Why adjust APAP. Isn't it auto?

[oxygenium65]

Hi!
I'm sooo noob, i need desperately some smart, correct anwers for sleep-nurse, please.

Arguments and questions are:

1. - Why people adjusting pressures if they have APAP?
It's AutoPAP.. no need to adjust, it's automatic, you can leave it 4-20.

2. - Why patients need to see their data (even only displaydata), it only shows how that appropriate APAP has responded.

I would be grateful if you could help!

[Wulfman]

Hi!
I'm sooo noob, i need desperately some smart, correct anwers for sleep-nurse, please.

Arguments and questions are:

1. - Why people adjusting pressures if they have APAP?
It's AutoPAP.. no need to adjust, it's automatic, you can leave it 4-20.

2. - Why patients need to see their data (even only displaydata), it only shows how that appropriate APAP has responded.

I would be grateful if you could help!

Unfortunately, far too many doctors don't understand APAPs/Autos, either.

Do you have any idea of how LONG it would take for the pressure to get from "4" to, say, "15".....if that's what pressure was needed to clear an apnea? It could take many minutes and your blood oxygen could have dropped dangerously low by then.
The APAPs don't go from "4" to "15" instantaneously. They have to slowly TRY each progressive pressure increase to see if that will clear the event.

The "data" tells us whether our our machines (pressure) and masks (leakage data) are doing their job. Not enough pressure is insufficient therapy and significant mouth or mask leakage is going to negate the therapy.

Anybody who THINKS that a wide-open pressure range (4 - 20) will give effective therapy is.......DELUSIONAL!!! (and stupid)


Den

[DreamStalker]

It is foolish to argue with foolish sleep nurses

1) No can leave wide open unless expectation is all out treatment failure. If min left at 4, machine cannot respond quickly enough to prevent apnea/hypopnea. Max left at 20 is no big deal UNLESS you have mask leaks/run-away pressure feed back loop or if patient is sensitive to central type apneas.

2) Intelligent interpretation of data (sleep nurses not eligible) can help pinpoint problems with treatment that lead to faster resolution and optimal treatment.

My advice ... ditch the dumb nurse and the dumb medical equipement provider and take control of your own treatment!

[Wulfman]

It is foolish to argue with foolish sleep nurses

1) No can leave wide open unless expectation is all out treatment failure. If min left at 4, machine cannot respond quickly enough to prevent apnea/hypopnea. Max left at 20 is no big deal UNLESS you have mask leaks/run-away pressure feed back loop or if patient is sensitive to central type apneas.

2) Intelligent interpretation of data (sleep nurses not eligible) can help pinpoint problems with treatment that lead to faster resolution and optimal treatment.

My advice ... ditch the dumb nurse and the dumb medical equipement provider and take control of your own treatment!

Unless.......you're married to the dumb nurse and the dumb DME is a brother-in-law......or they're in some way related.

Den

[DreamStalker]

It is foolish to argue with foolish sleep nurses

1) No can leave wide open unless expectation is all out treatment failure. If min left at 4, machine cannot respond quickly enough to prevent apnea/hypopnea. Max left at 20 is no big deal UNLESS you have mask leaks/run-away pressure feed back loop or if patient is sensitive to central type apneas.

2) Intelligent interpretation of data (sleep nurses not eligible) can help pinpoint problems with treatment that lead to faster resolution and optimal treatment.

My advice ... ditch the dumb nurse and the dumb medical equipement provider and take control of your own treatment!

Unless.......you're married to the dumb nurse and the dumb DME is a brother-in-law......or they're in some way related.

Den

Ditch ... divorce ... same difference to me

[boston]

im not trying to hijack this thread, but my apap ,is set at 6-15, now that ive been on it for a few months and my 90% pressure is usually in the 14's, but lately i have seen a 13 sneak in, ive been thinking of changing it to 11-16, would you guys agree that would be a good decision ??

[DreamStalker]

im not trying to hijack this thread, but my apap ,is set at 6-15, now that ive been on it for a few months and my 90% pressure is usually in the 14's, but lately i have seen a 13 sneak in, ive been thinking of changing it to 11-16, would you guys agree that would be a good decision ??

If your leak plots are fairly level and within suggested mask rate and your PSG showed no centrals ... I don't see why not.

[Goofproof]

That's why we use the program data, the leak plot is a important part of deciding what to do, if it's not under control moving the pressure will be based on faulty data. and while better than guessing, the LCD data isn't good enough. Jim

Most people do better with a 3 cm pressure spread on auto, or a set pressure on CPAP. Don't let the French Fry Cook, set your auto to 4cm to 20 cm, demote him back to Cold Drinks.

[Wulfman]

im not trying to hijack this thread, but my apap ,is set at 6-15, now that ive been on it for a few months and my 90% pressure is usually in the 14's, but lately i have seen a 13 sneak in, ive been thinking of changing it to 11-16, would you guys agree that would be a good decision ??

What's your AHI been? Also, what do the pressure charts show near the bottom of the reports? Along the lines of what DreamStalker wrote, if "events" and not leaks are driving your pressure increases, then you should adjust accordingly. I try to determine what pressure shows the fewest events (lowest AHI) and narrow the range around those numbers. I don't like to use the "90%" figure very much as there's usually a "sweet spot" somewhere between the "Average pressure" and the "90% pressure".


Den

[boston]

okay, all of this is from the LCD, as I am waiting till after the holidays for my $$$ to recover before getting the card reader and software

90 % pressure
7 day avg - 13.8
30 day avg - 14.0

system leak
7 day avg - 27.6
30 day abg - 28.5

AHI
7 day avg - 1.4
30 day avg - 1.8

[fortomorrow]

How long DOES the machine take to get from 4cm to 15cm anyway? Does anyone know?

My neurologist prescribed my APAP at 5-20cm. I changed it to 8-20cm, because in my titration study most of my apnea were gone at 8cm (my pressure on CPAP was 12cm because that's what it took to make ALL the events go away supposedly, but I can't stand 12cm). 5cm would hardly be enough to clear the CO2 from my mask.

[Wulfman]

okay, all of this is from the LCD, as I am waiting till after the holidays for my $$$ to recover before getting the card reader and software

90 % pressure
7 day avg - 13.8
30 day avg - 14.0

system leak
7 day avg - 27.6
30 day abg - 28.5

AHI
7 day avg - 1.4
30 day avg - 1.8

I think I'd go with the minimum at about 12. (you could try 11, too, as per your previous post) However, I don't think I'd raise the maximum pressure at this time.

If I were you, I'd be clearing the data after recording each night and use/record the individual nightly info. I've heard the averages from the LCD aren't that accurate.

Den

[boston]

I think I'd go with the minimum at about 12. (you could try 11, too, as per your previous post) However, I don't think I'd raise the maximum pressure at this time.

If I were you, I'd be clearing the data after recording each night and use/record the individual nightly info. I've heard the averages from the LCD aren't that accurate.

Den

thanks for your response, i am going to change my minimum to 12 and leave my max at 15 and see what happens, I feel like I am on the edge of getting that 'refreshed feeling' in the morning, and am SO hoping this helps.

side note: i just changed my pressure, slapped my mask on so i could see the difference of pressure set at 12 vs. pressure at 6. WHOA, Ive never used the ramp before, but I sure will be now.

[carbonman]

side note: i just changed my pressure, slapped my mask on so i could see the difference of pressure set at 12 vs. pressure at 6. WHOA, Ive never used the ramp before, but I sure will be now.

B, using the same great information you have received,
I went from 8 titration to now, 12.5, life is wonderful.....but,
I did it in small steps, over about a ~6wk period.
Made the transition much easier and
I could see the improvments as I went up.

A .5 or 1cm increase at a time was very managable.

Hope this helps.

[ozij]

How long DOES the machine take to get from 4cm to 15cm anyway? Does anyone know?

My neurologist prescribed my APAP at 5-20cm. I changed it to 8-20cm, because in my titration study most of my apnea were gone at 8cm (my pressure on CPAP was 12cm because that's what it took to make ALL the events go away supposedly, but I can't stand 12cm). 5cm would hardly be enough to clear the CO2 from my mask.

A Respironics has three "modes": a stable mode, called "Ptherapy", a mode in which it drops pressure slightly to see if you can benefit from less pressure called "Pcrit" and a mode in which it searches upwards to see if it can achieve better results. It also has a whole bunch
of rules in the form of: "during this pressure stat, if this event happens x times within y minutes, raise the pressure 1 cm and wait for z minutes".

The end result of all those rules is that if your events happen to be just slightly outside the rules the machine won't raise the pressure.

The decision about when to respond is based on analysis of your breathing pattern over several breaths. In Respironics, for example, If you're snoring, moving from 4 to 15 will take about 10 minutes (First raise within 15 seconds of 3 snores that happen within 30 seconds, and then at the rate of 1 cm. per minute if snoring continues). If you are no longer snoring, you have to have 2 apnea within 3 minutes - for the machine to raise its pressure by 1 cm. Which means that (in Ptherapy or Popt) if you happen to have your apneas within 4 minutes of each other, pressure won't be raised. As I said, there is a whole bunch of complex rules like that that decide how the machine responds.

However, the bottom line is that the machine cannot be trusted to give you proper therapy if the minimum is too low.

I assume your sleep nurse, oxygenium, and your neurologist fortomorrow, are just 2 of many people who don't realize that in machines (as in real life...) "titration" and "therapy" are not the same thing. They confuse the automatic adjustments of the titration process with those one would want to have for smart therapy. It's an understandable confusion, since the companies' PR certainly fudges the issue. It confused many of us on this forum as well. And as has been said, most of these sleep, breathing and nervous system professional, who have learned a lot about the human body, don't really know the nittygritty of the machines' functioning. Many of them are people persons, not machine or computer oriented at all - which is OK, in its way. But here we have therapy given by a machine that is guided by a computer program - and that's a new ballgame.
The majority of us use the internet without understanding what makes it function - no problem about that. But those of us who have to troubleshoot communication problems have to know more. I think that much of the medical profession hasn't realized that troubleshooting APAP therapy demands better knowledge of how the machine work.

It was many hours of trying to get therapy from the auto titrating machines that taught members of this forum that for the majority of users, one has to set a minimum that will maintain a certain level of good breathing. Welcome to the club, fortomorrow - you've learned that also now. 8 seems to be your reasonable minimum.


O.