My first night on RemStar Auto - what gives?

[derek]

After three months of 12 cm on RemStar Plus, and waking exhausted each morning with "tired lungs", I finally got my RemStar Auto yesterday. I set it to work between 8 - 14 cm, with C-Flex set a 3.

What a difference in breathing! The night was soooo comfortable. No tired lungs this morning.

BUT, here's the problem: I looked at the pressure several times last night, it never seemed to budge from 8 cm. Nor did it feel any higher when I woke at any point.

I'm down on Cape Cod for the Valentine's weekend get-away, so I cannot look at what really happened with Encore Pro until Monday. I tested the unit by holding my breath several times and the pressure bumped up, so the device is working in APAP mode.

I'll drop the minimum down to 6 cm tonight and see what happens. Maybe my tongue-in-cheek signature is correct
Any suggestions?

derek

[Mikesus]

Well, its possible that you don't need 12. When was your last sleep study?

[-SWS]

I concur with Mike. My guess is that you are not seeing missed sleep event detection or any sort of machine malfunction. Rather I strongly suspect your lower RemStar Auto pressure results corroborate what your lungs have recently been trying to tell you: a fixed pressure of 12 cm is now too high for you.

Forgetting all about so called "classic" apnea for the moment, I believe there's yet another physiological airway failing mechanism at play for some of us. This may apply to you, and I'm convinced it applies to me. Without CPAP I am a chronic open-mouth snorer. That means that I not only wake my wife up snoring, but that I will wake up with a sore and inflammed throat because of it. Every time I wake up after an extended sleep without CPAP, I have a sore throat: sore from being excessively dry and likely sore from the friction of tissue on tissue as well. Here's an interesting web page that shows how untreated snoring (not apnea) can cause airway swelling, leading to the same end result as "classic" apnea:
http://www.sleep-breathing.bc.ca/evolutn.htm

So your PSG was but one or two night's sample of sleep data. For whatever resason, your obstructive physiology might very well have changed for the better. If you felt suspicious or uncomfortable about those new lower pressures delivered by the Remstar Auto, you might try to borrow or rent a recording pulse oximeter for several nights running to ensure you have no unaddressed obstructive sleep events that might result in desaturations. Of course, your own subjective assessment will be an important evaluation tool as well.

Good luck and welcome to AutoPAP!

[derek]

Titration was the night the Boston Red Sox won the world-series (they let us watch until the end. Maybe the excitement affected the study.)

derek

[-SWS]

Titration was the night the Boston Red Sox won the world-series (they let us watch until the end. Maybe the excitement affected the study.) derek

I was just getting ready to suggest "baseball-induced apnea." Then I finally thought to myself: "Now what are the odds on that?"

On a serious note, my understanding is that several factors can aggravate our obstructive apneas. Sleep position is probably the most common. For most people supine sleep aggravates apnea. So when a sleep tech insists on titrating a patient (who normally side or stomach sleeps) in the supine position, the "optimum" pressure yielded in that titration can be skewed relative to the way that patient sleeps at home. Medications can aggravate obstructive apneas as well---as can alcohol.

Any other hose heads out there have anecdotes about needing less pressure than originally titrated?

[derek]

More info - being a Saturday morning, I set the minimum pressure down to 4 cm and took a 90 min nap. zzzzzz...

The pressure was up to 6.5 cm when I woke. (which is way lower than my prescribed 12 cm !!!) Maybe thats where I belong, and why why it didn't budge at 8 last night.

derek

[wading thru the muck!]

Derek,

Hold any analysis until you've seen the data while your zzZZ-ing. I think the reason most of us live with OSA long before we get treated is though we nearly choke to death dozens of times a night we are nearly completely unaware of this fact. The data shows what happens while we are unaware.

Glad to hear you like your C-flex auto, I like mine more and more everytime I use it.

[-SWS]

I've always maintained reservations about possible CO2 washout shortcomings at only 4 cm. Most patients with most masks should be just fine at 4 cm, however. I have also heard that many or most sleep techs will begin titrations at 5 cm. At 4 and 5 cm quite a few patients complain they subjectively feel "starved for air". Perhaps these are patients with either fixed and/or variable nasal impedance problems such as myself (both fixed and variable in my case).

There are a few patients who manifest great variability with respect to required pressures. Perhaps you are one of these as Muck's "wait and see" statement implies.

[gailzee]

I seem to be using ''less'' pressure as well. My husband keeps shining a flash light on my APAP and reports to me the numbers, at this point I am just HAPPY TO FALL ASLEEP WITH THE BEAST ON MY FACE. Last night he told me I hit ''7''. It's a miracle he, and his flash light do not wake me up, thereby telling me I am getting a deeper quality of sleep, I didn't have before. Then I go to 8, down to 5, 6, all over but never the 14, the DME RT set it as. They had me set to start out at 8, I could've blown leaves in autumn out my sinuses with that, so I'm down to a 5, find a little pushing on exhale, so I'm going to get it changed to 6. Rested gal and Wading re the best experts along with Ted, Chrisp, Titrator, etc. to explain things that I can quite express in writing. They are excellent hosers who can answer your questions. ALso CPAP.com is very accomodating, they have been an excellent supplier and question/answer-er for so many. THANK GOD FOR THIS board. You will never learn as much as you do here.

Good luck, happy sleeping..

Gailzee
who even as an English major, cannot top the signatures on this board!!!!!!!!!!!!

After three months of 12 cm on RemStar Plus, and waking exhausted each morning with "tired lungs", I finally got my RemStar Auto yesterday. I set it to work between 8 - 14 cm, with C-Flex set a 3.

What a difference in breathing! The night was soooo comfortable. No tired lungs this morning.

BUT, here's the problem: I looked at the pressure several times last night, it never seemed to budge from 8 cm. Nor did it feel any higher when I woke at any point.

I'm down on Cape Cod for the Valentine's weekend get-away, so I cannot look at what really happened with Encore Pro until Monday. I tested the unit by holding my breath several times and the pressure bumped up, so the device is working in APAP mode.

I'll drop the minimum down to 6 cm tonight and see what happens. Maybe my tongue-in-cheek signature is correct
Any suggestions?

derek

[-SWS]

Heck, I didn't even notice the part about not having access to your Encore Pro data until just now. But then again, I'm having one of my bad attention deficit days today.

Indeed, exactly as Wader says: looking at the LCD panel will not be very revealing about what's going on between you and your AutoPAP as you sleep. The Encore Pro data is the only good way to get a handle on that. Even an occasional spouse flashlight check can fall seriously short. Great spouse, though!