe obstructive sleep apnea,
even though he's using a DreamStation Auto CPAP device.
Just not good enough.
Let's scroll down, and check out Dave's breathing,
and let's see how the Phillips auto algorithm
is changing the pressure
in response to Dave's obstructive events.
Here we go.
So this section right here,
the flow rate is Dave's breathing.
Every breath he takes,
we can see in high definition on SleepHQ,
which is really cool,
and just above it, we have the pressure changes.
This is the automatic algorithm,
changing the pressure over time,
in response to what's happening
(dashboard popping)
on the flow rate,
and every manufacturer
has their own specific, unique auto algorithm,
their own formula that they use
to determine the pressure changes.
Let's zoom in and see this in action.
Let's see what's going on.
I'm just clicking and dragging my mouse here,
so we can zoom right in, and we can see Dave's breathing,
and we can see what's happening with the pressure.
So all these little yellow bars here
are the obstructive events,
and you can see them really clearly.
So this is Dave breathing in, out, in, out.
He's taking big deep breaths,
and then all of a sudden, look.
(gasping)
(inhaling)
(exhaling)
(inhaling)
(exhaling)
(inhaling)
This right here is just textbook obstructive apnea,
as clear as an example as I can possibly give you.
Now, let's have a look at what the pressure is doing
in response to this textbook obstructive apnea.
(dashboard popping)
Starts off 10.6,
and you can see it gradually moves up to 11.6.
It's doing the right thing.
He's still obstructive, goes up again to 12.6.
It's trending up, which is what you want
because the idea is,
currently, there is no air getting into Dave's lungs,
so the pressure needs to increase to force air in.
That's how it works.
All right, it pauses for a little bit here,
and then it goes up again to 13.6,
but have a look.
This is where it gets really confusing.
He's clearly still obstructive, the machine knows it.
The machine is flagging these events obstructive apneas,
but the pressure goes from 13.6 down to 11.6.
Now, let's scroll forward here.
Look how long the pressure now stays at 11.6.
I'm gonna zoom out a bit.
So this is where the pressure dropped
from 13.6 to 11.6 at 6:20,
and it stayed at 11.6, right up until this point here, 6:36.
For 16 minutes, it stayed at the same pressure,
but have a look at the breathing during that time.
Clear obstructive events,
and the pressure stayed the same for 16 minutes.
Right, let's zoom out again,
and go to this next section again.
All right.
It's a similar story again.
All right, so 6:36, the pressure starts to go up again.
Goes up to 12.6, then it goes up to 13.6,
and now it's at 14.6,
so it's gone up another centimeter
from where it was previously,
but once again, it drops back down to 12.6.
It drops back down two again,
and this time, let's have a look.
6:41 all the way to 6:58, 17 minutes.
It stayed at 12.6.
Let's have a look at the breathing.
Again, clear obstructive apneas.
There is no reason that auto algorithm
should be staying at the same pressure for 17 minutes
when breathing looks like this.
Zoom out a little bit again.
All right.
Now, once again, the pressure goes up.
Let's have a look.
So the pressure trends up again.
All right.
It's finally figured out, yep, we're still not controlled,
we need more air.
13.6 up to 14.6, and finally gets to 15.6.
Okay, that's where it's got to,
and it does its drop again.
Now this time, show you what happens this time.
This time, the pressure just slopes down
over a really long period of time,
but what is that?
So let's have a look from there to here.
Okay.
So the pressure's at 13.6,
and it just gradually comes all the way down to 10.6,
but once again, there's just apneas
as far as the eye can see.
For some reason,
and perhaps it's because there was
those couple of false central apnea flags in the mix,
the machine's decided that no more pressure is required
when there is a lot more pressure required,
lots, lots more.
Now, it comes down to this point here,
where it flatlines.
Let's zoom in on there,
and what happens here,
eventually, Dave has an obstructive event here,
they're false flagged it an essential event,
it's not, it's obstructive,
and then he wakes up, and that's what happens.
The pressure's come back down,
he's having too many obstructive events,
he's probably woken up to go to the toilet,
Maybe he's done a big,
(gasping) and just woken up out of sleep.
Okay.
So that's what's happened here,
he's woken up and he's restarted the the machine again
at five centimeters, that's where it starts.
So the big problem I have with the Phillips algorithm,
right here, is it's taking way too long
to increase the pressure,
and treat those sleep apnea events,
and I'll show you how ResMed does it in a second,
which is 10 times better.
I don't have an issue, personally, with them doing this
little step up, step up, step up, and then step down,
to make sure that they're not inducing central apnea.
However, you can't...
in this little section here, there is no central apnea flag,
so you can't keep the pressure at the same low rate
with all this obstructive apnea happening
(dashboard popping)
for 15 minutes.
Not on.
That's rubbish.
This isn't some sort of really complex case
with lots of central apnea, mixed apnea,
high leak rates, mouth leak rates,
where the automatic algorithm
can't figure out what's going on.
This is just clear, textbook, obstructive sleep apnea,
and it knows it.
It's flagging.
Look, it's flagging away.
The machine knows it's obstructive sleep apnea,
but look, the pressure, it's not changing.
It's not changing at all,
and now, let's take a look at Dave's ResMed results.
So here we are, guys, same profile.
All I've done here is switched
from the DreamStation to Dave's AirSense 10,
and we're now looking at Sunday, March 28th
with the DreamStation.
It was one day prior, Saturday, March 27th,
and have a look at the dramatic improvement in the AHI.
4.49 on the AirSense 10 versus 39.1 on the DreamStation Go,
only one day prior.
Now, let's scroll down and check out Dave's breathing,
but more importantly,
how is ResMed doing things differently
to get Dave these fantastic results?
Let's check out the ResMed algorithm,
and how it's changing the pressure,
and it's just fascinating to see,
it really is.
Now, you might recall, with the DreamStation Go,
we had all those yellow flags,
those obstructive apnea events,
and then the pressure was gradually stepping up,
and then it would drop down,
and stay flatline for 15 minutes,
and then it would step up again, and repeat.
Have a look at how different this is, right here.
Look at Dave's breathing here.
There's no flags at all,
but look at the pressure change.
It's already moving up.
Look at it go.
I mean, it's moving very fast.
It flatlines for a little bit here,
and then we get this one hypopnea flag,
and then it really ramps up the pressure quite quickly,
and it goes up to 15.76,
so it's gone from five to 15.76
in a matter of nine minutes.
(laughing)
Nine minutes, incredible.
It's like the ResMed device is ahead of the curve.
It's increasing the pressure
prior to those obstructive events happening.
It's preventing them from happening.
All right, now let's zoom out,
and see what else we've got here.
Here's another great example.
So here we have those yellow flags again,
the obstructive apnea flags,
like we saw with the DreamStation data,
but look at the pressure change this time around.
Look at how quickly it gets up to 14.92
to even out the breathing.
It's 15 minutes.
With the DreamStation, before, it'd take an hour,
and we'd have another 50 of these obstructive apnea events
before it reached adequate pressure
because it goes up a couple of notches,
then it comes down, and then it flatlines,
and then it goes up a couple of notches.
Whereas this, there is no need
for the pressure to drop down
because the airway is clearly obstructed.
They're not central apneas.
They're flagging the apneas correctly,
so there's no need for that pressure to come down
unless the breathing stabilizes.
If the breathing stabilizes,
then it can gradually come down
(soft music) because you don't want it to be up
at a really high rate all the time.
Fascinating.
Dave also wears a RemSleep 02 Ring each night
to monitor his blood oxygen levels and heart rate,
and here's the results.
On the left, over here, we have the DreamStation results,
and they're terrible.
Have a look at his blood oxygen levels,
dropping all the way down to 70%.
This is because he's having so many obstructive events
that there's not enough air getting into his lungs,
and have a look at the difference in the ResMed results.
Blood oxygen level's nice and stable,
rarely dipping below 90.
It just goes to show how important it is
to treat those obstructive apneas nice and quick,
get 'em sorted, get your breathing nice and stable,
so you don't end up
with blood oxygen levels looking like this,
which is gonna put a whole lot of stress on your heart,
and cause disturbed sleep,
and here's the bottom line;
the ResMed auto algorithm is far superior
to the Phillips one,
and there's a lot of scientific literature
to backup my claims.
Now, I know the last couple of years
have been very, very difficult for Phillips users,
with all the Foamgate stuff,
and I know there's a number of you out there
that have no choice.
You're stuck with Phillips, and that's just the way it is,
and that sucks.
For those of you that are stuck with Phillips,
I highly recommend changing your mode,
your therapy mode,
from automatic mode to fix pressure mode.
I don't think the auto algorithm is up to scratch.
It leaves a lot to be desired,
from the evidence I'm seeing,
and the evidence I'm reading.
There's some great links in the description of the video.
I highly recommend you check them out,
but I'd switch to CPAP mode,
find a good, set level of pressure that controls your apnea,
maybe get an 02 Ring as well,
and make sure that your blood oxygen levels
are nice and stable.
I also know there's a large number of Phillips users
that do have a choice,
but for whatever reason, too lazy, can't be bothered,
don't wanna spend the money,
you're sticking with Phillips,
and hopefully after seeing some of these results
that I'm showing you,
which are honest, this is real data guys, real users,
you'll wake up and go,
"Yeah, okay.
One thing to have toxic foam,
and to be poisoning me, night after night,
but two, to not be working well,"
and that's what it's about.
Uncontrolled sleep apnea,
these blood oxygen levels are far more dangerous
than any toxic foam, I can tell ya that much.
Until next time, guys, sleep well, look after your mates,
and I'll see you soon,
and if you can afford it,
go and get yourself a new CPAP machine,
and put that shit in the bin.
If they're having apnea, the pressure goes up,
if the breathing's stable, the pressure...
(singing)
Ah, why can't I fucking figure it out.
I'm such a piece of shit.