New Guy - Need Help w/ Settings

[alanhj13]

This is my first week and I still have issues falling asleep and waking up through the night. I tried a combination of some recommendations, lowering my max and increasing my min. I The new setting felt better (just went by feeling not very scientific). Some advice I received was that large gaps in numbers are not good. With the Data on the machine, how do I tweet the machine to the best settings?

I adjustment my machine as someone recommended to 11.5 min to 15 max but the increased low setting seem like too much air pressure for me.
I also am still having leaking problems while sleeping on my side. Once the leaking stops any slight movement causing bursts of air to leak out. I might eventually have to try the masks some of you have recommended.

Here are my Settings and data:
Therapy cmh2o Max 20 cm(changed to 15.5cm last night), Min 4.5 (changed to 5.5 last night), Auto A-FLEX
Data: 4 Sessions, 29.3 hrs / 7 Day Leak Avg 38.9/ Apn Hyp Index 7 day Avg AHI=9.4/ 90% avg AHI=9.4

Respironics M Series Auto CPAP w/ A FLEX and Humidifier
Respironics ComfortFull 2 Mask
Infineer Encore Smart Card Reader
Sleepap Pillow

Thanks for the help...

[Wulfman]

I would say you need to move your minimum pressure up higher and as quickly as you can tolerate it. Can you handle 8 cm? When you say "....too much air pressure for me.", your machine is probably going up beyond that number anyway, so as soon as you can get there is what I'd do if I were you. Many people are prescribed much higher than that on straight CPAP......and expected to handle it.

You would also do well to clear out your nightly totals after recording them and rely less on the "averages" your machine is giving. Do you know how to reset your nightly data?

Sorry to read you have that mask. I bought one out of curiosity a couple of years ago, but I could only handle it for three nights before going back to my comfy UMFF.

Also, please fill out your profile so we'll know what you have in future posts.


Den

[rested gal]

Some advice I received was that large gaps in numbers are not good.
----
I adjustment my machine as someone recommended to 11.5 min to 15 max but the increased low setting seem like too much air pressure for me.
===
Here are my Settings and data:
Therapy cmh2o Max 20 cm(changed to 15.5cm last night), Min 4.5 (changed to 5.5 last night), Auto A-FLEX
---
Respironics M Series Auto CPAP w/ A FLEX

I'm not a doctor or anything in the health care field, but I don't think "large gaps in numbers" (if you mean a wide difference between the minimum and maximum pressure settings on an autopap) is a problem for most people. What I think is important is setting the minimum pressure right. And by that I mean setting the minimum pressure up high enough to prevent most apneas/hypopneas from the start.

In other words, using the autopap almost as if it were a straight cpap, with the minimum pressure set at or very close to what you'd be prescribed if you were using a cpap machine at a single straight pressure.

A wide open (20) maximum pressure setting is usually not the problem, imho. To get good treatment and a low (under 5) AHI, I think where a person sets the minimum pressure is the key. For most people with plain vanilla OSA.

I agree with Den:

I would say you need to move your minimum pressure up higher and as quickly as you can tolerate it.

If the minimum pressure is set right (high enough), then it really doesn't matter for most people if the maximum pressure is left wide open up at 20. Doesn't matter because the machine won't even have to use the higher pressures at all if the minimum pressure is set high enough to prevent most events. All bets are off, however, if a person has uncontrolled leaks. Too much leaking around the mask, or mouth air leaks if not wearing a full face mask can interfere with an autopap doing its job effectively. If leaks are not nice and low, then I'd cap the maximum pressure setting about 5 cm above where I set the minimum pressure.

So, why use an autopap at all if the minimum pressure is going to be set to work. in effect, like a straight cpap? Why not just use plain cpap in the first place?

My answer would be... sometimes being able to set a minimum pressure just one or two cm's below "prescribed" pressure can allow a mask to seal better, or allow the person to exhale more comfortably, and still prevent most apneas/hypopneas from even getting started. But a margin of mostly unused "maximum" pressures is up there and available in case more pressure is needed briefly at some times during the night, or on occasional nights.

For example, if I had been prescribed "cpap @ 10 cm H2O", I'd set the autopap at 10 - 20 or 9 - 20 or 8 - 20. With an autopap that has A-Flex, I'd set A-Flex at 3 or at 2...whichever felt smooth and natural for breathing out. I like "3", myself. I wouldn't use a "Ramp" setting, unless I really needed to start out very low just to get to sleep at all. I'd rather have treatment start right from the get-go.

But before I tried to figure out what pressure range suited me, I'd make sure leaks were under control.

Regarding this:
"This is my first week and I still have issues falling asleep and waking up through the night."
---
"I also am still having leaking problems while sleeping on my side. Once the leaking stops any slight movement causing bursts of air to leak out."

Moreso than what machine we use or what pressure(s) we use, the mask is the number one piece of the puzzle to get right. The mask, imho, is the main thing that can interfere with being able to "sleep" while getting treatment. A mask that doesn't allow a person to sleep in their favorite sleep positions, or that springs leaks every time the head moves, is going to disrupt sleep.

A lot about this kind of treatment is a tradeoff until we get EVERYthing comfortable. We're trading off the drops in O2 that apneas can cause and the sleep disruptions of apneas and hypopneas for other kinds of sleep disruption -- equipment related sleep disruptions. The feel of the mask gouging the face, the feel or sound of leaks hitting the face or the bedcovers, the feel of straps digging in, rainout dripping on the face, hose tugging at the mask when we try to turn over, difficulty breathing out against pressure.... the list can go on and on.

Gotta get a comfortable mask (that can be a lonnnnngggg, expensive process finding the right mask) and gotta have leaks under control before we can really get a good idea about what pressure tweaks work best for us no matter what machine we use.

Good luck, Alan. You're off to a great start with a good machine. Hope you can get the mask issue solved. I had to use a Full Face mask (tried several of them) during my first months because I'd mouth breathe during sleep. I hated every FF mask I used. My solution was to use tape over my mouth to prevent mouth breathing so I could switch to a much more comfortable (for me) nasal pillows type of mask.

[alanhj13]

Thanks Wulfman & rested gal. I will increase my min. setting higher. From what I am learning, the MASK is EVERYTHING. I'll probably end up getting another FF mask. I am not sure I could ever tape my mouth shut that would be weird. Before I purchased my machine I used my wife's scarf to tie around my head to stop my mouth breathing at night (feel off of course)...my wife and kids got a kick out it. It looked like I had a tooth ache or something.
From all that I am reading the perfect setup is like the Holy Grail. But once you got it, that's it ... I'll get there.
My doctor hasn't perscribed my settings. I was just told I had sleep apnea (results for sleep study) and was given a prescription to by a machine. My DR. told me to come back after 2 months with my Mem card (from my machine) to see how I am doing. So I don't think I should erase the data. For now, I don't have a clue what to do with this thing. It's a good thing I have cpap.com to go to...
Well, gotta go try my new settings. It's 9:00pm here in Dubai.
Buy the way, I ordered my CPAP gear on CPAP.com. I would have had to pay over double the price here.
THANKS AGAIN

[alanhj13]

Wulfman and Rested Gal,

I increased my minimum pressure to from 8cm and increased my max back up to 20cm. It felt better. Wulfman mentioned reseting my nightly data. How do I do that? I could not find any info on this in the Users Guide. If my nightly AHI reading is above 5 AHI should I keep increasing my minimum setting until I reach 5 ?

I have been using my machine for about a week but the reading says 4 Sessions and Summary 5 (total 49 hrs). What does that mean? Is a Session one night? Sometimes I shut off my machine to go to the bathroom. The air is so loud I do not want to disturb my wife's sleep. If the AUTO OFF setting is used it takes too long to shut off. How does turning off the machine effect the Session? I would expect to have a lot more sessions not less.

It has been a week now and I have made good progress. I can now Fall Asleep and I am getting more comfortable using the mask and machine. I do not get sound, continuous sleep yet, but I know I will eventually.

rested gal, I will be posting a new topic on Switching from FF to Nasal Mask. I would like your input.
Thanks,
Alan

[Wulfman]

Wulfman and Rested Gal,

I increased my minimum pressure to from 8cm and increased my max back up to 20cm. It felt better. Wulfman mentioned reseting my nightly data. How do I do that? I could not find any info on this in the Users Guide. If my nightly AHI reading is above 5 AHI should I keep increasing my minimum setting until I reach 5 ?

I have been using my machine for about a week but the reading says 4 Sessions and Summary 5 (total 49 hrs). What does that mean? Is a Session one night? Sometimes I shut off my machine to go to the bathroom. The air is so loud I do not want to disturb my wife's sleep. If the AUTO OFF setting is used it takes too long to shut off. How does turning off the machine effect the Session? I would expect to have a lot more sessions not less.

It has been a week now and I have made good progress. I can now Fall Asleep and I am getting more comfortable using the mask and machine. I do not get sound, continuous sleep yet, but I know I will eventually.

rested gal, I will be posting a new topic on Switching from FF to Nasal Mask. I would like your input.
Thanks,
Alan

If the AHI is still above 5.0, I'd move it up 1 cm. at a time for a few days each.
You want to make sure you turn off your machine BEFORE taking your mask off whenever you are not going to be using it......bathroom visits or whatever. If you don't, it'll screw up your leak data.
A "Session" is anytime it's running. If you are away from the machine for one hour or more, it will start a new session.

Den

Resetting the data is not in the "User's Guide".
Use this procedure:


==========Resetting LCD Display Data====================

To reset LCD Therapy data (does NOT erase any data from SmartCard):

1. Hold down the (<-) (->) buttons while plugging in the power on the back,
wait for 2 beeps or 5 seconds, release buttons.
2. Press the (->) key and navigate to Therapy screen.
3. Press and HOLD down the (-) minus key for 5 seconds and/or until therapy data is reset to Zero.
4. Press the (->) key to scroll back to main menu, press (+) key to enter Setup or
On/Off button to exit.

[alanhj13]

Wulfman,

That did it, THANKS!

[GumbyCT]

UPDATE for Accessing the PRS1 Menu (Respironics System One)

With power ON, highlight <Setup> then Press & Hold the "Control Wheel" & "Ramp buttons" for at least 5 seconds. After a double beep the Provider Mode Screen will appear. Turn the wheel to move between options. Press the wheel to select the <Highlighted Option>. Time out will happen after 1 minute of inactivity. Select <Back> to move to the previous menu page and <Exit> to leave "Provider Mode".

Be Sure to write down ALL settings before making any changes, then write down the changes too.

Good Luck