Breaking up OA clusters- PR System One Remstar Auto w/ Aflex

I noticed lately that machine not increasing pressure fast enough to open airway. The result seen on the graph is OA clustering, occurring close together. I see no unintentional leaks on graph. Is this typical with my machine? Pressure range set 10- 20.

coolbranch wrote:I noticed lately that machine not increasing pressure fast enough to open airway. The result seen on the graph is OA clustering, occurring close together. I see no unintentional leaks on graph. Is this typical with my machine? Pressure range set 10- 20.

auto machines respond to trends, faster to some things, slower to others. they're actually a bit slow to respond to apneas and hypopneas, so as to be less disruptive of sleep (iirc). others are more more up on exactly how the prs1 auto algorithm responds. the s9 autos, for instance, are much faster responding to snores and flow limitations.

if your lower pressure is too low, then you'll have events until the machine can get up there.

Thanks palerider. I see where my average pressure was 10.69 last week and 10.84 for last 30 days. I will bump the lower range from 10 to 11 and follow how the adjustment affect overall statistics.

Thanks, This is the same issue (and similar device) that I'm having. So, I'm very new to this.... but folks are comfortable with adjusting pressure apparently? Without Dr's guidance? What are potential downsides to this tweaking?

MyJanine wrote:but folks are comfortable with adjusting pressure apparently? Without Dr's guidance? What are potential downsides to this tweaking?

Yes, most of us are comfortable with tweaking our pressures with minor adjustments and some even big adjustments and/or even buying a totally different machine.

When it comes to auto adjusting pressures (APAP mode) normally a little increase in the minimum pressure isn't a big deal any way because most of the time there is a rather wide range and the machine can go there anyway and usually does so by allowing the apap range to be whatever (like 20) there's sort of an implied feeling that since the machine already is increasing on its own...us helping it with a little better head start with the minimum isn't a big deal anyway. Now if your RX was for 8 cm in fixed cpap mode and you decided to change it to 12 cm fixed cpap mode...that's a big change because the machine in cpap mode won't change. Not that it would stop me but that's another story.

Most of the time DMEs are more worried about the fact that we figured out how to adjust the pressures than the fact that we did adjust the pressures. Most of the time when using auto mode no one even notices that the minimum was ever changed because if they look at the software reports most of the time they are going to look at the overall average pressure.

Downside to increasing the minimum pressure in APAP mode??? Slap on the hands from DME or doc if they happen to be real control freaks. Maybe some aerophagia issues but if the machine has been running a lot higher anyway just changing the minimum is unlikely to make that worse. Centrals that might be pressure triggered...again if the machine is already running higher anyway for the bigger part of the night...if centrals aren't an issue then it is unlikely that a small cm increase in the minimum will trigger centrals where there weren't centrals when the machine was running higher anyway.

I don't ever advise someone change anything else they are comfortable doing it and understand why a change might improve things.
If you aren't comfortable...don't do it...get with your DME or doctor. In your situation...sooner would be better.

Sometimes DMEs and doctors think that in apap mode the machine can always find the "right" pressure and they just leave the settings wide open like yours is and it would work great that way if you only needed 8 or 9 cm pressure to keep the airway open but you need more and the machine can't respond quickly enough in your situation. I don't know exactly what minimum you are going to end up needing but IF you decided to change it yourself I would do it slowly in relatively small increments. First reason being small increments are an easier adjustment and second being you might get lucky and find out that you don't need as much minimum as first thought. 1 cm increments over maybe a week or so are easier adjustments than a big 3 cm increase in one fell swoop.

I 100% agree with Pugsy's assessment.

My Dr., if I decided to call him, will ask about the overall average and especially 90% pressure to determine if machine pressure range setting is doing the job.

My experience with Respironics APAP machines is that they are a little slow in increasing the pressure to respond to a cluster. So, you might look at your graphic information and see what pressure was needed to resolve the clusters and try setting the EPAP to a little below that. That gives the machine a head start and may resolve them altogether.

I always recommend discussing this type of thing with your doctor (Not the DME - the only thing the DME can do for you in these circumstances is give you a hard time. They are not permitted to give you medical advice, nor are they permitted to adjust your machine without a prescription from your doctor.) after showing your doctor the reports you have. Most doctors will be comfortable with this type of change especially when you keep them in the loop so they can keep you out of trouble.